Cognitive Dysfunction in Mental illness
Mental illness affects many people, but what most do not realize is that it does not just cause emotional problems – it causes cognitive problems, too. People with depression, anxiety, schizophrenia, anorexia nervosa, obsessive compulsive disorder, Asperger’s disorder, and other psychiatric disorders may find it difficult to think clearly, pay attention, and remember. For some, the cognitive problems are only evident during the episodes of illness. For others, the cognitive problems are more persistent. If psychiatric illness is managed well, the person can lead a more productive life and have longer periods of stability.
At the Lieber Clinic, we offer state-of-the-art treatment for the cognitive symptoms of mental illness. Here, individuals who are experiencing cognitive problems can receive treatment to improve their thinking skills.
1. Computer-based cognitive skills groups: These groups offer highly individualized training using the widely recognized NEAR model (Neuropsychological and Educational Approach to Remediation). In these groups, individuals work at their own computer on tasks identified as helpful for them. Each participant works at his or her own pace, so while a group of people works, the group differs from a group where everyone is doing the same task at the same time.
2. Verbally-based cognitive skills groups: These groups discuss strategies to improve cognitive skills and develop ways to use new cognitive abilities to improve performance of everyday tasks.
3. Social skills groups: These groups focus on social cognition, which has been defined as cognitive skills used in social interactions. These groups help people become more accurate at perceiving the intentions and dispositions of others and act appropriately in social contexts.
4. Task groups: These groups are task oriented groups, where participants work on projects that they have been having difficulty completing on their own. For example, work may be focused on the completion of a resume or application, learning time management skills and calendar use, managing the home and independent living skills, and so on.
How do you know if these groups would be right for you?
There are different mental illnesses and they affect cognition differently. Furthermore, not every person is affected in the same way. Some of the problems people often experience include the ability to:
- pay attention; remember and recall information
- process information quickly
- respond to information quickly
- think critically
- plan, organize and problem-solve
- initiate speech
How can cognitive dysfunction be treated?
At the Lieber Clinic, we treat cognitive dysfunction in three ways:
1. Your psychiatrist will make sure that your medications are best for your overall condition, including the cognitive problems you may be having.
2. We offer cognitive skills training groups for people with different diagnoses. Since each disorder may affect cognition differently, it can be helpful to work with people who share similar problems. We offer groups for people with ADHD, psychotic disorders, anxiety and obsessive compulsive disorder, affective disorders and early onset dementia.
3. We offer education and information so you will be informed about your condition and how to best treat it.
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OFFICIAL STATEMENT REGARDING THE EFFICACY OF COGNITIVE TRAINING
AT THE LIEBER CLINIC
Web based Brain training programs have been in the news recently regarding the science behind these programs’ advertising claims. Since we use these programs in our Cognitive Skills Program at Lieber Recovery we anticipate there may be questions about the news articles.
There are a couple of important messages:
- First and foremost, we use the cognitive exercises from these companies because there is science to back up restorative cognitive training for people with psychiatric disorders like Schizophrenia or Affective Disorders. There is a difference between brain training for the general public and cognitive remediation. The news articles discuss whether there is an evidence base for using web based cognitive exercises for older adults. Unfortunately, these news articles did not reference the many psychiatric disorders that have associated cognitive decline and the evidence based treatments that use web based cognitive exercises to promote neuroplasticity and recovery goal attainment.
- Cognitive Skills Training is a clinician led therapy. At Lieber Recovery we use the NEAR model of treatment. In the NEAR model, web based activities are tools and not stand- alone treatments that patients use alone or with clinician “check ins”. We carefully evaluate the exercises we recommend, we monitor performance, we provide feedback and bridging, and we discuss how cognitive exercises are relevant to recovery goals. In other words we use the web based cognitive exercises in a clinical context.
- Cognitive Skills Training is more than computer exercises. At Lieber Recovery Clinic we carefully consider how each person learns, and what cognitive skills need to be developed to facilitate the desired work, educational, and social outcomes. Then we help people practice the cognitive skills in multiple settings, not just on the computer exercises. This is to promote generalization of skill to real life situations. Every session includes a verbal discussion where we talk about how cognition is used in everyday life. We share strategies to improve and compensate for cognitive problems.
As clinicians who are helping patients with cognitive deficits, our staff stay educated about the “business” of cognitive health. There are an increasing number of products, and we train our staff to evaluate them for use in NEAR. NEAR is a clinician led therapy that uses cognitive exercises from various companies as tools to facilitate cognitive enhancement and recovery.
Alice Medalia, PhD
Professor of Medical Psychology
Columbia University Medical Center
Director of the Lieber Recovery Clinic