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Reviews and Overviews   |    
Cognitive Training in Mental Disorders: Update and Future Directions
Matcheri S. Keshavan, M.D.; Sophia Vinogradov, M.D.; Judith Rumsey, Ph.D.; Joel Sherrill, Ph.D.; Ann Wagner, Ph.D.
Am J Psychiatry 2014;171:510-522. doi:10.1176/appi.ajp.2013.13081075
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Dr. Keshavan has received grant funding from Sunovion. Dr. Vinogradov has received consulting fees from AmGen, Brain Plasticity Institute, EnVivo, Genentech, and Hoffman La Roche. The other authors report no financial relationships with commercial interests.

Dr. Keshavan has been supported by NIH grants MH092440 and MH060902. Dr. Vinogradov has been supported by NIH grants MH068725, MH082818, MH068725, MH081051, and MH081807 and the Stanley Medical Research Institute.

The opinions and assertions contained in this article are the private views of the authors and are not to be considered as official or as reflecting the views of the Department of Health and Human Services, NIH, or NIMH.

This research is based on a workshop sponsored by NIMH that was held on April 9 and 10, 2012. The workshop participants were Matcheri Keshavan, Harvard University (co-chair); Ann Wagner, NIMH (co-chair); Yair Bar-Haim, Tel Aviv University; Cameron Carter, University of California Davis; David Chambers, NIMH; Bruce Cuthbert, NIMH; Daniel Dickstein, Bradley Hospital/Brown University; Amy Dorin, FEGS Health and Human Services System, New York; Shaun Eack, University of Pittsburgh; Amit Etkin, Stanford University; Adam Gazzaley, University of California San Francisco; Russ Glasgow, National Cancer Institute; Adam Haim, NIMH; Jeffrey Halperin, Queens College; Courtenay Harding, The Coalition of Behavioral Health Agencies, New York; Robert Heinssen, NIMH; Thomas Insel, NIMH; Wendy Kates, SUNY Upstate Medical Center; Ellen Leibenluft, NIMH; Susan McGurk, Boston University; Alice Medalia, Columbia University; Sarah Morris, NIMH; Alvaro Pascual-Leone, Harvard Medical School; Daniel Pine, NIMH; Judith Rumsey, NIMH; Christopher Sarampote, NIMH; Suzy Scherf, Pennsylvania State University; Joel Sherrill, NIMH; David Sommers, NIMH; Leanne Tamm, Cincinnati Children’s Hospital Medical Center; Carol Tamminga, University of Texas Southwestern Medical Center; Sophia Vinogradov, University of California San Francisco; Bruce Wexler, Yale University; Til Wykes, University of London Institute of Psychiatry.

From the Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston; the Department of Psychiatry, University of California, San Francisco; San Francisco VA Medical Centers, San Francisco; the Clinical Neuroscience Research Branch, Division of Adult Translational Research and Treatment Development, NIMH, Bethesda, Md.; the Treatment and Preventive Intervention Research Branch, Division of Services and Intervention Research, NIMH, Bethesda; and the Neurobehavioral Mechanisms of Mental Disorders Branch, Division of Developmental Translational Research, NIMH, Bethesda.

Address correspondence to Dr. Keshavan (mkeshava@bidmc.harvard.edu).

Copyright © 2014 by the American Psychiatric Association

Received August 13, 2013; Revised November 22, 2013; Accepted December 19, 2013.

Abstract

Objective  This article reviews the conceptual basis, definitions, and evolution of cognitive training approaches for the treatment of mental disorders.

Method  The authors review the current state of the knowledge on cognitive training in psychiatric illnesses, and its neural and behavioral targets, and summarize the factors that appear to relate to a successful response, including learner characteristics that influence clinical outcome. They also discuss methodological issues relevant to the development and testing of cognitive training approaches, with the goal of creating maximally efficient and effective approaches to training. Finally, they identify gaps in existing knowledge and outline key research directions for the future.

Results  While much of the early research has been conducted in schizophrenia, cognitive training has more recently been applied to a widening range of neuropsychiatric illnesses, including attention deficit hyperactivity disorder, mood disorders, and substance use disorders. Cognitive training harnesses the inherent neuroplastic capacities of the brain, targeting neural system function across psychiatric disorders, thus improving the cognitive processes that play a role in emotion regulation, clinical symptoms, and adaptive community functioning.

Conclusions  Cognitive training offers considerable promise, especially given the limited efficacy of pharmacological interventions in ameliorating cognitive deficits. However, more research is needed to understand the mechanisms underlying cognitive training, predictors of response, generalization and real-world applicability, and approaches to dissemination in practice settings.

Abstract Teaser
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FIGURE 1. Taxonomy of Approaches to Cognitive Enhancements in Mental Illnessa

a Cognitive training is one of many potential interventions to enhance cognitive functioning.

FIGURE 2. Translational Hierarchy of Outcomes With Cognitive Therapya

a Carefully targeted improvements in neural system function in mental illness should translate into better community functioning via their effects on cognition.

FIGURE 3. Critical Windows of Neuroplasticity During Human Lifea

a Cognitive training makes use of experience-dependent plasticity that is present throughout the human lifespan.

FIGURE 4. Schematic Representation of the Interaction Between Feed-Back and Feed-Forward Information Processing Operations
Anchor for Jump
TABLE 1.Points for Consideration in the Design, Conduct, and Review of Cognitive Training Intervention Research
+

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