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Cognitive training in mental disorders: update and future directions - PubMed

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Cognitive training in mental disorders: update and future directions

Matcheri S Keshavan et al. Am J Psychiatry. 2014 May.

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.

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Figures

Figure 1
Figure 1. Taxonomy of approaches to cognitive enhancements in mental illness

Cognitive training is but one of an array of potential interventions to enhance cognitive functioning. TMS= Transcranial Magnetic Stimulation. tDCS= Transcranial Direct Current Stimulation.

Figure 2
Figure 2. Translational hierarchy of outcomes with CT

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

Figure 3
Figure 3. Critical windows of neuroplasticity during human life

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

Figure 4
Figure 4. Schematic representation of the interaction between feed-back and feed-forward information processing operations

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