More about neuroplasticity

Last week we described briefly some research about the relationship between bran plasticity and emotional wellbeing. This week, we would like to talk about another area where there is some very exciting research that links brain plasticity and mental wellbeing. In addition to the symptoms usually associated with schizophrenia (hallucinations, delusions, disordered thinking; see NIMH’s website for a description of schizophrenia and its symptoms, there are other symptoms which are as important but hardly mentioned and include: inability to understand information, trouble focusing attention, and problems with memory (in particular, maintaining and using information which is known in behavioral research as “working memory”). The reason why this is an important deficit, is because there is evidence that shows that cognitive deficits like those described, will have an impact on more functional outcomes; things like employment, education, social interaction, and even ability to live independently.

There is some very recent research that focuses on some of the brain mechanisms that may be involved in this deficit (some neurochemicals and their receptors that do not work as intended). Also, there is some research that tries to tackle these deficits from a different point of view: Cognitive Remediation Therapy (CRT), whose main goal is to teach individuals some strategies to improve their cognitive skills go here and here  for links to some of these studies). These skills include things like rote memorization, and/or the use of strategies to memorize/pay attention to key pieces of information.  Regarding CRT, one study that we found is a meta-analysis by McGurk and others. Meta-analysis is a great tool for research, because it helps summarize in a scientific way the information contained in many studies. In this case, the authors summarized and compared the results of 26 studies to explore whether the use of CRT helped individuals with schizophrenia not only to have better memory, attention and problem solving, but also better functional outcomes. The analysis showed great promise in several areas: improvement in cognitive areas like attention, verbal learning and memory, ability to process information faster and ability to solve problems. Interestingly, the analysis also showed that at least within these studies, there seems to be no relationship between the length of the program (number of hours spent learning the techniques and practicing) and the improvements observed. It seems that as long as the individuals practiced between 5 and 15 hours (the program with the maximum length was 15 hours), there were no differences in improvement, with one exception: Verbal learning and memory. However, it is possible that this relationship does not seem to be important, because the studies did not go far enough in time to observe changes. Only six programs assessed changes in the individuals 8 months after the program ended. Therefore there will be no way to know if the effect of number of hours helped change or maintain the improvements after 8 months.

There were two other interesting findings. One is that the CRT programs seem to have minor impact on the more traditional symptoms of schizophrenia (though there are some other studies that suggest improvements in mood and self-esteem).  The other finding is also a minor improvement on the functional outcomes; things like working on competitive jobs, improvement in the individual’s social relationships and ability to solve interpersonal problems. However, for the second finding, the researchers also found that studies that combined CRT with psychiatric rehabilitation had a stronger effect than those studies that used only CRT.

Although the results are not conclusive, this time, the bottom line seems to be that the combination of clinical therapy, psychiatric rehabilitation and some type of cognitive improvement program holds the most promise as far as being able to improve memory, attention, concentration, and also improve functional outcomes like maintain employment, and have meaningful relationships with other individuals (go here for similar conclusions).

Is it possible that the results found are just like a “sugar pill” (i.e., a placebo effect)? It does not seem likely. Some of the studies compared CRT versus more clinician’s attention and found that individuals who attended CRT showed much more improvement than those who received only more clinician’s attention.

Some factors still need further study. For example, since only a few studies reassessed individuals a few months (8 at most) after the program ended, it is unclear if the number of hours of practice will have a significant impact on maintaining this cognitive improvement longer. Similarly, only a few studies try to relate changes in the more cognitive tasks (memory, attention, problem solving) with functional outcomes (going back to –and maintaining—employment, improvement in social relationships). This is an area where the Mental Health Center of Denver (MHCD) and the MHCD Research institute are currently working to further understand the relationship. Stay tuned for forthcoming blogs where we will talk about mental health research using functional outcomes.