Attention Shaping: a Reward-Based Learning Method to Enhance Skills Training Outcomes in Schizophrenia

Authors

Steven . M. Silverstein, University of Medicine and Dentistry of New Jersey
William D. Spaulding, University of Nebraska-LincolnFollow
Anthony A. Menditto, University of Missouri-Columbia
Adam Savitz, Weill Medical College of Cornell University
Robert P. Liberman, University of California, Los Angeles
Sarah Berten, University of Medicine and Dentistry of New Jersey
Hannah Starobin, Weill Medical College of Cornell University

Document Type

Article

Date of this Version

2009

Citation

Schizophrenia Bulletin vol. 35 no. 1 pp. 222–232, 2009

Comments

Copyright The Author 2008. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.

Abstract

Disturbances in sustained attention commonly interfere with the ability of persons with schizophrenia to benefit from evidence-based psychosocial treatments. Cognitive remediation interventions have thus far demonstrated minimal effects on attention, as have medications. There is thus a gap between the existence of effective psychosocial treatments and patients’ ability to effectively engage in and benefit from them. We report on the results of a multisite study of attention shaping (AS), a behavioral intervention for improving attentiveness and learning of social skills among highly distractible schizophrenia patients. Patients with chronic schizophrenia who were refractory to skills training were assigned to receive either the UCLA Basic Conversation Skills Module (BCSM) augmented with AS (n = 47) or in the standard format (n = 35). AS, a reward-based learning procedure, was employed to facilitate patients’ meeting clearly defined and individualized attentiveness and participation goals during each session of a social skills training group. Primary outcome measures were observational ratings of attentiveness in each session and pre- and post-BCSM ratings of social skill and symptoms. Patients receiving social skills training augmented with AS demonstrated significantly more attentiveness in group sessions and higher levels of skill acquisition; moreover, significant relationships were found between changes in attentiveness and amount of skills acquired. Changes in attentiveness were unrelated to level or change in antipsychotic medication dose. AS is an effective example of supported cognition, in that cognitive abilities are improved within the environmental context where the patient is experiencing difficulty, leading to gains in both attention and functional outcome.