Reducing Risky Behaviors

Proposal details

Title: Restructuring Brain Potential to Reduce Risk Behavior Increase and Enhance Self Esteem and Enhance Executive Function Skills; Can Targeted Computer Assisted Cognitive Training and Peer to Peer Support Work Together to Improve Measures of Executive Function to Strengthen Self Regulation Skills and Reduce High Risk Behaviors in Vulnerable Populations?
Research Area(s): Emotion and Self Regulation
Physical Conditions
Background: Rationale Kandel (2008); Posner & Rothbart(1998); Burgess & Simon (2005) show evidence for integration in the fields of cell biology, neurophysiology, neuro imaging and psychiatry as does the research of Gordon et al (2008) who outlines the way executive function, emotional affect and social integration work together to influence executive function. The study on reduction of risky behaviors will draw on these precepts as a foundation. Furthermore, Posner’s Executive Attentional Network theory provides a measureable framework from which to work. Posner and Peterson (1990) propose that executive attention involves three aspects — alerting (ability to achieve and maintain an alert state); orienting (the selection of information from sensory input); and executive control (resolving conflict among responses). Executive attention skills include the ability to attend to spatial environments, human interactions and objects within sensory environments thought to be fundamental for human cognition. Executive attention refers to abilities for self regulation particularly in conflict situations where multiple responses are possible (Holmboe & Johnson,2005). Executive function refers to the planning skills framework applied to carry out the chosen course of action (Posner & Rothbart,1998). Risky behaviors are often the result of mild brain damage which can increase loss of self locus and reduced planning skills. There are multiple theories used to explain these deficits such as Cohen’s Contextual Information Theory which states damage to a single process/system is responsible for multiple executive function deficits, although this theory may generate hope in that symptoms share a common cause and by inference leads to support for a one size fits all solution (Cohen et al, 1990; Cohen and Servan-Schreiber, 1992; Cohen, Braver and O’Reilly, 1998). In contrast, Grafman’s Structured Event Complex Theory suggests executive dysfunction depends on where the damage is located and focuses on the nature of representations stored within the frontal lobes “a set of events, structured in a particular sequence, that as a complex composes a particular kind of activity that is usually goal-oriented” (Grafman 2002, p. 298). This theory indicates that multi faceted , personally targeted therapy may increase effectual outcomes. Training protocols will focus on Executive attention efficiency in the aspects of alerting, orientating and self regulation (Fan, J., McCandliss, B.D., Sommer, T., Raz, A. & Posner, M.I. (2002) and will train categorization abilities thought to be crucial for intelligence and processing speed (Posner & Rothbart, 1998). Emerging evidence shows the human brain can regenerate some cortical thickness, white and grey matter with targeted training protocols (Greenwood et al, 2007: May et al, 2008). The research question is based on the following conceptual framework. Executive attention skills inform multiple aspects of cognition inclusive of attention, memory, facial recognition, processing ability, and mental rotation. Processing ability is limited by what is attended to. Memory is influenced by material processed, emotional affect and the efficiency of categorization (Posner M., 2008). Working memory is crucial for enabling comprehension; however slowed perceptual and categorization skills can in turn inhibit the amount of material available for working memory to process. (Burgess & Shallice, 1997). Working memory facilitates retrieval and learning (Burgess & Simons, 2005). Sohlberg M M; McLaughlin K A; Pavese A; Heidrich A; Posner M I (2000) found executive attentional skills improved with practice and the effect was robust when tested even with novel neuropsychometric measures. Burgess & Simons, (2005). Valenzeula found targeted brain optimization in combination with peer to peer group support sessions enhance efficacy for cognitive behavioral interventions (Valenzeula et al, 2008). Social support is also an important predictive marker for mental health and provides a hands on safe environment where study interventions can be practiced and personalized (Oaten et al, 2008). Wells and colleagues (2006) demonstrate that an integrative metacognitive approach delivers more effectual results than peer support or therapy alone. Training protocols will include measures that train the above subsets of executive attention in alerting and orientating. Self regulation will be trained at conscious levels in a computer ‘game’ format. Subconscious feed forward aspects of self regulation will be trained with the assistance of biofeedback. Self regulation not only assists learning but may also regulate some aspects of dopamine and oxytocin production particularly when accompanied by a positivity bias embedded in training. A positivity bias or the ability to perceive positive expression is linked to increased confidence, mental health, confidence and self control. (Toates,2009). Theoretically this could complement recovery and reduce risky behavior by enhancing self motivated cognitive control. Many aspects of executive attention and learning occur at subconscious and implicit levels causing conceptual operation of executive attention to be abstract in nature. Stimuli and previous learning can be implicit, explicit, or combinatory and influence factors such as affect, cognitive reserve, and sensory interference (Williams et al,2008; Rock, 2008). Self regulation training can present a visual picture of internal processes governing executive attention enabling individuals to influence sub conscious stimuli on a conscious level.
Aims: The purpose of this research is to investigate protocols in which targeted cognitive computer training can be personalized to contribute to gains in executive function measures which improve planning, decision making and increase the quality of life for individuals enabling reduction in risky behaviors through long term self regulation and improved executive function.
Method: This is an open enrollment pilot trial exploring the use of computer-assisted executive attention training with a focus on problem solving and emotional self-regulation, as well as systematic training of processing speed, categorization skills, working memory, facial recognition and attention deficits in conjunction with weekly peer to peer support group meetings. The program relies on modular, contextual, and embedded approaches to treatment. Participants will ‘brain train’ at the rate of four times per week for 45 minutes over a three month period. In addition they will be part of an existing peer to peer support group. 50% of Participants will be waitlisted once enrolled they will serve as their own controls. Outcomes will be assessed using measures that focus on functioning within cognitive domains, across domains and in everyday life and that assess long-term outcomes. Proposed instruments for pre and post testing include WebNeuro in conjunction with BRAINnet and the BADS Battery (Behavioral Assessment of the Dysexecutive Syndrome).