Scaffolded instruction remediates Wisconsin Card Sorting Test deficits in schizophrenia: A comparison to other techniques

This study compared the efficacy of two instructional techniques, scaffolding and direct instruction, with a practice control condition in the remediation of Wisconsin Card Sorting Test (WCST) deficits among 45 highly chronic schizophrenic patients. The extent to which learning of the WCST generalised to other cognitive tests, including an object sorting task, the Short Category Test, Trail Making and Stroop tests, was also examined. The affective experience of the subjects was assessed via Rosenberg's Self-Esteem Scale and the Positive and Negative Affect Schedule (PANAS). Subjects who received scaffolded instruction improved significantly in the number of WCST categories achieved. The improvement was sustained one month later. Generalisation to other cognitive tests was encouraging but limited. The scaffolded group improved in their selfesteem and maintained a high positive affect. These findings have implications for psychosocial and cognitive rehabilitation.

[1]  D. Meichenbaum.  Cognitive-Behavior Modification , 1977 .

[2]  K. Mueser,et al.  Remediation of cognitive deficits in schizophrenia. , 1990, The American journal of psychiatry.

[3]  Carol S. Dweck,et al.  Motivational processes affecting learning. , 1986 .

[4]  R. Asarnow,et al.  Attention/information processing, neuropsychological functioning, and thought disorder during the acute and partial recovery phases of schizophrenia: A longitudinal study , 1982, Psychiatry Research.

[5]  M. Strauss,et al.  Impaired Wisconsin Card Sort Performance in Schizophrenia May Reflect Motivational Deficits , 1991 .

[6]  M. Haut,et al.  On the nature of Wisconsin Card Sorting Test performance in schizophrenia , 1996, Psychiatry Research.

[7]  R. Weisberg,et al.  Transferring old associations to new situations: A nonautomatic process , 1978 .

[8]  M. Strauss,et al.  Impaired Wisconsin Card Sort performance in schizophrenia may reflect motivational deficits. , 1991, Archives of general psychiatry.

[9]  P. Stratta,et al.  Information processing strategy to remediate Wisconsin Card Sorting Test performance in schizophrenia: a pilot study. , 1994, The American journal of psychiatry.

[10]  A. Vita,et al.  Non-selective impairment of Wisconsin Card Sorting Test performance in patients with schizophrenia , 1997, Schizophrenia Research.

[11]  D. Watson,et al.  Development and validation of brief measures of positive and negative affect: the PANAS scales. , 1988, Journal of personality and social psychology.

[12]  R. Liberman,et al.  Symptom monitoring in the rehabilitation of schizophrenic patients. , 1986, Schizophrenia bulletin.

[13]  M. Green,et al.  A training procedure for remediating WCST deficits in chronic psychotic patients: an adaptation of errorless learning principles. , 1996, Journal of psychiatric research.

[14]  M. Green,et al.  Cognitive remediation in schizophrenia: is it time yet? , 1993, The American journal of psychiatry.

[15]  D. Wood,et al.  How Children Think and Learn: The Social Contexts of Cognitive Development , 1988 .

[16]  L. Fuentes.  [Selective attention deficit in schizophrenia]. , 2001, Revista de neurologia.

[17]  M. Bell,et al.  Performance on the Wisconsin Card Sorting Test as a predictor of rehospitalization in schizophrenia. , 1996, The Journal of nervous and mental disease.

[18]  D. Meichenbaum.  Cognitive-Behavior Modification: An Integrative Approach , 1977 .

[19]  B. Frost,et al.  Specific cognitive flexibility rehabilitation in schizophrenia , 1993, Psychological Medicine.

[20]  T. Goldberg,et al.  Further evidence for dementia of the prefrontal type in schizophrenia? A controlled study of teaching the Wisconsin Card Sorting Test. , 1987, Archives of general psychiatry.

[21]  R. Heinrichs.  Schizophrenia and the brain. Conditions for a neuropsychology of madness. , 1993, The American psychologist.

[22]  D. Luchins,et al.  Maintenance of training effects on the Wisconsin Card Sorting Test by patients with schizophrenia or affective disorders. , 1994, The American journal of psychiatry.

[23]  H. Huynh,et al.  Estimation of the Box Correction for Degrees of Freedom from Sample Data in Randomized Block and Split-Plot Designs , 1976 .

[24]  Joel Jeffries,et al.  Clinical Handbook of Psychotropic Drugs , 1994 .

[25]  R. Siegert,et al.  Improving schizophrenic in-patients' Wisconsin card-sorting performance. , 1996, The British journal of clinical psychology.

[26]  Relation between latency and redundancy-associated deficit in schizophrenic reaction time performance. , 1980 .

[27]  Mary Lamon,et al.  Conceptual transfer insimple insight problems , 1988, Memory & cognition.

[28]  D. C. Howell.  Statistical Methods for Psychology , 1987 .

[29]  W. C. Halstead.  PRELIMINARY ANALYSIS OF GROUPING BEHAVIOR IN PATIENTS WITH CEREBRAL INJURY BY THE METHOD OF EQUIVALENT AND NON-EQUIVALENT STIMULI , 1940 .

[30]  Kurt Goldstein,et al.  Abstract and concrete behavior an experimental study with special tests. , 1941 .

[31]  Maritza G. Freyslinger,et al.  Scaffolded instruction and the remediation of Wisconsin Card Sorting Test deficits in chronic schizophrenia , 1995, Schizophrenia Research.

[32]  P. Corrigan,et al.  Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia. , 1992, Schizophrenia bulletin.

[33]  B. Spring,et al.  Cognitive remediation in schizophrenia: should we attempt it? , 1992, Schizophrenia bulletin.

[34]  B. Zimmerman,et al.  Self-regulation of learning and performance: Issues and educational applications. , 1994 .

[35]  M. Albert,et al.  Modular Disjunction in Schizophrenia: A Framework for a Pathological Psychophysiology , 1990 .

[36]  D. A. Smith,et al.  Flat affect in schizophrenia does not reflect diminished subjective experience of emotion. , 1993, Journal of abnormal psychology.

[37]  I. Begg,et al.  Problem-oriented training promotes spontaneous analogical transfer: Memory-oriented training promotes memory for training , 1991, Memory & cognition.

[38]  Z. Jocic,et al.  Problem solving by schizophrenic and schizoaffective patients on the Wisconsin and California Card Sorting Tests. , 1994 .

[39]  M. Rosenberg.  Conceiving the self , 1979 .

[40]  S. Ganzell,et al.  Wisconsin Card Sorting Test performance in schizophrenia: remediation of a stubborn deficit. , 1992, The American journal of psychiatry.

[41]  D M Baer,et al.  An implicit technology of generalization. , 1977, Journal of applied behavior analysis.

[42]  T. Goldberg,et al.  Further evidence of dementia of the prefrontal type in schizophrenia , 1987 .

[43]  Ajw Vanderdoes,et al.  WHAT DETERMINES WISCONSIN CARD SORTING PERFORMANCE IN SCHIZOPHRENIA , 1992 .

[44]  J. Everett,et al.  The Selective Attention Deficit in Schizophrenia: Limited Resources or Cognitive Fatigue? , 1989, The Journal of nervous and mental disease.

[45]  R. Reitan.  Validity of the Trail Making Test as an Indicator of Organic Brain Damage , 1958 .

[46]  J. Overall,et al.  The Brief Psychiatric Rating Scale , 1962 .

[47]  P. Stratta,et al.  Remediation of Wisconsin Card Sorting Test performance in schizophrenia. A controlled study. , 1997, Psychopathology.

[48]  D. Meichenbaum,et al.  Training schizophrenics to talk to themselves: A means of developing attentional controls , 1973 .

[49]  A. Bellack.  Cognitive rehabilitation for schizophrenia: is it possible? Is it necessary? , 1992, Schizophrenia bulletin.

[50]  J. Zihl,et al.  Cognitive deficits in schizophrenia and affective disorders: evidence for a final common pathway disorder , 1998, Acta psychiatrica Scandinavica.

[51]  A. Green.  International Perspectives in Schizophrenia: Biological, Social and Epidemiological Findings , 1992 .

[52]  D. Meichenbaum.  The effects of instructions and reinforcement on thinking and language behavior of schizophrenics. , 1969, Behaviour research and therapy.

[53]  D L Braff,et al.  The generalized pattern of neuropsychological deficits in outpatients with chronic schizophrenia with heterogeneous Wisconsin Card Sorting Test results. , 1991, Archives of general psychiatry.

[54]  A. Silverstein.  Two- and Four-Subtest Short Forms of the Wechsler Adult Intelligence Scale-Revised. , 1982 .

[55]  D. Braff,et al.  A multimethod approach to assessing perseverations in schizophrenia patients , 1998, Schizophrenia Research.

[56]  K H Nuechterlein,et al.  Effects of attention training on information processing in schizophrenia. , 1994, Schizophrenia bulletin.

[57]  Michael F. Green,et al.  Neuropsychological predictors of skills training for chronic psychiatric patients , 1992, Psychiatry Research.

[58]  K. Nuechterlein,et al.  Information processing and attentional functioning in the developmental course of schizophrenic disorders. , 1984, Schizophrenia bulletin.

[59]  R. Bjork,et al.  Learning, Remembering, Believing: Enhancing Human Performance , 1994 .

[60]  J. Bruner.  Child's Talk: Learning to Use Language , 1985 .

[61]  D. Laplane.  Thought and language. , 1992, Behavioural neurology.

[62]  Jacob Cohen.  A Coefficient of Agreement for Nominal Scales , 1960 .

[63]  C. Mateer,et al.  Effectiveness of an attention-training program. , 1987, Journal of clinical and experimental neuropsychology.

[64]  J. Stroop.  Studies of interference in serial verbal reactions. , 1992 .

[65]  D. Meichenbaum,et al.  Nurturing Independent Learners: Helping Students Take Charge of Their Learning , 1998 .

[66]  P. Stratta,et al.  Tower of Hanoi and WCST performance in schizophrenia: problem-solving capacity and clinical correlates. , 1999, Journal of psychiatric research.

[67]  R. Steffy,et al.  Relation between latency and redundancy-associated deficit in schizophrenic reaction time performance. , 1980, Journal of abnormal psychology.

[68]  John G. Borkowski,et al.  General Problem-Solving Skills: Relations between Metacognition and Strategic Processing , 1989 .

[69]  P. Giovacchini,et al.  The Self in Transition: Infancy to Childhood , 1992 .

[70]  K. Holyoak,et al.  Overcoming contextual limitations on problem-solving transfer. , 1989 .

[71]  R. Lockhart,et al.  Conceptual transfer in simple insight problems. , 1988, Memory & cognition.

[72]  J. Ridley.  Studies of Interference in Serial Verbal Reactions , 2001 .

[73]  K. Tallent,et al.  Wisconsin Card Sorting Test deficits in schizotypic individuals , 1999, Schizophrenia Research.

[74]  D. Middleton,et al.  An Experimental Evaluation of Four Face-to-Face Teaching Strategies , 1978 .

[75]  Mark A. McDaniel,et al.  Discovery Learning and Transfer of Problem-Solving Skills , 1990 .

[76]  P F Liddle,et al.  Schizophrenic Syndromes and Frontal Lobe Performance , 1991, British Journal of Psychiatry.

[77]  K. Holyoak,et al.  Schema induction and analogical transfer , 1983, Cognitive Psychology.

[78]  D. C. Howell.  Statistical methods for psychology, 3rd ed. , 1992 .

[79]  N. Harvey.  The Stroop Effect: Failure to Focus Attention or Failure to Maintain Focusing? , 1984 .

[80]  P. Stratta,et al.  Wisconsin card sorting test and Stroop test performances in Schizophrenia: a shared construct , 1997, Neuroscience Letters.

[81]  R. Liberman,et al.  Whither cognitive-behavioral therapy for schizophrenia? , 1992, Schizophrenia bulletin.

[82]  M. Green,et al.  Monetary reinforcement and Wisconsin Card Sorting performance in schizophrenia: Why Show Me the Money? , 1998, Schizophrenia Research.

[83]  D. Perkins,et al.  Rocky Roads to Transfer: Rethinking Mechanism of a Neglected Phenomenon , 1989 .