Toward a Science of Effective Cognitive Training

A long-standing question in the behavioral sciences is whether cognitive functions can be improved through dedicated training. It is uncontested that training programs can lead to near transfer, meaning increased performance on untrained tasks involving similar cognitive functions. However, whether training also leads to far transfer, meaning increased performance on loosely related untrained tasks or even activities of daily living, is still hotly debated. Here, we review the extant literature and, in particular, the most recent meta-analytic evidence and argue that the ongoing crisis in the field of cognitive-training research may benefit from taking a more mechanistic approach to studying the effectiveness of training. We propose that (a) adopting a more rigorous theoretical framework that builds on a process-based account of training and transfer, (b) considering the role of individual differences in the responsiveness to training, and (c) drawing on Bayesian models of development may help to solve controversial issues in the field and lead the way to designing and implementing more effective training protocols

Computational and behavioral markers of model-based decision making in childhood

Human decision-making is underpinned by distinct systems that differ in flexibility and associated cognitive cost. A widely accepted dichotomy distinguishes between a cheap but rigid model-free system and a flexible but costly model-based system. Typically, humans use a hybrid of both types of decision-making depending on environmental demands. However, children's use of a model-based system during decision-making has not yet been shown. While prior developmental work has identified simple building blocks of model-based reasoning in young children (1–4 years old), there has been little evidence of this complex cognitive system influencing behavior before adolescence. Here, by using a modified task to make engagement in cognitively costly strategies more rewarding, we show that children aged 5–11-years (N = 85), including the youngest children, displayed multiple indicators of model-based decision making, and that the degree of its use increased throughout childhood. Unlike adults (N = 24), however, children did not display adaptive arbitration between model-free and model-based decision-making. Our results demonstrate that throughout childhood, children can engage in highly sophisticated and costly decision-making strategies. However, the flexible arbitration between decision-making strategies might be a critically late-developing component in human development

Age difference between heterosexual partners in Britain: Implications for the spread of Chlamydia trachomatis

Heterosexual partners often differ in age. Integrating realistic patterns of sexual mixing by age into dynamic transmission models has been challenging. The effects of these patterns on the transmission of sexually transmitted infections (STI) including Chlamydia trachomatis (chlamydia), the most common bacterial STI are not well understood. We describe age mixing between new heterosexual partners using age- and sex-specific data about sexual behavior reported by people aged 16-63 years in the 2000 and 2010 British National Surveys of Sexual Attitudes and Lifestyles. We incorporate mixing patterns into a compartmental transmission model fitted to age- and sex-specific, chlamydia positivity from the same surveys, to investigate C. trachomatis transmission. We show that distributions of ages of new sex partners reported by women and by men in Britain are not consistent with each other. After balancing these distributions, new heterosexual partnerships tend to involve men who are older than women (median age difference 2, IQR -1, 5 years). We identified the most likely age combinations of heterosexual partners where incident C. trachomatis infections are generated. The model results show that in >50% of chlamydia transmitting partnerships, at least one partner is ≥25 years old. This study illustrates how sexual behavior data can be used to reconstruct detailed sexual mixing patterns by age, and how these patterns can be integrated into dynamic transmission models. The proposed framework can be extended to study the effects of age-dependent transmission on incidence in any STI

Feasibility of Narrative Exposure Therapy in an outpatient day treatment program for refugees: Improvement in symptoms and global functioning

Background  Refugees are at high risk for developing post-traumatic stress disorder (PTSD). Narrative exposure therapy (NET) is an evidence-based treatment of PTSD, designed for patients exposed to (multiple) traumatic events and recommended for patients with culturally diverse backgrounds. In clinical practice, adherence to the NET-protocol has been challenged because of psychosocial complexities and comorbid disorders.  Objective:  The current study investigated the feasibility of NET embedded in an outpatient day treatment programme for refugees and examined reduction in PTSD symptoms and improvement of global functioning as well as correlates of change.  Method Participants were patients who consecutively entered an outpatient daytreatment programme from 2013-2017. The majority had a history of prior unsuccessful treatment. PTSD was assessed with the Clinically Administered PTSD Scale (CAPS) before and after finishing NET. Global Assessment of Functioning (GAF) was used to examine changes in functioning. Changes in PTSD scores and functioning were analyzed using paired t-tests and reliable change indices. Patients showing significant improvement were compared to those who did not, on patient and treatment characteristics, including sex, age, region of origin, childhood trauma and treatment duration and dosage of NET.  Results:  Of 97 patients, 76 (78.4%) completed NET. Completers had a longer residency and were more likely to have a partner. Significant reductions in PTSD symptoms and improvements in global functioning were observed. Twenty-eight percent showed reliable improvement with large effect sizes. Four patients did no longer meet the criteria for PTSD. No strong moderators for changes were found. Patients who did not improve more often had a history of childhood trauma. Conclusions NET embedded in an outpatient day treatment programme appears to be feasible. In those who improved, a substantial decline in symptoms and improvement of functioning were observed. The findings suggest that a socially supportive living environment enhances acceptability of trauma-focused treatment in refugees

Enduring effects of Preventive Cognitive Therapy in adults remitted from recurrent depression:A 10 year follow-up of a randomized controlled trial

BACKGROUND: Prevention of recurrence is a challenge in the management of major depressive disorder (MDD). The long-term effects of Preventive Cognitive Therapy (PCT) in preventing recurrence in MDD are not known.METHODS: A RCT comparing the addition of PCT to Treatment As Usual (TAU), versus TAU including patients with recurrent depression who were in remission at entry (N=172). PCT consisted of eight weekly group sessions. TAU involved standard treatment. Primary outcome is time to first recurrence of a depressive episode as assessed by blinded interviewers over 10 years based on DSM-IV-TR criteria.RESULTS: Also over 10 years, the protective effect of PCT was dependent on the number of previous episodes a patient experienced. The protective effect intensified with the number of previous depressive episodes (Cox regression; p=.004, Hazard ratio=.576, 95% CI=.396-.837) and is mainly established within the first half of the 10 year follow-up period. For patients with more than three previous episodes (52% of the sample), PCT significantly increased the median survival time (713.0 days) versus patients that received TAU (205.0 days). No enduring effects were found on secondary outcomes.LIMITATIONS: Dropout rates were relatively high for secondary outcomes, but relatively low for the primary outcome. Results were comparable after multiple imputation.CONCLUSIONS: PCT in remitted patients with multiple prior episodes has long-term preventive effects on time to recurrence. To reduce recurrence rates, booster sessions might be necessary. A personalized medicine approach might be necessary to reduce recurrence rates even further.</p