Development of a paradigm for studying the effects of brief Goal Management Training with Implementation Intentions

Cognitive rehabilitation interventions such as Goal Management Training (GMT) and the Implementation Intentions strategy have been developed with the aim of improving prospective memory (PM) in everyday life. The aim of this study was to provide “proof of concept” for an experimental paradigm that could be used to evaluate the effects of Goal Management Implementation Intentions training (GMTii) derived from the principles of GMT and Implementation Intentions. Thirty adults were randomised to either GMTii or a control training condition. A computerised PM task that involved an ongoing task into which a PM task was embedded was completed pre-training and post-training. In addition, a novel yet similar PM task was completed post-training to assess generalisability of any effect. The two groups had similar overall performance pre-training. Post-training, the GMTii group demonstrated significantly better performance on the familiar computerised PM task showing less performance decay over time compared to the control group. The GMTii group also showed better performance on the novel task. The results demonstrated that brief GMTii significantly improved PM performance compared to control training and that computerised PM tasks were sensitive to this effect. The results suggest that this paradigm could be used to study the effects of metacognitive rehabilitation interventions

Music for Sleep: Music-based interventions to promote sleep in adults

Abstract available at each chapter

Imaging the effects of cognitive rehabilitation interventions: developing paradigms for the assessment and rehabilitation of prospective memory

Prospective memory (PM), the ability to remember to carry out future intentions and goals following a delay filled with other unrelated tasks is often compromised following brain injury and other psychological and psychiatric disorders affecting the frontal lobes. It has long been acknowledged that patients with frontal lobe lesions can show relatively intact performance in laboratory settings yet their everyday functioning in multitasking situations requiring PM may be severely impaired (Mesulam 1986). The last 15 years has seen a marked expansion into research and theoretical models of prospective memory and its neural basis with the findings from recent neuroimaging studies suggesting that Brodmann’s area 10 plays an important role in PM (Burgess et al., 2011). The aim of this thesis was to develop paradigms for assessing prospective memory that could be used to measure the behavioural and functional changes in the brain following brief cognitive rehabilitation interventions with the first part of the thesis (Chapters 2-4) investigating the convergent and ecological validity of computerised assessment measures of PM in a group of young and older neurologically healthy individuals, as well as in individuals with acquired brain injury. The second part of the thesis (Chapters 5 and 6) investigated the behavioural and neural changes associated with a brief PM intervention developed from the principles of Goal Management Training (Robertson 1996; Levine et al., 2000; 2012) and Implementation Intentions (Gollwitzer 1993; 1996). Chapter 1 provides a brief overview of the assessment and rehabilitation of PM. Chapter 2 assessed age related changes in performance on the computerised PM tests and a modified version of the Hotel Test (Manly et al., 2002) in a group of young and older neurologically healthy individuals. Both the computerised tasks and the modified Hotel Test (mHT) were found to be sensitive to the effects of ageing. Chapter 3 investigated the effects of a brief break filled with an unrelated task on performance on computerised PM tasks. A brief break was found to have a negative effect on performance with the amount of performance decay correlating with self-reported memory functioning. Chapter 4 assessed the convergent and ecological validity of the computerised PM tasks and their sensitivity to brain injury. The tasks were found to have good convergent validity with the mHT and the CAMPROMPT. The informant- and self-ratings of everyday memory and goal management functioning correlated with task performance in the ABI sample. Chapter 5 investigated whether brief intervention aimed at reducing PM lapses would be successful in improving performance on computerised PM task compared with a control training intervention. Chapter 6 investigated the functional changes in brain activation associated with this brief training. Significant behavioural improvements on the computerised PM tasks were seen following brief training with some evidence of transfer of the effect to a novel task. Significant changes in neural activations within Brodmann’s area 10 were seen following brief training in the trained group compared to the control group. The findings have implications for the assessment and rehabilitation of individuals with PM problems and are discussed in relation to cognitive theories of PM

The effectiveness of the behavioural components of cognitive behavioural therapy for insomnia in older adults:A systematic review

Insomnia is more prevalent in older adults (< 60 years) than in the general population. Cognitive behavioural therapy for insomnia is the gold-standard treatment; however, it may prove too cognitively taxing for some. This systematic review aimed to critically examine the literature exploring the effectiveness of explicitly behavioural interventions for insomnia in older adults, with secondary aims of investigating their effect on mood and daytime functioning. Four electronic databases (MEDLINE – Ovid, Embase – Ovid, CINAHL, and PsycINFO) were searched. All experimental, quasi-experimental and pre-experimental studies were included, provided they: (a) were published in English; (b) recruited older adults with insomnia; (c) used sleep restriction and/or stimulus control; (d) reported outcomes pre-and-post intervention. Database searches returned 1689 articles; 15 studies, summarising the results of 498 older adults, were included – three focused on stimulus control, four on sleep restriction, and eight adopted multicomponent treatments comprised of both interventions. All interventions brought about significant improvements in one or more subjectively measured facets of sleep although, overall, multicomponent therapies demonstrated larger effects (median Hedge's g = 0.55). Actigraphic or polysomnographic outcomes demonstrated smaller or no effects. Improvements in measures of depression were seen in multicomponent interventions, but no intervention demonstrated any statistically significant improvement in measures of anxiety. This corroborates with the existing consensus that multicomponent approaches confer the most benefit, and adds to the literature by demonstrating this to be the case in brief, explicitly behavioural interventions. This review guides future study of treatments for insomnia in populations where cognitive behavioural therapy for insomnia is not appropriate

Working memory updating training promotes neural plasticity & behavioural gains: a systematic review & meta-analysis

Aims: Recent reviews yield contradictory findings regarding the efficacy of working memory training and transfer to untrained tasks. We reviewed working memory updating (WMU) training studies and examined cognitive and neural outcomes on training and transfer tasks. Methods: Database searches for adult brain imaging studies of WMU training were conducted. Training-induced neural changes were assessed qualitatively, and meta-analyses were performed on behavioural training and transfer effects. Results: A large behavioural training effect was found for WMU training groups compared to control groups. There was a moderate near transfer effect on tasks in the same cognitive domain, and a non-significant effect for far transfer to other cognitive domains. Functional neuroimaging changes for WMU training tasks revealed consistent frontoparietal activity decreases while both decreases and increases were found for subcortical regions. Conclusions: WMU training promotes plasticity and has potential applications in optimizing interventions for neurological populations. Future research should focus on the mechanisms and factors underlying plasticity and generalisation of training gains

The effects of music listening interventions on cognition and mood post-stroke: a systematic review

Introduction: Music listening may have beneficial psychological effects but there has been no comprehensive synthesis of the available data describing efficacy of music listening in stroke. Areas covered: We performed a systematic review examining the effects of music listening interventions on cognition and mood post-stroke. We found five published trials (n=169 participants) and four ongoing trials. All studies demonstrated benefits of music listening on at least one measure of cognition or mood. Heterogeneity precluded meta-analysis and all included studies had potential risk of bias. Common reporting or methodological issues including lack of blinding, lack of detail on the intervention and safety reporting. Expert commentary: It is too early to recommend music listening as routine treatment post-stroke, available studies have been under-powered and at risk of bias. Accepting these caveats, music listening may have beneficial effects on both mood and cognition and we await the results of ongoing controlled studies

Incidence and prevalence of post-stroke insomnia: a systematic review and meta-analysis

Problems with sleep are reported to be common after stroke but the incidence and prevalence of insomnia and insomnia symptoms following stroke is not yet established. The aim of this review was to conduct a systematic review and meta-analysis of the incidence and prevalence of insomnia and insomnia symptoms in individuals affected by stroke. We searched seven main electronic databases to identify studies until September 25, 2018. No studies examining incidence of post-stroke insomnia were identified. Twenty-two studies on prevalence of insomnia or insomnia symptoms including individuals with stroke were included with fourteen studies suitable for inclusion in the meta-analysis. Meta-analysis indicated pooled prevalence of 38.2% (CI 30.1–46.5) with significantly higher prevalence estimates for studies using non-diagnostic tools, 40.70% (CI 30.96–50.82) compared to studies using diagnostic assessment tools 32.21% (CI 18.5–47.64). Greater insomnia symptoms were indicated in those with comorbid depression and anxiety. The prevalence of both insomnia and insomnia symptoms are considerably higher in stroke survivors compared to the general population. Studies investigating the incidence, insomnia symptom profile and changes in insomnia prevalence over time are needed to inform clinical practice and to encourage tailored interventions that consider this symptomatology. PROSPERO registration number CRD42017065670

Measuring the effects of listening for leisure on outcome after stroke (MELLO):A pilot randomized controlled trial of mindful music listening

Background: Cognitive deficits and low mood are common post-stroke. Music listening is suggested to have beneficial effects on cognition, while mindfulness may improve mood. Combining these approaches may enhance cognitive recovery and improve mood early post-stroke. Aims: To assess the feasibility and acceptability of a novel mindful music listening intervention. Methods: A parallel group randomized controlled feasibility trial with ischemic stroke patients, comparing three groups; mindful music listening, music listening and audiobook listening (control group), eight weeks intervention. Feasibility was measured using adherence to protocol and questionnaires. Cognition (including measures of verbal memory and attention) and mood (Hospital Anxiety and Depression Scale) were assessed at baseline, end of intervention and at six-months post-stroke. Results: Seventy-two participants were randomized to mindful music listening (n = 23), music listening (n = 24), or audiobook listening (n = 25). Feasibility and acceptability measures were encouraging: 94% fully consistent with protocol; 68.1% completing ≥6/8 treatment visits; 80–107% listening adherence; 83% retention to six-month endpoint. Treatment effect sizes for cognition at six month follow-up ranged from d = 0.00 ([−0.64,0.64], music alone), d = 0.31, ([0.36,0.97], mindful music) for list learning; to d = 0.58 ([0.06,1.11], music alone), d = 0.51 ([−0.07,1.09], mindful music) for immediate story recall; and d = 0.67 ([0.12,1.22], music alone), d = 0.77 ([0.16,1.38]mindful music) for attentional switching compared to audiobooks. No signal of change was seen for mood. A definitive study would require 306 participants to detect a clinically substantial difference in improvement (z-score difference = 0.66, p = 0.017, 80% power) in verbal memory (delayed story recall). Conclusions: Mindful music listening is feasible and acceptable post-stroke. Music listening interventions appear to be a promising approach to improving recovery from stroke