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Scientific Lectures //

Title: From Mechanism to Treatment: Using cognitive remediation as a treatment for psychopathic…

Arielle Baskin-Sommers, Ph.D.

Presented: September 12, 2013

ABSTRACT: Despite the similar behavior problems of psychopathic and externalizing individuals, the dysfunctional cognitive-emotional interactions underlying these disorders are substantially different. Psychopaths are characterized by an attention bottleneck that causes them to be oblivious to contextual information that would otherwise contraindicate their behavior. Externalizers are characterized by high emotional reactivity and cognitive control deficits that are exacerbated in affectively charged situations. Although these disorders are notoriously resistant to standard interventions, it should be possible to achieve greater therapeutic benefit using cognitive remediation strategies that specifically target their respective deficits.
Cognitive remediation involves training individuals in particular cognitive skills. Using a 2 group by 2 treatment crossover design, we are currently evaluating the extent to which cognitive remediation may be used to modify the dysfunctional cognitive-emotional interactions associated with psychopathy versus externalizing. More specifically, we are evaluating the extent to which training attention to context (ATC) can alter the deficit associated with psychopathy. Simultaneously, we are evaluating the extent to which practicing affective cognitive control (ACC) enhances self-regulation in prisoners with externalizing.
Briefly, all inmates complete a pre-treatment assessment involving five computerized tasks that measure the cognitive-affective deficits associated with psychopathy and externalizing using a combination of task performance and psychophysiological assessments (startle; event-related potentials). Inmates are randomly assigned to ATC or ACC, with half of the inmates receiving a training (3 computerized tasks) that matches their specific deficit and half receiving a training that does not match their deficit (but matches the deficit of the other group). At the end of 6 weeks of training, inmates complete a post-treatment assessment that is identical to the pre-treatment assessment.
Thus far, findings indicate that the psychopathy and externalizing groups display differential deficits (e.g., psychopaths are less sensitive to contextual cues in the Stroop whereas externalizers show no deficit; externalizers display poorer inhibition during reward in the NBack task but psychopaths do not) and differential pre- to post- improvement on nearly all tasks (e.g., only individuals who receive the deficit-matched treatment improve from pre to post.) Moreover, nearly all of the training tasks are showing improvement over time and the improvement is relatively specific to the targeted groups (e.g., only psychopaths perform poorly on the ATC training (e.g., reversal-learning task) on the first day of training but improve by the end of training; only externalizers initially perform poorly on the ACC training (e.g., distress tolerance task), but improve with training over the 6 sessions).  Finally, improvement on training predicts improvement on the pre/post tasks for the group receiving the deficit-matched treatment (e.g., for psychopaths reversal-learning training predicts improvement on the Stroop; for externalizers improvement on distress tolerance predicts improvement on the NBack). 
Overall, this research provides a framework for translating advances in basic cognitive and affective science into increasingly effective and efficient therapeutic interventions for disinhibitory psychopathology.

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