ENGLISH VERSION : intervention on cognitive reinforcement through method feuerstein referred to psychiatric patients resident in a facility

Reference Period October 2014 - May 2015

Applicator: Dr. Alessandro Richetta

INTERVENTION ON COGNITIVE REINFORCEMENT THROUGH METHOD FEUERSTEIN REFERRED TO PSYCHIATRIC PATIENTS RESIDENT IN THE COMMUNITY

From October 2014 to May 2015, a cognitive enhancement was carried out at a community for patients with psychiatric disorders performed with the Feuerstein method. This method created by psychologist R. Feuerstein allows to increase cognitive abilities based on the creation of a 'Mediated Learning Experience' through which the mediator works on two levels:

- the cognitive level. Intellectual skills are related to cognitive functions, which are numerous, observable and editable. For each session, the defective and "strong" cognitive functions are observed by dividing the three - step mental action: input - output - output with its cognitive functions for each phase

- the relational level. Each learning is closely related to the relational and self-esteem plan, and in each session, the most appropriate relational criteria are observed for the person to facilitate learning. In the Feuerstein method there are 12 mediation criteria.

This method involves the use of workbook exercises divided into 14 tools for 3 difficulty levels and increasing abstraction. The work papers put the person in a problematic situation to be solved. The person will be forced to adopt a strategy to resolve this difficulty, and then the mediator will ask the person to make a meta-cognitive reflection - a reflection on the strategy used, its functionality or not, and in the case of designing a new one. Only one tool belonging to the first difficulty level, is Point Organization, is used during the working period. This tool is useful as it activates all the cognitive functions provided by the method and allows you to introduce the concept of strategy. The intervention was designed so that working moments on the strategies found to resolve the cards would alternate with relative reflections to the creation of strategies to attain the goals of everyday life how to "use" and participate in the proposed group as an amplifier of reflections and strategies. Each patient was informed, after a period of observation, on what cognitive functions they intended to work on, so as to favor their intentionality. The project concerned four patients who participated consistently, while other patients partially participated only at an early stage. The following are the remarks made for each patient regarding the cognitive functions identified to be enhanced and the mediation criteria upon which it is worked.

B. N. woman over forty with schizoaffective disorder.

The patient had the need to work on the following cognitive functions :

INPUT (data collection phase):

Lacking observation : B. had a collection of surface and hasty information, she often didn't notice important details

Accuracy: Related to what was written above, care and precision were lacking

PROCESSING (processing phase): Hypothetical thought : make assumptions to find solutions to the problematic situations proposed. Initially, the patient had hypotheses but failed to produce an articulated motivation of why he had thought of that precise hypothesis. This was to have a negative impact on the next f.c.

Check hypothesis: check the thought that had promoted the adoption of a certain hypothesis, the job was not verified

Planning: the patient presented the tendency to go for trial and error without having a strategy to guide and organize the actions

Comparative behavior: little tendency to make comparisons 

OUTPUT (response):

Impulsivity: consistent with the c.f. identified in the previous phases, there was a tendency of the patient to start with work without thinking and without confronting with the rest of the group

CONSIDERATIONS :

In the INPUT phase there have been improvements in the ability to observe and consequently increase accuracy, the collection of data and details has increased over the months; the ability to motivate the proposed hypotheses has increased in the ELABORATION phase; there have been no improvements in verifying hypotheses, however, this cognitive function has remained at sufficient levels; in the OUTPUT phase there has been a decrease in impulse and a consequent increase in planning capacity;

Finally, the ability to use the comparison to get information is moderately improved

About MEDIATION CRITERIA, for B. are important :

1) the feeling of competence: it tends to devalue and to be considered inadequate. Often the feeling of being inadequate to the adolescent daughter has emerged.

2) planning and goal: to mediate the importan to find a way to achieve and maintain the established strategy by verifying its functionality (hypothesis verification).   

1. The patient identified the following daily-related goals:

A) to be able to shop at the supermarket: the patient reported the difficulty in spending in crowded places. Strategies found : 1) to buy in smaller places close to the facility 2) early in the morning or at lunchtime when there are few people. She founded, the first strategy, more functional.   

B) eat less: B. reported the desire to lose weight and along with L., another patient who showed the same desire, produced the following strategies: 1)watching TV to don't eat;  2) before sleeping, listen the radio; 3) eating a fruit before eating; 4) to end the lunch with a a little appetite; 5) use little dishes to have little food in the pot. The patient showed ability to do hypothesis and to identify strategies, however, it needs support in maintaining these strategies because of the scarce competence she attibute to herself. It can be supposed, however, that with a constant mediation she could improve on that plan. About the group, her considerations were relative to the perception that "union is the force" and that it is important to "put themselves in the shoes of others", showing so that mediation about the importance of participating and sharing with the group has been transposed by the patient. During the last meeting, B. said that she reflects more than before.

L. woman in forty with schizoaffective disorder - histrionic For L., the cognitive functions on which to intervene were the following.

INPUT (data collection phase). Systematic exploration: insufficient, various parts of the sheet were omitted; Precision: little observation for details.

ELABORATION Comparison: cognitive function little used by the patient to understand how she had done the job ; Hypothetical thinking : this c.f. was used by the patient in a very rigid way, basically once found a non-functional strategy, she identified a new one quite similar to the one just dropped out of planning; Planning : to design a strategy to achieve a goal

OUTPUT (response). Try and error: without a reference strategy , the initial pages of the patient were constantly erased and rewritten.

CONSIDERATIONS

INPUT phase, there was an improvement in observing systematically without leaving unexplored portions of the worksheet; the accuracy of the details has remained essentially the same, that is, sufficient levels.

ELABORATION have improved in the ability to make use of the comparison of the figures in the sheet, such as the comparison of their ideas with those of others; hypothetical thinking has also been improved by producing more hypotheses to deal with the problematic situation; the planning skill has improved by reaching sufficient levels.

In the OUTPUT phase there has been an improvement and a decrease with "try it randomly" behavior as measured by the decrease in the write-offs on the worksheet. 

According to MEDITATION CRITERIA, for L., is important to work on intentionality and reciprocity namely: what you want to do and why you do so in order to activate your own intentionality (this phase has been important for everyone but especially for L.). Another important aspect is sharing, helping her to get involved. With regard to this last point, L. showed that she was able to use the group by achieving his goals by asking to the group to help her.  

Objectives

A) Lose weight: For this purpose, refer to reading it at previous case of B. The results were seen at an early stage with a loss of 2.5 kg reported on 6/2/2015; afterwards, the patient had more difficulty even for foot problems that had limited mobility for gym exercises.   

1) she asked the group to help her deal with the problem at her feet and at the same time spend hours of the days she lived as too long, especially now that physical activity was limited. The strategies emerged were: take an anklet, go in the afternoon because are the longest hours, do 4km 3 times a week, make gymnastics after the race

2) in date 20/3 L. is happy because he succeeds in following a strategy for the weight loss, also bought a fit suit The patient notes how important it is to play resources even when "one's thinking he doesn't have it." About the strategies, L. says "there is the home and the world , if you face it with the gradualness of the observation, you'll see that's not so scary. "During the last encounter with L., she reports that she can have more patience with his mother and that conflicts with her are decreased.

C. P., a male patient in the forty with obsessive psychosis. The cognitive functions on which to intervene are essentially those related to the central processing phase. That is, it has shown a good ability to observe and take information, providing an adequate response at the output stage.   

ELABORATION

Comparative Behavior: not inclined to use the comparison point

Hypothetical thinking : c.f. sufficient enough, to develop and increase

Planning: low ability to build a strategy to reach the goal set.

CONSIDERATIONS

improvements have been observed in the ability to create hypotheses, finding more explanations of facts and events. Considering comparative behavior and planning, discontinuous improvements have been observed, the patient presents the c.f. considerably but emotionally he feels he can not do it. This is to be linked to the

MEDITATION CRITERIA observed and on which we've intervened. The criteria identified are two :

1) sense of competence, almost regularly on each meeting, it was necessary to strengthen the patient about his abilities in dealing with the problem situation proposed by the worksheet and subsequently to assist in the development of his feeling of incompetence and evaluation of the result obtained (it has always been shown to be up to the task with consequent pleasure and gratification)

2) awareness of modification, the reflections inherent in its ability to resolve the worksheet were aimed at making the patient to elaborate that is possible to change.

OBJECTIVES

A) Become good at using the web to use facebook, listen to music and watch movies. The strategy identified was

1) to increase cellular memory and

2) use cellular cells regularly to become more skilled

B) C.P. reported having more patience in waiting for the coach and being able to find a strategy to wait for it little: using the cellphone, sees the desired bus pass times and waits only at those times. With regard to creating strategies, C. says that "changing strategies other solutions can be founded."  

M.P., man over forty with schizophrenic disorder. The cognitive functions we have worked on were   

INPUT

systematic exploration: omitting some areas of the sheet during observation

hypothetical thinking: rigidity in making hypothesis re-planning, little ability to create strategies

logical thinking: this was perhaps the c.f. to require greater attention as the patient's reasoning was constantly diverted   

ELABORATION

hypothetical thinking: rigidity in making new hypotheses

planning: little ability to create strategies

logical thinking: this was perhaps the f.c. to require greater attention as the patient's reasoning was constantly diverted to different and secondary aspects, forgetting the central concept.

CONSIDERATIONS

the patient elaborates on the hypothetical thought that "creating hypotheses and all events allows to prevent unpleasant consequences" and on this aspect there was a margin of improvement; even with regard to the ability to plan, there was a good improvement margin as well as more accurate systematic exploration. Partially improved logical reasoning was somewhat less subject to discontinuation of speech and more focused on the main topic. Regarding the criteria of mediation for M. to elaborate the regulation and control of behavior (psychic, in this case) plays an important role. During the meetings, the reflections on staying focused on the "central point" are important to avoid losing the thread. In a session it was reported that this type of reflection would help him to have less confusion in head.   

OBJECTIVES

1) Going to live alone, the patient has identified useful self-help skills such as behaving properly, eating, cleaning, and sewing.

2) Listening to music using a stereo cassette, then the patient evaluated changing the support system which cd or key usb. During the last meeting, the patient reports that he has engaged in the various requests made by the mediator during the various sessions and this has helped him to feel "more fluid thoughts."

1. In time the participants learned to use the group most, with some attempt to use it even during casual moments during the week to process layers The goal of the patients, which has been named "incorrigible", has developed a team of members to work, it has to be foreseen that each one puts himself in the shoes of others in order to better understand the objective you want to find a solution; thinking as a group and not just as a single one allows you to find more appropriate and right answers. You could finally think about some strategies find as such, they provided solutions that were brought about by some external contribution, rather than solutions related to personal commitment. This has led to reflections on the ability to take responsibility and not to be only passive subjects.