Neuropsychology; Psychiatry; Schizophrenia; Veterans
"Exploring Ways to Restore Cognitive and Work Capacity" is our mission. Our goal is to restore functional capacity to people with disabling psychiatric conditions. We are particularly interested in vocational rehabilitation and neurocognitive rehabilitation and have tested interventions that can augment current best practices. Our work suggests that providing patients with on-going, specific feedback about their cognitive and work performance can improve vocational outcomes. Based on models of neuroplasticity, we have tested the use of computer-based cognitive exercises of attention, memory, language and executive functioning. We have found that such training can result in normal levels of task performance, improved neuropsychological test performance, and better functioning on the job. We have found that cognitive training combined with work therapy leads to greater productivity and when combined with supported employment leads to higher rates of competitive employment, especially for those with the poorest initial community functioning.
Evidence linking cognitive training to neuroplastic changes comes from pre-post fMRI studies that show improved cognitive efficiency on working memory tasks. Other methods being explored include social information processing groups, a CBT approach to negative cognitions regarding return to work, using D'serine as a cognitive enhancer to boost new learning in conjunction with cognitive training, and using motivation enhancing strategies. While most of our work has been with schizophrenia, we are now applying cognitive remediation approaches to patients in initial stages of substance abuse treatment and early stage Alzheimer's disease. Under development are new cognitive training software, simulated job interview training, and psychophysiological approaches.
Specialized Terms: Cognitive Remediation; Neuropsychology; Neuropsychology of Schizophrenia; Psychiatric Rehabilitation; Schizophrenia; Supported Employment
Extensive Research Description
NIDA Cognitive Remediation and Work Therapy in the Early Phase of Substance Abuse Treatment. Pilot study to determine whether these interventions improve substance abuse outcomes.
NIMH SBIR “Vocational Rehabilitation Training Simulation for the Psychiatrically Disabled, Phase 1.- Development of computer-based job interview role-play training.
VA Rehabilitation R&D “Cognitive Training to Enhance Work Program
NIMH "Cognitive Training and Enhanced Supported Employment.” - RCT of Positscience cognitive training with CMHC based Supported Employment
VA Rehabilitation R&D (Lysaker PI, Bell Co-PI). Effects of CBT and Cognitive Remediation on Work in Schizophrenia.” - RCT of CBT and Positscience cognitive training with VA work therapy.
- Bell MD, Choi KH, Dyer C, Wexler BE. Benefits of Cognitive Remediation and Supported Employment for Schizophrenia Patients with Poor Community Functioning. Psychiatr Serv. 2014 Jan 2. doi: 0.1176/appi.ps.201200505. [Epub ahead of print] PMID:24382594
- Smith MJ, Ginger EM, Wright K, Wright M, Olsen D, Bell MD, Fleming MF. Virtual Reality Job Interview Training For Individuals with Psychiatric Disabilities. Journal of Nervous and Mental Disorders 2014;202: 659–667 PMID: 25099298
- Johannesen, J.K., Lurie, J.B., Fiszdon, J.F., & Bell, M.D. (2013). The social attribution task – multiple choice (SAT-MC): A psychometric and equivalence study of an alternate form. ISRN Psychiatry, Volume 2013, Article ID 830825, http://dx.doi.org/10.1155/2013/830825
- Bell MD, Corbera S, Johannesen JK, Fiszdon JM, Wexler BE. Social Cognitive Impairments and Negative Symptoms in Schizophrenia: Are there Subtypes with Distinct Functional Correlates? Schiz Bull, 2013, 39, 186-196.
- Bell MD, Weinstein A, Simulated Job Interview Skill Training for People With Psychiatric Disability: Feasibility and Tolerability of Virtual Reality Training, Schiz Bull 2011, 37: S91-S97.
- Bell MD, Fiszdon JF, Greig TC, Wexler BW. Social Attribution Test-Multiple Choice (SAT-MC) in schizophrenia: Comparison with a community sample and relationship to neurocognitive, social cognitive and symptom measures. Schiz Research, 2010, 122:164-171.
- Bell MD, Johannesen JK, Greig TC, Wexler BE. Memory profiles in schizophrenia: categorization validity and stability. Schiz Research, 2010, 118:26-33.
- Bell MD, Tsang HWH, Greig TC, Bryson GJ. Neurocognition, social cognition, perceived social discomfort and vocational outcomes in schizophrenia. Schizophrenia Bulletin, 2009, 35(4), 738-747.
- Bell MD, Zito W, Greig T, Wexler BE. Neurocognitive Enhancement Therapy with Vocational Services in Schizophrenia: Work Outcomes at Two Year Follow-Up. Schizophrenia Research, 2008, 105:18-29.