The Neuropsychological Educational Approach to Remediation (NEAR)

Alice Medalia, PhD


A Computer-Assisted Cognitive Skills Training Program

"The Neuropsychological Educational Approach to Remediation (NEAR) emphasizes individualized training done in group formats, and combines techniques developed in both neuropsychological and educational models to target neuropsychological deficits as they affect information processing and cognition. Standing in stark contrast to other cognitive rehabilitation approaches, the NEAR model recognizes that engaging clients in learning tasks can be quite challenging because mental and medical illness impact motivation, and makes extensive use of educational techniques designed to promote learning by increasing motivation and task engagement. This holistic approach incorporates ideas culled from educational psychology, learning theory, rehabilitation psychology, and neuropsychology to create a comprehensive approach to remediation. The holistic approach encourages the promotion of an awareness of learning style, the promotion of self-esteem, and improves social-emotional functioning. In developing the NEAR approach, mass market software titles designed as educational tools were analyzed systematically on a variety of dimensions (Medalia, Revheim, Herlands, 2002). Required reading level, required level of computer skill, level of personalization, and cognitive skills trained were among the qualities rated. Using these criteria, over 20 software titles have been incorporated into the system thus far. The NEAR approach has been successfully implemented in outpatient and inpatient settings which serve a diverse psychiatric and substance abusing population (Medalia, Aluma, Merriam, 1999; Medalia, Dorn, Watras-Gans, 2000; Medalia, Revheim, Casey, 2000; Medalia, Revheim, Casey, 2001, Medalia, Revheim, Herlands, 2002)."
Tiffany Herlands, PsyD

Cognitive Training for Patients with Psychosis

Elizabeth W. Twamley, PhD


(reprinted with permission from Dr. Twamley)

The Cognitive Training intervention is a manualized, 12-week class comprised of modules on Prospective Memory, Vigilance, Verbal Learning/Memory, and Executive Functioning/Cognitive Flexibility. Participants learn and practice compensatory skills in these domains during a weekly two-hour class and during homework assignments. A randomized controlled trial comparing Cognitive Training to standard psychiatric care is currently underway, with outcome measures including neuropsychological performance, psychiatric symptoms, treatment adherence, and psychosocial functioning.

* Funded by a Young Investigator Award from the National Alliance for Research on Schizophrenia and Depression (NARSAD)

Social Cognition and Interaction Training (SCIT)

David Roberts, PhD, and David Penn, PhD

Social Cognition and Interaction Training (SCIT) is a 20-session manualized group intervention that has the goal of improving social cognition in schizophrenia in order to improve downstream social functioning. SCIT differs from "targeted" interventions that focus on one social cognitive domain (e.g. emotion perception) in that it targets all three of the most widely recognized domains of social cognitive abnormality in schizophrenia: Emotion Perception, Theory of Mind, and attributional style. SCIT differs from "broad-based" interventions such as Integrated Psychological Therapy and Cognitive Enhancement Therapy in that it excludes use of traditional cognitive remediation techniques. Instead, SCIT employs intervention techniques that we consider to be more narrowly social-cognitive.