CAT Intro Presentation UT Health San Antonio, Department of Psychiatry, Division of Community Recovery, Research and Training

Overview Symptom and cognitive challenges in serious mental illness How cognitive problems relate to community functioning How Cognitive Adaptation Training (CAT) can make a difference CAT Training International Center of Excellence Motivational Interviewing and CAT

Serious Mental Illness: Challenges related to outcome Behavioral Challenges Amotivation Decreased activity Social withdrawal Substance Use Insomnia Psychosis Delusions Hallucinations Disorganized speech/behavior Community Functioning/Behavior Work/School Interpersonal relationships Self-care/ADLs Medication Adherence Cognitive Challenges Attention Memory Executive functions Psychomotor Speed Mood and Emotional Challenges Depression Mania Anxiety

Understanding Cognitive Challenges Attention Memory Information-processing/psychomotor speed Executive functions Gold JM and Harvey PD Psychiatric Clin North Am, 1993; 16: 295-312; Maples & Velligan, 2007

Executive Functions Formulate plans for goal directed behavior Sequence behavior and thought Maintain goal-directed-action in the face of distraction Inhibit irrelevant or inappropriate behavior

Cognitive Functioning Predicts Real-World Outcomes Executive Function Attention Memory Psychomotor Speed Daily Living Skills Social Function Work Green MF. Am J Psychiatry, 1996; 153: 321-330 Velligan et al., Schiz Res, 1997; 25: 21-31

Cognitive Functioning Predicts Real-World Outcomes Executive Function Attention Memory Psychomotor Speed Daily Living Skills Social Function Work CAT Environmental Supports Green MF. Am J Psychiatry, 1996; 153: 321-330 Velligan et al., Schiz Res, 1997; 25: 21-31

Cognitive Adaptation Training (CAT) CAT is a manualized list of environmental supports such as signs, calendars, checklists and the reorganization of belongings designed to get around problems with cognitive functions and improve success in everyday behaviors Delivered in the home environment – typically weekly Is evidence-based Uses a motivational strengths perspective to facilitate a person’s initiatives and independence Treatment is based upon how the person thinks and behaves Level of executive function Type of behavior exhibited (apathy, disinhibition)

Areas for CAT Intervention Areas of Intervention Areas for CAT Intervention Bathing Laundry Dressing Grocery Shopping Dental Hygiene Transportation Orientation Leisure Skills Work/Vocational Skills Toileting Social Skills, Communication and Telephone Use Housekeeping/Care of Living Environment Eating, Nutrition and Cooking Money Management/Budgeting Medication Management Coping Skills I. What is Cognitive Adaptation Training? II. The Four Principles of Cognitive Adaptation Training III. CAT Assessments IV. CAT Intervention Strategies: Part I V. CAT Intervention Strategies: Part II VI. Differences Between CAT and Other Treatments VII. Introduction to CAT – A Review

Care of Living Environment I. What is Cognitive Adaptation Training? II. The Four Principles of Cognitive Adaptation Training III. CAT Assessments IV. CAT Intervention Strategies: Part I V. CAT Intervention Strategies: Part II VI. Differences Between CAT and Other Treatments VII. Introduction to CAT – A Review

Orientation I. What is Cognitive Adaptation Training? II. The Four Principles of Cognitive Adaptation Training III. CAT Assessments IV. CAT Intervention Strategies: Part I V. CAT Intervention Strategies: Part II VI. Differences Between CAT and Other Treatments VII. Introduction to CAT – A Review

Medication – Let’s make it easier Decreasing the number of steps needed to take medication increases the likelihood that it will be taken (Apathy) Prompting the likelihood medication will be taken (Disinhibition) Organization to address executive challenges Did I take my meds today?

Promoting healthy lifestyles to address medical comorbidities

Daily Checklist – Multiple Areas Mario's Daily Checklist   6/11 6/12 6/13 6/14 6/15 6/16 6/17 Wednesday Thursday Friday Saturday Sunday Monday Tuesday Take Morning Meds Take Shower Use Deodorant Use Mouth Wash Take PM Meds Change Clothes Brush Teeth Everyday I. Basic CAT Interventions II. Specific CAT Interventions III. Problems and Pitfalls IV. Implementing CAT – A Review

Daily Schedule

Differences Between CAT and Other Treatments or Case Management Very little sitting down in CAT Directive-offering suggestions, getting the person on board to move and do; prompting to help them do it themselves Customizing the environment to compensate for thinking and motivational problems A focus on empowerment and functioning-taking care of self and home, having leisure activities and friends, having meaningful daily activities I. What is Cognitive Adaptation Training? II. The Four Principles of Cognitive Adaptation Training III. CAT Assessments IV. CAT Intervention Strategies: Part I V. CAT Intervention Strategies: Part II VI. Differences Between CAT and Other Treatments VII. Introduction to CAT – A Review

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