1. National PLAN Alliance 2008 Conference Cognitive Enhancement Therapy November 8, 2008 Ray Gonzalez LISW-S, ACSW Sharon Shumaker LISW-S

2. What is Cognitive Enhancement Therapy (CET)? Developed by Gerard Hogarty and Samuel Flesher at the EPICS Program at the University of Pittsburgh Medical School CET Research funded by NIMH using a rigorous methodology 121 Subjects over three years Study published in the Archives of General Psychiatry, Sept. 2004 Normally takes 10 to 15 years to disseminate new medical technology

3. What is Cognitive Enhancement Therapy (CET)? Developed in response to observation that lack of vocational success was not due to lack of skills training Success has more to do with social cognition

4. Social Cognition Ability to act wisely Impairments to brain function can seriously affect social cognition Attention, Memory, Problem Solving, Mental Stamina

5. Attention, Memory, Problem Solving, Mental Stamina are necessary for… Perspective Taking Motivational Account Cognitive Flexibility Front Stage/Back Stage

6. Neuroplasticity Treatment of Traumatic Brain Injury has also taught us that impairments to the brain can be remediated Neuroplasticity of the brain means that impairments are not set in stone. Neuroplasticity makes rehabilitation and remediation possible

7. Components of CET Highly structured groups  Psycho-ed talks  Homework reporting in class  Exercises done in pairs Computer exercises Individual ‘coaching’ once a week

8. Components of the CET Group Consistent and Predictable Format Aids to Attention and Concentration Redundancy

9. Clients who are candidates for CET Stable Improved functioning but not well Stuck in their recovery process Have problems with social cognition

10. Coaching a CET group involves: Relearning patterns of interacting with group members Developing a new awareness of functional impairments of group members Developing skill to ask thoughtful questions of group members that challenge them to think for themselves rather than guess at what is expected of them.

11. Coaches become more skilled at: Listening Challenging clients at therapeutic level Offering support in a manner that engages the client in growth Being permissive in a way that allows for growth from ‘failure’ Offering authentic praise and reward

12. Ways CET benefits clients  Attention  Memory  Motivation  Affect  Awareness of social context  Vocational effectiveness  Interpersonal effectiveness  Active Thinking  Awareness of illness/disability  Dependability  Spontaneity  Foresightfulness  Perspective Taking  Cognitive Flexibility  Mental Stamina

13. Processing Speed Effect Sizes of CET & EST (Enriched Supportive Therapy at 12 and 24 Months by Composite Index CET EST 12 24 Social Cognition Social Adjustment NeurocognitionSymptoms Cognitive Style

14. Regions showing increased grey matter in EST patients compared to baseline Regions showing increased grey matter in CET patients compared to baseline MRI studies show Gray matter density increases with CET compared to EST at 1 year

15. CONTACT INFORMATION Center for Cognitive Innovation Ray Gonzalez, ACSW, LISW-S, Sharon Shumaker, LISW-S. c/o 5010 Mayfield Rd Suite 304 Lyndhurst, OH 44124 216-321-3611, ext. 204 email: rgonzalez@planNEohio.orgrgonzalez@planNEohio.org sshumaker@planNEohio.org website: www.planNEohio.orgwww.planNEohio.org