Kern Robert S, Green Michael F, Mitchell Sharon, Kopelowicz Alex, Mintz Jim, Liberman Robert P
Department of Psychiatry and Biobehavioral Sciences, UCLA Neuropsychiatric Institute and Hospital, Los Angeles, CA, USA.
Am J Psychiatry. 2005 Mar;162(3):513-9. doi: 10.1176/appi.ajp.162.3.513.
There is a clear need to develop psychosocial rehabilitation methods that compensate for neurocognitive deficits common to persons with severe and persistent mental illness. Errorless learning, a compensatory training intervention, has been successful in teaching entry-level job tasks. However, errorless learning's applicability to broader, more complex functions is unknown. The present study tested the extension of errorless learning for deficits in social problem-solving skills in patients with schizophrenia.
Sixty clinically stable outpatients with schizophrenia or schizoaffective disorder were stratified by gender and level of memory impairment before being randomly assigned to one of two training programs: errorless learning or symptom management. Groups were matched for training time, format and structure of training, and types of teaching aids used. Social problem-solving ability, measured by the Assessment of Interpersonal Problem-Solving Skills, was assessed at baseline, within 2 days of training completion, and after 3 months. Dependent measures were the scores for the receiving, processing, and sending skills areas from the Assessment of Interpersonal Problem-Solving Skills.
A repeated-measures analysis of covariance was conducted for each dependent measure with baseline Assessment of Interpersonal Problem-Solving Skills score entered as a covariate. For all three skills, there was a significant training group effect favoring errorless learning. Durability of errorless learning training effects extended to the 3-month follow-up assessment for processing and sending skills but not receiving skills.
Results support the extension of errorless learning to complex functions such as social problem-solving skills in the rehabilitation of persons with schizophrenia.
显然需要开发心理社会康复方法,以弥补重度持续性精神疾病患者常见的神经认知缺陷。无错误学习作为一种补偿性训练干预措施,已成功应用于入门级工作任务的教学。然而,无错误学习在更广泛、更复杂功能方面的适用性尚不清楚。本研究测试了无错误学习对精神分裂症患者社会问题解决技能缺陷的适用性。
60名临床症状稳定的精神分裂症或分裂情感性障碍门诊患者,根据性别和记忆损害程度进行分层,然后随机分配到两个训练项目之一:无错误学习或症状管理。两组在训练时间、训练形式和结构以及所使用的教具类型方面进行了匹配。通过人际问题解决技能评估来测量社会问题解决能力,在基线、训练完成后2天内以及3个月后进行评估。因变量是人际问题解决技能评估中接收、处理和发送技能领域的得分。
对每个因变量进行重复测量协方差分析,将人际问题解决技能评估的基线得分作为协变量纳入。对于所有三项技能,存在显著的训练组效应,支持无错误学习。无错误学习训练效果的持续性在处理和发送技能的3个月随访评估中得到体现,但接收技能方面未体现。
结果支持将无错误学习扩展到复杂功能,如精神分裂症患者康复中的社会问题解决技能。