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The Oslo Cognitive Training Programme

Allow us to inform the readers of Acta Psychiutrica Scandinavica about a cognitive training programme developed at the Centre for Child and Adolescent Psychiatry (CCAP) in Oslo. The programme aims to improve cognitive functioning, and to develop and strengthen cognitive skills, and takes into account the specific psychopathological characteristics of schizophrenia. It is our assumption that in many cases disorders at other levels of behavioural organization might only be effectively treated if cognitive deficits were dealt with first. The development of the Oslo Training Programme is based on research which has demonstrated that the most outstanding dysfunction can be related to the areas of attention, memory and executive functions (1). The programme is arranged in four modules, namely cognitive differentiation, attention, memory and social perception. The first module is based on the supposition of a generalized impairment in verbal intelligence, abstractionflexibility and auditory processing which is consistent with a left-hemispheric dysfunction hypothesis. The second module considers impairment of attention as a central feature of schizophrenia. With the assumption that deficits in attention are part of an underlying mechanism of other cognitive dysfunction, tasks aim to strengthen sustained attention, as well as to teach selective attention and scanning abilities. Memory is the focus of the third module, which is based on studies involving both verbal and visual memory. The tasks, which primarily involve short-term recall, aim to improve the patient’s ability to recall an increased number of items. The final module, namely social perception, involves the cognitive processes that allow the patient to respond and adapt appropriately to his or her environment. Training in verbal communication, attention and memory, as well as social perception, is conducted by administering systematic training procedures. During the first module, patients learn to discriminate between stimulus categories by participating in a card-sorting task. After demonstrating competence in this task, patients are introduced to a concept formation task where they are instructed to match antonyms and synonyms, distinguish concepts with different definitions and establish a hierarchy of related concepts (2). Attention and memory modules are presented simultaneously with the concept formation task. Following these modules, patients participate in the Social Perception Module, in which they are trained to encode social stimuli by viewing a series of slides showing actors engaging in different social activities and demonstrating emotions of differing intensity (2). The improvement of the patient’s ability to attend to the statements of others, so as to improve their ability to understand accurately what was said, and to encourage association between the patient’s thoughts and the statements of those with whom they interact, is the focus of the fourth programme. This training attempts to address the lack of integration between strategies that target information processing and social learning dysfunction. Programme structure. The four modules are systematically introduced to the patient over a period of 8-10 weeks. The training consists of 30 h of individual training with 15-min work sessions. The programme is developed such that the patient begins with elementary tasks and progresses to more difficult ones. The rate of progression is determined from the individual’s functioning. However, a standard protocol provides the structure for progression.