Current Studies
Our research group is focused on understanding the factors that are associated with functioning in everyday life for those with mental disorders and to develop interventions that target these factors so that quality of life can be improved. A primary focus of our work is to examine how cognitive functioning is associated with outcomes such as work, home life, socializing, recreation, and quality of life. In addition to studying the mechanisms of cognitive impairment, we develop treatment interventions to help those with mental illness improve their cognitive abilities, develop new strategies for deploying cognitive skills in daily life, and improve their confidence to approach and sustain engagement with cognitively complex tasks.
Action-Based Cognitive Remediation (ABCR)
We have developed a new cognitive remediation treatment, called Action-Based Cognitive Remediation. This treatment uses core principles of cognitive remediation, including cognitive training and development of new problem solving strategies (see an expert working group on this topic led by Dr. Bowie here). ABCR adds a number of techniques related to other cognitive and behavioural therapies, including goal setting, cognitive activation (behavioural activation with a focus on enriching the cognitive ecosystem by going after cognitive challenges), and using role-plays that simulate real world activities one might encounter in the home, socially, or at work. Thus, the ‘action’ part of ABCR refers to the notion that cognitive training opportunities will be maximally effective in producing substantial and sustained real world behaviour change when the skills and strategies that are learned in sessions are also directly applied to real world scenarios and the person has concrete plans for engaging with cognitively enriching experiences outside of therapy sessions.
Our initial study of ABCR, compared to traditional forms of cognitive remediation, found that the treatment resulted in better functioning outcomes and higher rates of completing treatment in a sample that included people with schizophrenia, bipolar disorder, and major depressive disorder.
With grant funding from the "Healthy Minds Canada - Pfizer Canada- Sun Life Mutual" award, we found that this treatment, compared to traditional cognitive remediation treatment, resulted in better functioning and work outcomes in those with depression.
More recently, our colleagues working with those in the early stages of psychotic disorders (a “First Episode Program”), have shown that ABCR produces better community functioning outcomes than a different style of treatment that focuses on modifying the living environment to minimize the burden of the cognitive difficulties experienced by those with mental illness.
Our colleagues in Copenhagen, Denmark, showed that ABCR produces large improvements in executive functioning for those with bipolar disorder. A secondary analysis in this study showed that ABCR increases activity in the dorsolateral prefrontal cortex within 4 weeks of treatment and that this activity increase predicted later improvements in executive functioning.
What’s next?
These studies by our team, and replicated by our colleagues, show that ABCR effectively improves cognition and that this improvement is driven by changes in brain functioning. Perhaps more importantly from a public health perspective, ABCR includes unique treatment approaches that elevate changes beyond brain function to improvements in quality of life and reduction of disability.
We developed a training program for clinicians and mental health networks so they can also take up ABCR in their practice. To date, we have trained over 25 sites as part of the Early Psychosis in Ontario Network, 50 clinicians who are part of the British Columbia Schizophrenia Society, as well as colleagues in New Zealand, Ireland, Ohio, Minnesota, Winnipeg, Montreal, and Halifax. If you would like to learn about training opportunities in ABCR for your clinical work, please contact us.
We are also modifying ABCR to be delivered online for remote, video-based treatment. Originally spurred on by the COVID-19 effects on providing treatment, we hope that this modification will help us also reach underserved communities and those who might not have the resources to engage in in-person therapy.
The Cognition x Cognition Interaction
In our experimental studies in the CPD lab, we are interested in the degree to which the two ‘types’ of cognition interact with each other. For example, we know that both neurocognitive functioning (attention, memory, executive functions) and cognitive processes (thinking styles and content) are both affected by mental illnesses. We know less about the ways in which these two cognitions affect each other. We have proposed a model (paper forthcoming) in which neurocognitive impairments can be thought to both affect and be exacerbated by thinking style (e.g., negative views of one’s ability).
In our early correlational work in this area, we showed that self-efficacy is an important predictor of functioning in schizophrenia and later in major depressive disorder. We have new measurement strategies and tasks to probe the interaction of this cognition x cognition relationship, showing that those with higher depressive symptoms skip more items on a working memory task as the difficulty increases, in spite of having a similar ability to do the task to those with minimal depressive symptoms. In an adaptation of the well-known physical effort task by Treadway, Tanya Tran developed a cognitive effort analog task and found that cognitive effort was a stronger predictor of functioning in depression than the traditional physical effort task. Chelsea Wood-Ross measured cognitive effort avoidance within a cognitive training environment, finding behavioural and neurophysiological evidence that those with depression disengage with cognitive training tasks as task difficulty increases.
What’s next?
These studies, and our future work, continue to give us insight into the ‘downstream’ effects that neurocognition have on the ways in which those with mental illness think about themselves and their abilities. The work has helped inform how we developed and continue to modify our treatments, including ABCR. In our recently funded 5-year project from Canadian Institutes of Health Research, we will be studying this interaction of cognition and cognition, along with other predictors such as early life events (in collaboration with Dr. Harkness’ lab) to discover predictors of recurrence of depressive episodes and recovery of functioning in those with their first episode of depression.
Stigma
Several of our studies are focused on applying more rigorous experimental design and objective assessment of biobehavioural responses to the characteristics of severe mental illness in order to better understand stigma and social isolation. To date, we have used EEG, behavioural coding, and covert assessments of threat perception in our experimental tasks.
With the information that we have learned from our experimental tasks studying stigma and social isolation, and in collaboration with those who have lived experience of psychosis and their family members, we developed a new treatment called Be Outspoken and Overcome Stigmatizing Thoughts (BOOST). This group therapy is co-facilitated by our peer support worker and uses psychoeducation, cognitive restructuring, and social and assertiveness skills to help those in the early stages of psychosis to prevent against the internalization of stigma and develop plans for staying socially active.
What’s next?
We recently received funding from Mental Health Research of Canada to conduct a larger trial of BOOST in a multi-site study.