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Conceptual basis |
Cognitive training is grounded in the idea that the brain is plastic. Brain plasticity refers to the ability for the brain to change and develop based on life experiences. Evidence for neuroplasticity includes studies on musical expertise and London taxicab drivers that have demonstrated that expertise leads to increased volume in specific brain areas. A 2008 study that trained older adults in juggling showed an increase in gray matter volume as a result of the training. A study attempting to train the updating component of executive function in young and older adults showed that cognitive training could lead to improvements in task performance across both of the groups, however, general transfer of ability to new tasks was only shown in young adults and not older adults. It has been hypothesized that transfer effects are dependent on an overlap in neural activation during the trained and transfer tasks. Cognitive training has been shown to lead to neural changes such as increased blood flow to the prefrontal cortex in attention training and decreased bilateral compensatory recruitment in older adults. |
Mental exercises |
Mind games for self-improvement fall into two main categories. There are mental exercises and puzzles to maintain or improve the actual working of the brain.Mental exercises can be done through simple socializing. Social interaction engages in many facets of cognitive thinking and can facilitate cognitive functioning. Cartwright and Zander noted that if an alien was visiting Earth for the first time, they would be surprised by the amount of social contact humans make. Caring for one another and growing up in a group setting (family) shows a certain degree of interdependence that shows deep phylogenetic roots. However, this social contact is declining in the United States. Face-to-face interaction is getting more and more sparse. Family and friend visits, including dinners, are not as common. The amount of social contact a person receives can greatly affect their mental health. A preference for being with others has a high correlation with well-being and with mental long-term and short-term effects on performance. |
There are many things involved in a simple interaction between two people: paying attention, maintaining in memory the conversation, adjusting to a different perspective than your own, assessing situational constraints, and self-monitoring appropriate behavior. It is true that some of these are automatic processes, but attention, working memory, and cognitive control are definitely executive functions. Doing all these things in a simple social interaction helps train the working memory in influencing social inference. |
Social cognitive neuroscience also supports social interaction as a mental exercise. The prefrontal cortex function involves the ability to understand a person's beliefs and desires. The ability to control one's own beliefs and desires is served by the parietal and prefrontal regions of the brain, which is the same region emphasizing cognitive control.The other category of mental exercises falls into the world of puzzles. Neurocognitive disorders such as dementia and impairment in cognitive functioning have risen as a healthcare concern, especially among the older generation. Solving jigsaw puzzles is an effective way to develop visuospatial functioning and keeping the mind sharp. Anyone can do it, as it is low-cost and can be intrinsically motivating. The important part about jigsaw puzzles is that it is challenging, especially compared to other activities, such as watching television. Engagement in such an intellectual activity predicts a lower risk in developing a cognition disorder later on in life.There is also the category of the self-empowering mind game, as in psychodrama, or mental and fantasy workshops – elements which might be seen as an ultimate outgrowth of yoga as a set of mental (and physical) disciplines.The ability to imagine and walk oneself through various scenarios is a mental exercise in itself. Self-reflection in this way taps into many different cognitive capabilities, including questioning rigid viewpoints, elaborating on experience, and knowing oneself through their relational context. |
Commercial programs |
By 2016, companies offering products and services for cognitive training were marketing them as improving educational outcomes for children, and for adults as improving memory, processing speed, and problem-solving, and even as preventing dementia or Alzheimers. They often have supported their marketing with discussion about the educational or professional background of their founders, some discuss neuroscience that supports their approach—especially concepts of neuroplasticity and transfer of learning, and some cite evidence from clinical trials. The key claim made by these companies is that the specific training that they offer generalizes to other fields—academic or professional performance generally or everyday life.CogniFit was founded in 1999, Cogmed in 2001, Posit Science in 2002, and Brain Age was first released in 2005, all capitalizing on the growing interest within the public in neuroscience, along with heightened worries by parents about ADHD and other learning disabilities in their children, and concern about their own cognitive health as they aged.The launch of Brain Age in 2005 marked a change in the field, as prior to this products or services were marketed to fairly narrow populations (for example, students with learning problems), but Brain Age was marketed to everyone, with a significant media budget. In 2005, consumers in the US spent $2 million on cognitive training products; in 2007 they spent about $80 million.By 2012, "brain training" was a $1 billion industry. In 2013 the market was $1.3 billion, and software products made up about 55% of those sales. By that time neuroscientists and others had a growing concern about the general trend toward what they called "neurofication", "neurohype", "neuromania", and neuromyths. |
Regulation and lawsuits |
Starting in January 2015, the United States Federal Trade Commission (FTC) sued companies selling "brain training" programs or other products marketed as improving cognitive function, including WordSmart Corporation, the company that makes Lumosity, and Brain Research Labs (which sold dietary supplements) for deceptive advertising; later that year the FTC also sued LearningRx.The FTC found that Lumosity's marketing "preyed on consumers' fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia, and even Alzheimer's disease", without providing any scientific evidence to back its claims. The company was ordered not to make any claims that its products can "[improve] performance in school, at work, or in athletics" or "[delay or protect] against age-related decline in memory or other cognitive function, including mild cognitive impairment, dementia, or Alzheimer's disease", or "[reduce] cognitive impairment caused by health conditions, including Turner syndrome, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), traumatic brain injury (TBI), stroke, or side effects of chemotherapy", without "competent and reliable scientific evidence", and agreed to pay a $50 million settlement (reduced to $2 million).In its lawsuit against LearningRx, the FTC said LearningRx had been "deceptively claim[ing] their programs were clinically proven to permanently improve serious health conditions like ADHD (attention deficit hyperactivity disorder), autism, dementia, Alzheimer's disease, strokes, and concussions". In 2016, LearningRx settled with the FTC by agreeing not to make the disputed assertions unless they had "competent and reliable scientific evidence" which was defined as randomized controlled trials done by competent scientists." For the judgment's monetary component, LearningRx agreed to pay $200,000 of a $4 million settlement. |
Effectiveness |
Studies that try to train specific cognitive abilities often only show task-specific improvements, and participants are unable to generalize their strategies to new tasks or problems. In 2016, there was some evidence that some of these programs improved performance on tasks in which users were trained, less evidence that improvements in performance generalize to related tasks, and almost no evidence that "brain training" generalizes to everyday cognitive performance. In addition, most clinical studies were flawed. But in 2017, the National Academies of Sciences, Engineering, and Medicine found moderate strength evidence for cognitive training as an intervention to prevent cognitive decline and dementia, and in 2018, the American Academy of Neurology guidelines for treatment of mild cognitive impairment included cognitive training.To address growing public concerns with regard to aggressive online marketing of brain games to older population, a group of scientists published a letter in 2008 warning the general public that there is a lack of research showing effectiveness of brain games in older adults.In 2010, the Agency for Healthcare Research and Quality found that there was insufficient evidence to recommend any method of preventing age-related memory deficits or Alzheimer's.In 2014 another group of scientists published a similar warning. Later that year, another group of scientists made a counter statement, organized and maintained by the Chief Scientific Officer of Posit. They compiled a list of published studies on efficacy of cognitive training across populations and disciplines.In 2014, one group of over 70 scientists stated that brain games cannot be scientifically proven as being cognitively advantageous, whether that be in preventing cognitive decline or improving cognitive functioning. Another group argued the opposite, with over 130 scientists saying that there is valid evidence in the benefits of brain training. The question is how these two groups reached different conclusions in reading the same literature. Different standards on both sides can answer that question. In a more specific manner, there is indeed a great deal of evidence that brain training does indeed improve performance on trained tasks, but less evidence in closely related tasks. There is even less evidence on distantly related tasks.In 2017, a committee of the National Academies of Sciences, Engineering, and Medicine released a report about the evidence on interventions for preventing cognitive decline and dementia.In 2017, a group of Australian scientists undertook a systematic review of what studies have been published of commercially available brain training programs in an attempt to give consumers and doctors credible information on which brain training programs are actually scientifically proved to work. After reviewing close to 8,000 studies about brain training programs marketed to healthy older adults, most programs had no peer reviewed published evidence of their efficacy. Of the seven brain training programs that did, only two of those had multiple studies, including at least one study of high quality: BrainHQ and CogniFit.In 2019, a group of researchers showed that claims of enhancement following brain training and other training programs have been exaggerated, based on a number of meta-analyses. Other factors, e.g., genetics, seem to play a bigger role. |
Cognitive training for Parkinson's disease |
A 2020 Cochrane review found no certain evidence that cognitive training is beneficial for people with Parkinson's disease dementia (PDD) or Parkinson's disease-related mild cognitive impairment (PD-MCI), however the authors also note that their conclusion was based on a small number of studies with few participants, limitations of study design and execution, and imprecise results, and that there is still an overall need for more robust studies involving cognitive training as it pertains to PDD and PD-MCI. |
See also |
Brain training programs |
Cognitive intervention |
Environmental enrichment |
Neurocognitive |
Neuroplasticity |
Sudoku |
Logic puzzle |
References |
Further reading |
Mole, Beth (June 20, 2016). "Billion-dollar brain training industry a sham – nothing but placebo, study suggests". Ars Technica. |
Marx, Patricia (July 29, 2013). "Mentally Fit". The New Yorker. |
"Could Brain Training Prevent Dementia?". The New Yorker. |
"Brain Training for ADHD: Help or Hype?". Larry Maucieri, Ph.D., ABPP-CN. Psychology Today. |
Cognitive behavioral training |
Cognitive behavioral training (CBTraining), sometimes referred to as structured cognitive behavioral training, (SCBT) is an organized process that uses systematic, highly-structured tasks designed to improve cognitive functions. Functions such as working memory, decision making, and attention are thought to inform whether a person defaults to an impulsive behavior or a premeditated behavior. The aim of CBTraining is to affect a person's decision-making process and cause them to choose the premeditated behavior over the impulsive behavior in their everyday life. Through scheduled trainings that may be up to a few hours long and may be weekly or daily over a specific set of time, the goal of CBTraining is to show that focusing on repetitive, increasingly difficult cognitive tasks can transfer those skills to other cognitive processes in your brain, leading to behavioral change. There has been a recent resurgence of interest in this field with the invention of new technologies and a greater understanding of cognition in general.The roots of CBTraining lie in a combination of cognitive behavioral therapy (CBT) and general cognitive training. Cognitive training seeks to improve cognitive functions for the sake of improved brain processing ability. The basic premise of CBT is that behavior is inextricably related to beliefs, thoughts and emotions. Between those two mentalities lies the idea that in changing the way a person responds to stimulus through training, it is possible to change a person's actions. |
However, the positive effects of CBTraining have been difficult to prove throughout the field of research. Lack of randomized controlled trials (RCTs) in many studies and a lack of a standardization of training methods and definitions of success make it difficult to compare studies with each other and find trends. Overall, many clinical reviews conclude that initial results expressing the benefits of CBTraining may have been overestimated, but the data shows positive enough results that continued research is encouraged. |
Description |
Methods |
Cognitive behavioral training (CBTraining) is a cognitive-based process designed with the aim to systematically break down emotionally driven dependencies and behaviors, replacing them with behaviors that are based on rational choice. Testing can be computerized or gamified. Bickel et al. describe this method of training as such, "adaptive-training programs rely on computerized algorithms that adjust intervention content to a patient's skill level in realtime in order to tax participants at the limit of their capacity and maintain engagement during training." Nixon and Lewis note that programs which adjust to participants' skill levels are more successful at encouraging participants to complete trainings since the testing itself can be repetitive and uninteresting.Inhibitory control training (ICT) is a method of CBTraining, which uses cues paired with promoting or inhibiting stimulus to change behavior. These cues can be general or specific to an undesirable behavior and use Go/no go or Stop-Signal tests. An example of a cue-specific ICT test was used in Stice et al.'s study designed to limit unhealthy food consumption by combining inhibitory signals with images of unhealthy food more often than non-food-related images.Working memory training (WMT) is a method that targets working memory enhancements as a vehicle for changing behavior. Working memory is "the ability to retain some information active for further use, and to do so in a flexible way allowing information to be prioritized, added, or removed." Self-regulatory and goal-maintaining behavior has been tied to working memory so WMT has emerged as a way to alter behavior through improving cognition. For example, Snider et al. sought to extend the time-related reward window in patients with alcohol dependency by improving working memory so they created twelve training exercises including one that had participants move objects on a digital desk while following auditory instructions in a particular order.Attentional bias modification (ABM) seeks to change an individual's behavior by directing their attention away from undesired cues and sometimes includes neutral cues that attention is directed towards. This is commonly carried out by a visual probe test like the one used by Kerst et al. on a handheld mobile device given to habitual cigarette smokers. Participants were asked to engage in three trainings and one assessment per day over a one week period and self report cravings and alterations, if any, in smoking habits. |
Difference from CBT |
Although CBTraining employs some similar concepts that define Cognitive Behavioral Therapy, there are some fundamental differences between CBTraining and CBT, both in philosophy and in application. CBTraining is training, not therapy. This is a critical distinction: unlike typical forms and applications of CBT, CBTraining is a process that is finite. In CBT, as with most therapy, the patient plays a large role in determining the direction of the therapy, including the intensity and duration. A CBTraining course, or program, is often broken up into a series of progressive, strategically ordered sessions designed to guide the participant through the process of training the brain away from impulsive thinking. The goal is to adjust the automatic processes that lead to undesired behaviors through repetitious training sessions designed to promote a desired behavior. CBTraining aims to change participants' behaviors through seemingly unrelated tasks by demonstrating near transfer (application of improved skills to circumstances that are very similar to those of the trained task) and far transfer (application of improved skills to circumstances that are very different from those of the trained task). |
Willpower |
In addressing addictive behavior and other potentially destructive behavior compelling to the participant, CBTraining uses an approach of urge conditioning/desensitization. This approach stands in contrast to what is commonly most instinctive to people (urge avoidance), and seems counter-intuitive at first. The approach of urge desensitization has been applied to patients with gambling addictions, and research has shown it to be effective. When a person is trying to quit smoking, for instance, the instinct is to remove all smoking paraphernalia from his presence. While this "out of sight, out of mind" approach seems to make sense, it does nothing to actually deal with the emotionally driven urge to smoke. A measure of success that is vital for positive results, but not often recorded in studies, is the determination to complete the program and adjust behaviors.Further distinguishing CBTraining from its closely related psychological predecessors is the inclusion of the concept of "Training" in place of "Therapy". CBTraining is a planned, intricately designed and systematically applied regimen that is purposely finite. CBTraining begins with a specific goal, and is constructed as a time-specific road map to achieving the goal. |
History of development |
Along with CBT, CBTraining also owes some debt to Albert Ellis's rational emotive behavior therapy (REBT), formerly known as Rational Emotive Therapy. REBT is classified as a form of CBT, and is anchored by the belief that a person is "affected emotionally by his/her perspective and attitude about outside things." As with CBTraining, REBT incorporates Positive Self-Image Psychology. Lou Ryan, a pioneer in the creation, development, and practical application of CBTraining, worked for some time under the guidance of Albert Ellis. In the early 1980s, Ryan, who was well-versed in Ellis's theories and philosophies, met Ellis in Hawaii after a series of seminars. Ellis recognized his own impact in Ryan's CBTraining programs, and played a peripheral part in some of the development. |
Specific applications |
Health and wellness |
CBTraining has been established to some degree in changing emotionally addictive behaviors related to tobacco. There is evidence that cognitive group behavioral training may be beneficial for patients with type 1 diabetes in their self-care. SCBT has been used to help people with diabetes manage their disease, with the primary goal being maintained lifestyle changes to slow or halt the progression of the disease. It has also shown some promise in reducing pain receptor reactions in the brain after a painful stimulus.In studies of overeating and obesity, researchers note that high impulsivity is correlated with overweight and obese individuals. CBTraining in the form of response inhibition training has shown positive results affecting amount and type of food eaten in a sitting and weight reduction, though the longevity of results requires more study. |
Addiction |
Alcohol Use Disorder (AUD) and Substance Use Disorder (SUD) have been correlated to cognitive impairments, though it is not known if one is cause for the other. Verdejo-Garcia et al. specifically indicate AUD and SUD patients display "deficits in reward and salience valuation, executive functions, and decision-making." Continued engagement in treatment programs for these diseases has also been related to cognitive levels leading researchers to aim to promote program engagement through improving cognitive skills in AUD and SUD patients. One study showed improvements in self-control and delayed reward valuation in participants who completed several working memory training sessions, but those gains did not transfer to other inhibition skills. The field of studying CBTraining in AUD and SUD patients suffers from lack of randomized controlled trials making it difficult to quantify results. Nixon and Lewis argue that with studies in this field, it is not sufficient to only show improvements in memory recall and decision-making, but those improvements must be applicable to participants’ lives outside of the study, their continued sobriety and engagement in society. |
PTSD |
CBTraining has been applied to symptoms of post-traumatic stress disorder in one study by showing participants traumatizing video clips and then having them play a game of Tetris for a specific amount of time. The study was designed to replace the act of recalling a traumatic memory, which is a visuospatial memory process, with another visuospatial activity within the desired time window in order to disrupt the brain's ability to solidify the original memory. Minimal results were reported. |
Disease management |
Cognitive Behavioral Training, applied in a structured way, has been used to deal effectively with women dealing with the stressors of having breast cancer (e.g., changing thoughts about stressors) in studies done at the University of Miami. |
In adolescents with behavior disorders |
Two studies examining CBTraining gamification applied to autism spectrum disorder used three levels of the game Junior Detective Training Program and 20 hours of the game Let's Face It! respectively to teach children to recognize facial cues, physical positions and other forms of emotional communication with moderately positive results. |
Efficacy |
Overall criticisms |
Although studies have been limited, initial data indicates that success with CBTraining is largely dependent on the active, cooperative participation of the patient. This essentially means that CBTraining, as it is presented in internet form, is geared towards participants who, in relation to the stages-of-change theory, are in the preparation and action stages. In other words, CBTraining is most effective when applied to people with a high motivation and capacity to change. |
Subsets and Splits