Extensions of Errorless Learning for Social Problem-Solving Deficits in Schizophrenia

Robert S. Kern, Michael F. Green, Sharon Mitchell, Alex Kopelowicz, Jim Mintz, Robert P. Liberman
2005 American Journal of Psychiatry  
Objective: 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
more » ... -solving skills in patients with schizophrenia. Method: 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 Prob-lem-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. Results: 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. Conclusions: Results support the extension of errorless learning to complex functions such as social problem-solving skills in the rehabilitation of persons with schizophrenia. (Am J Psychiatry 2005; 162:513-519) Mor e than 60 studies have provided empirical support for a relationship between neurocognition and community functioning among persons with schizophrenia (1). These findings emphasize the role of neurocognition, more than psychotic symptoms, in cross-sectional and prospective links to functional outcome. The neurocognitive functions most frequently implicated involve learning and memory, attention, and reasoning and problem-solving abilities. Despite this extensive knowledge base, few efforts have attempted to apply this knowledge to develop more effective rehabilitation interventions for persons with schizophrenia (2). Errorless learning is a training approach designed to compensate for impairments in neurocognition that impede or restrict skill acquisition. Errorless learning is based on a theoretically and empirically driven model, which proposes that learning occurring in the absence of errors is stronger and more durable. First introduced as an alternative to trial-and-error learning (3), errorless learning has been used extensively with the developmentally disabled and other neurologically impaired groups to teach new skills and curb maladaptive behavior (4-7). However, applications of errorless learning to schizophrenia patients have only appeared recently (8, 9). Among the neurocognitive disturbances common to schizophrenia, impairments in learning may be the most severe (10-12). Patient performance on tasks involving learning and recall of word lists and short passages is typically poorer compared with normal subjects (13, 14) , and their performance is marked by perseverative and intrusion errors (15). Performance is also compromised by problems in the ability to self-correct (i.e., using feedback to correct past mistakes and guide subsequent behavior), a disturbance prevalent in both neurocognitive test performance and clinical behavior (16, 17) . It is likely that a psychosocial intervention that bypasses problems associated with error commission would hold promise for persons with schizophrenia. Errorless learning has four components. 1) The to-belearned task is broken down into component parts. 2) Training begins on simple tasks that have a high likelihood of success. 3) Training proceeds through hierarchically ordered exercises in which the tasks are gradually made more difficult. High levels of proficiency are achieved at each level by using multiple instructional aids
doi:10.1176/appi.ajp.162.3.513 pmid:15741468 fatcat:f4dud4gfyng5fpo6ujdsbkgara