Compensatory Rehabilitation Programs

The aim of these programs is to overcome or circumvent cognitive deficits to improve broader aspects of functioning by taking advantage of the unimpaired cognitive processes or by making use of help in the surroundings to train behaviour that may be of interest (Green, 2009). Within this group of programs are the following. Errorless Learning (EL) (Terrace, 1963) is a training program based on the theoretical assumption that making mistakes can negatively affect certain groups with cognitive impairments. Two studies provide evidence that making mistakes during the learning process is especially problematic for persons with schizophrenia (O’Carroll, Russell, Lawrie, & Johnstone, 1999; Pope & Kern, 2006). In EL, the training task is broken down into smaller components to start training first more simple tasks and then later continue with more complex ones. During training, a wide variety of teaching methods are employed and reinforced with instructions to prevent errors occurring. Each component of a skill is over-learned by means of repetition. In EL, two main procedures are used: prevention of errors during the learning phase and automation of perfect task execution. Kern, Green, Mintz, and Liberman (2003) found that when carrying out occupational tasks cognitive deficits did not appear in those patients that had been trained using EA methods, but they did appear in those trained by conventional means. These results provide evidence that EA could, in effect, compensate deficits in cognitive functioning in people with schizophrenia. Cognitive Adaptation Training (CAT) (Velligan, Mahurin, Lefton, True, & Flores,1996) is a compensatory approach using environmental supports and clues such as signs,checklists, alarmed drug packaging, and encouraging the organization of belongings and the sequencing of appropriate routines such as administering self-medication and looking after oneself at home. Treatment strategies are based on a comprehensive evaluation of cognitive functioning, behaviour and the surroundings. CAT is centered on the premise that impairment in executive functioning leads to problems in developing appropriate behaviour and may even inhibit it. On the whole, compensatory programs do seem to prevent errors occurring during the learning process and they try to have tasks carried out perfectly (by breaking them down into smaller steps). However, they do not succeed in achieving premorbid levels of performance. These programs are more aimed at people with significant cognitive impairment that is difficult to restore and this renders them less suitable for people with recent illness who are more intact.