II - Cognitive Rehabilitation Strategies in Normal Aging

Editors: Backman, Lars; Hill, Robert D.; Neely, Anna Stigsdotter

Title: Cognitive Rehabilitation in Old Age, 1st Edition

Copyright 2000 Oxford University Press

> Table of Contents > Part II - Cognitive Rehabilitation Strategies in Normal Aging > 6 - Promoting a Sense of Control Over Memory Aging

6

Promoting a Sense of Control Over Memory Aging

Margie E. Lachman

The goal of this chapter is to present a rationale and framework for targeting beliefs about self-efficacy and control in memory improvement and rehabilitation programs. Negative beliefs about memory aging are widespread, and they are related to memory performance as well as to level of motivation for participating in memory training and rehabilitation programs. A conceptual model for guiding multifaceted interventions is presented. Evidence that self-defeating beliefs can be successfully modified through cognitive behavioral interventions programs is reviewed. Strategies are recommended for enhancing memory self-efficacy and control beliefs among older adults.

Beliefs About Memory Aging

Popular conceptions of aging portray memory loss as inevitable, universal, and irreversible (Lachman, 1991). Many middle-aged and elderly adults begin to report problems remembering important information as they get older. In a recent survey of 300 randomly sampled men and women aged 25 75 from the Greater Boston Area, 39% reported they had memory problems at least once a week or more, and 29% found these problems somewhat or very stressful (Lachman, Maier, & Budner, in preparation). When considered in relation to problems in 25 other domains, problems with memory were first most frequent for older adults, second most frequent for middle-aged adults, and third most frequent for young adults. These memory problems were rated among the top 5 out of 26 stressors for both middle-aged and older adults. These results are consistent with earlier surveys that showed that memory problems are frequently reported by adults over 40 years of age (see Aldwin, 1990; Cutler & Grams, 1988; Lachman, 1991).

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Thus, a view of aging in which memory problems increase is widespread.

There is some indication that reports of memory problems do not always correspond to actual difficulties (Zarit, Cole, & Guider, 1981; Gilewski, Zelinski, & Schaie, 1990). Thus, to a certain extent, memory complaints may reflect a kind of hypochondriasis of aging. Nevertheless, the prevailing view of aging includes a constellation of beliefs about the perceived change (decline) in abilities, lack of control over the decline, and limited potential for improvement. Indeed, one of the circumstances that may contribute to memory problems being stressful is that memory loss is often seen as a natural part of the aging process, with the accompanying belief that nothing can be done to control it. Beliefs about memory and aging, whether accurate or not, can have important implications for functioning and behavior.

Research on memory performance shows that there are declines with aging (Smith, 1996). However, not all aspects of memory change, not all individuals show decrements, and there is evidence that memory can be improved. Thus, the view of memory aging as inevitable, universal, and irreversible is erroneous. Nevertheless, many older adults believe there is little that can be done to improve their memory. The focus of this chapter is on the enhancement of beliefs about memory self-efficacy and control. These beliefs are considered an important foundation for successful memory improvement or rehabilitation (Elliott & Lachman, 1989; Lachman, Bandura, Weaver, & Elliott, 1995).

Relationship Between Memory Performance and Memory Beliefs

The relationship between memory beliefs and memory performance in later life has been of great interest since the early 1980s (Dixon & Hultsch, 1983; Grover & Hertzog, 1991; Hertzog, Dixon, & Hultsch, 1990; Lachman, Baltes, Nesselroade, & Willis, 1982; Lachman, 1991; Zarit et al., 1981). The nature of this relationship appears to vary as a function of the type of belief or aspect of memory that is studied.

A number of correlational studies have shown that beliefs about efficacy and controllability are related to cognitive performance. Those who have higher efficacy and a more internal sense of control have better performance on a wide variety of intellectual and memory tests (Grover & Hertzog, 1991; Lachman, 1986; Lachman et al., 1982; Stine, Lachman & Wingfield, 1993). Of interest is whether the beliefs develop in response to memory performance or whether the beliefs lead to changes in memory. There is some evidence that performance predicts changes in beliefs (Cornelius & Caspi, 1986; Grover & Hertzog, 1991; Lachman, 1983; Lachman & Leff, 1989). On the other hand, self-efficacy has been identified as an important predictor of cognitive change, along with education and lung function (Albert et al., 1995). Self-efficacy also was found to predict degree of improvement in memory training (Rebok & Balcerak, 1989). These data provide support for the interactive, reciprocal nature of change in cognition and attitudes during the aging process.

Mechanisms

One unanswered question is what the mechanisms are that link control beliefs and performance. There is some evidence that effort is a key mediator. In one study, Berry (1987)

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found that those who had higher self-efficacy spent more time studying memory materials. In another study, Stine et al. (1993) found that working memory was a likely mediator between control beliefs and performance. Riggs, Lachman, and Wingfield (1997) found that adults with more external control beliefs were less efficient in memory strategy use for processing text materials and benefited less from performance experience. Those who had greater self-efficacy and more internal control beliefs were more likely to engage in effortful processing, which resulted in better performance.

Another possible mediator is attributions. If performance is attributed to ability, this attribution is likely to affect efficacy. Bandura (1977) found that when internal stable attributions were made for performance outcomes, self-efficacy was more likely to be affected than if external attributions were made. If older adults have trouble remembering something and attribute this trouble to poor ability, this attribution could negatively affect their efficacy. In contrast, if they attribute the trouble to lack of effort, they may try harder the next time, and efficacy may not be lowered. On the other hand, making adaptive attributions in the face of good performance may have positive effects. In support of this contention, Lachman, Steinberg, and Trotter (1987) found that those who attributed successful memory performance to internal and stable factors improved more over two trials. These findings illustrate the processes whereby beliefs can both affect and be affected by memory. Stress is also a potential mediator of the relationship between control beliefs and memory performance. There is evidence that low levels of perceived control are associated with increased anxiety and stress (Bandura, 1997). Recent studies of stress reactivity measured with Cortisol have shown links between high levels of stress hormone and impaired memory performance (Seeman, McEwen, Singer, Albert, & Rowe, 1997). McEwen and Sapolsky (1995) have evidence from animals that prolonged stress does damage to hippocampal functioning. The finding that lowering stress can have a beneficial impact on memory performance in later life (Lupien, Lecours, Lussier, Schwartz, Nair, & Meaney, 1994) is encouraging and suggests the promise of interventions focused on control beliefs and stress reduction for improving memory.

Memory Training

Memory training often involves the teaching of mnemonic strategies such as the method of loci (Lapp, 1986; Poon, 1984; West, 1985; Yesavage, 1985). Although this approach has been useful in establishing the plasticity of memory in later life, it has not always been successful in providing a practical means for sustained memory improvement. In some cases, the results have been test-specific, subjects did not adopt the techniques outside the laboratory, and the effects dissipated after a short time (Anschutz, Camp, Markley, & Kramer, 1987). Moreover, memory researchers have not endorsed the use of formal mnemonics (Park, Smith, & Cavanaugh, 1990) because they are cumbersome and limited in their application to everyday tasks.

Multifactorial training programs that focus on training multiple skills have been the most effective (Floyd & Scogin, 1997; Verhaeghen, Marcoen, & Goossens, 1992). For example, Yesavage (1985) and his colleagues used pretraining of visualization techniques in conjunction with mnemonic strategy training and found significant improvement.

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Others have included anxiety reduction, relaxation, or stress inoculation techniques in conjunction with ability training, the result being enhanced effects (Hayslip, Maloy, & Kohl, 1995; Labouvie-Vief & Gonda, 1976; Neely & Backman, 1993). For example, successful memory improvement was found when encoding and attentional training were combined with relaxation (Neely & Backman, 1993).

Floyd and Scogin (1997) conducted a meta-analysis to examine the effects of memory training on subjective beliefs about memory functioning. Their general conclusion was that mnemonic training alone had little effect on beliefs about memory. They also found that in cases where memory training was supplemented with pretraining or included direct attention to beliefs, there were greater effects on beliefs.

The Role of Control Beliefs

One possible explanation for the limited impact of some previous cognitive training efforts (e.g., limited transfer or maintenance) is that many older adults believe that cognitive decrement is inevitable and that nothing can be done to control or change cognitive functioning (especially memory) in later life (Bandura, 1989; Elliott & Lachman, 1989). If older adults believe their memory is not as good as it used to be and there is nothing they can do to improve, they are unlikely to use effort to learn or implement new strategies.

Indeed, past work has shown that older adults hold more self-defeating attitudes about memory and other cognitive dimensions than the young, and that these beliefs become less adaptive over time (Cavanaugh, 1989; Cavanaugh & Green, 1990; Lachman, 1991; Lachman & Leff, 1989). Older adults are more likely than the young to believe that their memory is not as good as it used to be (Hertzog et al., 1990). The elderly are also less likely than the young to believe that they can control their memory and intellectual functioning. Finally, older adults are more likely than the young to explain memory failures with internal and stable attributions, such as poor ability (Erber, Szuchman, & Rothberg, 1990; Lachman & McArthur, 1986). The young are more likely to blame failures on lack of effort, which is a more malleable factor (Lachman, 1990).

Negative beliefs about memory competence and controllability, whether they are accurate or not, can have far-reaching consequences. These consequences include increased dependency on others, avoidance of cognitive challenges, seeking unnecessary medical attention, reliance on medication, anxiety, reduced effort, and decreased motivation to use one's cognitive skills (Bandura, 1989; Lachman, 1991). Previous research has shown that confidence in memory ability is related to performance (Bandura, 1989). It is possible that those who lack confidence but who see memory as controllable will be inoculated against a syndrome involving helplessness and dependency as they age (Lachman et al., 1995). The reason is that they see memory problems as surmountable with effort and engage in problem solving in the face of difficulty. In contrast, those who lack confidence and view memory loss as inevitable are likely to become helpless and reliant on others to cope with memory problems. They view difficulties as signs of deterioration over which they have no control. Thus, they will not invest effort in problem solving. The result is poor performance, which perpetuates a downward spiral of ability estimates, decreased motivation, and withdrawal from tasks involving memory.

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This set of circumstances provides the basis for a rationale for why it is important to target beliefs about efficacy and control when designing memory-training programs. Negative beliefs are a problem in their own right because they can lead to anxiety, depression, lack of involvement, and avoidance of situations that demand skills and thus can impact quality of life. Moreover, these beliefs may be related to the effectiveness of memory interventions. Those who hold negative beliefs refrain from attempting to improve their memories. Thus, it may be necessary to change negative beliefs prior to recruiting participants for a training program. Without such changes, even participants who do start out with the intention of improving are at higher risk of terminating the program.

There is some evidence that beliefs about efficacy, control, and attributions can be changed (Lachman et al., 1992; Rodin, 1983). However, unless rehabilitation efforts directly target beliefs, there seems to be little effect (Dunlosky & Hertzog, in press; Floyd & Scogin, 1997). Bandura (1997) suggested that older adults' self-efficacy beliefs are especially resistant to change. A number of researchers have used cognitive behavioral techniques such as attributional retraining, increasing motivation through rewards, manipulating control contingencies (Forsterling, 1985; Langer, Rodin, Beck, Weinman, & Spitzer, 1979; Rodin, 1983; Rodin, Cashman, & Desiderato, 1987), and cognitive restructuring (Duke, Haley, & Bergquist, 1991; Lachman et al., 1992) to enhance older adults' control beliefs and attributions. These studies have shown not only that it is possible to change attributions and control beliefs in the elderly, but also that these changes have positive effects on many types of performance and well-being.

Negative cognitions about memory capabilities can cause anxiety and interfere with task-related attention, the result being performance and motivational deficits. Therefore, directly addressing these maladaptive beliefs can result in higher levels of motivation and persistence for cognitive tasks by reducing anxiety and increasing self-confidence and providing motivation for memory improvement.

Importance of Cognitive-Behavioral Interventions in Enhancing Cognitive Training Effects

Research shows that optimal performance requires not only skills but also adaptive beliefs about one's abilities (Bandura, 1989). Those who have lower confidence and those who believe they have little control over their memory show poorer performance (Berry, West, & Dennehey, 1989; Hertzog et al., 1990; Lachman et al., 1987).

Few cognitive training studies have targeted or even assessed self-efficacy or control beliefs. In those that have looked at efficacy or control, there was no evidence that these beliefs changed without additional training focused on attitudes about memory (Floyd & Scogin, 1997; Hill, Sheikh, & Yesavage, 1987; Rebok & Balcerak, 1989). The one exception is test-specific beliefs: Older adults are good at monitoring changes in their test performance after training (Devolder, Brigham, & Pressley, 1990; Dittmann-Kohli, Lachman, Kliegl, & Baltes, 1991).

Anxiety and depression can also affect performance through distraction and interference with sustained attention. What is important is that underlying these affective dimensions there is often a low sense of efficacy and control (Bandura, 1997). Allthough

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some training programs have chosen to target anxiety directly with relaxation training (e.g., Labouvie-Vief & Gonda, 1976), it may be more effective to directly address the underlying cognitions that fuel the anxiety that is, low efficacy and control rather than to eliminate just the symptoms. Anxiety and stress often occur in response to beliefs about incompetence (efficacy) and lack of ability to change or prevent decline (control).

According to cognitive behavioral models, beliefs in efficacy and control are important for several aspects of the training: to ensure attention to and motivation for the training, to foster an adaptive learning environment (e.g., reduced anxiety, increase effort, focused attention), and to facilitate transfer and maintenance of the skills beyond the initial training by instilling self-confidence in handling challenging situations.

However, the elderly seem to be more resistant than the young to changes in efficacy and control beliefs (Bandura, 1997). Whereas the young boost their efficacy after successful performance experiences, the elderly appear to need multiple inputs to promote efficacy change, such as persuasion, vicarious reinforcement (modeling), and direct performance feedback. This need may be due, in large part, to ingrained societal views about the irreversibility of aging-related changes and implicit views of memory aging (Elliott & Lachman, 1989; McDonald-Miszczak, Hertzog, & Hultsch, 1995). Thus, it is critical to build cognitive-behavioral strategies directly into cognitive training programs to promote beliefs that foster effective learning.

It is unlikely that a focus only on changing beliefs would lead to effective memory enhancement. Ideally, beliefs can be targeted in conjunction with skills training. Confidence and control beliefs provide a resource for dealing with anxiety and failure, the tools needed for persistence, and the motivation to engage in cognitive improvement and challenges in daily life. Instruction and application of skills to daily cognitive tasks can be facilitated by cognitive restructuring.

Self-Guided Practice Versus Instructor-Guided Training

There has been a great deal of debate about the role of experience in memory deficits associated with aging (Baron & Mattila, 1989; Salthouse, 1987, 1991). The current status of this work is that age differences in memory may be minimized, but not completely eliminated, with extended practice. Nevertheless, a number of studies have demonstrated that self-guided practice with cognitive materials results in improved performance, and in many cases, those in testing-only or self-guided practice conditions have done as well as those in instructor-guided training groups, particularly in skills that are already in the repertoire (Baltes, Sowarka, & Kliegl, 1989; Blackburn, Papalia-Finlay, Foyce, & Serlin, 1988; Camp, Markley, & Kramer, 1983; Hofland, Willis, & Baltes, 1981; Kotler-Cope & Camp, 1990; Lachman et al., 1992; Willis, 1990). These results suggest, in part, that performance may improve because of increased experience and familiarity with testing materials as well as reductions in anxiety or other noncognitive beliefs (Salthouse, 1991; Willis, 1990). It is also possible that generating one's own strategies can foster a sense of competence and control. Although practice affects performance, there is less evidence that it has an impact on beliefs (Floyd & Scogin, 1997). Blackburn et al. (1988) found that self-guided practice

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effects were more durable over time than tutor-guided effects. These studies, however, have typically included highly educated and healthy samples. It will be important to determine whether self-guided practice is equally effective for less positively selected, more diverse samples. Dunlosky and Hertzog (1998) recommended the use of self-regulatory skills to teach older adults to monitor their own learning. This approach is consistent with a cognitive-behavioral one and is likely to foster a sense of efficacy and control, as participants see they can improve through their own efforts.

Conceptual Model of Age-Related Loss, Control, and Motivation

The conceptual model presented in figure 6.1 illustrates the interplay of aging-related losses and changes in attitudes and motivation, and captures the cyclical nature of aging (Lachman, Ziff, & Spiro, 1994). Similar to the social breakdown syndrome proposed by Kuypers and Bengtson (1973), this model examines the relationship between internalized negative expectations and aging-related declines.

As illustrated in Figure 6.1, aging-related loss such as decline in cognitive functioning can lead to a lowered sense of control. This may involve a low sense of efficacy (lack of confidence in abilities to change), external beliefs (feeling one cannot do something about it because it is not under one's own control), and/or attributions to internal stable causes (it is due to aging or poor ability). This lowered control in turn affects motivation to change and results in reduced effort and persistence in the face of difficulties; it may also result in affective changes such as depression and/or anxiety. This process is cyclical in that the lowered effort can result in further mental or physical deterioration through disuse, deconditioning, or atrophy.

Cognitive changes such as memory loss or physical changes such as functional limitations are typically associated with the aging process. These changes, however,

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may be modified or even reversed (Evans, 1995; Schaie & Willis, 1986). However, as illustrated in Figure 6.1, experiencing increased forgetfulness or slowing may bring with it a lowered sense of control. There is the feeling that one is less capable of doing things (low efficacy), that these changes are due to unchangeable aspects of the aging process (maladaptive attributions), and, therefore, that nothing can be done (poor outcome expectancies) (Lachman et al., 1994). These lowered control beliefs may be associated with decreased motivation to engage in daily activities with cognitive demands, and to increased distress about one's limitations and the potential downward course of aging. The cyclical nature of the model indicates that regardless of where one begins, this is an ongoing process. Thus, for example, it is just as plausible that motivational deficits trigger memory decrement as it is that memory decline triggers lowered sense of control. What is critical is that once the process is in motion, unless there is some intervention it is likely to continue in a downward path.

Figure 6.1. Conceptual model of cognitive aging, control, and motivation.

In the model of age-related loss, the sense-of-control, motivational, and affective factors are considered antecedents and consequences of aging-related losses. Attention to these components of the model is expected to be useful for interventions designed to encourage older adults not only to begin memory improvement programs, but also to facilitate long-term maintenance of memory skills.

Multifaceted Interventions

Whereas most interventions focus on only one target, the conceptual model presented in Figure 6.1 provides a framework for a multifaceted approach to memory rehabilitation. As shown in Figure 6.2, the intervention strategy involves teaching skills to compensate for or prevent loss (e.g., mnemonics, use of external aids) and changing beliefs in efficacy and control, which are tied to motivational factors such as setting

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realistic expectations and goals needed for behavioral changes. There is some evidence from past research that efficacy and control beliefs can be enhanced in older adults (Lachman et al., 1992; Rodin, 1983).

Figure 6.2. Intervention strategies: Multiple targets.

Cognitive Rehabilitation and Cognitive-Behavioral Interventions

Cognitive behavioral strategies, long used for clinical purposes (Bandura, 1989; Beck et al., 1979; Meichenbaum, 1977; Seligman, 1991), instill adaptive beliefs such as greater perceived control and more realistic assessment of cognitive failures and abilities. Rodin et al. (1987) concluded that more generalized and long-term effects would be found in cognitive interventions that affect subjects' feelings of control. Instilling and strengthening the belief that memory can be improved with effort should enhance the elderly's motivation to try new memory challenges and to persist even in the face of difficulties. Desire to try to remember is low if one believes one does not have the necessary skills or that one's efforts will not pay off.

According to Bandura (1977), behavior change is also determined by self-efficacy beliefs and outcome expectations (represented as external control beliefs in Figure 6.1), that is, whether one expects a desirable response to one's actions. One may have high self-efficacy for memory, but if one believes that there is nothing he or she can do to prevent or remediate aging-related losses, there would be little motivation to learn new strategies. The benefits of practice and strategy use are often not immediate, and one needs to stick with them for some time in order to feel the rewards. Thus, one must have a high degree of motivation. The belief that practice will help to improve one's memory and that one has some control over the memory aging process is an important source of motivation.

Given that one may encounter some difficulties as one tries to improve one's memory, another important attitudinal ingredient is the attributions one makes in the face of failure (Abramson, Seligman, & Teasdale, 1978). If one makes adaptive attributions (i.e., sees failures as due to changeable factors), one is more likely to persist and exert effort in difficult circumstances. In contrast if one uses maladaptive attributions (i.e., sees poor outcomes as due to stable, unchangeable factors such as old age), one is more likely to become discouraged and to curtail efforts.

We have developed a cognitive-behavioral intervention that targets efficacy, control, and attributions related to cognitive aging (Lachman et al., 1992). In our program, the cognitive restructuring treatment was administered by two clinical psychologists in two 1.5-hour sessions. There were four components to the program: (a) developing awareness of negative beliefs about memory, (b) promoting the view of memory as controllable through effort, (c) modeling adaptive attributions for memory successes and failures, and (d) practicing positive thinking about memory. Videotapes were used in which actors portrayed different approaches to interpreting memory successes and failures in laboratory and real-world tasks. Some of the actors conveyed positive views by responding to difficult memory tasks with statements about how they could succeed through the use of strategies or extra effort. They also modeled the use of adaptive attributions for memory problems. In contrast, other actors demonstrated negative views by responding to memory loss with maladaptive attributions (e.g., due to getting older) and a sense of hopelessness about memory improvement. The group leader led

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discussions about the films to highlight the differences between the positive and negative views. These discussions were effective in helping the participants to become aware of their misconceptions and negative, self-defeating beliefs about memory and aging, many of which were similar to those portrayed by the actors.

A homework assignment was designed to help participants develop more adaptive attitudes by thinking of an example where a positive attitude had helped them deal with circumstances that were seemingly insurmountable. The discussion of the homework was then applied to the area of memory to illustrate the point that there are ways to improve memory and that memory is controllable.

The study design for the multifaceted intervention (Lachman et al., 1992) included several conditions with different combinations of the treatments (cognitive restructuring, self-generated memory strategies training, and combined) and two control groups (practice and no-contact). It was predicted that the greatest improvement in self-conceptions of memory would occur for those who received both self-generated memory strategies training and cognitive restructuring, followed by those who received only cognitive restructuring. Similarly, the greatest improvement in memory performance was expected for those in the combined-training group, followed by the strategy-training group. As predicted, the combined-treatment group showed the greatest change on the following memory control beliefs: improvement, effort, and inevitable decrement. The strategy generation group showed the greatest improvement in capacity. For test-specific predictions, the practice group increased the most in the text and working-memory tasks, perhaps because the practice group had more experience with these tasks than the other groups. All groups had equal amounts of practice on list recall and name-face recall and showed similar increases in predictions for these tasks.

Through the use of a cognitive-behavioral intervention, older adults' beliefs about memory controllability and efficacy were improved. The cognitive restructuring was most effective in changing self-conceptions of memory when it was combined with the self-generated memory strategy training.

When combined with cognitive training for encoding and attention, the cognitive-behavioral treatment was effective in changing beliefs about memory efficacy and control (Lachman et al., 1992). We found that beliefs about control changed more when specific information was provided about the relationship between effort and memory improvement and the diversity (rather than universality) of memory aging across persons and different aspects of memory (Lachman et al., 1992).

The training effects were strongest at the first posttest, however, and the effects were weaker by 3 months. These findings highlight the need to concentrate on how to maintain these changes in beliefs to achieve long-term effects. We also found that self-guided practice and retesting were as effective as tutor-guided training for memory improvement. Although practice was as effective as strategy generation for improving memory, this was not the case for changing beliefs about memory.

The cognitive restructuring program was broadly based on cognitive-behavioral theory and clinical methods (Beck & Emery, 1985), with a combined focus on changing attitudes and behaviors (skills). In addition to using this two-pronged intervention approach with memory, we have also applied it in the realm of exercise with a strength (resistance) training program. The cognitive-behavioral technique was effective in promoting regular exercise among sedentary older adults (Lachman et al., 1997; Jette et al., 1999). We found greater adherence to the exercise program and more extensive

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progression across resistance levels for those who received the cognitive-behavioral training than those reported in previous studies.

A key feature of cognitive-behavioral interventions is individualized goal setting. Programs should be tailored to the individual needs and capacities of the participants, allowing for gradual progress. This approach enables participants to identify their weaknesses and to select areas of desired improvement. Many training studies have shown individual differences among the elderly in their responsiveness to training. Typically, those who are younger and healthier and have higher initial levels of functioning, show greater increments (B ckman, 1989; Lachman et al., 1992; Schaffer & Poon, 1982; Yesavage, Sheikh, Friedman, & Tanke, 1990). Thus, memory-training programs may need to be modified to ensure their effectiveness for particular target groups.

A customized program can also be beneficial in reducing anxiety levels because the participants know that the program has been designed for them. Otherwise, they may assume the program is too difficult for them or does not address their particular needs. Other behavioral techniques may include a signed commitment or contract, keeping track of work with a diary or log, and incentives or rewards for progress or reaching goals. Periodic feedback from the trainer serves both to check on skill attainment and to provide helpful social support. Cognitive restructuring strategies teach adults how to address their concerns and how to generate alternatives to their negative, self-defeating thoughts. These strategies serve to instill mastery and a sense of control, which are valuable for sustaining newly acquired strategies and skills because they help the individual to overcome challenges and obstacles that interfere with progress.

Within the model (see Figure 6.2), cognitive restructuring, along with memory training, is expected to increase the sense of control because it promotes a view of memory aging as controllable through effort rather than as the result of uncontrollable aging. One important lesson for older adults to learn is that what used to be relatively effortless (e.g., remembering phone numbers, recalling names, remembering the details of a movie) now may require more effort. The cognitive restructuring intervention informs them that they do have some control and that the investment of effort pays off.

Conclusion

Beliefs about memory have been found to become more negative with aging (Lachman, 1991). The assumptions that memory performance declines and that this decline is difficult to prevent or change is pervasive. These beliefs about memory self-efficacy and controllability are related to performance as both antecedents and consequences, as depicted in Figure 6.1. These beliefs can have damaging consequences for performance and the effectiveness of memory-training programs. Memory-training programs that do not include a specific focus on beliefs about memory efficacy and control are typically not effective in changing these beliefs. Thus, a focus on changing memory-related beliefs is important for enhancing the motivation to engage in memory training, as well as for optimizing the degree of effort invested in making memory improvements. Older adults who firmly believe that they have the potential to effect change in their memories are likely to be favorably predisposed to benefit from memory rehabilitation programs.

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Cognitive Rehabilitation in Old Age
Cognitive Rehabilitation in Old Age
ISBN: 0195119851
EAN: 2147483647
Year: 2000
Pages: 18

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