Altering the Cognitive-Affective Dysfunctions of Psychopathic and Externalizing Offender Subtypes with Cognitive Remediation

Abstract

Cognitive remediation is a treatment approach with the potential to translate basic science into more specific, mechanism-based interventions by targeting particular cognitive skills. The present study translated understanding of two well-defined cognitive-emotion dysfunctions into novel deficit-matched interventions and evaluated whether cognitive remediation would demonstrate specific and generalizable change. Two antisocial-subtypes, individuals with psychopathy and externalizing traits, are characterized by cognitive-affective problems that predispose them to engage in significant substance abuse and criminal behavior, culminating in incarceration. Whereas individuals with psychopathy fail to consider important contextual information, individuals with externalizing traits lack the capacity to regulate affective reactions. Training designed to remedy these subtype-specific deficits led to improvement on both trained and non-trained tasks. Such findings offer promise for changing neural and behavioral patterns, even for what many consider to be the most recalcitrant treatment population, and presage a new era of translating cognitive-affective science into increasingly specific and effective interventions.

Figures

Fig. 1. Study Design

Prior to training, all inmates completed a battery of behavioral and psychophysiological assessments that evaluated the cognitive-affective deficits typically associated with these antisocial subtypes. Using a fully crossed 2 × 2 design, inmates were then randomly assigned to one of two computerized training programs, where half of the inmates received a cognitive remediation training (3 computerized tasks) that matched their specific cognitive-affective deficit (solid line) and half received a treatment that did not match their deficit (but matched the deficit of the other subtype of antisocial offender; dashed line). At the end of 6 weeks of training, inmates completed a post-training assessment battery that was identical to the one that was administered pre-training.

Fig. 2. Differential Effects of Subtype-Specific Training

Only the targeted antisocial subtype, individuals with psychopathy completing ATC training or individuals with externalizing traits displayed ACC training, displayed significant improvement in performance over the six-week training period. Individuals who received a training that did not match their deficit (i.e., individuals with psychopathy who completed ACC and individuals with externalizing traits who completed ATC) did not show improvement in performance. Asterisks indicate significant differences. ATC=Attention to Context, ACC= Affective Cognitive Control.

Fig. 3. Effect of Training on Pre-Post Tasks

Individuals who received the training that matched their cognitive-affective deficit (i.e., individuals with psychopathy who completed ATC and individuals with externalizing traits who completed ACC) displayed significant improvement in performance on tasks that were different than their training. Hence, these individuals showed generalizability of training to other measures. Antisocial individuals who received a training that did not match their deficit (i.e., individuals with psychopathy who completed ACC and individuals with externalizing traits who completed ATC) did not show improvement in cognitive-affective functioning. Asterisks indicate significant differences. ATC=Attention to Context, ACC= Affective Cognitive Control.