About the Book

• The Lady and the Unicorn: A Psychological Metaphor



• Dreaming�With Eyes Wide Open: Schizophrenic Hallucinations



• Information Processing in Schizophrenia



• Clarification of our Clinical versus Forensic Function: Dual Relationship



• Art Psychotherapy



• Lord of the Rings: A Psychological Metaphor



• Aviation Psychology



• So, You have just been Passed by a Girl! A Holley Carborator may help



• Approaches in Memory Rehabilitation



• Memory Enhancement Module



• Negaunee Center



• The Final Transition



• Is Deinstitution- alzation a Misnomer



• Token System: a Psychiatric Case Study



• A Token Economy System: Inpatient Psychiatric Population



• Insight: An Aspect of Neurocognition

Approaches in Memory Rehabilitation

Reviews of the cognitive rehabilitation literature (Glisky & Schacter, 1986; Schacter, Rich, & Stampp, 1985; Sohlberg & Mateer, 1989; Wilson, 1987) have identified three commonly used techniques to rehabilitate memory: first are repetitive recall drills; second are mnemonic strategic approaches; and third is training using prosthetic devices. One method which deserves attention as a possible treatment strategy is mnemonics.

Mnemonics has been defined in Webster's dictionary as assisting or intending to facilitate memory. Chaplin's (1971) Dictionary of Psychology defines mnemonics as "the art of improving memory with the aid of artificial systems" (p. 300). Based upon these definitions, mnemonics is almost any technique in which memory for some experience is enhanced. Mnemonics usually involves associations between things to be remembered and words, numbers, and mental images. The sheer volume and variety of memory opportunities seem infinite (i.e., verbal, spatial, sensory, physically, time linked, categorical, and procedural). This paper will primarily focus upon a few selected techniques for improving memory recall.

Mnemonics techniques have been used for centuries (Patten, 1990). Mnemonics has been used successfully with a variety of populations for improving or enhancing memory (see Cook, 1989 for a review) such as: improve recall of biographical information in adolescents (Dretzke & Levin, 1990); to improve name-face recall in the elderly (Gratzinger, Sheikh, Friedman, & Yesavage, 1990); to teach medical terminology in adults (Troutt-Ervin, 1990); to help learning disabled to learn vocabulary words (Mastropieri, Scruggs & Fulk, 1990); to improve note taking and outlining as a study strategy in children (Williams, 1990); to improve motivational aspects and to make learning easier for college students (Higbee, 1990); to enhance name-face associations in the closed head injured population (Goldstein, McCue, Turner, & Spanier, 1988); to treat severe Korsakoff-type amnesia (Goldstein & Malec, 1989); and to improve retention time in dementia (Hill, Evankovich, Sheikh, & Yesavage, 1987). Thus, considering the use of mnemonics techniques with the psychiatric population warrants serious consideration.

One mnemonic technique is to utilize visual imagery for association between items, names, and locations. Visual imagery techniques focus upon improving retention and memory recall abilities. Research by Gasparrini and Satz (1979), and Konopak and Williams (1988), found significant improvement in recall by using visual imagery techniques in contrast to rote memorization and verbal mediation. Cognitive researchers (e.g., Atwood, 1971; Bower, 1970; Higbee, Clawson, DeLano, & Campbell, 1990; Pavio, 1969), and professional mnemonists (e.g., Furst, 1944; Gordon, Valentine, & Wilding, 1984; Lorayne & Lucas, 1974) have emphasized the utility of imagery techniques as a means of organizing information for subsequent recall. O'Connor and Cermak (1987) stated that "their evidence comes from experimental investigations demonstrating that an individual's memory capacity can be increased dramatically when to-be remembered items are aligned with an image" (p. 266).

An example of this visual imagery technique is the method of loci (location). Examples of the method of loci were demonstrated by Luria's 1968 study of a famous mnemonist, Shereshevskii. His procedures involved forming mental images of items placed at various points along a well-known street, for instance, placed upon a window sill, in a doorway, and by the curb. This method also has been studied in nonbrain-damaged subjects (e.g., Groninger, 1971; Higbee, 1977; Ross & Lawrence, 1968). The method of loci has been used with the elderly population with some success in an experimental situations (Robertson-Tchabo, Hausman, & Arenberg, 1976). In another study, Anschutz, Camp, Markely, and Kramer (1985) found that elderly subjects demonstrated near perfect performance using this technique to remember a grocery shopping list. Images of locations can be paired with items to be remembered assisting the individual by visualizing a location, such as rooms in their house as cues to help them recall information. However, it was also found that the elderly did not spontaneously use this technique outside the clinical setting.

Some of the most common verbal techniques are chaining or linking, first-letter cueing, and semantic or phonetic elaboration. Link system is applied by forming a memory association from one item to another. This linking technique has been helpful in remembering lists of items (Higbee, Clawson, DeLano, & Campbell, 1990). By using this technique items are then organized into a list, which successively links items together so that one item leads to the next item.

Training in mnemonic peg word strategies is another popular technique which has been used for memory rehabilitation purposes (Harris, 1978; Lorayne & Lucas, 1974; Pressley & Ahmad, 1986; Wood & Pratt, 1987). The technique of using a pegword mnemonic system is to associate images of an object with items to be remembered. This peg word technique asks the subjects to visually associate a list of objects (e.g., teapot or a radio) with the numbers 1 through 10.

Each one of these as well as other memory strategies or techniques have been utilized to improve memory functioning within nonclinical populations. Furthermore, these same techniques have been also utilized in a variety of clinical populations as well. The broad question is whether these same techniques can assist cognitive rehabilitative efforts with the psychiatric population. Memory recall deficits have been found within the schizophrenic population, but whether these deficits existed premorbidly or are a consequence of their illness has yet to be determined. Nevertheless, the information processing model, the stress vulnerability model, and Luria's neuropsychological theories of cognitive retraining, provide a viable framework for further investigation.
Approach

In a review of the literature on cognitive deficits in schizophrenia, memory recall deficits stand out as a predominant feature (Culver, Kunen, & Zinkgraf, 1986; George & Neufelt, 1985). This may be a factor in other psychotic disorders as well (Liberman, Massel, Mosk, & Wong, 1985). The thrust of psychiatric rehabilitation is aimed towards the mitigation of deficits which may adversely affect psychosocial adjustment in the mentally ill population. This is an important question since most of the traditional treatment interventions with psychiatric patients involve verbal or written material requiring functional memory abilities. If the psychiatric patient is impaired due to a basic information processing deficit (i.e., memory recall), then the potential usefulness of material presented in training program may be diminished.

Does memory enhancement training result in lower severity of psychiatric symptomatology? Improving the ability for psychiatric patients to learn to recognize, monitor, and cope with their symptoms has been shown to reduce recidivism and increase community residency (Liberman et al., (1986).

Also when the memory system becomes dysfunctional, it would severely limit the cognitive integrative processes required to respond to everyday demands. A dysfunctional memory system could adversely affect one's ability to accurately perceive sensory stimuli, give meaning to experiences and retrieve memory from storage. Without the ability to utilize the fund of knowledge in memory one can not learn from experiences or react to sensory stimulation. In schizophrenia the finding of slow information processing creates a vulnerability to interference impacting negatively on and subsequent higher cognitive processing. This slowness in information processing may occur at the encoding stage and perhaps contributes to the various types of thought disorders seen in some types of schizophrenic patients. Thus, it was hypothesized that improvement in the memory recall deficit would have a direct positive influence upon lowering symptomatology, by improving cognitive functioning as well.

The process of deinstitutionalization has required alternative approaches to rehabilitation of schizophrenics. A comprehensive approach which includes skills training, along with teaching cognitive, coping, and problem-solving skills best addresses the problems of stabilization in the community and theoretically prevents rehospitalization due to decompensation.

References