Cognitive Reinforcement in Mental Illness

Often, the therapy of those suffering from a psychitaric disorder focuses on the behavioural and psychological background of the disorder, which is the aspect that requires most of the work. Despite that, mental illness also causes cognitive deterioration, an amount compared to its severity. Thus, the cognitive side of individuals with psychopathology is affected but usually remains untouched during treatment. As therapists, we require from the patients/ clients to engage in procedures and changes, but we do not ensure that they have the appropriate mechanisms to do so. Thus, aside from the approach one follows, some cognitive exercises, especially in the form of a game, could be introduced into therapy from time to time. The exercises can change their level of difficulty depending on the level of response of each one in particular, and can aim in improving verbal fluency, mental calculations, attention, memory- they can be applied to individuals with psychopathology, cognitive and neuropsychological disorders, even in rehabilitation from strokes, and they are especially helpful to the chronic patients.

Some ideas for exercises:

1. Opposite words (happy/ sad, sweet/ bitter, fast/ slow)
2. Synonym words (sunny/ bright, beautiful/ handsome, cute/ sweet)
3. Correlations: finding categories of words starting from a specific letter (animals starting with p, plants starting with a, professions starting with k, objects starting with l)
4. Categorization: listing words in categories (animals that go slow, plants that smell a lot, professions found in a court, objects in an office)
5. Story with given words (for example: doctor/ medication/ flue/ sick, store/ discount/ dress/ skirt, painting/colours, talent)
6. Alternatively, one person provides a list of words, and another tells the story
7. The bus: a bus begins from the starting point with x passengers. In the first stop, x come in the bus, and x passengers leave it. Same in the second, third, fourth stop. How many passengers are left in the end?
8. Questions of geography and culture
9. Reverse connections (for example tub, bottle, glass= water, shining, morning, sky= sun, beach, swimming, cool= sea)
10. What do they have in common? (squid/ pen= ink, human/ dolphin= mamals)
11. Story: the first person says a word and the next one repeats it, adding one more, until a sentence is created (or an entire story)

Some ideas for games:

1. Hangman game
2. Guess who?
3. Knowledge questions (trivial)
4. Differences between two similar pictures
5. Treasure hunt
6. Jenga
7. Ball (with a target/ moving target)
8. Find Waldo (from the book, or objects in the area)
9. Drawing (someone paints a word without speaking and the rest try to find the word- for example love, hate, summer, anxiety, beauty, music)
10. Alternatively, we can ask someone to draw a situation or a story

Cognitive exercises can be introduced in the form of a game, for a brief period of time during a session, and can not only offer cognitive stimulation, but also laughter and fun. They are also exercises that do not require special knowledge neither from the patients/ clients, nor from the therapists.

Literature: Euthimiou, Kavouridi, Karpathiou, Liberopoulou, Nikolaou, Trifonopoulos, Sakka, 2012. Cognitive Exercise. Guide for Health Professionals, Athens, Studio Press; Liberopoulou, Sakka, 2006. Cognitive Reinforcement of Patients with Alzheimer's Disease, A Guide for the Caregivers, Athens, Ithaki; Katsari, Margioti, Nika, Sakka, Zoi, 2011. Activities for Individuals Who Suffer from Alzheimer's Disease, Athens, Grigori; L. Heiden, M. Hersen, 2011. Introduction to Clinical Psychology, Athens, Pedio; A. Xristopoulou, 2008. Introduction to the Adult Psychopathology, Athens, Topos.

Note: The photo of the exercises is taken from the book Cognitive Exercise, Guide for Health Care Professionals.