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American Journal of Psychiatric Rehabilitation, 11: 123–143

Taylor & Francis Group, LLC # 2008

ISSN: 1548-7768 print=1548-7776 online

DOI: 10.1080/15487760801963660

The Neuropsychological Educational Approach to Cognitive Remediation (NEAR) Model: Practice Principles and Outcome Studies

Alice Medalia

Columbia University Medical Center,
New York, New York, USA

Bryan FreilichMontefiore Medical Center, Albert Einstein College
of Medicine, Bronx, New York, USA

NEAR is an evidence based approach to cognitive remediation which was specifically developed for use with psychiatric patients. NEAR emphasizes the fact that cognitive remediation is essentially a learning activity and there-fore instructional techniques incorporate basic educational principles that havebeen shown to enhance learning. Rather than using a fixed software package, NEAR uses a variety of exercises, which are chosen based on whether they meet the criteria to both address neuropsychological deficits and be motivating and engaging. The theory behind the NEAR program, prac-tice principles and outcome studies are reviewed.

Cognitive impairment is now recognized as a debilitating andfrequently occurring symptom in many psychiatric conditions. These deficits, which commonly present as problems in attention, memory, and executive functioning, have been found in patients with schizophrenia, depression, substance abuse, and bipolar disorder (Fioravanti, Carlone, Vitale, Cinti, & Claire, 2005; Fleming,

Address correspondence to Alice Medalia, PhD, 180 Fort Washington Avenue HP234,New York, NY 10032, USA. E-mail: am2938@columbia.edu

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124 A. Medalia and B. Freilich

Blasey, & Schatzberg, 2004; Quraishi & Frangou, 2002). Studies have consistently demonstrated that individuals with psychotic illnesses score significantly below normal control subjects on cognitive tests (Fleming et al., 2004; Heinrichs & Zakzanis, 1998), with milder deficits present in individualswith affective disorders without psychosis (Hill, Keshavan, Thase, & Sweeney, 2004; Schatzberg, Posener, DeBattista, Kalehzan, Rothschild, & Shear, 2000). These def-icits are persistent and not simply related to the episode of illness (Heaton, Gladsjo, Palmer, Kuck, Marcotte, & Jeste, 2001; Olley, Malhi, Mitchell, Batchelor, Lagopoulos, & Austin, 2005). Thus, even when the person ispsychiatrically stable, cognitive impairment remains evident. Cognitive impairment in psychiatric disorders has also been shown to negatively impact multiple aspects of daily functioning such as treatment response, employment status, social relationships, living status, and community functioning (Green, 1996; Green, Kern, Braff, & Mintz, 2000; Revheim & Medalia, 2004). Recognition of this significant impact onfunctional outcome has fueled an interest in developing efficacious treatments to enhance cognition.

Cognitive remediation refers to behavioral-based training techniques given to improve cognitive functioning. Clients are given exercises with the expectation that there will be improve-ments in attention, memory, and problem-solving, and that these improvements will translate into greatercompetency at negotiating real world challenges. At the most basic level, cognitive remedia-tion is a learning activity, and as such it is important to consider the factors that influence learning. Ideally, a theory of learning informs evidenced-based practices that are designed to treat cogni-tive impairment. The Neuropsychological Educational Approach to Cognitive Remediation (NEAR; Medalia, Revheim,& Herlands, 2002) is an evidenced-based approach to cognitive remediation that utilizes a set of carefully crafted instructional techniques that reflect an understanding of how people learn best.

The purpose of this article is to review the treatment principles and theoretical basis behind NEAR, discuss how these principles are applied to clinical practice, and provide a review of studies...
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