Why don't we just jump straight into some questions? So the first one here says, I'm not seeing the app in the app store. What should I be looking at? Yeah, so it is not in the app store. Unfortunately, this app is a web based app. So that means it's only accessible on a computer. It could be accessible on a tablet or phone, and the tablet would probably be big enough. I think a phone would have some formatting issues. We developed this app on a shoestring budget. It's not a high production values kind of app. It's pretty basic, but all the information is there. And so what you do is you go to cogsmart.com and click register, and it'll set the user up. You just have to enter an email address and a password, and then it'll set it up, and you just proceed through the app on the website. All right, excellent. One of the questions we have comes in and asks, would these strategies apply to those with TBI as well? Yes, so we've done quite a bit of research with veterans with TBI. So when veterans started coming back from Iraq and Afghanistan with TBIs in the early 2000s, there really wasn't much available for them. And so we very quickly retooled and redeveloped the manual for that population. And I had one slide in there, it was really quick, so I apologize if it was too quick. But yes, we've found some cognitive effects, some effects on post-concussive symptoms, and quite large effects on quality of life in veterans with TBI. We have another question that asks about how this app complements tests or evaluations that you would recommend at baseline. So I wonder if you can talk a little bit about baseline assessment, using the tool, retesting. I know you made the comment of saying you don't teach to the test, but how do these two things fit together? Yeah, and so I'm a neuropsychologist by training, and so I use pretty standard neuropsychological test battery. If you look at any of the randomized controlled trials that I've published, you can see some of the tests that I've commonly selected. I think looking at test performance pre and post is a great idea for clinical trials. And we do find improvements on test performance when we look at group data and compare experimental to control groups. Now there's an issue if you're just treating someone clinically, what you get if you test them pre and post, you'll get practice effects. And so then it's really difficult to know, did the person improve due to learning these strategies or did they improve due to a practice effect? And so I think in the context of individual treatment, that post-testing is probably not going to be as informative because you just won't be able to determine the cause of the change. But what you can do is administer tests of their subjective cognitive problems. We have a scale called the Cognitive Problems and Strategies Assessment, and it goes over 30 cognitive problems and 30 cognitive strategies. We often use this before and after treatment in our randomized controlled trials. And this way we can really see the change in people's perceptions of their own cognitive difficulties and also their improvements in strategy use over time. It's also on the website and you can download that for free. Excellent. I'm wondering if you can comment a little bit on workforce. We have a comment here that says, most mental health clinicians and case managers have not had training or have little knowledge about cognitive executive functioning for people with SMI. How can we increase the capacity of our workforce? Yeah. I would really encourage folks to download the manual and take a look at it. And I think what you'll find is that you don't need a lot of background training in neuropsychology or neuroscience as applied to SMI to be able to teach these strategies. The strategies are very straightforward. I usually tell clinicians, if you know how to work with clients or patients and you know how to teach a strategy, you could probably do this pretty effectively. And so I know that neuropsychologists have a lot of interest in this area because they've done the assessment, then they want to do the treatment. And so I think it is probably a lot of neuropsychologists who are using this, but it's also been used by psychiatric nurses, occupational therapists, speech and language pathologists, master's level clinicians, non-neuropsychologist clinicians, social workers, marriage and family therapists. There's been a bunch of different types of mental health clinicians who've used it. And they always ask me, well, where's there a training that I can go to to learn how to do this? And I usually just tell them, take a look at the manual, give it a try. And if you have questions, let me know. And I don't tend to get a lot of questions. So I glean from that, that it's pretty straightforward. But certainly if anybody on the webinar today wants to give it a go, I'm always available for consultation. I really enjoy talking with providers about how they're doing it, what adaptations they make, how their clients and patients like it and so on. So I'm very easy to reach. Excellent. Why don't we take one more quick question, which basically says, are the results dose-dependent? In other words, will longer treatment, more sessions result in greater improvements? That is a wonderful question that we would have to answer in a new study. And the short answer is, I don't know. I suspect that more reinforcement of the strategies would result in better strategy use, which would then result in better downstream effects. That just stands to reason. And we haven't done super long follow-ups of the durability of some of these interventions. We're planning studies like that now. But I think a lot of behavioral interventions have shown a durability problem. We're really trying to establish new habits, and we're hoping that these habits are resistant to forgetting, and then they'll just remain with the person for the rest of their life. But we really don't have the data to show that that's happening yet. So that'll be really important to establish. But I think any kind of booster session, reinforcement, maybe reinforcement with the app. If you have clinicians who are trained in teaching these strategies, they can reinforce them at every visit and check in on that. So that would be very interesting to look at in a study. Sounds like a great study. Thank you again.

CogSmart app

traumatic brain injuries

strategy use

serious mental illnesses

mental health professionals