6 tiers of holistic neuropsych rehab

Model name + 6 tiers

Holistic biopsychosocial model

• Molecular (pharmacological)

• Network interventions (brain)

• Peripheral physiological interventions (body macro level)

• Cognitive interventions

• Behavioural interventions

• Contextual (socio-environmental interventions)

Molecular (pharmacological) tier: example + what it does

• E.g. cognition-enhancing medications + neurotrophic factors

• Supports neuroprotection + neuroplasticity

Network intervention tier: description (1), examples (2)

• Non-invasive methods of directing electrical or magnetic to the brain to stimulate network excitability

  • Repetitive transcranial magnetic stimulation TMS (rTMS)

  • Transcranial direct current stimulation (tDCS)) to stimulate

Peripheral physiological tier description (1)

• Employ bodily activity (e.g. aerobic activity) to improve brain function

Cognitive tier description (1) + 3 approaches

• Improve cognitive processes through structured practice

  • Restorative drills

  • Modulatory bias-retraining

  • Compensatory environmental adaptations

Behavioural tier description + example

• Use classical + operant conditional principles to reshape behaviour

  • E.g. exposure therapy for anxiety (classical)

Contextual (socio-environmental) tier (1) + examples (2)

• Modify physical + social environment

  • E.g. family psychoeducation

  • Community reinforcement approach (CRA) → makes health-promoting behaviours more rewarding than substance use

Cognitive interventions in practice: restorative approaches description, examples (2)

• Uses “drill and practice” exercises to help repair damaged neural networks

• Computerised software useful for attention + memory retraining

• Cognitive enhancement therapy (CET): combines social + non-social cognitive exercises → significant functional gains in patients with schizophrenia.

Modulatory approaches description

• Aim to address cognitive biases + emotional regulation processes

Example of modulatory approach

• Cognitive reappraisal in CBT → reframe distressing thoughts

Compensatory approach

• Overcome and work around underlying cognitive deficits through support methods (external or internal)

External compensatory methods: name + examples

• Compensatory adaptation training

  • Alarms, reminders, daily checklists to help MDD patients complete tasks despite exec dysfunction

Internal compensatory method example

• Future event simulation → overcome memory deficits

  • E.g. in prospective memory deficits in addiction