Introduction to Cognitive Function Development Therapy

Cognitive Function Development Therapy (CFDT) is an effective, non-invasive, non-pharmaceutical intervention. It utilizes increasingly challenging and varied activities to repeatedly target specific neural networks and cognitive processes. Delivered well, CFDT is dynamically adaptive to recipient needs and situations. Delivery is through personal interaction based on a therapeutic relationship. As such, CFDT has an unmatched capacity to produce long-lasting, far-reaching, transferrable effects in recipients.

A significant challenge to correctly defining what we mean by Cognitive Function Development Therapy is to agree upon a definition of Cognitive Functions. The challenge ensues through a lack of generally accepted definitions, even within the academic and research literature. Then, once we agree on what Cognitive Functions are, we need to agree on a definition of Therapy that differentiates and distinguishes it from activities often confused with it.

Key Working Definitions

Thus, we will set forth, for our purposes, a few key working definitions that – hopefully – will aid the therapist and other interested parties:

• Client – Clients are the individuals who receive CFDT. The client may or may not be the Responsible Party. Clients can be individuals, members of a small group simultaneously receiving CFDT, or members of a large group which the Therapist is facilitating. Clients can be face-to-face or remote from the therapist (i.e. interacting via Skype or Zoom on the Internet).

• Cognitive Function – Cognitive Functions are observable, desirable, targeted client behaviors that can be mapped to one or more Neural Networks through various Cognitive Processes. It is important to note that the observable functions or behaviors are only manifestations of underlying Cognitive Processes. The Cognitive Function Development Institute’s (CFDI) Therapeutic Model posits there are three primary, interconnected, interdependent cognitive functions:

  • Attention – The ability to focus on relevant information, processes, and activities while disengaging from or ignoring that is not relevant. Attention comprises three process networks: (1) alerting, (2) orienting, and (3) executive. It serves as the bridge between sensory information and memory.

  • Memory – Globally, memory is the ability to encode information for later use and to retrieve encoded information when needed. Memory can be conceptualized from a functional basis (e.g. declarative, implicit, episodic, or semantic) or durational basis (e.g. short term, intermediate-term, long term).

  • Working Memory – Working memory is a conceptual construct. That is, it does not exist as an aspect or consequence of neural anatomy. Rather, working memory is the functional intersection of attention and memory. The information in working memory transitively exists as complex patterns of neutrally generated electrical oscillations of varying frequencies. Despite the lack of a neurological structure or network to which working memory can be associated, there are well-documented, measurable, functional behaviors that we can attribute to it.

• Cognitive Process – Cognitive Processes are internal behaviors which cannot be directly observed, but which can be inferred both from observing external Functions and from measuring electrochemical and oscillatory activity in the underlying Neural Network(s): e.g., utilizing a top-down executive processes to attend to goal-directed stimuli and ignoring bottom-up salient distracting stimuli, while drawing upon coded representations of similar concepts from memory, in order to effectively manipulate calculations about the attended stimuli before encoding a new memory. That’s the internal Cognitive Processes that go into the external, observable behavior of appreciating and remembering the fall colors displayed by a particular tree in the park. In a typical CFDT delivery environment, the Therapist will not have the equipment or expertise to directly measure Neural Network activity, and will, therefore, need to rely on observations of Cognitive Functions to make inferences about the unseen Cognitive Processes and underlying Neural Network activities.

• Neural Network – A Neural Network is a set of anatomical brain features (usually on a macroscopic scale) that operate in a sophisticated manner, which results in realizing one or more Cognitive Processes. The activity within and between various Neural Networks is synchronized by complex modulation of multiple electrical oscillation frequencies, much like the modulation of radio frequencies that allow you to precisely tune to your favorite station while excluding signals from other stations. Returning again to the concept of working memory, recall that it does not result from a given brain structure or neural network. Instead, it results from a complex interaction of many regions and features throughout the brain, whose activity is synchronized by the modulation of multiple oscillatory frequencies. Thus, when we provide therapeutic activities designed to develop “working memory,” what we’re really doing is providing activities that drive the reallocation, development, and integrated interaction of existing neural resources such that the resultant Cognitive Processes yield an observable increase in the Client’s ability to retain and manipulate larger amounts of information with greater speed and accuracy. We then say that their “working memory” has improved.

• Responsible Party – The Responsible Party is the person(s) or organization(s) legally, medically and/or financially responsible for the Client (which can, of course, be an adult Client). In most cases, the Responsible Party will initiate the request for therapeutic assessment and will accept responsibility for or make arrangements for any financial costs arising from therapy delivery. There can be multiple responsible parties for a given Client, each responsible for a different aspect of the Client’s affairs. For example, a behavioral health center may recommend CFDT for their adolescent Client, who lives with his or her parents. In this case the behavioral health center is the medically (and likely the financially) responsible party, and the parents are the legally responsible party. Alternatively, an adult Client participating in an intensive substance abuse outpatient program may be his or her own legally responsible party (and may have some or all the financial responsibility), while the recommending treatment center is the medically responsible party.

• Therapist – A therapist is an individual well-trained in the delivery of CFDT. It should be noted that, just as there are significant differences between teaching / tutoring, training, and therapy, so too we should distinguish between a teacher / tutor, a trainer, and a therapist.

  • Teachers / Tutors deliver content that the Client or student is to learn. A change in Client behavior is usually not considered as an outcome of the content delivery process. Rather, what is sought is that the Client ingests the delivered content and can, on-demand, demonstrate some minimal level of proficiency recalling, utilizing, or synthesizing the content. “Good teaching,” then, refers to the teacher’s ability to make the content ingestible, and may refer to guiding desired student outputs. For example, if the Client is to memorize the US presidents, the teacher may formulate a song or visual story to facilitate memorization and on-cue recall.

  • Trainers provide routines and procedures designed to improve observable behaviors with little or no understanding of the underlying cognitive processes, targeted neuroplastic changes, or outcome transferability. For example, if the Client is to memorize the list of presidents, the trainer will provide timed drills and strategies to facilitate on-cue recall performance. In this case, a training goal may be to get the Client to shorten the time to recite all the presidents from 2 minutes to 20 seconds. Training can effectively enhance performance on targeted behaviors but does not drive neurological remodeling that results in far-reaching transferrable effects.

  • Therapists seek to drive targeted structural and performance changes in the underlying Neural Networks such that the resultant Cognitive Processes yield measurable changes in the observable Cognitive Functions. For example, while loading the client’s working memory with a recall activity of a list of presidents, the therapist may further stress the Client’s executive control process by directing the Client to attend to goal-oriented stimuli while ignoring salient distractor stimuli. By doing so at a relatively slow rhythmic beat, multiple aspects of the client’s attentional neural network will be exercised and developed with observable transferability to other, unrelated activities. The client may or may not achieve the speedy proficiency of recalling all the US presidents in under 20 seconds – doing so is not the therapeutic goal. Instead, the integrated exercises of the client’s attentional system will result in the client being able to identify, attend to, and act upon all the relevant information in a given situation – such as how to non-violently handle an emotionally intense situation in which the client previously would have been provoked to fighting.

Keys to Delivery of Cognitive Function Development Therapy

When we provide cognitive function development therapy, we are seeking lasting structural and performance changes to the Client’s underlying neural networks. These changes could be directly measured with the proper equipment and expertise (as is often reported in the academic and research literature). Without the requisite equipment and expertise, however, we must measure specific external behaviors and infer the progress of neuroplastic remodeling based on our understanding of how the observed behaviors arise from the neural networks. Thus, the components of delivering CFDT include:

• Maintaining, at a minimum, a conceptual understanding of the underlying Cognitive Processes and Neural Networks;
• Mapping observable, external targeted Function behavior(s) to their underlying Processes and Networks;
• Dynamically delivering therapeutic activities to drive structural and performance changes in targeted Networks;
• Reasonably inferring the present state of neuroplastic remodeling resulting from therapeutic interventions delivered to date;
• Evaluating and communicating the transferability of observed Function development; and
• Incorporating Client and Responsible Party feedback regarding Function development and transference into the inferred state of neuroplastic remodeling to refine the delivery of forthcoming therapeutic activities.

A good portion of therapy involves creating and maintaining an understanding of the underlying Processes and Networks, and how these result in the observable functional behavior. A portion of the therapeutic process involves a dynamic dialog between the client, the responsible party, and the therapist based on the therapist’s theoretical understanding. Sandwiched in the middle of the therapeutic process, though – where it might be said “the rubber meets the road” – is the translation of theoretical understanding to delivered activities.

Consider, for example, a client who has difficulty remembering names and events. A teacher / tutor will deliver the list of names and events to the Client, again and again, using slight modifications, hoping that eventually something “sticks.” A trainer will create a visual story that incorporates the names and events and deem it a success if the Client can rattle off all the memorized items in under a minute.

A therapist, on the other hand, will first look to get an informed understanding as to why the client is having difficulty remembering certain items. Is there trauma in the Client’s past? Is the client experiencing any current or chronic medical or behavioral health conditions? Trauma can impair the hippocampus – a brain part crucial to encoding and recalling memories. Medical or behavioral health conditions can impact the executive control network such that the individual has impaired ability to inhibit attention to sensory information and thus does not maintain focus on goal-oriented stimuli long enough for systematic memory encoding to take place.  In either case, the resultant observable behavior – difficulty remembering names and events – is the same. The effectual therapeutic intervention, however, will be quite different for the two cases.

The therapist’s theoretical / conceptual understanding of the client’s neurologic pathology or cognitive impairment is used to dynamically direct specific therapeutic activities. Effectual delivery of therapeutic activities has the following characteristics:

• Empathy – Empathy is the most important quality of a therapist. Used here it denotes the therapist’s capacity to dynamically evaluate the Client’s appreciation of, response to, need for, and impact from a given activity or set of activities, the therapeutic session, and the developing therapeutic relationship. In short, empathy gives the therapist a real-time “feel” for where the Client is in relation to the therapy. Empathy is absolutely necessary for a therapist and can be developed with experience, but it cannot be taught. It is an inherent personal characteristic that the individual brings to the table as a therapist. An individual attempting to deliver therapy without this innate quality of empathy will gravitate toward teaching / training, or will have significant difficulty maintaining a beneficial therapeutic relationship with the Client.

• Fun, Goal-Oriented, & Challenging – CFDT is most beneficial when the Client experiences it as game-like activities. Making therapy fun will encourage the client’s choice of behaviors to be in alignment with the therapeutic process. It will direct the Client to repeat and transfer developmentally beneficial behavior through training the underlying neural reward network. Goal-oriented activities engage top-down executive control processes through which the therapist can direct Client development. And activities need to be challenging enough to drive targeted reallocation of neural resources, without being so challenging so as to leave the client frustrated and defeated.

• Sustained Intensity – Targeted neuroplastic remodeling and reallocation of neural resources requires that the therapist sustains activity intensity long enough for the brain to say, “Whew, I need more connections here.” This is very similar to the sustained intensity required to improve cardiovascular conditioning or a weightlifter’s strength. The body responds to demands for improvement of targeted organs or structures only if and when the demand so warrants improvements. If the intensity is dropped soon after the Client first articulates discomfort all that is achieved is momentary tiredness. Likewise, if activity intensity is maintained at too high a level or for too long – whether in physical fitness training or CFDT – the results can be just as unhelpful. The CFDT therapist must empathetically determine the level of intensity which a Client can maintain for the duration of the session – which will often be realized as a dynamic balance between having fun and feeling slightly frustrated.

• Know your Real Target – The real target of CFDT is not the outward Functional behavior, but the unseen Cognitive Processes and underlying Neural Networks. Activities, therefore, should not be selected in trainer-like “cookbook” fashion. Rather, activities are selected, and dynamically adjusted, to drive neural changes that result in long-lasting, far-reaching transferable effects.

Conclusion

Cognitive Function Development Therapy, or CFDT, is a non-invasive, non-pharmaceutical, activity-based intervention. It is effectual for numerous situations in which the recipient has experienced cognitive declined, impairment, or in which cognitive improvement is desirable.

CFDT is distinct from training (e.g., so-called “brain-training”) and teaching / tutoring. The overriding focus of training is improved proficiency at performing specific tasks (as measured by speed and accuracy). While training can and does develop objectively measurable neurological changes, the nature of training is antithetical to generating far-reaching effects.

Teaching is primarily concerned with the delivery and ingestion of information. It is agnostic to behavioral changes and neuroplastic remodeling. Instead, the goal of teaching is demonstrated proficiency by the learner to recall and utilize the delivered content.

CFDT specifically seeks to drive targeted structural and proficiency changes within the recipient’s various neural networks, with the goal of developing long-lasting, far-reaching transferrable benefits for the client.