Improving Theory of Mind (ToM) Performance: A Training Study
Kristine
1
Lundgren ,
Background
Many patients with TBI exhibit debilitating communication impairments related to
ToM.
Assessment of ToM often uses false-belief tasks that involve recognizing that other
people can have ideas/thoughts about the world that are not true.
Many authors have pointed out that children or adults may fail a false belief task
either due to a selective ToM problem or due to limitations that apply across
domains, such as executive function.
The "modularity" of ToM deficits is particularly unclear in adult with TBI who
often exhibit diffuse as well as focal lesions and idiosyncratic patterns of
overlapping deficits:
Poor performance by patients on ToM tasks may be to some degree due to
executive function (attention, working memory, inhibition) impairments linked to
the prevalence of frontal and prefrontal system involvement.
There is a special ToM capacity that can be dissociated from executive function.
(This has been supported by Saxe, 2003).
There are few studies that explore the best means of treating ToM deficits in
individuals with acquired brain injury. The Theory of Mind Training program
(Lundgren et al, 2008; Lundgren & Brownell, 2010) has been shown to improve
ToM performance for a small group of individuals with TBI and a small group with
right hemisphere brain damage secondary to stroke.
It is unclear as to whether the same improvements in ToM performance would have
been obtained using another treatment approach, such as a type of executive
function training program.
The goal of the present study was to contrast the effectiveness of an attention
training program used to improve one aspect of executive functioning with a
visually based program targeted specifically at the treatment of ToM deficits on one
specific cognitive-communicative task, interpreting cartoons whose humor requires
ToM.
1
Jablonski ,
1
Bennett ,
Hiram
Cheryl
Virginia
1University of North Carolina at Greensboro
2Boston College
Participant
Successful communication relies in large part on social-cognitive abilities that are
often impaired in patients with Traumatic Brain Injury (TBI).
Theory of Mind (ToM), using other people's beliefs to understand and predict their
behavior, is a fundamental and also complex construct that is directly relevant to
communication success.
2
Brownell ,
First-Order Beliefs
& John
1
Case
Second-Order Beliefs
S-7
•
•
•
•
24 year old male
6 months post severe traumatic brain injury
High School graduate
College student at the time of injury
Methods
Results
Changes in S7’s ToM performance and
attention were examined in the context of a
single subject experimental design.
S-7 was enrolled in two treatments presented
in sequence:
1. The Attention Process Training
Program (APT-I: Sohlberg & Mateer,1987),
2. The Theory of Mind Training Program
(Lundgren & Brownell, 2010).
The Attention Process Training Program was associated with
improvement on attention measures (mean post treatment mean pre treatment) / SD pre treatment) = 7.05) but not on
cartoon interpretation: (mean post treatment - mean pre
treatment) / SD pre treatment) = 0.72
In contrast, the ToM training program was associated with good
improvement on cartoon interpretation (mean post - mean pre) /
SD pre = 2.25, but not on attention measures: (mean post - mean
pre) / SD pre) = 1.10
Z score data for S7
Before, during, and after the trainings data
were collected on two dependent measures:
attention and ToM. Cartoon interpretation.
Probes of ToM (first and second order belief
cartoons: Larson, 2003) and attention (Paced
Auditory Serial Addition Test; Gronwall, D.
1977) were administered.
One month following completion of the APT-I
training protocol, the patient began the ToM
training program that followed the same
design.
Summary
• The Theory of Mind Training
Program yielded significant training
effects and appears to be an effective
means of improving performance on
one type of ToM task.
•There is a functional dissociation
between ToM and executive function:
Executive function (attention) is not
the sole explanation for ToM.
Both attention and ToM are potential
targets for intervention.
Implications
This research suggests that the Theory
of Mind (ToM) training program is an
effective means to improve ToM in
individuals with TBI. Yet, further
research is still needed to determine
whether improved ToM performance
on training tasks leads to functionally
significant gains.
References
Gronwall, D. (1977). Paced Auditory Serial Addition Task: A measure of
recovery from concussion. Perceptual and Motor Skills, 44, 367-373.
Lawson, G. (2003). The complete far side: 1980-1994. Riverside, NJ: Andrews
McMeel Publishing.
Green: Paced Serial Addition Task; arrows start APT training
Blue: ToM cartoon interpretation; arrows: stop APT and start
ToM training
Lundgren, K. & Brownell, H. (2010). Theory of Mind Training Following
Acquired Brain Damage. In J. Guendouzi, F. Loncke, & M. J.
Williams (Eds). Handbook of Psycholinguistics & Cognitive
Processing: Perspectives in Communication Disorders. London:
Psychology Press.
Sohlberg, M. M. & Mateer, C. A. (1987). Effectiveness of an attention training
program. Journal of Clinical and Experimental Neuropsychology, 9,
117-130.
Turkstra, L.S., Dixon, T.M., & Baker, K.K. (2004). Theory of mind and social
beliefs in adolescents with traumatic brain
injury. Neurorehabilitation, 19, 245-256.
[email protected]