NEAR - Neuropsychological and Educational Approach to the Remediation of Cognition
NEAR is a recovery-oriented, evidence-based cognitive health intervention model designed for implementation in diverse systems of mental health care. NEAR is conducted in small clinician-led groups and is adaptable for inpatient, outpatient, forensic, and residential settings. It is unique among Cognitive Remediation approaches in that it is structured with the explicit intent to enhance cognition and motivation for learning simultaneously to maximize therapeutic gains.
History of NEAR
NEAR was developed in the late 1990s and has been used worldwide since.
The clinician manual, available through Oxford University Press since 2009, provides materials and information to set up and run a cognitive remediation program.
Further clinician training is available through the Center for Practice Innovations https://practiceinnovations.org/initiatives/cognitive-health-solutions/overview
Is NEAR right for me?
NEAR promotes effective cognitive and functional change by targeting the cognitive skills identified as being integral to a person’s recovery and by empowering individuals to use their skills in personally meaningful ways.
NEAR clinicians are most often psychologists, social workers, mental health counselors, vocational rehabilitation counselors, and occupational therapists. NEAR clinicians are often champions for recovery and facilitate cross-disciplinary collaboration.
NEAR is complementary to any recovery-oriented service. Implementation studies across the globe have found NEAR to be effective for improving cognition and goal attainment. NEAR is rated with high satisfaction by service participants.
What does a NEAR session involve?
NEAR begins with an evaluation of an individual’s learning goals, cognitive strengths, and areas of cognitive health need. Cognitive skills are collaboratively selected as focus areas and specific exercises are chosen from a range of web-based learning platforms accordingly. NEAR typically entails 24-30 sessions, scheduled 2 to 3 times weekly.
Each session includes time for individual cognitive practice with feedback and strategy coaching from the clinician. The clinician prompts clients to “think about their thinking” so that approaches found to be efficient and effective for completing cognitive exercises are likely to transfer to cognitive tasks outside of sessions. Instructional techniques support motivation and deepen engagement in the learning process. Collaboration between the client and clinician throughout ensure that learning activities remain relevant as clients’ needs and recovery goals evolve. Each session concludes with a group-based verbal discussion. A manual guides several types of activities which reinforce cognitive skill and strategy use and their application to daily life. Manuals are available for free at www.teachrecovery.com
How can I provide NEAR to my clients?
Training to be a NEAR certified clinician starts with independent course work which can be found here:
https://practiceinnovations.org/initiatives/cognitive-health-solutions/overview
A series of synchronous learning webinars provides the specific knowledge and skills you need to:
set up your program
conduct sessions
motivate and support clients
evaluate client progress
evaluate and optimize your program’s clinical efficiency and utility
NEAR therapists benefit from regular supervision from a trained NEAR therapist. Train the trainer courses are offered through https://practiceinnovations.org/initiatives/cognitive-health-solutions/overview
Explore research around this programme
Integrative cognitive remediation for early psychosis: Results from a randomized controlled trial.
Vidarsdottir OG, Roberts DL, Twamley EW, Gudmundsdottir B, Sigurdsson E, Magnusdottir BB. (2019)
Cognitive training in affective disorders improves memory: a preliminary study using the NEAR approach.
Naismith SL, Redoblado-Hodge MA, Lewis SJG, Scott EM, Hickie IB (2010b).
The pilot study of a Neuropsychological Educational Approach to Cognitive Remediation for patients with schizophrenia in Japan.
Ikezawa S, Mogami T, Hayami Y, et al. (2012)
Translating cognitive behavioral interventions from bench to bedside: The feasibility and acceptability of cognitive remediation in research as compared to clinical settings.
Medalia A, Erlich MD, Soumet-Leman C, et al. (2019)
Feasibility and pilot efficacy of cognitive remediation for people in residential substance use treatment.
Allan J, Thompson A, Carlyle M, Thomas M, Medalia A. (2022)
Cognitive remediation in large systems of psychiatric care.
Medalia A, Saperstein AM, Erlich MD, Sederer LI. (2019)
A randomized controlled trial of cognitive remediation in schizophrenia.
Hodge MA, Siciliano D, Withey P, Moss B, Moore G, Judd G, Shores EA, Harris A. (2010)
More about NEAR
The NEAR model values shared decision making between a client and therapist to personalize treatment through the identification of cognitive goals and the selection of computer-based cognitive exercises from a broad menu of options, appreciating each individual’s learning needs and interests.
The NEAR model is flexible in that no one software program is used exclusively. Rather, NEAR clinicians are trained on how to evaluate different learning platforms and exercises so that those most appropriate for the setting and population can be employed. Group-based verbal discussions complement computer-based cognitive practice by providing further opportunity for cognitive skill building, to practice strategies to facilitate successful completion of cognitive tasks in daily life, and to develop awareness of one’s process of thinking to support generalization.
In the NEAR model, every group member plays a role in creating a positive learning environment. NEAR aims to foster a culture that promotes the value of good cognitive health to support the process of recovery.
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