New horizon in improving ageing with improvisational theatre.

Cognitive decline, mental health and mindset factors can all affect the autonomy and well-being of older adults. As the number of older adults across the globe increases, interventions to improve well-being are urgently needed. Improvisational theatre (improv) and improv-based interventions are well-suited to address this need. Studies have shown that participation in improv-based interventions has a positive impact on mental health indicators, including depressive symptoms, well-being and social connectedness, as well as cognitive skills such as attention and memory. In addition, improv-based interventions have been beneficial for people with dementia, improving positive affect, self-esteem and communication. In this article, we describe improvisational theatre, or improv, and the reasons it has emerged from a form of spontaneous theatre that involves playfulness and creativity to an important tool to effect behavioural change in individuals and groups. We then review the literature on the effects of improv in ageing populations, with a focus on social, emotional and cognitive functioning. Finally, we make recommendations on designing improv-based interventions so that future research, using rigorous quantitative methods, larger sample sizes and randomised controlled trials, can expand the use of improv in addressing important factors related to autonomy and well-being in older adults.

I Won't Forget to Do It If It's Important: A Multinomial Processing Tree Analysis of Social Importance and Monetary Reward on Event-Based Prospective Memory.

While previous research has suggested that prospective memory may be enhanced by providing a social motive (i.e., social importance) or by promising a monetary reward for successful performance, to the best of our knowledge, the underlying mechanisms responsible for these effects are still largely unexplored. In a sample of 96 younger adults, this study investigated how social importance and promising a monetary reward influence the prospective component and the retrospective component of event-based prospective memory separately, with the application of a multinomial modeling approach. Results revealed enhanced prospective memory performance for all importance conditions compared to a standard condition. This improvement was characterized by an increased allocation of resource-demanding attentional processes in performing the prospective memory task at the expense of the ongoing task without an increase in the perceived importance of the prospective memory task. The model-based analyses showed that the beneficial effects of importance arise from an increased engagement of the prospective component, leaving the estimates for the retrospective component unaffected.

Applied improvisation and transdisciplinary simulation: a necessity for any health curriculum?

From practising a procedure, such as a lumbar puncture, to explaining the aim and method and listening to concerns, the practice of health professionals requires a range of skills, often classified into technical and non-technical skills. Just as gestures and procedures can be taught, so can empathy and communication skills. This article introduces an innovative approach that unites both necessary types of skills. The specific framework of improvisational theatre ("improv") has widespread application, including the training of health professionals (health training improv). By sharing close contexts and skills, health training improv provides a valuable, safe, and effective learning environment that allows practitioners to practice exercises and situations that align with particular objectives. We created a transdisciplinary team to develop a programme of Health Professional Training Improv (HPTI), bringing together the fields of health, psychology, simulation, and arts. Since 2019, various health student groups (nurses, midwives, medical doctors, and speech therapists) have participated in a 16-h applied improv training workshop under the supervision of a professional improv facilitator. Additionally, drama students completed applied improv for health courses, which trained them to act as simulated patients, with a view to the implementation of transdisciplinary improv simulation sessions at SimUSanté (a multidisciplinary health simulation facility located in France). Students' feedback emphasized their interest in HPTI, the realism of the simulation sessions, and the skills they felt had improved. This feedback needs to be supplemented with quantitative data from standardised assessments. The development of this rich pedagogical and research framework, based on a transdisciplinary approach, has brought different fields together to prepare students for real patient encounters. It is essential to continue this training and conduct research to evaluate the curricula developed.

Prospective memory assessment: Scientific advances and future directions.

Prospective Memory (PM), the ability to remember to realize intended actions in the future, is crucial for maintaining autonomy. Decades of research has focused on a so-called age PM paradox, where older adults outperformed younger adults on some PM tasks, but not others. Contributing to this paradox is heterogeneity in and a lack of valid assessment methods. Previous research showed a lack of convergent validity between performance-based PM and both self-report and informant-report measures. We argue that questionnaires may be relevant to obtain information regarding patients' awareness of their PM difficulties but need to be used in conjunction with performance-based tools. Within performance-based PM tools there are also difficulties in measurement: 15-60 min experimental tasks and batteries have a good reliability but cannot usually fit in a standard clinical evaluation, while shorter PM measures have lower reliability and sensitivity. In this perspective paper, we encourage researchers to develop more ecologically valid tools. Innovative PM paradigms that allow participants to generate their own intentions and that take task costs into consideration should be developed. Future research will also need to focus on cognitive factors, personality and online evaluation, to improve PM assessment and develop ad-hoc rehabilitation programs.

Systematic review and meta-analysis of cognitive impairment in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is commonly associated with cognitive complaints. To bring out the neuropsychological symptomatology inherent to ME/CFS, we conducted a systematic review according to PRISMA and MOOSE guidelines of the literature through the analysis of 764 studies published between 1988 and 2019 by using PubMed Central website and Clarivate analytics platform. We performed a meta-analysis to delineate an idea of the neuropsychological profile inherent in ME/CFS. The clinical picture typically affects visuo-spatial immediate memory (g = - 0.55, p = 0.007), reading speed (g = - 0.82, p = 0.0001) and graphics gesture (g = - 0.59, p = 0.0001). Analysis also revealed difficulties in several processes inherent in episodic verbal memory (storage, retrieval, recognition) and visual memory (recovery) and a low efficiency in attentional abilities. Executive functions seemed to be little or not affected and instrumental functions appeared constantly preserved. With regard to the complexity and heterogeneity of the cognitive phenotype, it turns out that determining a sound clinical picture of ME/CFS cognitive profile must go through a neuropsychological examination allowing a complete evaluation integrating the notion of agreement between the choice and the number of tests and the complexity intrinsic to the pathology.

Teenagers Tell Better Stories After Improvisational Theater Courses.

Improvisational theater (improv) is a booming theatrical practice, applying in many fields (teaching, medicine or entrepreneurship). Its effects on cognitive and behavioral processes are beginning to be demonstrated, despite scientific publications that are still rare, particularly about language. This study aimed to evaluate the effects of improv on adolescent narrative skills. Twenty-seven middle school students were recruited and divided into two groups: an IMPRO group (n = 13), composed of novice and intermediate improvisers, and a CONTROL group (n = 14), composed of middle school students doing theater. The evaluation took place in two experimental times spaces 3 months apart (11 sessions). It consisted in the creation of a written narrative resulting from previously observed images. We used quantitative criteria to carry out the analysis of this story (coherence, cohesion, lexicon, and syntax), according to the methodologies of PELEA and EVALEO. We showed an effect of the improv on coherence, which suggests that the practice of improv introduces teenagers to improve the narrative skills and the planification of a story, unlike written theater.

Instruments Measuring Prospective Memory: A Systematic and Meta-Analytic Review.

OBJECTIVE: To identify the available measures to assess prospective memory (PM) abilities, to describe their content, and to quantitatively summarize the effects of various diseases on PM depending on the type of assessment. METHOD: Three databases (PsycInfo, PsycArticles and PubMed) were searched up to June 2019 to identify the existing PM measures. The identified PM measures were classified according to the type of assessment: test batteries, single-trial procedures, questionnaires, and experimental procedures. The characteristics and psychometric properties were presented. PM performances were compared between patients with various diseases and controls depending on the type of assessment. RESULTS: Most of the 16 measures identified evaluated both event- and time-based tasks, were linked to functional outcomes, showed empirical evidences regarding validity and reliability, and provided parallel versions. To a slightly lesser extent, few measures provided normative data, translations/adaptation into another language, cutoff scores for diagnostic purposes, qualitative scoring, parallel version, and external aids during the test. Compared to healthy controls, patients had significantly poorer performances when PM was assessed with experimental procedures. Heterogeneous data precluded the interpretation of a summary effect for test batteries, single-trial procedures, and questionnaires. Planned subgroup analyses indicated consistent PM impairment for patients compared to controls for three test batteries. However, PM complaints did not differ between patients and controls. CONCLUSIONS: These results suggest that the use of PM test batteries and experimental procedures are relevant for detecting performance variations in diverse clinical populations. Clinical implications and directions for future research are discussed.

Improving Teenagers' Divergent Thinking With Improvisational Theater.

Improvisational theater (improv) is supposed to have an impact on cognitive processes (divergent thinking, flexibility, language, memory, problem solving, and co-construction), academic performance, and everyday life in many ways. However, little research studied on the psychological impact of improv, with some results highlighting a divergent thinking enhancement in children and adults, but not with teenagers, one of the most important age groups to practice improv. Therefore, this study aims to assess divergent thinking for middle school students before and after an 11-weeks session compared to a control group with a sport practice. The Alternative Uses Task (AUT) was used before and after the session for both groups to evaluate divergent thinking. The improv group had better performance in originality, flexibility and gave less prototypical items after the improv sessions compared to before, while the control group performance was similar before and after. Our results suggest that improv helps teenagers' divergent thinking to improve, not only with experimental games in the lab context but also after ecological sessions. We urge scientists to study in depth psychological impacts of improvisational theater and applied improvisation, for a better understanding of improv and as a model to study embodied cognition.

Dynamic and Functional Approach to Human Memory in the Brain: A Clinical Neuropsychological Perspective.

The way how cognition is conceived and represented in brain functioning will directly impact clinical investigations of people with cognitive difficulties. This is particularly evident in the field of clinical neuropsychology where methodologies and tools are justified on a fundamental level by the theoretical foundations adopted. The present article outlined how the dominant influences of structural and anatomo-clinical theories of memory have led to a particular conception of clinical investigations. We propose to reconsider these dominant methods in favor of a more dynamic and functional representation of memory that would be clinically more appropriate. More precisely, we argued that relying exclusively on a particular memory conception (i.e., structural) may not be sufficient considering the range of real-life variables affecting a patient's memory. By extracting clinically meaningful information in more functional and dynamic memory conceptions, we also aim at underlining the potentials advantages of such theories in facilitating personalized assessments and follow up of patients in clinical neuropsychology. We suggest that a dynamic, functional, and integrative conception of memory would be more coherent with the trend in clinical neuropsychology to promote a more collaborative interaction between the clinician and the patient. Finally, considering the absence of empirical studies on the possible benefits of implementing such recent memory concepts in clinical practice, we encourage researchers and clinicians to test in the field of clinical neuropsychology, the usefulness and explanatory power of more dynamic and functional representation of memory in order to objectively demonstrate its validity outside the research loop.

Hey Teacher, Don't Leave Them Kids Alone: Action Is Better for Memory than Reading.

There is no consensus on how the enactment effect (EE), although it is robust, enhances memory. Researchers are currently investigating the cognitive processes underlying this effect, mostly during adulthood; the link between EE and crucial function identified in adulthood such as episodic memory and binding process remains elusive. Therefore, this study aims to verify the existence of EE in 6-10 years old and assess cognitive functions potentially linked to this effect in order to shed light on the mechanisms underlying the EE during childhood. Thirty-five children (15 second graders and 20 fifth graders) were included in this study. They encoded 24 action phrases from a protocol adapted from Hainselin et al. (2014). Encoding occurred under four conditions: Verbal Task, Listening Task, Experimenter-Performed Task, and Subject-Performed Task. Memory performance was assessed for free and cued recall, as well as source memory abilities. ANOVAS were conducted to explore age-related effects on the different scores according to encoding conditions. Correlations between EE scores (Subject-Performed Task/Listening Task) and binding memory scores (short-term binding and episodic memory) were run. Both groups benefited from EE. However, in both groups, performance did not significantly differ between Subject-Performed Task and Experimenter-Performed Task. A positive correlation was found between EE and episodic memory score for second graders and a moderate negative correlation was found between EE and binding scores for fifth graders. Our results confirm the existence of EE in 6 and 10 year olds, but they do not support the multimodal theory (Engelkamp, 2001) or the "glue" theory (Kormi-Nouri and Nilsson, 2001). This suggests instead that episodic memory might not underlie EE during early childhood.

Regularity effect in prospective memory during aging.

BACKGROUND: Regularity effect can affect performance in prospective memory (PM), but little is known on the cognitive processes linked to this effect. Moreover, its impacts with regard to aging remain unknown. To our knowledge, this study is the first to examine regularity effect in PM in a lifespan perspective, with a sample of young, intermediate, and older adults. OBJECTIVE AND DESIGN: Our study examined the regularity effect in PM in three groups of participants: 28 young adults (18-30), 16 intermediate adults (40-55), and 25 older adults (65-80). The task, adapted from the Virtual Week, was designed to manipulate the regularity of the various activities of daily life that were to be recalled (regular repeated activities vs. irregular non-repeated activities). We examine the role of several cognitive functions including certain dimensions of executive functions (planning, inhibition, shifting, and binding), short-term memory, and retrospective episodic memory to identify those involved in PM, according to regularity and age. RESULTS: A mixed-design ANOVA showed a main effect of task regularity and an interaction between age and regularity: an age-related difference in PM performances was found for irregular activities (older < young), but not for regular activities. All participants recalled more regular activities than irregular ones with no age effect. It appeared that recalling of regular activities only involved planning for both intermediate and older adults, while recalling of irregular ones were linked to planning, inhibition, short-term memory, binding, and retrospective episodic memory. CONCLUSION: Taken together, our data suggest that planning capacities seem to play a major role in remembering to perform intended actions with advancing age. Furthermore, the age-PM-paradox may be attenuated when the experimental design is adapted by implementing a familiar context through the use of activities of daily living. The clinical implications of regularity effect are discussed.

Talk the talk and walk the walk. Evaluation of autonomy in aging and Alzheimer disease by simulating instrumental activities of daily living: the S-IADL.

OBJECTIVE: The autonomy of individuals is linked to the achievement of instrumental activities of daily living that require complex behavior. In the elderly, the assessment of autonomy is usually based on questionnaires that have strong subjective constraints. Considering this fact, we tested elderly healthy adults and Alzheimer disease patients using a new measure, the S-IADL (Simulation of Instrumental Activities for Daily Living), to assess the ability to perform effectively activities of daily living. METHOD: The S-IADL shares many items with the well-known IADL questionnaire proposed by Lawton & Brody (1969). However, as opposed to the IADL, the assessment of autonomy is not based on the completion of a questionnaire but requires the realization or simulation of various activities of daily living. Eighty-three participants (69 healthy elderly, and 14 Alzheimer Disease patients) completed the IADL and performed the S-IADL assessment. RESULTS: Results revealed that, like the IADL, the S-IADL is able to identify AD patients who are likely to encounter difficulties in performing everyday activities, and no major differences were found between the IADL and the S-IADL. CONCLUSIONS: We outlined some advantages for prefering, in certain situation, this new tool based on simulation of activities in functional evaluation. Finally, we discuss the main limits of the S-IADL that should be investigated prior to its utilization by clinicians.

From Bill Shankly to the Huffington Post: How to Increase Critical Thinking in Experimental Psychology Course?

Although critical thinking and source checking are basic prerequisites to become a psychologist, or a scientist, it is usually difficult to have students interested in experimental methods courses. Most first year students are tempted not to attend these courses. Such behaviors are reinforced by arguments that "everybody is different" and "people are not numbers." Consequently, students have difficulties to develop source and evidence checking skills, and may be more prone to believe in any supposed expert. This paper presents two ways to involve students during lectures and seminars. The first method consists in presenting, during the initial lecture of the year, a fake scientific concept which students will believe as true. This phenomenon is called the "Bill Shankly syndrome" and it only exists if someone believes that the information is given by a serious lecturer, presenting oneself as a world-class researcher. The second method consists in training students to become reviewers using evidence checking of a mainstream media article which promises scientifically proven ways to be happy. The use of these methods may stimulate students' interest in research methods and its practical applications from week one.

The Still Enigmatic Syndrome of Transient Global Amnesia: Interactions Between Neurological and Psychopathological Factors.

Transient global amnesia (TGA) is a neurological syndrome that usually occurs in middle-aged or older people. It is characterized by the abrupt onset of profound anterograde amnesia, associated with more variable retrograde amnesia and repetitive questioning. The whole episode lasts no more than 24 h. Almost 60 years after its first descriptions, the etiology of TGA remains unknown. Until now, TGA has been described exclusively as a memory disorder, but there is a growing body of evidence to show that emotional and psychological factors (as anxious and depressive symptoms) are present at different times of TGA. Their role therefore needs to be clarified. First, these factors seem to play a part in triggering TGA, at least for a subgroup of patients, suggesting the existence of an emotional TGA subtype. Second, recent research shows that almost all the TGA patients displayed modifications of their emotional state during the episode, possibly linked to sudden memory loss. The level of depressive and anxious symptoms could even reach a pathological threshold in patients with the so-called "emotional TGA subtype". Third, the persistence of these depressive and anxious symptoms after the end of the episode could account for lasting memory disorders in some patients. Finally, the analysis of these emotional syndrome and emotional factors and the recent data in neuroimaging could allow us to gain a better understanding of the pathophysiological mechanisms behind TGA. The aim of this review was thus to discuss whether the anxious and depressive symptoms are causative, resultant or coincidental of TGA.

Just do it! How performing an action enhances remembering in transient global amnesia.

Transient global amnesia (TGA) is a clinical syndrome characterized by the sudden onset of a massive episodic memory deficit that spares other cognitive functions. As such, it provides a unique human amnesia model for testing the enactment effect (i.e., better memory for performed actions than for verbally encoded sentences). Our main aim was to test whether the enactment effect is preserved in TGA patients, both to have a better understanding and to test the robustness of this effect in a massive amnesia. Object-action pairs were encoded under four conditions: verbal, experimenter-performed, and two enacted conditions (self-performed and self-performed with choice). We tested object-action pair retrieval using cued recall (CR) and recognition tasks, and source memory using a free recall task. We also assessed binding, executive functions, short-term memory, episodic memory, anxiety and mood. We run correlations to control for their putative effects on memory for action. Data were collected from 24 patients, 16 of whom were examined during the acute phase and eight the day-after, as well as from 18 healthy controls. The memory performances of the patients in the acute phase improved for both (i) the CR score, between the verbal, experimenter-performed and self-performed with choice conditions, and (ii) the total recognition score, between the verbal condition and the two enacted conditions. Correlations were found between self-performed task (SPT) enhancement and both the binding and anxiety. In spite of their severely impaired episodic memory, patients with TGA benefit from the enactment effect. These results are discussed in relation to the role of motor components and episodic integration in memory for actions. We suggest that enactment effect can be used in clinical practice and rehabilitation, possible even for patients with a massive memory impairment.

Awareness of disease state without explicit knowledge of memory failure in transient global amnesia.

INTRODUCTION: Transient global amnesia (TGA) is a syndrome characterised by the rapid onset of antero- and retrograde amnesia, accompanied by temporal disorientation and iterative questioning. It is now established that the acute phase is associated with a raised level of anxiety and a depressed mood. We conducted a thorough investigation of patients' perceptions of their disease state, focusing on the links between their lack of explicit knowledge of amnesia during the acute phase and their emotional experience. METHOD: Explicit knowledge of memory deficits was assessed during TGA by means of an original scale inspired by Bisiach et al. (1986) and self-reported scales measuring patients' perceptions of their current memory and their cognitive and behavioural functioning. At the same time, we probed the patients' emotional experience (sources of worry, and levels of worry, anxiety and depression) via questionnaires. Data were collected from 20 patients in the acute phase, 16 in the peri-acute phase, 16 who were assessed the day after the episode and 14 healthy controls. Each patient underwent a follow-up examination 2 months later. RESULTS: Patients in the acute phase displayed a lack of explicit knowledge of their amnesia and overestimated their memory performances. They also expressed higher levels of worry and anxiety than controls, and a more depressed mood. CONCLUSIONS: Although they were aware of their disease state, the TGA patients were unable to identify the nature of their memory deficits and overestimated their memory performances. These memory misperceptions and the inability to acknowledge memory failure occurred concomitantly with changes in the patients' emotional state. This particular pattern of awareness could be regarded as a reaction to the suddenness and massiveness of the amnesia.