Transcript of Talking Heads with Dr. Noosha Niv – Episode 2

Harnessing Neuroplasticity: Dr. Sophia Vinogradov on Cognitive Training for Psychosis

Announcer: This is talking heads. Explore the latest in research and policy about serious mental health disorders with Dr Niv.

Dr Niv: Hi, I’m Dr Niv and today’s guest is Dr Sophia Vinogradov. Dr Vinogradov is the Donald W. Hastings Endowed Chair in Psychiatry and Department head of psychiatry and behavioral sciences at the University of Minnesota Medical School. Her research focuses on cognitive dysfunction and psychosis. and more specifically neuroscience informed cognitive training methods aimed at improving cognition and functional outcomes. Welcome, Dr Vinogradov. Thank you so much for joining me today. I want to start off with what led you to psychiatry and more specifically the focus on schizophrenia and psychotic symptoms.

Dr Vinogradov: When I was a medical student, I of course had the chance to rotate through number of different specialties surgery, OBGYn, medicine, and I enjoyed them all. I really enjoyed studying medicine. But when I got to my psychiatry rotation, that’s when I had really the aha moment. Uh I found it very very interesting to listen to different individuals um and the changes that they had had in their subjective experience. Uh the way that some of those changes in their subjective experience was causing them distress or making it difficult for them to function. And I found myself wondering a great deal what must be happening uh you know inside of the brain uh inside of the body so that someone’s having these kinds of changes to their internal world and I decided I wanted to study that and I really would enjoy working with people who were going through these experiences. Schizophrenia came a little bit later when I actually became a psychiatry resident and once again I was rotating on different places some inpatient units some outpatient clinics and I found that I very much enjoyed speaking with individuals who had been having the experience of psychosis losing touch with reality could be hearing voices. It could be having their thoughts get scrambled or changed. It could be having delusional ideas. I was always very impressed by two things. The first was the incredible courage and resilience and fortitude that someone who has had these symptoms um needs to display often in order to in a sense pick themselves up and figure out how they’re going to recover and how they’re going to lead a a life which is fulfilling to them. So I was always very very moved by the the stories of individuals I would meet. And then at a more I would say scientific level, I became very curious again about what was happening inside the brain that would cause the brain to have challenges with some of the really basic elemental processes that we take for granted and and that allow us to to function as human beings. Things like perceiving reality, uh being able to communicate uh you know in a comprehensive organized fashion, uh being able to um make sense of the world, make decisions that make sense. Uh if that gets taken away from you through an illness, how shattering that must be. Um and and how can we learn more about that so we can come up with better treatments.

Dr Niv: And we know it really impacts outcomes, like functional outcomes. Right.

Dr Vinogradov: Right. Right. And I would say, you know, what’s what became clear as I was beginning my career especially focused on schizophrenia and and and I don’t even use that word anymore because I don’t know what schizophrenia is um I think the more you work with individuals who who struggled with psychosis symptoms, the more you realize that each individual is completely unique. And although you can see certain similarities among groups of symptoms across individuals, it’s it’s definitely not one-size-fits-all. And but in any case, when people have an illness, it could be schizophrenia, it could be schizoaffective disorder, it could be bipolar disorder with psychosis where they are experiencing psychosis, one of the things we’ve learned is that there are the clinical symptoms which people are very aware of and their their friends and family are aware of and we as doctors focus on treating such as hearing things or seeing things or having delusions. But then there are the cognitive uh effects of the illness and and it’s particularly those cognitive effects of the illness that difficulty thinking, concentrating, attending, remembering, making decisions. Those are the factors or or aspects of of the illness that really make it hard to have the kind of uh satisfying functioning that people want. And those are not symptoms of the diagnosis, right? But they are such core components that impact our functioning.

Dr Niv: That is correct. You can see those kinds of cognitive impairments occurring in many different conditions in things like Alzheimer’s or a dementia after a stroke. We see it in bipolar illness. We see it in depression, PTSD. You can have these kinds of impairments as well, but we tend to see them more consistently um when someone has schizophrenia or related illness.

Dr Niv: Okay. And so how did all that lead you to cognitive training?

Dr Vinogradov: That’s a great question. If I retrace the steps, I would say that I had been becoming increasingly interested in some of these cognitive findings in in psychosis spectrum illnesses partly because they can be a window into which parts of the brain are not working very well in a way that sometimes it’s harder to figure out with symptoms. We know we’ve got a better understanding of how certain parts of the brain are responsible for certain kinds of cognitive operations. So I was getting interested in that and we of course were were discovering that it is something we see a lot in schizophrenia and it impacts functional outcome but I was beginning to get tired of thinking about deficits or impairments or what was wrong and I was becoming more interested in thinking about well what can we do about it? What is still intact? What can we still harness uh so so we can help people in their recovery? And at about the same time I had the very good fortune of hearing a talk given by a basic neuroscientist whose name is Michael Mersnik uh to whom I owe a great deal. He really opened my eyes to the field of brain plasticity or what we sometimes say call neuroplasticity. Brain plasticity refers to the fact that the brain as an organ is constantly changing is capable of changing and is changing as it encounters new experiences in the world, new learning experiences, new training experiences. That’s what the brain evolved to do, to learn and change and adapt to the environment. And he had done many of the very fundamental basic science experiments uh using animal models to show that even in adult animals, there’s a huge capacity for brain plasticity that exists throughout the lifespan. And it really is a matter of giving, you know, the animal in in the case of his experiments is training uh opportunities uh and you can get, for example, the brain of a aging rat, which is beginning to look like like, you know, a very aging person, where it’s not remembering things as well, and it’s not smelling things as well. And you can train that aging rat through intensive training to start to behave again like a younger rat. Its memory gets better, its ability to recognize different smells gets better, and when you actually look inside the brain, the brain of the aged rat now looks like the brain of a young rat. So, So this is this notion that we have this incredible capacity to change throughout the lifespan. Mike had been thinking about these ideas with respect to human illnesses uh given how his work was going and he had been thinking about schizophrenia because he’s a brilliant researcher and then he reached out to me and he said why don’t we try to do a study together in schizophrenia and that’s kind of how I got interested.

Dr Niv: Wonderful. That’s so exciting. Before we get too far talking about cognitive training can we talk a little bit about how how confusing the terminology is in this field. It’s it seems like the word like cognitive training, cognitive remediation, cognitive rehabilitation. They’re they’re used somewhat interchangeably, but they’re really two quite distinct and different interventions, aren’t they?

Dr Vinogradov: I would say so. Of course, there is overlap among them. There was uh at the same time that I was becoming interested in this basic science work uh that Mike had been doing and and colleagues of his have been doing, there was another field of study that had been going on in schizophrenia for for some years which came out of a more psychological um background as opposed to a neuroscience background. Uh I would say more of a rehabilitation background and this field of study recognized also that cognitive impairments are an issue and took more of a rehabilitation kind of an approach and I think that’s where the term sort of cognitive remediation and cognitive rehabilitation originated. It was from those researchers who saw that when you have an individual who is struggling with some of these uh cognitive impairments, uh what works is to have that individual be in a I would say somewhat more holistic environment which attempts to help them rehabilitate and remediate and in some cases compensate for what they’re undergoing. And and that field of study came out of a a background, for example, of working with people who had head injuries. Um or who had had strokes where we know they have to have you know PT and OT and and rehabilitate themselves. And so whereas some of the underlying themes are the same which is that an individual can have these cognitive impairments and you have to help them in a sense get the brain working better or you have to change the environment so that it’s not as hard for their brain to work and do what it needs to do. I would say it was just a slightly more um it was just an approach that came more out of this sort of remediation rehabilitation concept. Uh whereas the cognitive training kind of neuroscience uh field that that I first became interested and began working in really came from basic science experiments in how do you harness actual changes in the cortex of adult animals when when you need that cortex to be remapping itself.

Dr Niv: So if I could try to simplify what you just so it’s um cognizant training would be primarily the treatment promotes changes in the brain which then leads to improvements in functional outcomes. Whereas this other type that the uh cognitive remediation or rehabilitation is really it’s more skills based right you’re compensating for these deficits with different types of skills that hopefully in the long term might cause some change in the brain but we don’t know that right

Dr Vinogradov: yes yeah I would say yes partially although there were and are a number of cognitive remediation researchers who re recognize that you have to have a combination of having people learn skills along with having them in a sense wake up the brain if you will or train the brain. They tend to be more focused when they do their cognitive remediation exercises that they will sometimes add to their treatment package or often can have as part of their treatment package. They will focus more on tend to focus more on I would say sort of higher order cognitions and I don’t want to get too geeky here but simply say that it tends to not have the same kinds of if you will um training specifications that we think about from this neuroscience-based perspective. I want to add that as the field has matured particularly in the last you know five uh five or so years many of us don’t see that these divisions or this difference in jargon is really that important.

Dr Vinogradov: Uh I think where most of us would would have a lot of agreement is that actually what’s becoming clear is that individual have individual needs. Um, and a cognitive training program that’s very neuroscience informed, such as I have been studying, will be useful for certain subgroups of individuals under certain circumstances or perhaps at certain stages of the illness and in different more comprehensive or or um skills-based uh intervention may be better for other groups of patients or maybe at a different stage of the illness. Uh, and yet another group of patients may benefit from all of the above.

Dr Niv: Do know what predicts response yet?

Dr Vinogradov: We have some ideas. Um there early ideas. So for example, one of the forms of training that I have focused on has been very focused on getting the auditory system to work better. Uh we know in psychosis spectrum illness a sizable proportion of individuals have got impairments in how the auditory system is processing auditory information. And there is some evidence uh from a couple of different studies that those individuals who are showing more of those impairments will benefit most from that kind of training, not surprisingly. And so we have a few other hints like that that depending on an individual’s profile of, if you will, strengths and weaknesses, um, a more specifically tailored program would be beneficial to them. The issue is that makes a lot of sense intuitively, makes a lot of sense clinically, but to do the research needed to create the evidence base where we to say that with 100% confidence is a little bit harder because you have to recruit, you know, 200 people with a certain kind of set of impairments or strengths and weaknesses and 200 of another and 200 of another. Um, and those are just hard studies to do.

Dr Niv: The sheer numbers make it challenging.

Dr Vinogradov: Yeah. Just the number and the intensity of the work and so forth. Yeah.

Dr Niv: Can we take the example you gave? So, someone who has some weaknesses in auditory processing, can you talk about like what does that mean in a practical world? Can you give an example of what that means and then what is the intervention for them

Dr Vinogradov: in the practical world um I’m not sure that the person would necessarily say I have difficulty processing auditory information right it might be that this is someone who has challenges with auditory working memory which means that they’re told a list of instructions um that they need to follow maybe you know four or five different steps that they need to do um in order to get their grocery list taken care of or do a sequence of errands It might be hard for them to register and hold on to that sequence of information that’s been given to them. It might be hard for them to just remember it. They might find themselves um being spoken to that it’s easy for them to get distracted. They can’t hold on to that spoken information as it’s coming into them. There’s some indirect evidence that impairments in in certain aspects of auditory information processing are associated with attentional difficulty. with difficulties hearing and picking up the nuances of say the emotional tone in somebody’s language whether it’s humorous whether it’s sarcastic aspects of it may be uh associated with certain kinds of proneness to hallucinatory activity so I don’t know that there’s like a one-tone correspondence I can say that the person will definitely feel this in the real world I don’t think that’s the case because the brain is much more complicated than that but These are some of the tendencies that such a person might might experience. If someone is having difficulty picking up the nuances of people’s voices, whether they’re happy or sad or being sarcastic, it makes it really difficult for them to have really satisfying social interactions, right? Um, and that has all sorts of consequences in real life. So, that would be what what difficulties with auditory information processing could could potentially look like. The training itself focus focuses on getting the brain to be faster and more accurate and um more efficient at rapidly taking in auditory information in the frequency bands that are common in human speech and just being able to process it and operate upon them. So, exercises might include hearing sound sweeps, sweeps of sounds, um and being able to register them faster and faster and and understand which one came first and which one came second. It could be exercises in which the person who’s training hears different um syllables being said. Um it has to remember the syllables in sequence and the list of syllables gets longer faster kind of has to be processed more more quickly and efficiently. It could involve brief sentences or whole words uh where the individual has to process what the words are saying. It could involve tone discrimination training. So training the brain to get better and better at distinguishing ing subtle distinctions between tones.

Dr Niv: Those would be some examples.

Dr Niv: Okay. And if the problem was more in the visual category, is it similar that they would start processing visual stimuli?

Dr Vinogradov: Yeah.

Dr Niv: And and it do the exercises it sounds like they get progressively harder as they go along?

Dr Vinogradov: Yeah, they’re adaptive. That’s the that’s the that’s the key magic ingredient. And I would say in terms of some of the some of the older cognitive remediation literature and some of what we’ve been doing, I would say that would be would have been one distinction which is you know there’s a real focus on adaptive uh training exercises because one of the things we know is if you’re going to create plastic changes in the brain you have to get the brain to a sweet spot where it’s training hard enough so that it’s creating new mapping.

Dr Vinogradov: Okay, not so hard that it’s failing all the time. Has to have about an 80% success rate so that it’s it’s learning how to remap the information more quickly and more efficiently. Has to be making a few mistakes so it’s realizing find distinctions among things. So Again, the neuroscience has given us really some very detailed specifications for how the exercises need to be delivered.

Dr Niv: And when you talk about create mapping, does that mean you’re seeing actual physical changes in the brain as a result of the training?

Dr Vinogradov: Yes. One of the things we’ve done is a series of imaging studies, brain imaging studies. So, we have done um a number of different kinds of brain imaging methods. Uh the details are not important, but we have shown that the brain activation patterns actually change in people who have done the training compared to a control group who just did regular computer games. So, it’s kind of like, you know, having you go to the gym and you do a very special strength training and we can show that your muscles are growing. We’ve been able to show something similar uh in the brain.

Dr Niv: Got to exercise those muscles. The brain.

Dr Vinogradov: Yeah. And and like all exercise regimes that work, brain training is hard work. And I think one of the eye-opening experiences we’ve had as researchers is that We’ve demonstrated that these kinds of training approaches can be helpful, but we’ve also seen that people don’t like them. It’s like saying to people, you’re going to go to the gym 5 days a week and you’re going to get on the weight machine and every time you go to the gym, you’re going to have to work a little bit of a heavier weight and do more reps

Dr Vinogradov: and it’s kind of boring and it’s hard work and you’re puffing and panting and most people go, “No, thank you.”

Dr Niv: In partially because they’re not seeing the benefit immediately, right? It takes time.

Dr Vinogradov: Correct.

Dr Niv: What is it to ical course of treatment like let’s talk one session at a time. How long is a typical session?

Dr Vinogradov: We like to see people training at least 30 minutes at a time.

Dr Niv: Okay,

Dr Vinogradov: ideally 5 days a week, four to five days a week. Um so it’s not trivial.

Dr Vinogradov: Um there have been some studies in fact a number of sort of failed studies where they failed to show an effect of the kind of training we’ve done and and almost all of them people were allowed to train when they wanted and when you looked back they did 20 minutes here and 20 minutes there, then two weeks later later another 30 minutes. And you know, if you did that at the gym, you wouldn’t see anything. So, we get the best results when people are doing 30 in the in our old studies, we would even do up to 60 minutes. That’s a lot to ask people nowadays. Um, but I would say 30 minutes four times a week.

Dr Niv: Okay. And for how how long?

Dr Vinogradov: Um, we like to see people do this for um 8 to 10 weeks.

Dr Niv: 8 to 10 weeks. Okay.

Dr Vinogradov: Yeah.

Dr Niv: And you you for the best results. What are the best results? What are the best outcomes we can hope for?

Dr Vinogradov: Well, we have seen uh when we’ve done the more intensive training, uh we’ve seen cognition improve even in individuals who’ve been ill for 20 years, we’ve shown that those who have made the most improvement for whatever reasons because there is individual variation. But those who were able to show the most improvement after training are those who when we bring them back six months later and reinter them are the ones who are showing more functional gains in the real world, social functioning, um you know, just real world functioning. So that’s the kind of benefits we see. Now, like every treatment we have um in medicine, there’s variation. You know, you’ve got maybe 20 to 30% of people who really adhere to the treatment, put their whole heart into it, and get better.

Dr Vinogradov: And you’ve got another 20% who go, eh, you know, not really. I’m not going to take this as prescribed, and maybe they don’t benefit. so much and then there’s a group in the middle which gets some benefit uh but maybe not the full extent and quite honestly it’s probably not all due to individual effort. There are going to be individuals who have different forms of the illness and some forms of the illness may be more responsive to this kind of an intervention than others possibly because of just their own neurochemical changes possibly also because of medications people are taking.

Dr Niv: Okay.

Dr Vinogradov: Uh we have in one study shown that when people are taking medications that um I’m going to get very geeky here. Sorry. But that blockeric functioning as some of the psychiatric medications do. It’s blocking a pathway in the brain that the brain needs to be plastic.

Dr Niv: Okay.

Dr Vinogradov: So that’s just a long winded way of saying that medications can play a role as well.

Dr Niv: So if they’re on that medication, they’re not as likely to correct. Okay. And are these improvements you’re seeing are they are they sustained or do they diminish over time like Do we need booster sessions to maintain gains?

Dr Vinogradov: We don’t know the answer to that yet. Our hunch is that some people will show some gains uh that are pretty durable, certainly up to 6 months. We’ve seen that and it becomes a virtuous cycle. The more they’re feeling better and functioning better and their cognition is better, the more they’re able to go out and get that job and hold a job or go back to school and then everything just becomes this this wonderful cascade. But we suspect uh many individuals would benefit from booster sessions. We haven’t studied it formally, but it’s something we would recommend.

Dr Niv: Okay. And is the impact of cognitive training different if people get it earlier in the course of treatment? I know you you had a study on that. I don’t know if it’s ongoing.

Dr Vinogradov: Yes, we have looked at it. I would say our impression is that the earlier in the illness that it’s delivered, the more beneficial it is because you have helped the brain recover functioning early as opposed to waiting 10 or 20 years. and the brain has really kind of been more in more of a downward spiral. But I also want to emphasize that it’s never too late.

Dr Niv: Okay?

Dr Vinogradov: It’s like exercise, right? If you start lifelong habits of being in really good shape when you’re in your 20s, teens, 20s, you have that the rest of your life. If you wait till you’re 50, it’s not as great, but it’s not a bad thing, right?

Dr Niv: I love that analogy. It’s so fitting, right?

Dr Vinogradov: So, we, you know, it seems to make sense that we might want to integrate this with a coordinated specialty care for the onset.

Dr Niv: Yeah.

Dr Niv: Um, are Are there differences in outcomes if you receive cognitive training in person versus like remotely on your computer at home?

Dr Vinogradov: We haven’t really studied outcome per se, but it is clear over and over that remote training while it has many benefits obviously flexibility, ease, just you know convenience, it’s hard to keep people motivated in the same way that we have been able to keep people motivated when we were doing all of our studies in person. It’s like again, it’s kind of like the gym analogy. If you go to the gym and you’ve got a trainer and they’re waiting for you or you’re with a small group of people and you all train together, you just you show up more, you put more effort into it. If it’s kind of something you’re going to, you know, put on your phone and prop your phone up and then do some exercises at home based on some program you’ve logged on to, you’re just not going to put as much effort into it. Over and over, we we see like physical training, the more you put into it, the more you get have it.

Dr Niv: Okay. And so for the person who wants to try this at home, it would be really important to maybe have a support system or support person encouraging them to do it.

Dr Vinogradov: Absolutely. And even so, you know, we have not cracked that one. It’s people say, “Yeah, yeah, I’ll do it.” You know, my parents will encourage me, but it’s not the same. I don’t know. I don’t know what the solution is at this point.

Dr Niv: Okay. And are there for again for the person who does want to do it at home, are there ideal conditions. I mean, obviously they need a computer, they need web access, they need the software. Are there other conditions they want to create in their home to increase the odds of this working for them?

Dr Vinogradov: Focus, freedom from distraction, the ability to sort of say, “These 30 minutes are mine, and I’m going to just focus on this.” Um, I think doing it when you’re rested, uh, not when you’re tired. Uh, doing it and making sure you have able to have sleep so you can consolidate the learning afterwards. I think all the things again that you would do if you were physically training, right? You wouldn’t do it if you’re sick or exhausted or at 10:00 at night. Right.

Dr Niv: Right. Um I I want to ask you one more question before I get to other people’s actually two questions. One um you know this isn’t widely available. What do you think it would need for us to make this intervention available across the country to more people

Dr Vinogradov: but payer solution? So right now there is no way to pay for um the subscription to the software for except you know through research funds obviously when we do research studies. There’s no way to pay for coaches um who could coach you through it and who can assess your progress and bug you if you’re not doing it. You know, again, like people pay for a personal trainer, a personal coach, uh there’s no way to reimburse practitioners who are prescribing it. There’s no way to reimburse a practitioner who takes 30 minutes out of their appointment time to tell an individual about here’s how we’re going to do it. Here’s how I recommend. Here’s the best way to handle it. Let’s set up a you know law book that you can all of that. I could do as a practitioner and I would have no way to to bill and get paid for that time.

Dr Niv: So, the finances are a real obstacle.

Dr Vinogradov: The finances, right? It’s like any treatment. How do you start a treatment if no one’s going to pay for it?

Dr Niv: Right. Okay. One last question before I get to a few questions from Facebook. Are you applying cognitive training to other conditions?

Dr Vinogradov: Yeah, we haven’t been actively in my group. We have colleagues who are obviously maybe not surprisingly um applying this uh to um young adults with autism spectrum disorders to uh depression, uh bipolar illness, PTSD, attention deficit disorder of course has a long uh and rich um kind of history of having different kinds of uh brain training. Uh and there’s actually a company now that has had received FDA approval for a software program focused on ADHD. That’s brain training.

Dr Vinogradov: Um so I would say there are a number of studies going on in number of different uh illnesses. Yeah.

Dr Niv: What’s the name of the one for ADHD?

Dr Vinogradov: ADHD. The company is called Achily. A K I L I.

Dr Niv: Okay. Um, all right. A few questions came in from people. I want to try the computer version at home. Which one is better, auditory or visual? And I’m guessing you would say it depends on the person.

Dr Vinogradov: I would say it depends on the person. I would say if you don’t know or if you don’t know how to assess. So, some of the different programs um and and the one that I I know best and disclaimer, it’s the group that I’ve done most rec arch with I I don’t have a financial interest in this company but I’ve been working and doing research with them for years. Uh it’s called Brain HQ and you can go into Brain HQ and there’s a self assessment or there’s an assessment kind of sequence that you do and then it will feed you exercises based on how you’re doing on that assessment and so it’ll create a personal trainer for you.

Dr Niv: That’s awesome. Okay, the next question are there studies of cognitive training in children with psychosis?

Dr Vinogradov: You know in children um I’d heard that one colleague was considering it but had not um actually uh start I don’t know if she’d actually ever started it. Uh it’s a challenging population um in terms of it does require all this effort and attention but I don’t know of any studies personally myself.

Dr Niv: Okay. And the last one from social media my son doesn’t understand he has schizophrenia. Would this treatment help him accept his illness? So I guess I would reframe that as does it impact insight?

Dr Vinogradov: Yeah. Yeah. It’s a great question. I I don’t know because we do research anyone who participates in our study has to sign informed consent and to sign informed consent means you are willing to say I have schizophrenia and I’m interested in this study. Um so we’ve never studied people who don’t have any insight. I would say that people have told us afterwards when we break the blind and we and we talk to people they will tell us their thinking feels clearer. They will tell us that when they feel like they’ve had a response. Uh they will feel like certain just thinking tasks and remembering tasks come a little bit easier to them how that translates into insight. I don’t know. I suspect insight involves again sorry for the geeky answer but I would say there’s one study we did where we gave a very intensive course of training to people. These are people who’ve been ill for on average 20 years old. So we had auditory, we had visual, we had social cognition. I didn’t mention that. But we also have exercises to train the ability of the brain to respond to social emotional information like expressions on faces and emotions and emotional tone of voice. And we did see in those individuals that those who got the training afterwards um showed improvement on uh something we call reality monitoring, which is the ability to distinguish information coming from the outside versus information coming from the inside. And that my guess that that would be related to perhaps an improvement in insight if you’re having a better ability to figure out what’s coming from inside of me versus what’s coming from the outside world. Speculation at this point,

Dr Vinogradov: but interesting question.

Dr Niv: And last question is, what are what are you most excited about in the field of psychosis right now? What do you think has the most potential to have a positive impact on people?

Dr Vinogradov: Well, in my own research, I you know, I continue to be excited about the potential and I continue to be a little bit kind of questioning about how do we actually turn this into something that people want to do, which I think is what size of researchers around the world are always like struggling with. Right. Right.

Dr Vinogradov: Um I do think there are going to be ways we can add in cognitive enhancing medications or neurom modulation brain stimulation techniques to accelerate so that people don’t have to do 30 or 40 hours of training. They can do 10 hours maybe and still get benefit. So we’re looking at that and I think that’s very interesting and exciting and other groups are looking at this too.

Dr Niv: So you have ongoing studies right now.

Dr Vinogradov: Yeah, we’re starting Yeah. Yeah. We’re starting some up as are some other people. So I think that’s very exciting. Uh I think getting it to people earlier um right away first episode we’ve been doing research in that area. I think that’s very exciting.

Dr Vinogradov: Uh one of our studies we showed that if we gave this training to people in the early phases of the illness and we looked at them six months later those who got the training their positive symptoms. So the hallucinations and delusions had improved and this was without changes in their meds. This was this was just from somehow being exposed to the training itself made the brain a better processor. I would say in the field of psychosis more generally, not just my own research, although research I’ve been involved in, is I think we’re beginning to get closer to understanding some of the different subtypes there are of these illnesses and that’s going to give us really important insights into much more tailored treatments than we have now.

Dr Niv: So, there’s a lot of hope in that precision medicine.

Dr Vinogradov: Oh, definitely. Definitely. Yeah.

Dr. Niv: All right. Well, thank you so much for your time.

Dr Vinogradov: Thank you, Noosha. Great interview.

Dr Niv: Thank you so much. much. Have a wonderful day.

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