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Unlike most products reviewed on this site, HAPPYneuron Pro may only be used through a therapist, rather than allowing direct purchase and access by a consumer.  Therefore, this review contains information directed toward therapists and their patients.


Review by expert Dr. Alice Saperstein, Ph.D., Assistant Professor of Medical Psychology, Columbia University Medical Center

PROS

  • HAPPYneuron Pro’s CR-Psychiatry program provides a flexible platform that supports direct therapist-guided practice and strategy coaching, while also allowing continued independent practice within a therapist designated training plan.
  • CR-Psychiatry is cost-effective – one subscription provides personal accounts for 10 users at one time.
  • The efficacy of CR-Psychiatry is supported by independent research.

CONS

  • Clients with more severe neurocognitive impairment may experience limited progression through the pre-set levels of increasing cognitive challenge within each exercise.
  • Some exercises may have low perceived utility value (i.e. limited face value), which can potentially limit user engagement and motivation for learning.

Description

The purpose of HAPPYneuron Pro is to provide a web-based platform for professionals to deliver cognitive remediation (CR) to clients with psychiatric disabilities in a person-centered manner.

Primary target populations for the CR-Psychiatry program are people with

  • schizophrenia
  • bipolar disorder
  • depression

This program is intended to facilitate a cooperative working relationship for clients and CR therapists, as a personalized training plan of cognitive exercises may be created and adapted to suit the specific needs of each individual. The program allows for flexibility in the selection of cognitive domains for practice, as well as in the selection of where cognitive practice occurs.

Computer-based training with CR-Psychiatry is well suited for clinic or office use, and provides the option for in-home practice. It is expected that clients will be able to navigate through the web-based program independently, provided a criterion of basic computer literacy is met, and a training plan has been created by a trained therapist. Clients may independently access exercises designated in the training plan, and therapists can view results and send messages through the web-based platform to stay abreast of clients’ practice and progress.

The learning goal of the CR-Psychiatry program in HAPPYneuron Pro is to improve cognition in a range of domains that are deemed pertinent for the client’s neurocognitive need.

Ease of Use and User Experience

User Interface

HAPPYneuron Pro provides a simple and user-friendly interface that is easily navigable, provided a basic level of computer literacy. It is strongly recommended that all clients are provided with an initial walk-through of program features to facilitate independent navigation to and between assigned exercises. Clients with more severe cognitive impairment will benefit from a greater level of therapist guidance with respect to use of program features and navigation

Appropriateness of Content

Instructive language is simply presented and appropriate for the majority of users. Supplemental to verbal instructions, users can choose to view a dynamic demonstration for each exercise. By providing two modalities of instruction, SBT Pro effectively supports independent use. However, clients with more severe cognitive impairment and/or lower reading ability may require more therapist support with respect to understanding exercise instructions.

Exercises vary in degree of verbal content. Language used in some exercise stimuli (e.g. Restaurant, Secret Files) may be unfamiliar to many clients which may limit independent usability, particularly those with lower achieved education or lower reading ability. Therapists should therefore be cognizant of this so as to provide appropriate recommendations and in-person support.

Appropriateness of Feedback

HAPPYneuron Pro provides users with graphically and narratively presented feedback on exercise performance including level of accuracy, errors, response rate, and exercise progression. Feedback is provided at the end of each learning trial, as opposed to real-time progress updates. Opportunities to view solutions allow users to compare their responses to the correct solution.

Users may experience variable benefit from the feedback parameters. Therefore supplemental therapist feedback is strongly recommended to help clients understand performance feedback, utilize feedback to improve performance, and generate and apply strategies to aid learning in subsequent trials.

Cognitive Challenge

HAPPYneuron Pro exercises offer practice in a range of cognitive domains at a baseline level of challenge that is appropriate to the majority of clients for whom this program is recommended. In some cases, the initial level of challenge may be too high for clients with more severely impaired cognition who would benefit from more focused practice using the targeted cognitive skill (e.g. abstract reasoning) prior to combining use of multiple cognitive domains (e.g. abstract reasoning plus processing speed).

The level of exercise difficulty automatically increases after the user achieves 100% accuracy on two consecutive trials, thereby allowing for both task mastery and continuous cognitive challenge. However, the step from one level of difficulty to the next may be too great for clients with more impaired cognition who may need a more gradual progression in the degree of cognitive load. The CR-Psychiatry program does not allow therapists to control specific exercise parameters to individualize degree of cognitive load within and between levels of each exercise. Pre-set parameters and automated stepwise progression are provided for therapists’ convenience. However, therapists who seek more control over exercise parameters can refer to the SBT Pro Rehabilitation program which does have this feature.

Ease of Account Management

HAPPYneuron Pro allows for therapists to manage up to 10 client accounts with one subscription. The user interface for therapists is easily navigable, allowing for the therapist to create and manage individualized training plans and view client progress in multiple domains including the exercises employed, dates and frequency of independent training sessions, the number of trials and rate of progression through levels of exercise difficulty. Clients can independently log in, choose which exercises in the training plan to use, and read personal messages from the therapist. The CR-Psychiatry program therefore supports a collaborative client-therapist relationship, opportunities for independent learning and continued practice between in-office visits.

Scientific Basis

The HAPPYneuron Pro website offers an extensive list of research studies representing diverse international efforts focused on the development and study of web-based cognitive remediation. Completed research using the CR-Psychiatry program demonstrates treatment-related improvement in neurocognition in people with schizophrenia and depression. Efficacy of the CR-Psychiatry program for people with bipolar disorder is not yet known.

Training with CR-Psychiatry is not directly associated with improvement in functional outcomes, although reports indicate that neurocognitive gain is generally associated with positive change in functioning. These findings are consistent with the purpose of cognitive remediation, as stated on the HAPPYneuron Pro website – “to help people develop the underlying cognitive skills that will make them better able to function in daily tasks, including those performed in school, work, social interactions, and independent living.”

The citation list includes a number of conference presentations, some articles in high impact peer-reviewed journals (e.g. Schizophrenia Research, American Journal of Psychiatry), and several projects in progress. Many studies are collaborative with the SBT Pro scientific team, but were predominantly carried out at independent research institutions. The magnitude of effect on neurocognition, relative to other web-based or strategy-based cognitive remediation programs, is to-be-determined. The cognitive domains in CR-Psychiatry are informed by the scientific literature on areas of greatest impairment in the target populations, including attention, working memory, verbal memory, processing speed, and problem solving ability.

Qualitative Review of Program Efficacy

HAPPYneuron Pro offers a comprehensive program package that is flexible to meet the specific cognitive needs of each client. Across cognitive domains, exercises offer continuous levels of cognitive challenge such that the degree of difficulty increases as clients master each level, thereby providing individually paced practice.

The program also allows therapists to control progression to higher levels of challenge when the program is employed in face-to-face sessions. The degree of difficulty is modulated with respect to the cognitive demands and the number of skills exercised at one time. Levels employ preset parameters for therapists’ convenience.

CR-Psychiatry provides opportunities for repeated practice of cognitive skills in varied contexts which will reinforce and promote generalization of cognitive gains. In addition, graded levels of challenge with each exercise, and availability of multiple exercises within each cognitive domain support motivation for learning by varying learning context and providing opportunities for user choice. In addition, CR-Psychiatry exercises allow clients to employ cognitive strategies (e.g. trial and error), and prompts to do so are included in exercise instructions.

A limitation of the CR-Psychiatry program is that only some exercises utilize real-world examples for cognitive practice (e.g. You’ve Got Voicemail), which may reduce users’ perceived utility value of cognitive exercises and limit potential transfer of cognitive gains to daily functioning.

To be effective, CR-Psychiatry is recommended for use along with a trained CR therapist, combining face-to-face sessions and independent between-session practice. It is not recommended for client use that is solely independent from a trained mental health professional. As with all computer-based approaches to cognitive remediation, CR-Psychiatry is most likely to be effective in improving cognition and supporting functional gains when used in conjunction with other skills-based interventions.

Estimate of efficacy relative to similar products

CR-Psychiatry has many attributes that recommend its use in clinical practice for people with psychiatric disabilities. SBT Pro provides a platform for intensive therapist-guided and independent practice on a set of cognitive skills that are pertinent to the targeted populations and are relevant for improving functioning. With respect to learning context, some clients may prefer and benefit from this style of learning platform, which is two-dimensional and moderate in the degree of user-program interaction; stimulus presentation is simple, but colorful, engaging, and more modern than other commercially available software programs.

The program offers an effective, streamlined approach to cognitive training. However, some clients may prefer other web-based programs that, relative to HAPPYneuron Pro, are more game-like and provide a more complex sensory experience.  The therapist should be cognizant of the client’s learning style to determine if this platform is appropriate.

Cost

A 3-month subscription can be purchased for $150, providing for 10 individual accounts. Additional accounts can be purchased in increments of 10. Therefore a course of cognitive remediation can be offered at a rate of $15 per client.

An advantage of this program’s subscription service is that user accounts can be activated and deactivated, such that a deactivated user’s account can be reactivated without incurring loss of personal data. One subscription therefore offers flexibility to the subscriber, and provides a personalizable and cost effective method of delivering cognitive remediation to people with psychiatric disabilities.

Reviewed July 2014

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