Angelica Lopez

3Nur- 6/ RLE 1

Strategy for Semantic Association Memory (SESAME) training: Effects on brain

functioning in schizophrenia
By Synthia Guimond, Sophie Beland and Martin Lepage

Published on: October 2017

Citation: Guimond, S., Beland, S., & Lepage, M. (2017). Strategy for Semantic Association
Memory (SESAME) training: Effects on brain functioning in schizophrenia. Psychiatry Research:
Neuroimaging, 271, 50-58. doi: http://dx.doi.org/10.1016/j.pscychresns.2017.10.010

I. Statement of the problem

What are the impacts or effects of a brief Strategy for Semantic Association Memory
(SESAME) training program on the memory and brain activity of schizophrenia patients who
exhibit deficits in self- initiation of semantic encoding strategies?

II. Research Method

The study made use of an uncontrolled research design where patients where specifically
chosen under a specific list of criteria, where subjected to a treatment and whose response where
analyzed but where not compared to a control group. The research approach used was abductive
reasoning where in the researchers have started with an incomplete set of observations and recent
studies but not a theory and have used such knowledge to generate new knowledge and findings.
In this study itself, the researchers wanted to test out whether, as said by other studies, semantic
strategies are diminished in schizophrenia patients due to diminished memory caused by changes
in neural or cognitive changes.

To find this out, the respondents were first subjected to the SEMT encoding trial wherein
they were shown 128 pairs of items which was divided into 2 groups: in the semantic part, patients
were asked to tell whether the 2 pairs can be in one category or not. Meanwhile, in the orientation
part, they were asked which of the pair is bigger in real life. For the next stage which focused on
memory, the patients were shown pictures wherein they must answer: “which of the 4 pictures on
the right have been paired with the picture on the left with regards to the previous activity?” After
these, the patients answered a questionnaire assessing their use of encoding strategies in answering
the previous activities. Lastly, the researchers conducted 2 one- hour sessions (within 2 weeks)
with the patients which focused on self- reflection of one’s memory: why one forgets, how to
improve memory and how to use the previously mentioned encoding strategies in life situations.

The treatment used in the research was the Semantic Association Memory (SESAME)
training which was designed by researchers themselves to test the effect or relationships of the use
of semantic strategies to memory improvement and therefore to neuronal/ cognitive improvement
in patients with schizophrenia. To analyze their findings, the researchers made use of the paired t-
test/ dependent t- test to know whether there is significant difference in the pre and post treatment.
They also measured the cortical thickness of the patients’ brain and the brains activity using MRI.
III. Summary of Findings
With regards to the first phase of the experiment, data showed that respondents have the
same performance in answering the question on categorizing pictures during the pre and post
treatment but showed significant improvement during the post treatment when it comes to the
question on sizes in real life. There is also improvement with regards to the use of encoding
strategies post treatment according to the respondents’ answer in the Subjective Strategies
Encoding questionnaire. According to MRI results, there is no significant difference with the
brain’s activity when it comes to the category and size questions. Meanwhile, there is significant
brain activation in the left Dorsolateral Prefrontal Cortex (DLPFC) and right inferior parietal
lobule. Lastly, data also showed cortical thickness in the DLFPC and left middle frontal gyrus.

IV. Conclusion/ Recommendations

The research showed that SESAME training can improve semantic strategies and memory
of patients with schizophrenia. This also showed that SESAME training can help in the
improvement of neuronal/ cognitive activities in the brain as seen in the changes in the DLFPC.
Still, I do recommend that further study should be conducted because this research have
only studied a total of 15 patients. Also, I think that the researchers should have focused on what
aspect of treatment as a time instead of using or testing out varied activities such as the category-
size question, memory question, use of questionnaire and training sessions. These can affect the
result and create confusion as to what specific treatment was effective and did the most
improvements for the respondent.

V. Implications to the ff:

a) Nursing Education- This research teaches nursing students that simple activities like
memory games, flashcards, etc. can make a difference in a patient’s condition. Mentally ill
patients do not simply need medications to improve one’s self rather sometimes non-
pharmacologic ways can still be better.
b) Nursing practice- Nurses often make use of non- pharmacologic ways to improve patient
condition and memory training is another good way to initiate improvements in the brain
activity and semantic strategy of a patient with schizophrenia.
c) Nursing administration- This model or training can be recreated and used as a therapy
for patients with memory problems or difficulties in semantics.
d) Nursing research- This research, though not completely perfect on its own can still be
developed through other researches. It gives future researchers like me an idea on how I
can improve patient care in a simple yet effective manner. It inspires me to find ways on
how I can fill in the gaps with memory improvement or semantics in mentally ill patients
just with the use of games, word plays and other entertaining activities.

VI. Reason for choosing

I have chosen this research first because it caught my interest as to how memory and
semantics can be improved with such simple strategy or therapy. I know that I can use such model
in taking care of mentally ill patients.