Habit-formation as a mechanism of action in cognitive adaptation training

Cognitive Adaptation Training (CAT) is an effective psychosocial treatment for serious behavioral health conditions that uses environmental supports such as signs and checklists to cue and sequence adaptive behavior in the home environment and improve functional outcomes. CAT has been found to improve targeted behaviors, role functioning, and community tenure in multiple randomized trials. While CAT has been shown to improve cognition after 12 months, initial improvements in target behaviors and functional outcomes are not attributable to improved cognition. This article describes a putative mechanism of action for CAT based on dual process theory. Improvement in CAT treatment is proposed to result from continued paring of cues (context situations) with behavior that leads to automatic behaviors and habit formation that bypasses cognitive and motivational problems typically associated with serious behavioral health conditions. Data that examine habit formation using automatic processes is presented to support the proposed mechanism of action.