CogniFit - Inhibition

What is inhibition?

Inhibition or inhibitory control is the ability to inhibit or control impulsive (or automatic) responses, and create responses by using attention and reasoning. This cognitive ability is one of our Executive Functions and contributes to anticipation, planning, and goal setting. Inhibition or inhibitory control blocks behaviors and stops inappropriate automatic reactions, changing one response for a better, more thought-out response adapted to the situation.

Dr. Russell Barkley proposed a model of behavioral self-regulation, where inhibitory control was the basis of the proper functioning of the rest of the executive functions. Inhibitory control is necessary for shifting, controlling impulsivity or interferences, working memory, regulating affectation or emotions, etc. Poor inhibition is one of the main problems of ADHD. Deficient inhibition may manifest itself in three different levels:

• Motor level: Poor control in motor behavior which manifests in hyperactivity. For example, when a child is in class, they may not be able to control themselves from getting up when they get bored sitting.
• Attentional level: Manifests itself in distractibility and difficulty paying attention. For example, if a child is reading a book and they get distracted by a sound outside.
• Behavioral level: Manifests itself in impulsive behavior that cannot be inhibited. For example, honking your horn when you get frustrated at the driver in front of you.

The frontal structures of the brain are the last ones to mature during development, which is why it's common to see young children have trouble controlling their behavior and managing unexpected changes or events. Children tend to have trouble inhibiting actions once they have been started. If there are not specific issues to prevent inhibition from developing naturally, it will increase and develop as we age.

Inhibition is one of our most used cognitive functions. It is how the brain corrects a behavior. Inhibition is what makes it possible for us to stay quiet when you want to say something, but know that you shouldn't, it's what helps you stay quiet and seated when you're in class, it's what helps you stay safe when someone merges into your lane without using their blinker, and it's what helps you study or work, even when you get bored or want to get up. Inhibition allows you to react to unforeseen or risky situations safely and quickly. Well developed inhibition or inhibitory control can help improve behavior and make it possible to perform better academically, at work, on the road, and with friends.

Examples of inhibition

• If you're studying and check your phone, chat with your friends, or go to the kitchen to get a study snack, your inhibition levels are lower than they might be during moments when you're studying hard and avoiding distractions. A successful student will be able to inhibit these actions and likely perform better academically.
• It's common to see similar situations at an office. Many employees will find themselves automatically doing things that are distracting them from their job, like looking at their phone, talking to colleagues, or investing time in worrying about personal activities. If an employee has good inhibitory control, they will be more efficient workers.
• It's also not uncommon for unexpected changes or accidents to happen when driving. You might be getting ready to take your exit on the highway and have to swerve to miss a car that changed lanes without using their blinker. Your ability to react and stop and inhibit an action is possible due to your inhibition.
• Some people have the tendency to dwell on negative thoughts and problems. This would also be due to problems with inhibitory control, as they aren't able to "turn off" and control these negative thoughts.
• If you get bitten by a mosquito, it's normal to want to scratch yourself to relieve the itch. People with good inhibitory control will be able to keep themselves from scratching the bug bite, even though it itches. Poor inhibitory control may make it difficult to resist scratching the itch, causing the bug bite to bleed and scab.
• If you're having dinner with your family and your brother-in-law (who you don't like very much) says one annoying thing after another, you might have a hard time keeping yourself from saying something to him. However, if you have good inhibitory control, you'll be able to control yourself and keep calm. If you have poor inhibitory control, you risk ruining the dinner.
• People with poor inhibitory control tend to interrupt conversations, making it difficult to maintain a fluid conversation. It's common for someone with poor inhibition to speak or answer a question without having fully thought about it, causing them to frequently make mistakes.

Disinhibition and other disorders related to poor inhibition or inhibitory control

Behavioral Inhibition (BI)is a problem that appears during childhood and is characterized by having an excess of inhibition. A child with Behavioral Inhibition will likely have problems when exploring new places, people, or objects, and will have an intense anxiety of the unknown, which usually leads to the child avoiding social situations. This is similar to shyness but may appear in non-social situations.

It's quite common for people with prefrontal lobe brain damage from a stroke, chronic traumatic encephalopathy, or tumors to suffer from disinhibition. This sometimes translates into simple and incessant talking or the tendency to touch anything that they can reach, because their lack of inhibition keeps them from being able to inhibit what they say or do. However, disinhibition can sometimes cause behavioral problems, leading to aggressiveness, cursing, or inappropriate sexual behavior.

There are also some cases of people with brain damage whose language and behavior is affected conversely. Unlike someone with disinhibition problems, there are also some people whose speech is over-inhibited causing them to not talk often. However, when they do talk, they speak fluidly and comprehensively.

In addition to the problems stated above, poor inhibition is also the main problem in disorders like Attention Deficit Hyperactive Disorder (ADHD), or Obsessessive Compulsive Disorder (OCD). ADHD may cause both behavioral and cognitive disinhibition. Behavioral disinhibition generally causes a child to be impulsive and reject an activity or idea of they don't like it or makes them getting up and walk around when they're bored. Disinhibition on a cognitive level will generally make it very difficult, or even impossible, to inhibit distracting stimuli, making it difficult to pay attention. People with OCD are unable to inhibit or control their catastrophizing thoughts that make them anxious, focusing their attention on what they're worried about.

Alcohol and drugs can significantly affect inhibition. In general, alcohol intoxication causes alterations in inhibitory control and is one of the reasons why it's illegal to drive with a certain blood alcohol level. Alcoholism can permanently affect inhibition. Recent studies show that binge drinking (drinking a large amount of alcohol in a short period, combined with periods of abstinence) can damage inhibition similarly to alcoholism.

How can you measure and assess inhibition?

Inhibitory control is based on many daily behaviors. Our ability to fit into our environments and handle distractions and unexpected changes depend directly on inhibition. This is why assessing inhibitory control can be helpful in a variety of different environments. Academic areas: Know if a child may be more distracted or if they may have behavioral or anger problems. Medical areas: Know if a patient has suicidal tendencies and poor inhibition that may lead to a higher risk of suicidal behaviors. Professional areas: Police, soldiers, or other professionals who handle weapons or dangerous tools must have excellent inhibition to avoid accidents.

The CogniFit team used the Test of Variables of Attention (TOVA) and the Stroop Test (Stroop, 1935) as the references to assess inhibition. Aside from inhibition, these tests also measure response time, processing speed, shifting, hand-eye coordination, and updating.

• Processing Test REST-INH: Blocks of numbers and different shapes will appear on the screen. At first, the user will have to pay attention to the size of the shape and indicate which is bigger. The user will then have to indicate which block has a higher number.
• Equivalencies Test INH-REST: Names of colors will appear on the screen, and the user will have to give a response as quickly as possible when the word corresponds to the color in which it's written. If they do not correspond, the user will not give any response.
• Inattention Test FOCU-SHIF: A light will appear in each corner on the screen. The user will have to click on the yellow lights as quickly as possible and avoid clicking on red lights.

How can you improve inhibition?

Like our other cognitive skills, inhibition can be learned, trained, and improved. CogniFit may help make this possible.

Neuroplasticity is the basis of rehabilitating and improving inhibition and other cognitive skills. CogniFit has created a battery of exercises to help recover deficits in inhibition and other cognitive functions. Like our muscles, the brain and its connections need to be used and challenged in order to get stronger and work better. If you frequently exercise inhibition, the brain connections and its structures will become stronger as well.

CogniFit has a team of professionals specialized in synaptic plasticity and neurogenesis processes, which has made it possible to create the personalized cognitive stimulation program to fit the needs of each individual user. This program starts with an evaluation of inhibition and other fundamental cognitive abilities. With the results from this assessment, the cognitive stimulation program from CogniFit will automatically create a personalized training program to train the user's executive functions and other cognitive skills that scored below the average in the initial assessment.

A consistent and challenging cognitive stimulation is the best way to improve inhibition. CogniFit has professional assessment and rehabilitation tools to help optimize these cognitive functions. CogniFit recommends training for 15 minutes a day, two to three times a week.

CogniFit's assessment and brain training is available online and on mobile. There are a number of interactive games and activities to play on a computer, tablet, or cell phone. After each session, CogniFit will create a detailed graph of the user's cognitive progress.