Cognitive pragmatics: From theory to clinical treatment

Over the last thirty years, Cognitive Pragmatic theory (Airenti, Bara and Colombetti, 1993a; 1993b; Bara, 2010) has provided a unified theoretical framework capable of explaining the development, decline and communicative difficulties in typical and atypical populations and in various clinical conditions. Based on pioneering studies in the field of experimental pragmatics, it has emerged that pragmatic ability is not a subcomponent of Theory of Mind, i.e., the ability to attribute mental states to oneself and others, and it is also specific to other cognitive abilities, such as executive functions, i.e., the articulate set of skills enabling effective and flexible execution of goal-directed behaviors. This awareness has led to the development of training programs such as Cognitive Pragmatic Treatment (CPT), which specifically target the improvement and enhancement of communicative-pragmatic ability realized through linguistic, paralinguistic and extra-linguistic (non-verbal) channels. The effectiveness of such training is underpinned by numerous behavioral studies showing improvement in communicative performance in various neurological and psychiatric populations as well as in autistic and healthy aging. The results of behavioral studies have been complemented by fMRI studies showing functional reorganization of brain networks involved in the processing of specific communicative aspects, but not involving brain areas traditionally associated with the "mentalizing network" or executive functioning. Finally, a new application of CPT adapted for autistic adolescents involves its application via digital means of communication (i.e. telepractice). The article provides a critical overview of the clinical applications in the rehabilitation field arising from the Cognitive Pragmatic theory and concludes with recent applications and some possible future developments.