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Jimenez AM, Green MF. Disturbance at the self-other boundary in schizophrenia: Linking phenomenology to clinical neuroscience. Schizophr Res 2024; 272:51-60. [PMID: 39190982 DOI: 10.1016/j.schres.2024.07.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024]
Abstract
In this selective review, we describe the current neuroscientific literature on disturbances of the self-other boundary in schizophrenia as they relate to structural and experiential aspects of the self. Within these two broad categories, the structural self includes body ownership and agency, and the experiential self includes self-reflection, source monitoring, and self-referential and autobiographical memory. Further, we consider how disturbances in these domains link to the phenomenology of schizophrenia. We identify faulty internal predictive coding as a potential mechanism of disturbance in body ownership and agency, which results in susceptibility to bias (over- or under-attributing outcomes to one's own actions or intentions). This is reflected in reduced activity in the temporoparietal junction (TPJ), a heteromodal association area implicated in several aspects of self-other processing, as well as reduced fronto-parietal functional connectivity. Deficits of the experiential self in schizophrenia may stem from a lack of salience of self-related information, whereby the mental representation of self is not as rich as in healthy controls and therefore does not result in the same level of privileged processing. As a result, memory for self-referential material and autobiographical memory processes is impaired, which hinders creation of a cohesive life narrative. Impairments of the experiential self implicate abnormal activation patterns along the cortical midline, including medial prefrontal cortex and posterior cingulate/precuneus, as well as TPJ. In fact, TPJ appears to be involved in all the reviewed aspects of the self-other disturbance. We conclude with suggestions for future work, including implications for interventions with critical timing considerations.
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Affiliation(s)
- Amy M Jimenez
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, USA; VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, UCLA, USA.
| | - Michael F Green
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, USA; VA Rehabilitation R&D Center on Enhancing Community Integration for Homeless Veterans, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, UCLA, USA
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2
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Wiesepape CN, Smith EA, Hillis-Mascia JD, Queller Soza SE, Morris MM, James AV, Stokes A. Metacognition as a Transdiagnostic Determinant of Recovery in Schizotypy and Schizophrenia Spectrum Disorders. Behav Sci (Basel) 2024; 14:336. [PMID: 38667132 PMCID: PMC11047686 DOI: 10.3390/bs14040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/24/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
The term schizotypy refers to the latent personality organization that is thought to underpin the liability to develop schizophrenia and associated disorders. Metacognition, or the ability to understand and form increasingly complex and integrated ideas of oneself, others, and one's community, has been proposed to be an important transdiagnostic construct across schizophrenia spectrum disorders and a range of both clinical and non-clinical manifestations of schizotypy. In this paper, we review evidence that deficits in metacognition are present in individuals with relatively high levels of schizotypy and that these deficits are related to symptomology, function, and quality of life. We address the idea that decrements in metacognition may also contribute to the progression from schizotypy to more severe manifestations, while the amelioration of these deficits may enhance aspects of recovery, including the ability to form an integrated sense of self, others, and the wider world. We also review the following two recovery-oriented psychotherapies that target metacognition to promote recovery in individuals with clinical manifestations of schizotypy: Evolutionary Systems Therapy for Schizotypy (ESTS) and Metacognitive Reflection and Insight Therapy (MERIT).
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Affiliation(s)
- Courtney N Wiesepape
- Austin VA Clinic, Veterans Affairs Central Texas Health Care, Austin, TX 78744, USA
| | - Elizabeth A Smith
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
| | | | | | - Madyson M Morris
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | | | - Alexis Stokes
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
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3
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Montemagni C, Brasso C, Bellino S, Bozzatello P, Villari V, Rocca P. Conceptual disorganization as a mediating variable between visual learning and metacognition in schizophrenia. Front Psychiatry 2023; 14:1278113. [PMID: 38179251 PMCID: PMC10765532 DOI: 10.3389/fpsyt.2023.1278113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
Objectives The aim of this study was to evaluate the relative contributions of visual learning and conceptual disorganization to specific metacognitive domains in a sample of outpatients with stable schizophrenia. Methods A total of 92 consecutive outpatients with stable schizophrenia were recruited in a cross-sectional study. We analyzed the data with five path analyses based on multiple regressions to analyze the specific effect of visual learning on metacognitive capacity and metacognitive domains and the possible mediating role of conceptual disorganization. Results We found that (i) visual learning was negatively correlated to metacognitive capacity and its domains on the one hand and conceptual disorganization on the other hand; (ii) conceptual disorganization was negatively associated with metacognition and its domains; and (iii) when the mediation effect was considered, conceptual disorganization fully mediated the relationship between visual learning and mastery, whereas it served as a partial mediator of the effect of visual learning on the other metacognition domains, i.e., self-reflectivity, understanding others' mind, and decentration. Conclusion These results delineate an articulated panorama of relations between different dimensions of metacognition, visual learning, and conceptual disorganization. Therefore, studies unable to distinguish between different components of metacognition fail to bring out the possibly varying links between neurocognition, disorganization, and metacognition.
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Affiliation(s)
- Cristiana Montemagni
- Dipartimento di Neuroscienze "Rita Levi Montalcini", Università Degli Studi di Torino, Turin, Italy
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Claudio Brasso
- Dipartimento di Neuroscienze "Rita Levi Montalcini", Università Degli Studi di Torino, Turin, Italy
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Silvio Bellino
- Dipartimento di Neuroscienze "Rita Levi Montalcini", Università Degli Studi di Torino, Turin, Italy
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Paola Bozzatello
- Dipartimento di Neuroscienze "Rita Levi Montalcini", Università Degli Studi di Torino, Turin, Italy
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Vincenzo Villari
- Dipartimento di Neuroscienze "Rita Levi Montalcini", Università Degli Studi di Torino, Turin, Italy
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Paola Rocca
- Dipartimento di Neuroscienze "Rita Levi Montalcini", Università Degli Studi di Torino, Turin, Italy
- Dipartimento di Neuroscienze e Salute Mentale, A.O.U. Città Della Salute e Della Scienza di Torino, Turin, Italy
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4
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Haugen I, Stubberud J, Haug E, McGurk SR, Hovik KT, Ueland T, Øie MG. A randomized controlled trial of Goal Management Training for executive functioning in schizophrenia spectrum disorders or psychosis risk syndromes. BMC Psychiatry 2022; 22:575. [PMID: 36031616 PMCID: PMC9420179 DOI: 10.1186/s12888-022-04197-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Executive functioning is essential to daily life and severely impaired in schizophrenia and psychosis risk syndromes. Goal Management Training (GMT) is a theoretically founded, empirically supported, metacognitive strategy training program designed to improve executive functioning. METHODS A randomized controlled parallel group trial compared GMT with treatment as usual among 81 participants (GMT, n = 39 versus Wait List Controls, n = 42) recruited from an early intervention for psychosis setting. Computer generated random allocation was performed by someone independent from the study team and raters post-intervention were unaware of allocation. The primary objective was to assess the impact of GMT administered in small groups for 5 weeks on executive functioning. The secondary objective was to explore the potential of the intervention in influencing daily life functioning and clinical symptoms. RESULTS GMT improved self-reported executive functioning, measured with the Behavior Rating Inventory of Executive Function - Adult version (BRIEF-A), significantly more than treatment as usual. A linear mixed model for repeated measures, including all partial data according to the principle of intention to treat, showed a significant group x time interaction effect assessed immediately after intervention (post-test) and 6 months after intervention (follow-up), F = 8.40, p .005, r .37. Improvement occurred in both groups in objective executive functioning as measured by neuropsychological tests, functional capacity, daily life functioning and symptoms of psychosis rated by clinicians. Self-reported clinical symptoms measured with the Symptoms Check List (SCL-10) improved significantly more after GMT than after treatment as usual, F = 5.78, p .019, r .29. Two participants withdrew due to strenuous testing and one due to adverse effects. CONCLUSIONS GMT had clinically reliable and lasting effects on subjective executive function. The intervention is a valuable addition to available treatment with considerable gains at low cost. TRIAL REGISTRATION Registered at clinicaltrials.gov NCT03048695 09/02/2017.
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Affiliation(s)
- Ingvild Haugen
- Division of Mental Health Care, Innlandet Hospital Trust, P. O. Box 104, 2381 Brumunddal, Norway
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Department of Research, Lovisenberg Diaconal Hospital, P.O. Box 4970, Nydalen, 0440 Oslo, Norway
| | - Elisabeth Haug
- Division of Mental Health Care, Innlandet Hospital Trust, P. O. Box 104, 2381 Brumunddal, Norway
| | - Susan R. McGurk
- Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, 930 Commonwealth Avenue, Boston, MA 02215 USA
| | - Kjell Tore Hovik
- Division of Mental Health Care, Innlandet Hospital Trust, P. O. Box 104, 2381 Brumunddal, Norway
- Department of Psychology, Inland Norway University of Applied Sciences, P.O.Box 400, Elverum, Norway
| | - Torill Ueland
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Norwegian Centre for Mental Disorders Research, Oslo University Hospital, Postboks 4956, Nydalen, 0424 Oslo, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, P.O. Box 1094, 0317 Oslo, Norway
- Research Division, Innlandet Hospital Trust, P.O. Box 104, 2381 Brumunddal, Norway
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Bonfils KA, Novick DM. Application of Interpersonal and Social Rhythm Therapy (IPSRT) for Depression Associated With Schizophrenia Spectrum Disorders. Am J Psychother 2021; 74:127-134. [PMID: 33445959 DOI: 10.1176/appi.psychotherapy.20200024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with schizophrenia spectrum disorders frequently experience depression, yet depressive symptoms are often unaddressed. The authors propose that interpersonal and social rhythm therapy (IPSRT) may be effective for individuals with these disorders who experience depression. IPSRT is a manualized, evidence-based treatment for bipolar disorders. It combines the core elements of interpersonal psychotherapy for unipolar depression with social rhythm therapy to target disrupted social rhythms. The authors highlight evidence for the potential utility of IPSRT to treat patients with schizophrenia spectrum disorders and present a case example. IPSRT is one promising therapy that could fill a treatment gap for people with schizophrenia spectrum disorders by addressing depressive symptoms. Future work should build on this rationale and case example to design and implement a randomized controlled trial of IPSRT for treatment of schizophrenia spectrum disorders and evaluate needed modifications.
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Affiliation(s)
- Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg (Bonfils); U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Novick)
| | - Danielle M Novick
- School of Psychology, University of Southern Mississippi, Hattiesburg (Bonfils); U.S. Department of Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh (Novick)
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6
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O'Connor LK, Yanos PT. Where are all the psychologists? A review of factors impacting the underrepresentation of psychology in work with serious mental illness. Clin Psychol Rev 2021; 86:102026. [PMID: 33813162 DOI: 10.1016/j.cpr.2021.102026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/18/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
Over the last few decades, clinical psychologists have played a key role in the development of empirically-validated psychosocial interventions for those with serious mental illness (SMI). However, in contrast to these substantial contributions, clinical psychologists in the United States are grossly underrepresented in treatment provision with this population (Roe, Yanos, & Lysaker, 2006; Rollins & Bond, 2001). This review aims to highlight various factors contributing to the establishment and perpetuation of this underrepresentation. First, we highlight systemic factors (e.g., the emergence of managed care) through an examination of the evolving role of the clinical psychologist. Next, we review training-based factors (e.g., limitations to SMI specific training) through a review of training in clinical psychology. Through an examination of training factors, the role of mental health stigma amongst clinicians toward individuals with SMI is identified as a potential perpetuating factor of this underrepresentation. Factors associated with clinician stigma are then reviewed and the relationship between clinical training and clinician stigma is considered. Lastly, important future directions to further investigate and address this underrepresentation are suggested - namely, investigating factors (training and individual) that may impact clinical psychology doctoral students' attitudes toward those with SMI.
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Affiliation(s)
- Lauren K O'Connor
- John Jay College of Criminal Justice, USA; CUNY Graduate Center, USA.
| | - Philip T Yanos
- John Jay College of Criminal Justice, USA; CUNY Graduate Center, USA
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7
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van der Meer L, Jonker T, Wadman H, Wunderink C, van Weeghel J, Pijnenborg GHM, van Setten ERH. Targeting Personal Recovery of People With Complex Mental Health Needs: The Development of a Psychosocial Intervention Through User-Centered Design. Front Psychiatry 2021; 12:635514. [PMID: 33897494 PMCID: PMC8060492 DOI: 10.3389/fpsyt.2021.635514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/25/2021] [Indexed: 12/21/2022] Open
Abstract
Long-term admissions in psychiatric facilities often result in a gradual erosion of the identity of people diagnosed with severe mental illnesses (SMIs) into merely "patient." Moreover, experiences of loss often reduced people's sense of purpose. Although regaining a multidimensional identity and a sense of purpose are essential for personal recovery, few interventions specifically address this, while at the same time take people's often considerable cognitive and communicative disabilities into consideration. This study describes the development process of a new intervention through user-centered design (UCD). UCD is an iterative process in which a product (in this case, an intervention) is developed in close cooperation with future users, such that the final product matches their needs. The design process included three phases: an analysis, design, and evaluation phase. In the analysis phase, the "problem" was defined, users' needs were identified, and design criteria were established. In the design phase, the collected information served as input to create a testable prototype using a process of design and redesign, in close collaboration with service users and other stakeholders. This resulted in an intervention entitled "This is Me" (TiM) in which service users, together with a self-chosen teammate, actively engage in new experiences on which they are prompted to reflect. Finally, in the evaluation phase, TiM was implemented and evaluated in a real-life setting. In a small feasibility pilot, we found indications that some people indeed demonstrated increased reflection on their identity during the intervention. Furthermore, TiM seemed to benefit the relationship between the service users and the mental health professionals with whom they underwent the experiences. The pilot also revealed some aspects of the (implementation of) TiM that can be improved. Overall, we conclude that UCD is a useful method for the development of a new psychosocial intervention. The method additionally increased our knowledge about necessary factors in targeting personal recovery for people with complex mental health needs. Moreover, we conclude that TiM is a promising tool for supporting people with SMI in redeveloping a multidimensional identity and a renewed sense of purpose.
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Affiliation(s)
- Lisette van der Meer
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
| | - Tessa Jonker
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands
| | - Heleen Wadman
- BuurtzorgT Mental Health Institution, Groningen, Netherlands
| | - Charlotte Wunderink
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Research and Innovation Center for Rehabilitation, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Parnassia Group, Parnassia Noord Holland, Castricum, Netherlands.,Phrenos Center of Expertise on Severe Mental Illness, Utrecht, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands.,Department of Psychotic Disorders, GGZ-Drenthe, Assen, Netherlands
| | - Ellie R H van Setten
- Department of Rehabilitation, Lentis Center for Mental Health Care, Zuidlaren, Netherlands.,Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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8
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Subotnik KL, Ventura J, Hellemann GS, Zito MF, Agee ER, Nuechterlein KH. Relationship of poor insight to neurocognition, social cognition, and psychiatric symptoms in schizophrenia: A meta-analysis. Schizophr Res 2020; 220:164-171. [PMID: 32334936 DOI: 10.1016/j.schres.2020.03.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/02/2020] [Accepted: 03/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Poor insight (unawareness) about having a mental disorder is considered to be a core feature of the disorder. Further, poor insight has been associated with another core feature of schizophrenia, neurocognitive deficits. However, previous meta-analyses have shown that poor insight is more strongly related to positive symptoms and social cognition than to neurocognitive functioning. METHOD A meta-analysis of 123 studies of schizophrenia patients (combined n = 14,932) was conducted to determine the magnitude of the relationship between poor insight and neurocognition, social cognition, and positive symptoms, as well as negative symptoms, disorganization, and depression. The neurocognitive constructs were defined empirically using dimensions identified by the MATRICS initiative. RESULTS Meta-analytic findings showed that relationships were weak between poor insight and the six neurocognitive domains (r's range from -0.04 to -0.13), but that poor insight was moderately correlated with one aspect of social cognition, theory of mind (r = -0.23, p < .01). In addition, poor insight was moderately associated with reality distortion (r = 0.28, p < .01), disorganization (r = 0.29, p < .01), and negative symptoms (r = 0.20, p < .01). DISCUSSION Organizing the neurocognitive variables using the MATRICS domains continues to demonstrate that the relationship between insight and neurocognition is relatively weak. In comparison, we found moderate correlations between insight and theory of mind and several symptom domains. These moderate relationships are generally consistent with previous meta-analyses but are demonstrated more rigorously by examining more studies within the same meta-analysis.
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Affiliation(s)
- Kenneth L Subotnik
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America.
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Gerhard S Hellemann
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Michael F Zito
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Elisha R Agee
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Keith H Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America; Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States of America
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10
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Ridenour JM, Hamm JA, Czaja M. A review of psychotherapeutic models and treatments for psychosis. PSYCHOSIS 2019. [DOI: 10.1080/17522439.2019.1615111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Jay A. Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN, USA
| | - Meg Czaja
- Center for Motivation and Change, New Marlborough, MA, USA
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11
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Haram A, Jonsbu E, Hole T, Fosse R. Dialogue therapy in psychosis: A philosophical-ethical approach. NORDIC PSYCHOLOGY 2019. [DOI: 10.1080/19012276.2019.1586570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annbjørg Haram
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Egil Jonsbu
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
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12
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Morgades-Bamba CI, Fuster-Ruizdeapodaca MJ, Molero F. The impact of internalized stigma on the well-being of people with Schizophrenia. Psychiatry Res 2019; 271:621-627. [PMID: 30791334 DOI: 10.1016/j.psychres.2018.12.060] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/07/2018] [Accepted: 12/09/2018] [Indexed: 01/28/2023]
Abstract
Previous research has shown that the internalization of schizophrenia-related stigma is associated with a worse prognosis and more suicidal tendencies. Empirical literature suggests that affective well-being -composed of positive affect (e.g. pride, enthusiasm, vitality, inspiration) and negative affect (e.g. shame, guilt, annoyance, worry)- seems to be the key component which, when being negatively affected by internalized stigma and the subsequent deterioration of self-concept, would lead to more severe symptomatology, lower recovery, and higher risk of suicide. Thus, our aim was to delve into the process by which affective well-being is impacted by the two main dimensions of internalized stigma (stereotype endorsement and alienation), with self-esteem and self-efficacy as mediators. The model was tested by path analysis -maximum likelihood procedure- in a sample of 216 patients. Our results indicate that alienation would entail more damage than stereotype endorsement both on affective well-being and on self-concept. Findings suggest that self-esteem mediates the impact of both internalized stigma dimensions on both types of affect, and that self-efficacy mediates the impact of alienation on positive affect. It is concluded that, in clinical practice, an important effort should be made to prevent internalized stigma (especially, alienation) and to promote positive self-concept of patients (especially, self-esteem).
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Affiliation(s)
| | | | - Fernando Molero
- Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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13
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Haram A, Fosse R, Jonsbu E, Hole T. Impact of Psychotherapy in Psychosis: A Retrospective Case Control Study. Front Psychiatry 2019; 10:204. [PMID: 31031656 PMCID: PMC6470395 DOI: 10.3389/fpsyt.2019.00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background: The need for psychological therapies for psychosis has become apparent since long-term antipsychotic drug treatment has a range of adverse side effects, with moderate therapeutic effects at best. Aims: To investigate whether the psychotherapeutic approach, dialogue therapy (DT) is associated with improvements of symptoms and functioning beyond standard psychiatric treatment (ST) in both schizophrenia and other psychosis. Methods: A retrospective case-control design, comparing 54 patients with different psychoses who received DT with 54 patients in a control group receiving ST was carried out. The groups were matched on diagnosis, age, sex, and treatment start. Outcome measures were Global assessment of functioning (GAF) scores, medications at follow up, and hospital stays after completed outpatient treatment. Results: Mean time in treatment from inclusion to follow-up was 3 years and 5 months. At follow-up, GAF functioning (GAF-F) and GAF symptom (GAF-S) scores both were significantly higher in the DT group than the ST group. Effect sizes (Cohen's d) were large; 1.8 for GAF-S and 2.1 for GAF-F. At follow-up, the use of psychoactive drugs was significantly reduced despite a shorter time in psychotherapy in the DT group compared to the ST group. Days of hospitalizations after end of treatment in the study period were significantly reduced in both groups compared to the period before start of treatment. Conclusions: The findings from this exploratory study are consistent with the possibility that dialogue therapy may lead to improvements in symptoms and functioning compared to standard treatment in psychosis.
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Affiliation(s)
- Annbjørg Haram
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Egil Jonsbu
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Atadokht A, Ebrahimzadeh S, Mikaeeli N. The Effectiveness of Humor Skills Training on Positive and Negative Symptoms of Chronic Schizophrenia Spectrum. JOURNAL OF HOLISTIC NURSING AND MIDWIFERY 2019. [DOI: 10.29252/hnmj.29.1.273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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15
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Breitborde NJK, Moe AM. Optimizing Mental Health Treatment for Emerging Adults with First-Episode Psychosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1080/23794925.2018.1514546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Nicholas J. K. Breitborde
- Departments of Psychiatry & Behavioral Health and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Aubrey M. Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
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Lysaker PH, Gagen E, Moritz S, Schweitzer RD. Metacognitive approaches to the treatment of psychosis: a comparison of four approaches. Psychol Res Behav Manag 2018; 11:341-351. [PMID: 30233262 PMCID: PMC6130286 DOI: 10.2147/prbm.s146446] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual's response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person's relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA,
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,
| | - Emily Gagen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert D Schweitzer
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
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Bjornestad J, Veseth M, Davidson L, Joa I, Johannessen JO, Larsen TK, Melle I, Hegelstad WTV. Psychotherapy in Psychosis: Experiences of Fully Recovered Service Users. Front Psychol 2018; 9:1675. [PMID: 30233476 PMCID: PMC6131645 DOI: 10.3389/fpsyg.2018.01675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 08/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Despite the evidence of the importance of including service users' views on psychotherapy after psychosis, there is a paucity of research investigating impact on full recovery. Objectives: To explore what fully recovered service users found to be the working ingredients of psychotherapy in the recovery process after psychosis. Materials and Methods: The study was designed as a phenomenological investigation with thematic analysis as the practical tool for analysis. Twenty fully recovered service users were interviewed. Results: Themes: (1) Help with the basics, (2) Having a companion when moving through chaotic turf, (3) Creating a common language, (4) Putting psychosis in brackets and cultivate all that is healthy, and (5) Building a bridge from the psychotic state to the outside world. Conclusion: Therapeutic approaches sensitive to stage specific functional challenges seemed crucial for counteracting social isolation and achieving full recovery. Findings indicate that psychotherapy focusing on early readjustment to everyday activities, to what are perceived as meaningful and recovery-oriented, seems to be what is preferred and called for by service users.
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Affiliation(s)
- Jone Bjornestad
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Larry Davidson
- School of Medicine and Institution for Social and Policy Studies, Yale University, New Haven, CT, United States
| | - Inge Joa
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- TIPS – Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
| | - Tor Ketil Larsen
- Department of Clinical Medicine, Section of Psychiatry, University of Bergen, Bergen, Norway
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research, University of Oslo, Oslo, Norway
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Lysaker PH, Zalzala AB, Ladegaard N, Buck B, Leonhardt BL, Hamm JA. A Disorder by Any Other Name: Metacognition, Schizophrenia, and Diagnostic Practice. JOURNAL OF HUMANISTIC PSYCHOLOGY 2018. [DOI: 10.1177/0022167818787881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Humanistic psychology has made us aware that any understanding of schizophrenia must see persons diagnosed with this condition as whole persons who are making sense of what wellness and recovery mean to them. This has raised questions about what the diagnosis of schizophrenia means and whether the diagnostic label of schizophrenia is helpful when we try to conceptualize the actions and aims of treatment. To examine this issue we propose it is essential to consider what is systematically occuring psychologicaly in recovery when persons experience, interpret and agentically respond to emerging challenges. We then review how the integrated model of metacognition provides a systematic, person-centered, evidence-based approach to understanding psychological processes which impact recovery, and discuss how this guides a form of psychotherapy, metacognitive reflection and insight therapy, which promotes metacognitive abilities and support recovery. We suggest this work indicates that metacognitive capacity is something that can be diagnosed without stigmatizing persons. It can be used to meaningfully inform clinical practice across various theoretical models and offers concrete implications for rehabilitation.
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Affiliation(s)
- Paul H. Lysaker
- Roudebush VA Medical Center, Indianapolis IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aieyat B. Zalzala
- Roudebush VA Medical Center, Indianapolis IN, USA
- Purdue University, West Lafayette, IN, USA
| | | | - Benjamin Buck
- Puget Sound VA Health Care System, Seattle, WA, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bethany L. Leonhardt
- Indiana University School of Medicine, Indianapolis, IN, USA
- Eskenazi Health—Midtown Community Mental Health, Indianapolis, IN, USA
| | - Jay A. Hamm
- Purdue University, West Lafayette, IN, USA
- Eskenazi Health—Midtown Community Mental Health, Indianapolis, IN, USA
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Moljord IEO, Lara-Cabrera ML, Salvesen Ø, Rise MB, Bjørgen D, Antonsen DØ, Olsø TM, Evensen GH, Gudde CB, Linaker OM, Steinsbekk A, Eriksen L. Twelve months effect of self-referral to inpatient treatment on patient activation, recovery, symptoms and functioning: A randomized controlled study. PATIENT EDUCATION AND COUNSELING 2017; 100:1144-1152. [PMID: 28096034 DOI: 10.1016/j.pec.2017.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To investigate the effect of having a contract for self-referral to inpatient treatment (SRIT) in patients with severe mental disorders. METHODS A randomized controlled trial with 53 adult patients; 26 participants received a SRIT contract, which they could use to refer themselves into a Community Mental Health Centre up to five days for each referral without contacting a doctor in advance. Outcomes were assessed after 12 months with the self-report questionnaires Patient Activation Measure (PAM-13), Recovery Assessment Scale (RAS), and the Behavior and Symptom Identification Scale (BASIS-32) and analyzed using linear mixed and regression models. RESULTS There was no significant effect on PAM-13 (estimated mean difference (emd) -0.41, 95% CI (CI):-7.49-6.67), nor on the RAS (emd 0.02, CI:-0.27-0.31) or BASIS-32 (0.09, CI:-0.28-0.45). An exploratory post hoc analysis showed effect of SRIT in those with low PAM below ≤47 (p=0.049). CONCLUSION There were no group differences after 12 months, but both groups maintained their baseline levels. PRACTICE IMPLICATIONS SRIT contracts can be recommended as it supports the rights to self-determination, promote user participation in decision-making in own treatment without any indication of adverse effects.
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Affiliation(s)
- I E O Moljord
- Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
| | - M L Lara-Cabrera
- Tiller Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Ø Salvesen
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Trondheim, Norway
| | - M B Rise
- Department of Applied Social Sciences, Faculty of Health and Social Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - D Bjørgen
- KBT, Department of User Experience and Service Development, Trondheim, Norway
| | - D Ø Antonsen
- KBT, Department of User Experience and Service Development, Trondheim, Norway
| | - T M Olsø
- NAPHA, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway
| | - G H Evensen
- NAPHA, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway
| | - C B Gudde
- Department of Brøset, Centre for Research and Education, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Social Work and Health Science, Faculty of Social Science and Technology Management, NTNU, Trondheim, Norway
| | - O M Linaker
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - A Steinsbekk
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Trondheim, Norway
| | - L Eriksen
- Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway; Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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20
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Martins MJRV, Castilho P, Carvalho CB, Pereira AT, Santos V, Gumley A, de Macedo AF. Contextual Cognitive-Behavioral Therapies Across the Psychosis Continuum. EUROPEAN PSYCHOLOGIST 2017. [DOI: 10.1027/1016-9040/a000283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Abstract. Considering several etiologic, therapeutic, and comorbidity-related factors, a psychosis continuum model has been proposed for the understanding and treatment of psychotic disorders. Within the new emerging treatment approaches, Contextual Cognitive-Behavioral Therapies (CCBT) seem to hold promise for the psychosis continuum. However, considering their novelty for this specific population, the quality of efficacy evidence remains unclear. Objective: To examine, critically analyze, and summarize the results from studies based on therapeutic models within the CCBT approach (Mindfulness and Acceptance-based interventions, Compassion-Focused Therapy, Dialectical Behavior Therapy, and Metacognitive Therapy) for patients with a diagnosis within the psychosis continuum (schizophrenia, schizoaffective disorder, bipolar disorder). Methods: Three leading electronic databases (MEDLINE/PUBMED; PsycINFO; Cochrane Library), a grey literature database (OpenGrey), and registered clinical trials (ClinicalTrials.Gov) were searched using combinations of key terms regarding the CCBT models and the diagnosis considered. Reference lists of the relevant studies and reviews were searched. Only Randomized Controlled Trials (RCTs) were included. The “Cochrane Risk of Bias Assessment Tool” was used for quality assessment. Results: A total of 17 articles were included. This review was based on a majority of unclear or low risk of bias studies. Benefits regarding clinical variables such as psychotic symptoms, anxiety and depression, functioning or quality of life were found. Conclusion: Overall the studies supported some benefits of CCBT approaches for the psychosis continuum. The conceptual perspective on treatment has changed, nevertheless the outcomes assessed are still symptom-focused and there is still need for improvement. Methodological considerations and future directions are presented.
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Affiliation(s)
- Maria João Ruivo Ventura Martins
- CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Portugal
| | - Paula Castilho
- CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
| | - Célia Barreto Carvalho
- CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal
- Faculty of Educational Sciences, University of Azores, Portugal
| | | | - Vitor Santos
- Faculty of Medicine, University of Coimbra, Portugal
| | - Andrew Gumley
- Institute of Health and Well-Being, Glasgow University, UK
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21
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Ali A, Carre A, Orri M, Urbach M, Barry C, Hassler C, Falissard B, Berthoz S, Nordon C. The real-life effectiveness of psychosocial therapies on social autonomy in schizophrenia patients: Results from a nationwide cohort study in France. Psychiatry Res 2017; 247:97-104. [PMID: 27886580 DOI: 10.1016/j.psychres.2016.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/20/2016] [Accepted: 10/23/2016] [Indexed: 12/15/2022]
Abstract
The objectives of the present study were to describe the prescribing patterns for psychosocial therapies in routine clinical practice and to assess the impact of psychoeducation on symptoms and social autonomy of patients with schizophrenia. We used data from the nationwide French ESPASS observational cohort study including 5967 patients with schizophrenia, which provided data on exposure to psychosocial therapies from 4961 (83%) participants. Patients who initiated psychosocial therapy within the first 3 months of study onset (n=143) were compared to patients not subject to psychosocial therapy throughout follow up (n=4268), using parametric tests. Symptom severity and social autonomy at 6 months from baseline were compared between patients undergoing psychoeducation (n=117) and patients not subject to psychosocial therapy, matched (1:1) on propensity scores. Patients who initiated psychosocial therapy were significantly younger, more severely ill and used less often antipsychotic drugs than patients in the reference group. At 6 months, patients who initiated psychoeducation and their matched referents did not differ significantly in terms of symptom severity, but their level of improvement in social autonomy was significantly greater (p=0.005). In routine clinical practice, psychoeducation in addition to antipsychotic drugs provides some benefit among schizophrenia patients, particularly in terms of social autonomy.
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Affiliation(s)
- Aminata Ali
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Arnaud Carre
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France; Savoie Mont Blanc University, LIPP C2S EA 4145, Domaine Universitaire de Jacob, BP1104, 73000 Chambéry, France
| | - Massimiliano Orri
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Mathieu Urbach
- Centre Expert Schizophrénie, Versailles Hospital Centre,177 rue de Versailles, 78157 Le Chesnay cedex, France
| | - Caroline Barry
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Christine Hassler
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Bruno Falissard
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France
| | - Sylvie Berthoz
- Institute for Cognitive and Integrative Neuroscience, 146 rue Léo Saignat, 33000 Bordeaux, France
| | - Clementine Nordon
- CESP, Paris-Sud University, Paris-Saclay University, INSERM, 16 avenue Paul Vaillant-Couturier, 94805 Villejuif, France; LASER Analytica, 10 place de Catalogne, 75014 Paris, France.
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22
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Firmin RL, Luther L, Lysaker PH, Salyers MP. Veteran identity as a protective factor: A grounded theory comparison of perceptions of self, illness, and treatment among veterans and non-veterans with schizophrenia. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1231642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ruth L. Firmin
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Lauren Luther
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Paul H. Lysaker
- Roudebush VA Medical Center, Indianapolis, Indiana, USA
- Department of Psychology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michelle P. Salyers
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, Indiana, USA
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Luther L, Firmin RL, Minor KS, Vohs JL, Buck B, Buck KD, Lysaker PH. Metacognition deficits as a risk factor for prospective motivation deficits in schizophrenia spectrum disorders. Psychiatry Res 2016; 245:172-178. [PMID: 27543831 DOI: 10.1016/j.psychres.2016.08.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 01/19/2023]
Abstract
Although motivation deficits are key determinants of functional outcomes, little is known about factors that contribute to prospective motivation in people with schizophrenia. One candidate factor is metacognition, or the ability to form complex representations about oneself, others, and the world. This study aimed to assess whether metacognition deficits were a significant predictor of reduced prospective motivation, after controlling for the effects of baseline motivation, anticipatory pleasure, and antipsychotic medication dose. Fifty-one participants with a schizophrenia spectrum disorder completed measures of metacognition and anticipatory pleasure at baseline; participants also completed a measure of motivation at baseline and six months after the initial assessment. Baseline antipsychotic dose was obtained from medical charts. Hierarchical regression analysis revealed that lower levels of baseline metacognition significantly predicted reduced levels of motivation assessed six months later, after controlling for baseline levels of motivation, anticipatory pleasure, and antipsychotic dose. Higher baseline antipsychotic dose was also a significant predictor of reduced six month motivation. Results suggest that metacognition deficits and higher antipsychotic dose may be risk factors for the development of motivation deficits in schizophrenia. Implications include utilizing interventions to improve metacognition in conjunction with evaluating and possibly lowering antipsychotic dose for people struggling with motivation deficits.
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Affiliation(s)
- Lauren Luther
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States.
| | - Ruth L Firmin
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Kyle S Minor
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, IN, United States; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Eskenazi Hospital, Indianapolis, IN, United States; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, United States
| | - Benjamin Buck
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kelly D Buck
- Richard L. Roudebush Veteran's Affairs Medical Center, Indianapolis, IN, United States
| | - Paul H Lysaker
- Indiana University School of Medicine, Indianapolis, IN, United States; Richard L. Roudebush Veteran's Affairs Medical Center, Indianapolis, IN, United States
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Leonhardt BL, Kukla M, Belanger E, Chaudoin-Patzoldt K, Buck KD, Minor KS, Vohs J, Hamm JA, Lysaker PH. Emergence of psychotic content in psychotherapy: An exploratory qualitative analysis of content, process, and therapist variables in a single case study. Psychother Res 2016; 28:264-280. [DOI: 10.1080/10503307.2016.1219421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Bethany L. Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Elizabeth Belanger
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, USA
| | | | | | - Kyle S. Minor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
| | - Jenifer L. Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Jay A. Hamm
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Paul H. Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Roudebush VA Medical Center, Indianapolis, IN, USA
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Abarzúa M, Silva M, Navarro D, Krause M. Psychotherapy from the perspective of Chilean patients with schizophrenia /Psicoterapia desde la perspectiva de pacientes chilenos con esquizofrenia. STUDIES IN PSYCHOLOGY 2016. [DOI: 10.1080/02109395.2016.1189204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Affective empathy in schizophrenia: a meta-analysis. Schizophr Res 2016; 175:109-117. [PMID: 27094715 DOI: 10.1016/j.schres.2016.03.037] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/24/2016] [Accepted: 03/30/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Affective empathy, or the emotional response one has to the experiences or emotional states of others, contributes to relationship-maintaining behaviors and is key in fostering social connections, yet no work has synthesized the body of literature for people with schizophrenia. The aim of the present meta-analysis was to determine the extent to which those diagnosed with schizophrenia experience deficits in affective empathy. METHODS A literature search was conducted of studies examining empathy. Data were analyzed using a random effects meta-analytic model with Hedges' g standardized mean difference effect size. RESULTS Individuals with schizophrenia exhibited significant, medium deficits in affective empathy (k=37). Measurement type moderated the affective empathy deficit such that performance-based measures showed larger schizophrenia group deficits than self-report measures. CONCLUSION Consistent, significant deficits in affective empathy were found comparing people with schizophrenia to healthy controls, especially when using performance-based assessments. The medium effect suggests an important role for empathy in the realm of social cognitive research, and points to the need for further investigation of measurement techniques and associations with functional outcomes.
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Dubreucq J, Delorme C, Roure R. Metacognitive Therapy Focused on Psychosocial Function in Psychosis. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9334-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Metacognitive Reflective and Insight Therapy for a Person Who Gained Maximal Levels of Metacognitive Capacity and Was Able to Terminate Therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9322-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Disorganization and Individual Psychotherapy for Schizophrenia: A Case Report of Metacognitive Reflection and Insight Therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9326-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Mosiołek A, Gierus J, Koweszko T, Szulc A. Cognitive impairment in schizophrenia across age groups: a case-control study. BMC Psychiatry 2016; 16:37. [PMID: 26908293 PMCID: PMC4765123 DOI: 10.1186/s12888-016-0749-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 02/12/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The potential dynamics of cognitive impairment in schizophrenia is discussed in the literature of the field. Recent publications suggest modest changes in level of cognitive impairment after first psychotic episode. Present article attempts to explore cognitive differences between patients and controls across age groups and differences between age groups in clinical group. METHODS One hundred and twenty-eight hospitalized patients with schizophrenia (64 women and 64 men) and 68 individuals from the control group (32 women and 32 men) aged 18-55 years were examined. The patients were divided into age groups (18-25, 26-35, 36-45, 46-55). Both groups were examined using Wisconsin Card Sorting Test, Rey Auditory Verbal Learning Test, Rey Osterrieth Complex Figure Test, Trail Making Test (A and B), Stroop Test, verbal fluency test and Wechsler digit span. RESULTS Patients with schizophrenia obtained significantly lower scores versus the control group in regard to all the measured cognitive functions (Mann-Whitney U; p < 0.05. Most deficits were present in all age groups, however, statistically important impairment in executive functions (WCST) were present only in "older" groups. CONCLUSIONS Patients with schizophrenia obtained less favourable results than the control group in all age groups. Deficits regarding executive functions do not seem to be at a significant level among the youngest group, whereas they are more noticeable in the group of 46-55-year-olds. Executive functions are significantly lowered in the group aged 36-45 in comparison to the "younger" groups. The level of cognitive functions shows a mild exacerbation in connection with age, whereas cognitive rigidity proved to be related to the number of years spent without hospital treatment.
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Affiliation(s)
- Anna Mosiołek
- Clinic of Psychiatry, Department of Health Sciences, Medical University of Warsaw, Ul. Partyzantów 2/4, Pruszków, 05-802, Poland.
| | - Jacek Gierus
- Clinic of Psychiatry, Department of Health Sciences, Medical University of Warsaw, Ul. Partyzantów 2/4, Pruszków, 05-802, Poland.
| | - Tytus Koweszko
- Clinic of Psychiatry, Department of Health Sciences, Medical University of Warsaw, Ul. Partyzantów 2/4, Pruszków, 05-802, Poland.
| | - Agata Szulc
- Clinic of Psychiatry, Department of Health Sciences, Medical University of Warsaw, Ul. Partyzantów 2/4, Pruszków, 05-802, Poland.
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31
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She P, Zeng H, Yang B. Effect of self-consistency group intervention for adolescents with schizophrenia: An inpatient randomized controlled trial. J Psychiatr Res 2016; 73:63-70. [PMID: 26688437 DOI: 10.1016/j.jpsychires.2015.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of the study was to explore the efficacy of structural group therapy on the self-consistency and congruence of inpatient adolescents with a diagnosis of schizophrenia. METHOD Sixty inpatient adolescents with schizophrenia were randomly assigned to an intervention group (n = 30) and a control group (n = 30). The intervention group was provided with a 12-session structural group therapy program for six weeks (1 h, two times per week), while the control group participated in a handicraft group. All patients were assessed with the Self-Consistency and Congruence Scale (SCCS) and the Positive and Negative Syndrome Scale (PANSS) at pretest, posttest, three-month and one-year follow-up. The results were analyzed using t-test and repeated measures ANOVA. FINDINGS The two groups had no significant difference at the pre-test of outcome measures (p > 0.05). Significant differences existed between the two groups in ego-dystonic, self-flexibility, SCCS scores, positive syndrome, general psychopathology and PANSS scores after the intervention (p < 0.05). At the three-month follow-up, ego-dystonic, self-flexibility and PANSS scores were also found to be significantly different between the two groups (p < 0.05). But the outcome measures were not significantly different between the two groups at the one-year follow-up. CONCLUSION Structural group therapy in a mental health setting had a positive effect on improving self-consistency and congruence, positive symptoms and general psychopathology of inpatient adolescents with a diagnosis of schizophrenia.
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Affiliation(s)
- Pan She
- HOPE School of Nursing, Wuhan University, Hubei Province, PR China.
| | - Hongling Zeng
- Department of Children and Adolescent, Wuhan Mental Health Center, Hubei Province, PR China.
| | - Bingxiang Yang
- HOPE School of Nursing, Wuhan University, Hubei Province, PR China.
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32
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Luther L, Firmin RL, Vohs JL, Buck KD, Rand KL, Lysaker PH. Intrinsic motivation as a mediator between metacognition deficits and impaired functioning in psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2016; 55:332-47. [PMID: 26756621 DOI: 10.1111/bjc.12104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/21/2015] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Poor functioning has long been observed in individuals with psychosis. Recent studies have identified metacognition - one's ability to form complex ideas about oneself and others and to use that information to respond to psychological and social challenges-as being an important determinant of functioning. However, the exact process by which deficits in metacognition lead to impaired functioning remains unclear. This study first examined whether low intrinsic motivation, or the tendency to pursue novel experiences and to engage in self-improvement, mediates the relationship between deficits in metacognition and impaired functioning. We then examined whether intrinsic motivation significantly mediated the relationship when controlling for age, education, symptoms, executive functioning, and social cognition. DESIGN Mediation models were examined in a cross-sectional data set. METHODS One hundred and seventy-five individuals with a psychotic disorder completed interview-based measures of metacognition, intrinsic motivation, symptoms, and functioning and performance-based measures of executive functioning and social cognition. RESULTS Analyses revealed that intrinsic motivation mediated the relationship between metacognition deficits and impaired functioning (95% CI of indirect effect [0.12-0.43]), even after controlling for the aforesaid variables (95% CI of indirect effect [0.04-0.29]). CONCLUSIONS Results suggest that intrinsic motivation may be a mechanism that underlies the link between deficits in metacognition and impaired functioning and indicate that metacognition and intrinsic motivation may be important treatment targets to improve functioning in individuals with psychosis. PRACTITIONER POINTS The findings of this study suggest that deficits in metacognition may indirectly lead to impaired functioning through their effect on intrinsic motivation in individuals with psychosis. Psychological treatments that target deficits in both metacognition and intrinsic motivation may help to alleviate impaired functioning in individuals with psychosis. LIMITATIONS The cross-sectional design of this study is a limitation, and additional longitudinal studies are needed to confirm the direction of the findings and rule out rival hypotheses. Generalization of the findings may be limited by the sample composition. It may be that different relationships exist between metacognition, intrinsic motivation, and functioning in those with early psychosis or among those in an acute phase or who decline treatment.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Ruth L Firmin
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Jenifer L Vohs
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Eskenazi Hospital, Indianapolis, Indiana, USA.,Larue D. Carter Memorial Hospital, Indiana University Psychotic Disorders Research Program, Indianapolis, Indiana, USA
| | - Kelly D Buck
- Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Indiana University School of Medicine, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
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33
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Kennedy A, Ellerby M. A Compassion-Focused Approach to Working With Someone Diagnosed With Schizophrenia. J Clin Psychol 2015; 72:123-31. [PMID: 26662840 DOI: 10.1002/jclp.22251] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case report is a shared, compassion-focused therapy account between a therapist and someone with a 20-year history of schizophrenia. It shows the usefulness of compassion in facilitating the courage to address the worst symptoms of psychosis. It does this by promoting a mindfulness of mind and emotional regulation. This approach helped create an alternative position from which to ground and anchor the self so psychotic fears were less able to dominate.
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34
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de Jong S, van Donkersgoed R, Pijnenborg GHM, Lysaker PH. Metacognitive Reflection and Insight Therapy (MERIT) With a Patient With Severe Symptoms of Disorganization. J Clin Psychol 2015; 72:164-74. [PMID: 26636663 DOI: 10.1002/jclp.22249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
One recent development within the realm of psychotherapeutic interventions for schizophrenia has been a shift in focus from symptom management to consideration of metacognition, or the processes by which people synthesize information about themselves and others in an integrated manner. One such approach, metacognitive reflection and insight therapy (MERIT); in particular, offers a description of 8 therapeutic activities that should occur in each session, resulting in the stimulation and growth of metacognitive capacity. In this report, we present a description of 12 sessions with a patient suffering from schizophrenia manifesting significantly disorganized symptoms. Each MERIT element is described along with observed clinical and metacognitive gains. As illustrated in this report, these procedures helped the patient move from a state of having no complex ideas about himself or others, to one in which he could begin to develop integrated and realistic ideas about himself and others and use that capacity to think about life challenges.
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Affiliation(s)
| | | | | | - Paul H Lysaker
- Roudeboush VA Medical Center.,Indiana University School of Medicine
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35
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Lysaker PH, Kukla M, Dubreucq J, Gumley A, McLeod H, Vohs JL, Buck KD, Minor KS, Luther L, Leonhardt BL, Belanger EA, Popolo R, Dimaggio G. Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and self-expectation of goal attainment. Schizophr Res 2015; 168:267-72. [PMID: 26164820 DOI: 10.1016/j.schres.2015.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 01/19/2023]
Abstract
The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale-Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Marina Kukla
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Julien Dubreucq
- Center of Reference for Psychosocial Rehabilitation, CH Alpes Isère, Grenoble, France; Réseau Handicap Psychique (RéHPsy), Grenoble, France.
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jenifer L Vohs
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Wishard Hospital, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA.
| | - Kelly D Buck
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA.
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Elizabeth A Belanger
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH 109, Indianapolis, IN 46227, USA.
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
| | - Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
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36
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Luther L, Fukui S, Firmin RL, McGuire AB, White DA, Minor KS, Salyers MP. Expectancies of success as a predictor of negative symptoms reduction over 18 months in individuals with schizophrenia. Psychiatry Res 2015; 229:505-10. [PMID: 26162662 DOI: 10.1016/j.psychres.2015.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/09/2015] [Accepted: 06/21/2015] [Indexed: 11/30/2022]
Abstract
Negative symptoms are often enduring and lead to poor functional outcomes in individuals with schizophrenia. The cognitive model of negative symptoms proposes that low expectancies of success contribute to the development and maintenance of negative symptoms; however, longitudinal investigations assessing these beliefs and negative symptoms are needed. The current study examined whether an individual's baseline expectancies of success - one's beliefs about future success and goal attainment - predicted negative symptoms reduction over 18 months in individuals with schizophrenia-spectrum disorders (n=118). Data were collected at baseline, 9 months, and 18 months as part of a randomized controlled trial of Illness Management and Recovery. A mixed effects regression analysis revealed a significant reduction in negative symptoms over time, with a significant interaction effect between time and baseline expectancies of success. After controlling for baseline negative symptoms, demographic variables, and treatment conditions, those with high and moderate baseline expectancies of success evidenced a significant reduction in negative symptoms at 18 months, while those with low baseline expectancies of success did not evidence reduced negative symptoms. Findings support the cognitive model of negative symptoms and suggest that expectancies of success may be a useful treatment target for interventions aimed at reducing negative symptoms.
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Affiliation(s)
- Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, LD 124, 402 N. Blackford Street, Indianapolis, IN, USA.
| | - Sadaaki Fukui
- Center for Mental Health Research and Innovation, University of Kansas School of Social Welfare, Lawrence, KS, USA
| | - Ruth L Firmin
- Department of Psychology, Indiana University-Purdue University Indianapolis, LD 124, 402 N. Blackford Street, Indianapolis, IN, USA
| | - Alan B McGuire
- Department of Psychology, Indiana University-Purdue University Indianapolis, LD 124, 402 N. Blackford Street, Indianapolis, IN, USA; Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Dominique A White
- Department of Psychology, Indiana University-Purdue University Indianapolis, LD 124, 402 N. Blackford Street, Indianapolis, IN, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, LD 124, 402 N. Blackford Street, Indianapolis, IN, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, LD 124, 402 N. Blackford Street, Indianapolis, IN, USA
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37
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Bourdeau G, Lecomte T, Lysaker PH. Stages of recovery in early psychosis: Associations with symptoms, function, and narrative development. Psychol Psychother 2015; 88:127-42. [PMID: 25139504 DOI: 10.1111/papt.12038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 06/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study sought to explore the links between recovery stages, symptoms, function, and narrative development among individuals with a recent onset of psychosis. DESIGN A qualitative longitudinal study was conducted including quantitative data at baseline. METHODS Forty-seven participants were administered the Indiana Psychiatric Illness Interview three times over 9 months and content analysis was performed. Participants also completed the Social Functioning Scale, the Brief Psychiatric Rating Scale--Expanded, the California Verbal Learning Test, and the Trailing Making Test at baseline. Descriptive discriminant analysis was performed. RESULTS Results suggested that participants were mostly in the first two stages of recovery (moratorium, awareness) and that being in the awareness, rather than moratorium, stage was associated, to a different extent, with richer narrative development, better levels of psychosocial function, less negative and positive symptoms, and more years of education. Furthermore, recovery appeared to be a stable process over the assessment period. CONCLUSIONS Recovery is a complex concept including objective and subjective aspects. In the recovery path of persons recently diagnosed with psychosis, social engagement, narrative development, and occupational functioning seem to be particularly important aspects. This study is a first step, and future research is needed with larger and more diverse participant pools, and assessments conducted over longer periods of time. PRACTITIONER POINTS As greater level of social engagement was the most robust predictor of membership in the awareness versus moratorium stage, treatment of early psychosis should include interventions targeting social relations and social skills. As greater narrative development was the second most robust predictor, enhancing it via psychotherapy could be a pertinent clinical goal.
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Affiliation(s)
| | - Tania Lecomte
- Department of Psychology, University of Montréal, Québec, Canada
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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38
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Avdi E, Lerou V, Seikkula J. Dialogical Features, Therapist Responsiveness, and Agency in a Therapy for Psychosis. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2015. [DOI: 10.1080/10720537.2014.994692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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39
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Bo S, Kongerslev M, Dimaggio G, Lysaker PH, Abu-Akel A. Metacognition and general functioning in patients with schizophrenia and a history of criminal behavior. Psychiatry Res 2015; 225:247-53. [PMID: 25582967 DOI: 10.1016/j.psychres.2014.12.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 11/09/2014] [Accepted: 12/21/2014] [Indexed: 01/17/2023]
Abstract
Metacognitive difficulties have been linked to social dysfunction in schizophrenia. However, research examining the role of metacognition in the social functioning of patients with a history of violence and criminality is very limited. This research is especially important for this group given their relatively poor prognosis and their risk to reoffend, as well as the promising benefits of integrating metacognitive approaches in psychosocial treatments. In this study, the association between metacognition and global social functioning was examined in 79 patients with schizophrenia with a criminal background. We also examined the association of positive, negative and disorganized symptoms with social functioning and the extent to which metacognition mediates this association. The results indicate that poor social functioning is associated with metacognitive difficulties and higher levels of delusions and Conceptual Disorganization. In addition, meditation analyses showed that metacognition accounted for about 11% of the total effect size of the association between delusions and social dysfunction, suggesting that the relationship between delusions and social dysfunction is partially driven by impaired metacognition. These findings underscore the importance of interventions designed to enhance the patients׳ metacognitive capacities, that is, the more proximal capacities linked to poorer social functioning.
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Affiliation(s)
- Sune Bo
- Psychiatric Research Unit, Region Zealand, Roskilde, Denmark.
| | | | | | - Paul H Lysaker
- Roudebush VA Medical Center and the Indiana University School of Medicine, Indianapolis, USA
| | - Ahmad Abu-Akel
- School of Psychology, University of Birmingham, Birmingham, UK
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40
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Effects on cognitive and clinical insight with the use of Guided Self-Determination in outpatients with schizophrenia: A randomized open trial. Eur Psychiatry 2015; 30:655-63. [PMID: 25601635 DOI: 10.1016/j.eurpsy.2014.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/18/2014] [Accepted: 12/21/2014] [Indexed: 01/04/2023] Open
Abstract
Poor insight has a negative impact on the outcome in schizophrenia; consequently, poor insight is a logical target for treatment. However, neither medication nor psychosocial interventions have been demonstrated to improve poor insight. A method originally designed for diabetes patients to improve their illness management, Guided Self-Determination (GSD), has been adapted for use in patients with schizophrenia (GSD-SZ). The purpose of this study was to investigate the effect on insight of GSD-SZ as a supplement to treatment as usual (TAU) as compared to TAU alone in outpatients diagnosed with schizophrenia. The design was an open randomized trial. The primary hypothesis was cognitive insight would improve in those patients who received GSD-SZ+TAU as assessed by the BCIS. We additionally explored whether the intervention led to changes in clinical insight, self-perceived recovery, self-esteem, social functioning and symptom severity. Assessments were conducted at baseline, and at 3-, 6- and 12-month follow-up. Analysis was based on the principles of intention to treat and potential confounders were taken into account through applying a multivariate approach. A total of 101 participants were randomized to GSD-SZ+TAU (n=50) or to TAU alone (n=51). No statistically significant differences were found on the cognitive insight. However, at 12-month follow-up, clinical insight (measured by G12 from the Positive and Negative Syndrome Scale), symptom severity, and social functioning had statistically significantly improved in the intervention group as compared to the control group. "Improving insight in patients diagnosed with schizophrenia", NCT01282307, http://clinicaltrials.gov/.
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Bargenquast R, Schweitzer RD, Drake S. Reawakening Reflective Capacity in the Psychotherapy of Schizophrenia: A Case Study. J Clin Psychol 2015; 71:136-45. [DOI: 10.1002/jclp.22149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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42
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Gonzalez MT, Andvig E. Experiences of Tenants with Serious Mental Illness Regarding Housing Support and Contextual Issues: A Meta-Synthesis. Issues Ment Health Nurs 2015; 36:971-88. [PMID: 26735505 DOI: 10.3109/01612840.2015.1067262] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to analyze and synthesize findings from qualitative studies that explored the experiences of tenants with serious mental illness regarding housing support and contextual issues. Twenty-four articles were identified using a systematic search strategy. The total number of informants was N = 769. The reported findings were transcribed and analyzed using a systematic text condensation approach. The tenants' experiences were categorized into two main categories and subcategories (in parenthesis): Support Issues (Experience of Support Needs, Experiences with Receiving Support, Experiences with Support Approach) and Contextual Issues (Neighborhood Experiences, Community Experiences). The subcategories, with themes and subthemes, offer an in-depth understanding of the tenants' complex experiences concerning housing support and contextual issues.
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Affiliation(s)
| | - Ellen Andvig
- b Buskerud and Vestfold University College , Faculty of Health Sciences , Drammen , Norway
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43
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Hillis JD, Leonhardt BL, Vohs JL, Buck KD, Salvatore G, Popolo R, Dimaggio G, Lysaker PH. Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. J Clin Psychol 2014; 71:125-35. [PMID: 25557425 DOI: 10.1002/jclp.22148] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal-directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges.
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Cai C, Yu L, Rong L, Zhong H. Effectiveness of humor intervention for patients with schizophrenia: a randomized controlled trial. J Psychiatr Res 2014; 59:174-8. [PMID: 25266473 DOI: 10.1016/j.jpsychires.2014.09.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The primary aim of this pilot study was to evaluate the possible therapeutic effects of a 10-session humor intervention program in improving rehabilitative outcomes and the effects of the intervention on patients' sense of humor among patients with schizophrenia. METHOD Thirty subjects were randomly assigned into either the intervention (humor skill training) group (n = 15) or the control (doing handwork) group (n = 15). The results were analyzed using descriptive statistics, t-tests and ANOVA. FINDINGS Repeated measures analysis of variance (ANOVA) tests were conducted to examine the differences across conditions and time. A group by time interaction effect was observed on all of the outcomes, except positive symptoms of PANSS. The time main effect was also significant on the total score (p < 0.005) and the negative symptoms score (p < 0.001) of the PANSS. CONCLUSIONS The implementation of humor skill training in a mental health service can improve rehabilitative outcomes and sense of humor for schizophrenia patients who were in the rehabilitation stage.
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Affiliation(s)
- Chunfeng Cai
- HOPE School of Nursing, Wuhan University, Wuhan 430071, China.
| | - Liping Yu
- HOPE School of Nursing, Wuhan University, Wuhan 430071, China
| | - Lan Rong
- Wuhan City Mental Health Center, Wuhan, China
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45
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Ogden LP. "My life as it is has value": narrating schizophrenia in later years. QUALITATIVE HEALTH RESEARCH 2014; 24:1342-1355. [PMID: 25186771 DOI: 10.1177/1049732314546752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
I used thematic narrative analysis, informed by the developmental life course perspective, to formulate a line of semistructured questioning for interviews with 6 older adults who experienced ongoing symptoms of schizophrenia. From the 31 resulting interviews and 38 observation points, I developed life history narratives that yielded findings across four shared core themes. In this article I present my findings on the theme of narrative insight into schizophrenia in later years. Whereas only 2 of the participants had clinical insight into their mental illness, all had developed personal stories about their lives with schizophrenia. I discuss the significance of the shared narrative profile and the importance of using narrative insight to develop more effective clinical practices and to focus future research with older adults with schizophrenia.
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46
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Fogley R, Warman D, Lysaker PH. Alexithymia in schizophrenia: associations with neurocognition and emotional distress. Psychiatry Res 2014; 218:1-6. [PMID: 24794152 DOI: 10.1016/j.psychres.2014.04.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 02/18/2014] [Accepted: 04/07/2014] [Indexed: 11/27/2022]
Abstract
While alexithymia, or difficulties identifying and describing affect, has been commonly observed in schizophrenia, little is known about its causes and correlates. To test the hypothesis that deficits in emotion identification and expression result from, or are at least related to, deficits in neurocognition and affective symptoms, we assessed alexithymia using the Toronto Alexithymia Scale (TAS-20), symptoms using the Positive and Negative Syndrome Scale (PANSS), and neurocognition using the MATRICS battery among 65 adults with schizophrenia spectrum disorders in a non-acute phase of illness. Partial correlations controlling for the effects of social desirability revealed that difficulty identifying feelings and externally oriented thinking were linked with greater levels of neurocognitive deficits, while difficulty describing feelings was related to heightened levels of emotional distress. To explore whether neurocognition and affective symptoms were uniquely related to alexithymia, a multiple regression was conducted in which neurocognitive scores and affective symptoms were allowed to enter to predict overall levels of alexithymia after controlling for social desirability. Results revealed both processing speed and anxiety uniquely contributed to the prediction of the total score on the TAS-20. Results suggest that dysfunctions in both cognitive and affective processes may be related to alexithymia in schizophrenia independently of one another.
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Affiliation(s)
- Rebecca Fogley
- University of Indianapolis, School of Psychological Sciences, Indianapolis, IN, USA
| | - Debbie Warman
- University of Indianapolis, School of Psychological Sciences, Indianapolis, IN, USA
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
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Kukla M, Lysaker PH, Roe D. Strong subjective recovery as a protective factor against the effects of positive symptoms on quality of life outcomes in schizophrenia. Compr Psychiatry 2014; 55:1363-8. [PMID: 24939703 DOI: 10.1016/j.comppsych.2014.04.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Interest in recovery from schizophrenia has been growing steadily, with much of the focus on remission from psychotic symptoms and a return to functioning. Less is known about the experience of subjective recovery and its relationships with other important outcomes, such as quality of life and the formation and sustenance of social connections. This study sought to address this gap in knowledge by examining the links between self perceived recovery, symptoms, and the social components of quality of life. METHODS Sixty eight veterans with schizophrenia-spectrum disorders who were participating in a study of cognitive remediation and work were concurrently administered the Recovery Assessment Scale, Positive and Negative Syndrome Scale, and the Heinrichs-Carpenter Quality of Life Scale (QLS). RESULTS Linear regression analyses demonstrated that subjective recovery moderated the relationship between positive symptoms and both QLS intrapsychic foundations scores and QLS instrumental role functioning after controlling for negative symptoms. Further examination of this interaction revealed that for individuals with substantial positive symptoms, higher levels of subjective recovery were associated with better instrumental role functioning and intrapsychic foundational abilities. CONCLUSION Greater self perceived recovery is linked with stronger quality of life, both in regards to the cognitive and affective bases for socialization and active community involvement, even in the presence of substantial psychotic symptoms. Clinical implications of these findings are discussed.
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Affiliation(s)
- Marina Kukla
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center; Indiana University-Purdue University Indianapolis, Department of Psychology
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center; Indiana School of Medicine
| | - David Roe
- Department of Community Mental Health, University of Haifa, Israel
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McLeod HJ, Gumley AI, Macbeth A, Schwannauer M, Lysaker PH. Metacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis. J Psychiatr Res 2014; 54:109-15. [PMID: 24725651 DOI: 10.1016/j.jpsychires.2014.03.018] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 03/12/2014] [Accepted: 03/19/2014] [Indexed: 12/24/2022]
Abstract
The negative symptoms of schizophrenia are a major source of impairment and distress but both pharmacological and psychological treatment options provide only modest benefit. Developing more effective psychological treatments for negative symptoms will require a more sophisticated understanding of the psychological processes that are implicated in their development and maintenance. We extended previous work by demonstrating that metacognitive functioning is related to negative symptom expression across the first 12 months of first episode psychosis (FEP). Previous studies in this area have either been cross-sectional or have used much older participants with long-standing symptoms. In this study, forty-five FEP participants were assessed three times over 12 months and provided data on PANSS rated symptoms, premorbid adjustment, metacognitive functioning, and DUP. Step-wise linear regression showed that adding metacognition scores to known predictors of negative symptoms (baseline symptom severity, gender, DUP, and premorbid academic and social adjustment) accounted for 62% of the variance in PANSS negative symptom scores at six months and 38% at 12 months. The same predictors also explained 47% of the variance in positive symptoms at both six and 12 months. However, exploration of the simple correlations between PANSS symptom scores and metacognition suggests a stronger univariate relationship between metacognition and negative symptoms. Overall, the results indicate that problems with mental state processing may be important determinants of negative symptom expression from the very early stages of psychosis. These results provide further evidence that metacognitive functioning is a potentially relevant target for psychological interventions.
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Affiliation(s)
- Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK.
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Academic Centre, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK.
| | - Angus Macbeth
- NHS Grampian, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK; University of Aberdeen, Psychiatry Research Group, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen AB25 2ZD, UK.
| | - Matthias Schwannauer
- Section of Clinical & Health Psychology, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Paul H Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, USA; Department of Psychiatry, Indiana University School of Medicine, USA.
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Is living with psychosis demoralizing? Insight, self-stigma, and clinical outcome among people with schizophrenia across 1 year. J Nerv Ment Dis 2014; 202:521-9. [PMID: 24933416 DOI: 10.1097/nmd.0000000000000160] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lack of insight is a major target in the treatment of schizophrenia. However, insight may have undesirable effects on self-concept and motivation that can hinder recovery. This study aimed to examine the link between insight, self-stigma, and demoralization as predictors of symptoms and functioning. Insight, self-stigma, depressive and psychotic symptoms, and functioning were assessed among 133 outpatients with schizophrenia at baseline and 12 months later. The data were analyzed by hierarchical multiple linear regressions. More insight at baseline and an increase in self-stigma over 12 months predicted more demoralization at follow-up. Insight at baseline was not associated with any outcome variable, but self-stigma at baseline was related to poorer functioning and more positive symptoms at follow-up. More demoralization at baseline predicted poorer functioning 12 months later. Demoralization did not mediate the relationship between self-stigma at baseline and functioning after 1 year. Given the decisive role of self-stigma regarding recovery from schizophrenia, dysfunctional beliefs related to illness and the self should be addressed in treatment. Different psychotherapeutical approaches are discussed.
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Ringer JM, Buchanan EE, Olesek K, Lysaker PH. Anxious and avoidant attachment styles and indicators of recovery in schizophrenia: associations with self-esteem and hope. Psychol Psychother 2014; 87:209-21. [PMID: 23913519 DOI: 10.1111/papt.12012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 06/26/2013] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Having an insecure attachment style in schizophrenia has been linked to treatment response and symptom severity in schizophrenia. This study sought to further examine whether attachment style is related to subjective indicators of recovery including hope and self-esteem, independent of symptom level and secondly, whether attachment style in schizophrenia differs from attachment style of persons facing adversity in the form of a prolonged non-psychiatric medical illness. DESIGN Participants were 52 men with schizophrenia, and 26 with HIV/AIDS who had no history of experiencing severe mental illness. These groups were compared in terms of their endorsement of attachment style. METHODS All participants were administered the Experiences in Close Relationships measure of adult attachment style. The schizophrenia group was also given the Rosenberg Self-Esteem Scale to assess self-esteem, the Beck Hopelessness Scale as a measure of hope, and the Positive and Negative Syndrome Scale, as an assessment of symptoms. RESULTS Avoidant attachment in the schizophrenia group was linked with higher levels of hopelessness while anxious attachment was linked to lower levels of self-esteem. The association between anxious attachment and self-esteem persisted after controlling for severity of positive, negative, and depressive symptoms in a stepwise multiple regression analyses. Compared to the HIV/AIDS group, participants with schizophrenia had significantly higher levels of anxious attachment but not avoidant attachment style. CONCLUSIONS Attachment style may impact attainment of key subjective domains of recovery in schizophrenia such as self-esteem, independent of symptom severity. PRACTITIONER POINTS If self-esteem and/or hopelessness are identified as a focus of treatment, focusing on attachment style may be an important treatment component. Therapist understanding of patients' attachment style may allow for a better understanding of resistance in the therapeutic relationship. Helping persons with schizophrenia to recognize and change how they tend to relate to others may promote gains in subjective elements of recovery.
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Affiliation(s)
- Jamie M Ringer
- Roudebush VA Medical Center, Indianapolis, Indiana, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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