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Lysaker PH, Hasson-Ohayon I, Wiesepape C, Huling K, Musselman A, Lysaker JT. Social Dysfunction in Psychosis Is More Than a Matter of Misperception: Advances From the Study of Metacognition. Front Psychol 2021; 12:723952. [PMID: 34721183 PMCID: PMC8552011 DOI: 10.3389/fpsyg.2021.723952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Many with psychosis experience substantial difficulties forming and maintaining social bonds leading to persistent social alienation and a lack of a sense of membership in a larger community. While it is clear that social impairments in psychosis cannot be fully explained by symptoms or other traditional features of psychosis, the antecedents of disturbances in social function remain poorly understood. One recent model has proposed that deficits in social cognition may be a root cause of social dysfunction. In this model social relationships become untenable among persons diagnosed with psychosis when deficits in social cognition result in inaccurate ideas of what others feel, think or desire. While there is evidence to support the influence of social cognition upon social function, there are substantial limitations to this point of view. Many with psychosis have social impairments but not significant deficits in social cognition. First person and clinical accounts of the phenomenology of psychosis also do not suggest that persons with psychosis commonly experience making mistakes when trying to understand others. They report instead that intersubjectivity, or the formation of an intimate shared understanding of thoughts and emotions with others, has become extraordinarily difficult. In this paper we explore how research in metacognition in psychosis can transcend these limitations and address some of the ways in which intersubjectivity and more broadly social function is compromised in psychosis. Specifically, research will be reviewed on the relationship between social cognitive abilities and social function in psychosis, including measurement strategies and limits to its explanatory power, in particular with regard to challenges to intersubjectivity. Next, we present research on the integrated model of metacognition in psychosis and its relation to social function. We then discuss how this model might go beyond social cognitive models of social dysfunction in psychosis by describing how compromises in intersubjectivity occur as metacognitive deficits leave persons without an integrated sense of others' purposes, relative positions in the world, possibilities and personal complexities. We suggest that while social cognitive deficits may leave persons with inaccurate ideas about others, metacognitive deficits leave persons ill equipped to make broader sense of the situations in which people interact and this is what leaves them without a holistic sense of the other and what makes it difficult to know others, share experiences, and sustain relationships. The potential of developing clinical interventions focused on metacognition for promoting social recovery will finally be explored.
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Affiliation(s)
- Paul H. Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | | | - Courtney Wiesepape
- Department of Psychology, Indiana State University, Terre Haute, IN, United States
| | - Kelsey Huling
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, United States
| | - Aubrie Musselman
- Department of Psychology, Indiana State University, Terre Haute, IN, United States
| | - John T. Lysaker
- Department of Philosophy, Emory University, Atlanta, GA, United States
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Davies EL, Gordon AL, Hooper KJ, Laing RE, Lynch EA, Pelentsov LJ, Esterman AJ, Harvey G. Introducing the Needs in Recovery Assessment (NiRA) into clinical practice: protocol for a pilot study investigating the formal and systematic assessment of clinical and social needs experienced by service users at a tertiary, metropolitan mental health service. Pilot Feasibility Stud 2021; 7:181. [PMID: 34593044 PMCID: PMC8482663 DOI: 10.1186/s40814-021-00919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 09/17/2021] [Indexed: 11/14/2022] Open
Abstract
Background The Needs in Recovery Assessment (NiRA) is a newly developed needs assessment tool, designed to identify the needs of people recovering from mental illness. This tool has been evaluated outside of the clinical context for validity and reliability. The aim of this study is to introduce the NiRA into clinical practice and to evaluate the value of the NiRA as an adjunct to service delivery from the perspectives of stakeholders and to evaluate the barriers and facilitators of embedding the NiRA in a mental health service. Methods The establishment of the NiRA in a tertiary mental health unit over a 6-month period will be evaluated using a multi-methods approach. Quantitative data will be collected using the NiRA itself and the Recovery Self-Assessment (RSA). Face-to-face interviews with service users and clinicians will be conducted following the initial completion of the NiRA, with a follow-up interview for service users on discharge from the service. Regular informal follow-up with clinicians throughout the study will support the introduction of the NiRA. Descriptive statistics will be used to analyse quantitative data, and descriptive qualitative methods will be used to analyse data from interviews. Discussion Aligning mental health services with recovery-oriented frameworks of care is imperative. The NiRA is a tool that has been designed in accordance with recovery principles and may assist services to be more recovery-oriented. If the NiRA is able to achieve the aims and objectives of this project, a larger implementation study will be conducted. Trial registration Australian and New Zealand Clinical Trial Registry (ANZCTR), ACTRN12621000316808 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00919-8.
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Affiliation(s)
- Ellen L Davies
- Adelaide Nursing School, The University of Adelaide, Level 4 AHMS Building, 5 North Terrace, Adelaide, South Australia, 5001, Australia.
| | - Andrea L Gordon
- School of Biomedicine, The University of Adelaide, Level 3 Helen Mayo South, Frome Street, Adelaide, South Australia, 5001, Australia
| | - Kenneth J Hooper
- Youth Mental Health Service, SALHN, GP Plus Marion, 10 Milham St., Oaklands Part, South Australia, 5046, Australia
| | - Robert E Laing
- Adelaide Nursing School, The University of Adelaide, Level 4 AHMS Building, 5 North Terrace, Adelaide, South Australia, 5001, Australia
| | - Elizabeth A Lynch
- Caring Futures Institute, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia
| | - Lemuel J Pelentsov
- Clinical and Health Services, University of South Australia, Centenary Building, North Terrace, Adelaide, South Australia, 5001, Australia
| | - Adrian J Esterman
- Clinical and Health Services, University of South Australia, Centenary Building, North Terrace, Adelaide, South Australia, 5001, Australia
| | - Gillian Harvey
- Caring Futures Institute, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia
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Davies EL, Gordon AL, Hooper KJ, Pelentsov LJ, Esterman AJ. Evaluating the Reliability of the Needs in Recovery Assessment (NiRA) with Simulated Patients. Issues Ment Health Nurs 2021; 42:845-854. [PMID: 33759706 DOI: 10.1080/01612840.2021.1894618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Needs in Recovery Assessment (NiRA) is a tool designed to support recovery-oriented and person-centred approaches in mental health services through facilitating the identification and prioritisation of needs. The aim of this study was to evaluate the interrater reliability of the NiRA. Method: Ten mental health clinicians from various professional backgrounds used the NiRA to facilitate assessment interviews with Simulated Patients. Completed and semi-completed NiRA forms, questionnaires, and audio-visual recordings of assessment interviews were collected for analysis. The interrater reliability of the NiRA was calculated using percent agreement and Gwet's Agreement Coefficient (AC)1. Results: Percent agreement across all items of the finalised tool was 0.84 (item range: 0.55 to 1.0). Overall interrater reliability (Gwet's AC1) was 0.70 (95% CI 0.64-0.76) with items ranging from -0.08 to 1.0. Conclusion: The NiRA is a reliable tool and is ready to be trialled in a feasibility study in clinical settings. It is anticipated that the NiRA will facilitate a deeper understanding of service users' needs and a more targeted approach to meeting unmet needs.
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Affiliation(s)
- Ellen L Davies
- Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia.,Clinical and Health Services, University of South Australia, Adelaide, South Australia
| | - Andrea L Gordon
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia
| | - Kenneth J Hooper
- Youth Mental Health Service, Southern Adelaide Local Health Network, Oaklands Park, South Australia
| | - Lemuel J Pelentsov
- Clinical and Health Services, University of South Australia, Adelaide, South Australia
| | - Adrian J Esterman
- Clinical and Health Services, University of South Australia, Adelaide, South Australia
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