1
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Cloutier B, Lecomte T, Diotte F, Lamontagne J, Abdel-Baki A, Daneault JG, Gélineau Rabbath ME, de Connor A, Perrine C. Improving Romantic Relationship Functioning Among Young Men With First-Episode Psychosis: Impact of a Novel Group Intervention. Behav Modif 2023; 47:1170-1192. [PMID: 37496322 PMCID: PMC10403962 DOI: 10.1177/01454455231186586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Previous research has highlighted many of the challenges faced by individuals with psychosis in romantic relationships. The present study aimed to evaluate the impact of a novel group intervention for men with first-episode psychosis (FEP) on dating success, romantic and sexual functioning, self-esteem, self-stigma, mentalizing skills, and symptomatology, while using a repeated single-case experimental design and comparing results across two treatment modalities (i.e., in-person or online). Twenty-seven participants from five treatment sites completed a 12-week group intervention. Qualitative data was also collected to assess participants' subjective experiences with the program. In both modalities, significant improvements were observed for romantic functioning, mentalizing skills, and symptomatology, with effect sizes ranging from small to large. Several participants also attended more dates and entered committed relationships after the intervention. Most participants were satisfied with the program and many felt that they had learned new skills and gained confidence in dating. Future research should replicate these findings in larger and more inclusive samples.
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Affiliation(s)
| | | | | | | | - Amal Abdel-Baki
- Centre hospitalier de l’Université de Montréal, Clinique JAP, QC, Canada
| | | | | | - Alexandre de Connor
- Centre hospitalier universitaire de Montpellier, Centre de rétablissement et de réhabilitation Jean-Minvieille, Montpellier, France
| | - Cécile Perrine
- Établissement public de santé mentale Caen, Unité de réhabilitation psychosociale Ariane, Caen, France
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2
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Kilpatrick C, Kanas N. Is Virtual Group Therapy an Effective Alternative to In-Person Group Therapy for Patients with Early Psychosis? Int J Group Psychother 2023; 73:239-248. [PMID: 38446603 DOI: 10.1080/00207284.2023.2184624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
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3
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Rippon D, Shepherd J, Wakefield S, Lee A, Pollet TV. The role of self-efficacy and self-esteem in mediating positive associations between functional social support and psychological wellbeing in people with a mental health diagnosis. J Ment Health 2022:1-10. [PMID: 35510768 DOI: 10.1080/09638237.2022.2069695] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous research has observed positive associations between perceived quality of social support and mental well-being. Having access to functional social support that provides sources of care, compassion and helpful information have shown to be beneficial for mental health. However, there is a need to identify the psychological processes through which functional social support can elicit therapeutic outcomes on mental well-being. AIMS The present cross-sectional study aimed to examine the extent to which self-efficacy and self-esteem mediated the association between functional social support and mental well-being. METHOD Seventy-three people with a mental health diagnosis, who attended group-based activities as facilitated by a third sector community mental health organisation, took part in the present study. Participants were required to complete measures that assessed perceived quality of functional social support, self-efficacy, self-esteem, and subjective mental well-being. RESULTS A multiple mediation analysis revealed that self-efficacy and self-esteem fully mediated the positive association between perceived functional social support and mental well-being. CONCLUSIONS The implications of these results are that social interventions, which aim to facilitate the delivery of functional social support, could enhance mental well-being via their positive effects on self-efficacy and self-esteem.
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Affiliation(s)
| | | | | | - Ali Lee
- Waddington Street Centre, Durham, UK
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4
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Lecomte T, Abdel-Baki A, Francoeur A, Cloutier B, Leboeuf A, Abadie P, Villeneuve M, Guay S. Group therapy via videoconferencing for individuals with early psychosis: A pilot study. Early Interv Psychiatry 2021; 15:1595-1601. [PMID: 33354926 DOI: 10.1111/eip.13099] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/13/2020] [Indexed: 02/06/2023]
Abstract
AIM The COVID-19 pandemic has introduced many mental health professionals to therapy via videoconferencing. Mostly individual teletherapy has been offered and studied, although group therapy is often offered in clinics. In fact, little is known regarding group therapy's acceptability, feasibility, and potential impact when offered via videoconferencing. METHODS This pilot study offered group cognitive-behavioural therapy for psychosis via videoconferencing to 14 individuals with early psychosis either living in remote areas or confined during the pandemic. RESULTS The rate of consenting to the study (79%) and actual participation rates were acceptable (18.5 sessions out of 24). Although some technological obstacles were encountered, solutions offered allowed the videoconferencing group to be considered feasible for most participants and therapists. Prepost results on symptoms and self-esteem were comparable to those of other studies using the same group treatment but in-person. Alliance scores seemed similar as well. CONCLUSIONS More studies are warranted on the efficacy of group therapy via videoconferencing. This pilot study does offer promising results, suggesting that a wider range of people with early psychosis can be reached and benefit from the advantages of receiving an evidence-based group intervention.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Département de psychiatrie et d'addictologie, Université de Montréal, Montreal, Quebec, Canada
| | - Audrey Francoeur
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Briana Cloutier
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Quebec, Canada
| | - Amélie Leboeuf
- Hôpital en santé mentale Rivière-des-Prairies, Montreal, Quebec, Canada
| | - Pascale Abadie
- Hôpital en santé mentale Rivière-des-Prairies, Montreal, Quebec, Canada
| | - Marie Villeneuve
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Stephane Guay
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada.,École de criminologie, Université de Montréal, Montreal, Quebec, Canada
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5
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Gleeson JFM, Eleftheriadis D, Santesteban-Echarri O, Koval P, Bastian B, Penn DL, Lim MH, Ryan RM, Alvarez-Jimenez M. Positive and meaningful lives: Systematic review and meta-analysis of eudaimonic well-being in first-episode psychosis. Early Interv Psychiatry 2021; 15:1072-1091. [PMID: 33037789 DOI: 10.1111/eip.13049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. AIM Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. METHODS Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants. RESULTS Studies comprised six RCTs, eight prospective follow-up studies and three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent. CONCLUSIONS The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP.
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Affiliation(s)
- John F M Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Olga Santesteban-Echarri
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brock Bastian
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David L Penn
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle H Lim
- Centre for Mental Health & Iverson Health Research Innovation Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Richard M Ryan
- Department of Psychology, University of Rochester, Rochester, New York, USA.,Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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6
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Bourke E, Barker C, Fornells-Ambrojo M. Systematic review and meta-analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis. Psychol Psychother 2021; 94:822-853. [PMID: 33569885 DOI: 10.1111/papt.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/16/2021] [Indexed: 01/07/2023]
Abstract
AIM The moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with a severe mental illness. This is the first review to conduct a meta-analysis of associations between TA and therapeutic engagement as well as outcome in psychological therapy for psychosis. ELIGIBILITY CRITERIA Eligible studies conducted a quantitative investigation of the relationship between TA during a psychological therapy and outcome at a subsequent time-point. METHOD A systematic review examined the relationship between TA and engagement as well as outcome measures within psychological therapy for psychosis. Correlational meta-analyses using an aggregate random effects model were conducted. RESULTS Twenty-four studies were eligible for inclusion (n = 1,656) of which 13 were included in the meta-analyses. Client- and therapist-rated TA were associated with engagement in therapy (rclient (c) = 0.36, p = .003; rtherapist (t) = 0.40, p = .0053). TA was also associated with reduction in global (rc = 0.29, p = .0005; rt = 0.24, p = .0015) and psychotic symptoms (rc = 0.17, p = .0115; rt = 0.30, p = .0003). The systematic review identified no evidence or limited evidence for a relationship between TA during therapy and depression, substance use, physical health behaviours, global as well as social functioning, overall mental health recovery, and self-esteem at follow-up. Although number of studies was small, TA was related to a reduced risk of subsequent hospitalization in 40% of analyses (across two studies) and improved cognitive outcome in 50% of analyses (across three studies). CONCLUSIONS The observed TA-therapy engagement and TA-outcome associations were broadly consistent with those identified across non-psychotic diagnostic groups. Well-powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically. PRACTITIONER POINTS This is the first review to conduct a meta-analytic synthesis of the association between therapeutic alliance (TA) and both engagement and change in outcome in psychological therapies for psychosis. TA (as rated by therapist and client) was associated with the extent of therapeutic engagement as well as reduction in global mental health symptoms and psychotic symptoms. The significant associations between TA and engagement as well as change in outcome identified in the current review are broadly consistent with those observed across non-psychotic diagnostic groups. We consider factors that could impact upon the dynamic and potentially interdependent relationships between TA and therapeutic techniques, including attachment security and severity of paranoid ideation.
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Affiliation(s)
- Emilie Bourke
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Barker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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7
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Terrazas‐Carrillo E, Garcia E, Vásquez D, Sabina C, Soto I, Salazar R, Rodriguez AS. Inside Dating Relationships Involving Violence End Now: Participants’ perspectives at a 6‐month follow‐up. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Ediza Garcia
- Texas A&M International University Laredo TX USA
| | - Desi Vásquez
- Texas A&M International University Laredo TX USA
| | | | - Ivette Soto
- Texas A&M International University Laredo TX USA
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8
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Langlois T, Bourcier A, Olivier F, Lecomte T, Callahan S. Évaluation du sentiment d’efficacité des cliniciens lors d’une formation TCC pour la gestion des hallucinations auditives en groupe : étude Accept Voices©. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2020.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Webb R, Bartl G, James B, Skan R, Peters E, Jones AM, Garety P, Kuipers E, Hayward M, Greenwood K. Exploring the Development, Validity, and Utility of the Short-Form Version of the CHoice of Outcome In Cbt for PsychosEs: A Patient-Reported Outcome Measure of Psychological Recovery. Schizophr Bull 2020; 47:653-661. [PMID: 33215190 PMCID: PMC8084424 DOI: 10.1093/schbul/sbaa173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The original CHoice of Outcome In Cbt for psychosEs (CHOICE) measure was designed in collaboration with experts by experience as a patient-reported "Psychological Recovery" outcome measure for cognitive-behavioral therapy for psychosis (CBTp). A short version (CHOICE-SF) was developed to use as a brief outcome measure, with a focus on sensitivity to change, for use in future research and practice. CHOICE-SF was developed and validated using 3 separate samples, comprising 640 service users attending 1 of 2 transdiagnostic clinics for (1) CBTp or (2) therapies for voice hearing or (3) who took part in the treatment as usual arm of a trial. In the initial subsample of 69 participants, items from the original CHOICE measure with medium to large effect sizes for change pre- to post-CBTp were retained to form the CHOICE-SF. Internal consistency, construct validity, and sensitivity to change were confirmed, and the factor structure was examined in 242 participants. Specificity was confirmed by comparison with 44 participants who completed CHOICE at 2 time points but did not receive therapy. Validation of CHOICE-SF was carried out by confirming factor structure and sensitivity to change in a new sample of 354 and a subsample of 51 participants, respectively. The CHOICE-SF comprised 11 items and 1 additional personal goal item. A single-factor structure was confirmed, with high internal consistency, construct validity, and sensitivity to change. The CHOICE-SF is a brief, psychometrically robust measure to assess change following psychological therapies in research and clinical practice for people with psychosis and severe mental illness.
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Affiliation(s)
- Rebecca Webb
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Gergely Bartl
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Bryony James
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Rosie Skan
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Anna-Marie Jones
- R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Philippa Garety
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK,To whom correspondence should be addressed; tel: +44 1273 678409, fax: +44 1273 678058, e-mail:
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10
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Wright A, Browne J, Mueser KT, Cather C. Evidence-Based Psychosocial Treatment for Individuals with Early Psychosis. Child Adolesc Psychiatr Clin N Am 2020; 29:211-223. [PMID: 31708048 DOI: 10.1016/j.chc.2019.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Coordinated specialty care (CSC) first-episode models are an evidence-based practice in the treatment of first-episode psychosis. Group, individual, and family therapies in CSC aim to help the client and family understand and cope with the experience of psychosis, promote symptomatic and functional recovery and improve quality of life, and support the pursuit of personally meaningful goals of the client. Common elements to these interventions include building a therapeutic alliance, recovery orientation, education, and skills training, which can be directed to a range of targets, including problem-solving, communication, social skills, and social cognition.
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Affiliation(s)
- Abigail Wright
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue West, Boston, MA 02215, USA
| | - Corinne Cather
- Massachusetts General Hospital, Center of Excellence in Psychosocial and Systemic Research, 151 Merrimac Street, 6th Floor, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
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11
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Kopelovich SL, Strachan E, Sivec H, Kreider V. Stepped Care as an Implementation and Service Delivery Model for Cognitive Behavioral Therapy for Psychosis. Community Ment Health J 2019; 55:755-767. [PMID: 30623294 DOI: 10.1007/s10597-018-00365-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA.
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA
| | - Harry Sivec
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Valerie Kreider
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
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12
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Browne J, Mueser KT, Meyer-Kalos P, Gottlieb JD, Estroff SE, Penn DL. The therapeutic alliance in individual resiliency training for first episode psychosis: Relationship with treatment outcomes and therapy participation. J Consult Clin Psychol 2019; 87:734-744. [PMID: 31219276 DOI: 10.1037/ccp0000418] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). METHOD The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. RESULTS Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. CONCLUSIONS A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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13
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Wong AWS, Ting KT, Chen EYH. Group cognitive behavioural therapy for Chinese patients with psychotic disorder: A feasibility controlled study. Asian J Psychiatr 2019; 39:157-164. [PMID: 30639991 DOI: 10.1016/j.ajp.2018.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/24/2018] [Accepted: 12/24/2018] [Indexed: 11/18/2022]
Abstract
AIM Evidence for the effectiveness of individual cognitive behavioural therapy for psychosis (CBTp) is promising but evidence for presenting CBTp in a group setting and in the Asian context is limited. The present study is to evaluate the feasibility and effectiveness of Group CBTp in clinical practice. METHOD Forty-eight out-patients and day-patients with the schizophrenia spectrum disorders were recruited and randomly assigned to the group CBTp plus treatment as usual (TAU), or psychoeducation group (PsyEdI) plus TAU. Both interventions consisted of 7 consecutive weekly sessions with a booster session 4 weeks after the last session. Patients were assessed on outcome measures such as the Psychotic Symptom Rating Scales (PSYRATS), the Beck Depression Inventory (BDI), a Chinese version of the Beliefs About Voice Questionnaire-Revised version (BAVQ-R), at baseline and after treatment. RESULTS Patients received group CBTp (n = 25) showed significantly greater improvement in their delusion compared with those receiving PsyEdI (n = 23). Nearly 61% of patients in the group CBTp showed at least 50% reduction on their score of delusion in the PSYRATS. Group CBTp was also found to be effective in reducing patients' dysfunctional beliefs towards voices, especially in the subscale of benevolence and omnipotence, their conviction on delusion, as well as their distress from positive psychotic symptoms. CONCLUSION Group CBTp can be an effective adjunctive psychological intervention in improving positive psychotic experiences among people with persistent psychotic symptoms, and can be applied in routine clinical practice.
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Affiliation(s)
- Agatha W S Wong
- Clinical Psychology Service, Department of Psychiatry, Kowloon Hospital, HKSAR, Hong Kong.
| | - K T Ting
- Clinical Psychology Service, Department of Psychiatry, Kowloon Hospital, HKSAR, Hong Kong
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, HKSAR, Hong Kong
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14
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Valeri L, Sugarman DE, Reilly ME, McHugh RK, Fitzmaurice GM, Greenfield SF. Group therapy for women with substance use disorders: In-session affiliation predicts women's substance use treatment outcomes. J Subst Abuse Treat 2018; 94:60-68. [PMID: 30243419 PMCID: PMC9976621 DOI: 10.1016/j.jsat.2018.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/23/2022]
Abstract
In-session affiliation among members is a hypothesized mechanism of action of group therapy for women with substance use disorders (SUDs). We evaluated group affiliation as an independent predictor of SUD treatment outcome in women (n = 100), 18 years or older diagnosed with substance dependence, who were randomized to the single-gender Women's Recovery Group (WRG) or mixed-gender group therapy (Group Drug Counseling; GDC). Affiliative statements made by members in both groups were measured for 39 women in each treatment arm. We studied the relationship between frequency of affiliative statements categorized in quintiles and the trajectory of days of any drug use during 3 months treatment and 6 months post-treatment using a Poisson regression model with estimation via generalized estimating equations. Furthermore, we investigated whether the effect of affiliation on substance use was moderated by group therapy type. The relationship between amount of affiliation and substance use reduction was non-linear. At the end of the treatment phase (3 months), women who experienced the highest level of affiliation (>65 affiliative statements on average) were found to reduce substance use by about 1.75 days more (p-value = 0.02) than women who experienced the lowest level of affiliation (<26). The effects of affiliation persisted 6 months post-treatment and were moderated by therapy group, whereby women enrolled in the single-gender WRG appeared to benefit more from affiliation post-treatment. Training therapists to facilitate verbal affiliation may provide added therapeutic benefit to group therapy for women with SUDs.
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Affiliation(s)
- Linda Valeri
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Dawn E Sugarman
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - Meghan E Reilly
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States
| | - R Kathryn McHugh
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States
| | - Garrett M Fitzmaurice
- McLean Hospital, Laboratory for Psychiatric Biostatistics, Belmont, MA 02478, United States; Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States
| | - Shelly F Greenfield
- Harvard Medical School, Department of Psychiatry, Boston, MA 02115, United States; McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA 02478, United States; McLean Hospital, Division of Women's Mental Health, Belmont, MA 02478, United States.
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15
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Lecomte T, Leclerc C, Wykes T. Symptom fluctuations, self-esteem, and cohesion during group cognitive behaviour therapy for early psychosis. Psychol Psychother 2018; 91:15-26. [PMID: 28707407 DOI: 10.1111/papt.12139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/08/2017] [Indexed: 01/23/2023]
Abstract
UNLABELLED Group cohesion has been linked to positive changes in self-esteem and in symptoms during group psychotherapy in people with psychosis. These changes may be linked to changes in symptoms as fluctuations in self-esteem have been linked to symptom fluctuations. OBJECTIVE We aimed to determine the relationship between these three factors - group cohesion, self-esteem, and symptoms - during group cognitive behaviour therapy for psychosis (GCBTp). We hypothesized that group cohesion would precede changes in symptoms and self-esteem and that improvements in self-esteem would precede improvements in symptoms. DESIGN This is an uncontrolled longitudinal study recruiting from a convenience sample within two early psychosis clinics. METHODS Sixty-six individuals from first episode of psychosis treatment programmes participated in this study and received 24 sessions of a validated GCBTp protocol. Participants answered a brief questionnaire at the end of each session, measuring their group cohesion, self-esteem, and perception of their symptoms as worse, same, or better than usual. RESULTS Orthogonal polynomial contrasts for time effects were estimated with a mixed model for repeated measures with a random cluster effect and revealed a quartic trend regarding changes in symptoms over the 24 sessions. Self-esteem, symptoms, and group cohesion were strongly linked during a given session. Also, self-esteem changes predicted changes in symptoms up to two sessions later, and symptoms changes predicted self-esteem changes at the next session. Group cohesion preceded improvements in both self-esteem and symptoms; self-esteem also predicted improvements in group cohesion. CONCLUSION These results suggest that self-esteem and symptoms influence each other during therapy, with improvements in one leading to improvements in the other. Group cohesion also appears to be an essential prerequisite to positive changes in self-esteem and symptoms during GCBTp. PRACTITIONER POINTS This study emphasizes the interrelation between self-esteem improvements and symptom improvements, with improvements in one leading to improvements in the other, during group CBT for psychosis. Group cohesion, in this study, is a predictor of self-esteem and symptom improvements, suggesting that a special attention should be given to developing a strong alliance and group cohesion early on during CBT for psychosis.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology, CRIUSMM, University of Montreal, Québec, Canada
| | - Claude Leclerc
- School of Nursing, University of Quebec at Trois-Rivieres, Québec, Canada
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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16
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Berry K, Palmer T, Gregg L, Barrowclough C, Lobban F. Attachment and therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis. Clin Psychol Psychother 2018; 25:440-445. [PMID: 29446195 DOI: 10.1002/cpp.2178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/09/2022]
Abstract
We examine associations between client attachment style and therapeutic alliance in a 3-arm randomized controlled trial of brief motivational interviewing and cognitive-behavioural therapy compared with longer term motivational interviewing and cognitive-behavioural therapy or standard care alone. Client self-report measures of attachment style were completed at baseline, and both clients and therapists in the treatment arms of the trial completed alliance measures 1 month into therapy. We found that insecure-anxious attachment was positively associated with therapist-rated alliance, whereas clients with insecure-avoidant attachment were more likely to report poorer bond with therapist. There was no evidence that client attachment significantly predicted clinical or substance misuse outcomes either directly or indirectly via alliance. Nor evidence that the length of therapy offered interacted with attachment to predict alliance.
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Affiliation(s)
- Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Tom Palmer
- Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, UK
| | - Lynsey Gregg
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christine Barrowclough
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Fiona Lobban
- Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster, UK
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17
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Shattock L, Berry K, Degnan A, Edge D. Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: A systematic review. Clin Psychol Psychother 2017; 25:e60-e85. [PMID: 28961352 DOI: 10.1002/cpp.2135] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 01/31/2023]
Abstract
Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory-Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self-esteem outcomes. There was evidence for specific client-related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client-rated alliance, whereas baseline negative symptoms were associated with worse therapist-rated alliance. Therapist and therapy-related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client-rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist-rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan-theoretical, well-validated alliance measures to determine causal predictor variables.
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Affiliation(s)
- Lucy Shattock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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18
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Sugarman DE, Wigderson SB, Iles BR, Kaufman JS, Fitzmaurice GM, Hilario EY, Robbins MS, Greenfield SF. Measuring affiliation in group therapy for substance use disorders in the Women's Recovery Group study: Does it matter whether the group is all-women or mixed-gender? Am J Addict 2016; 25:573-80. [PMID: 27647710 DOI: 10.1111/ajad.12443] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A Stage II, two-site randomized clinical trial compared the manualized, single-gender Women's Recovery Group (WRG) to mixed-gender group therapy (Group Drug Counseling; GDC) and demonstrated efficacy. Enhanced affiliation and support in the WRG is a hypothesized mechanism of efficacy. This study sought to extend results of the previous small Stage I trial that showed the rate of supportive affiliative statements occurred more frequently in WRG than GDC. METHODS Participants (N = 158; 100 women, 58 men) were 18 years or older, substance dependent, and had used substances within the past 60 days. Women were randomized to WRG (n = 52) or GDC (n = 48). Group therapy videos were coded by two independent raters; Rater 1 coded 20% of videos (n = 74); Rater 2 coded 25% of videos coded by Rater 1 (n = 19). RESULTS The number of affiliative statements made in WRG was 66% higher than in GDC. Three of eight affiliative statement categories occurred more frequently in WRG than GDC: supportive, shared experience, and strategy statements. DISCUSSION AND CONCLUSIONS This larger Stage II trial provided a greater number of group therapy tapes available for analysis. Results extended our previous findings, demonstrating both greater frequency of all affiliative statements, as well as specific categories of statements, made in single-gender WRG than mixed-gender GDC. SCIENTIFIC SIGNIFICANCE Greater frequency of affiliative statements among group members may be one mechanism of enhanced support and efficacy in women-only WRG compared with standard mixed-gender group therapy for substance use disorders. (Am J Addict 2016;25:573-580).
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Affiliation(s)
- Dawn E Sugarman
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sara B Wigderson
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Brittany R Iles
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
| | | | - Garrett M Fitzmaurice
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - E Yvette Hilario
- School of Nursing, The University of Texas at Austin, Austin, Texas
| | | | - Shelly F Greenfield
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts. .,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
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19
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Berry K, Gregg L, Lobban F, Barrowclough C. Therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis. Compr Psychiatry 2016; 67:73-80. [PMID: 27095338 DOI: 10.1016/j.comppsych.2016.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/26/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND This paper examines the role of therapeutic alliance in predicting outcomes in a Randomized Controlled Trial of Motivational Interviewing and Cognitive Behavioral Therapy (MICBT) for problematic cannabis use in recent onset psychosis. METHODS All clients were participating in a three arm pragmatic rater-blind randomized controlled trial of brief MICBT plus standard care compared with longer term MICBT plus standard care and standard care alone. Participants completed measures to assess clinical symptoms, global functioning and substance misuse at baseline, 4.5months, 9months and 18months. Clients and therapists completed the Working Alliance Inventory approximately one month into therapy. Client alliance data was available for 35 participants randomized to therapy and therapist alliance data was available for 52 participants randomized to therapy. RESULTS At baseline, poorer client-rated alliance was associated with more negative symptoms, poorer insight and greater cannabis use, whereas poorer therapist-rated alliance was only associated with amount of cannabis used per cannabis using day. Alliance ratings were also positively associated with amount of therapy: client-rated alliance was higher in the longer compared to the briefer therapy; therapist-rated alliance was associated with greater number of sessions attended (controlling for type of therapy) and therapy completion. In predicting outcome, client-rated alliance predicted total symptom scores and global functioning scores at follow-up. Neither client nor therapist alliance predicted changes in substance misuse at any time point. CONCLUSIONS Findings demonstrate that individuals with psychosis and substance misuse who form better alliances with their therapists gain greater benefits from therapy, at least in terms of improvements in global functioning.
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Affiliation(s)
- Katherine Berry
- School of Psychological Sciences, University of Manchester, 2nd Floor Zocohnis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Lynsey Gregg
- School of Psychological Sciences, University of Manchester, 2nd Floor Zocohnis Building, Brunswick Street, Manchester, M13 9PL, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health, School of Health and Medicine, Division of Health Research, Lancaster University, LA1 4YG, UK
| | - Christine Barrowclough
- School of Psychological Sciences, University of Manchester, 2nd Floor Zocohnis Building, Brunswick Street, Manchester, M13 9PL, UK
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20
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Menon M, Andersen DR, Quilty LC, Woodward TS. Individual factors predicted to influence outcome in group CBT for psychosis (CBTp) and related therapies. Front Psychol 2015; 6:1563. [PMID: 26578995 PMCID: PMC4623397 DOI: 10.3389/fpsyg.2015.01563] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahesh Menon
- Department of Psychiatry, University of British Columbia Vancouver, BC, Canada ; Vancouver Coastal Health Vancouver, BC, Canada
| | - Devon R Andersen
- Department of Psychiatry, University of British Columbia Vancouver, BC, Canada ; BC Mental Health and Addiction Research Institute Vancouver, BC, Canada ; Department of Psychology, University of Saskatchewan Saskatoon, SK, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health Toronto, ON, Canada ; Department of Psychiatry, University of Toronto Toronto, ON, Canada
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia Vancouver, BC, Canada ; BC Mental Health and Addiction Research Institute Vancouver, BC, Canada
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21
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Massé M, Lecomte T. Metacognitive profiles in individuals with a first episode of psychosis and their relation to social functioning and perceived social support. Schizophr Res 2015; 166:60-4. [PMID: 26116327 DOI: 10.1016/j.schres.2015.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 05/08/2015] [Accepted: 05/11/2015] [Indexed: 11/28/2022]
Abstract
Poorer metacognitive abilities are recognized as strong predictors of social functioning deficits in individuals with schizophrenia, but have not been studied in relation to perceived social support. Furthermore, traditional measures of metacognition fail to consider ecological aspects such as the interaction between thinking of one's own or other's mind, and mastery. As a constellation, these abilities may influence domains of social functioning and perceived social support differently. Therefore, this study aimed to establish whether distinct metacognitive profiles exist within a population of individuals with a first psychotic episode, and to determine how such profiles influence individual domains of social functioning and perceived social support. Participants (n=50) were recruited from two early psychosis outpatient clinics in Montreal, Canada. Demographic information, social functioning and perceived social support were measured using self-reported questionnaires, and metacognition was scored from the transcripts of a semi-structured interview designed to avoid leading responses. Cluster analysis revealed three distinct metacognitive profiles: (1) overall better abilities; (2) poor abilities on thinking of one's own and other's mind, but better mastery; and (3) overall poorer abilities. Analyses showed significant differences between profiles only for self-reported intimacy and independent living abilities, with the second profile showing better abilities than the third. Profiles did not simply represent consistently higher or lower functioning across subscales. Although mastery was predictive of social functioning, the ability to think in an increasingly complex manner of one's self and others did not seem to improve functioning in individuals with a first episode of psychosis.
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Affiliation(s)
- Marjolaine Massé
- Université de Montréal, Department of Psychology, C-358, 90 Vincent d'Indy Street, C.P. 6128, Succ. Centre-Ville, Montreal, QC H3C 3J7, Canada
| | - Tania Lecomte
- Université de Montréal, Department of Psychology, C-358, 90 Vincent d'Indy Street, C.P. 6128, Succ. Centre-Ville, Montreal, QC H3C 3J7, Canada.
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