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Rattray NA, Natividad D, Spontak K, Kukla M, Do ANL, Danson L, Frankel RM, True G. Learning from women veterans who navigate invisible injuries, caregiving, and reintegration challenges. BMC Womens Health 2023; 23:665. [PMID: 38082289 PMCID: PMC10714493 DOI: 10.1186/s12905-023-02815-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND As women comprise a greater proportion of military service members, there is growing recognition of how their experiences in the early phase of military to civilian transitions have an important influence on their health and reintegration outcomes. Qualitative accounts of women veterans can inform programs that support transitioning service members. OBJECTIVES We examined narratives of civilian reintegration among women veterans to understand their experiences of adjusting to community life while coping with mental health challenges. METHODS/PARTICIPANTS We interviewed 16 post-911 era women who were within 5 years of separating from military service and developed a case study based on three participants. MAIN APPROACH Interviews were audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted to establish categories about reintegration. Immersion/crystallization techniques were used to identify exemplary cases that illustrated salient themes. KEY RESULTS Women veterans identified establishing a future career direction, drawing on social support, and navigating health care services as major factors influencing how they adjusted to civilian life. In addition, participants also highlighted the navigation of complex and intersecting identities (i.e., wife, mother, employee, friend, veteran, patient, etc.), further magnified by gender inequalities. These women performed emotional labor, which is often rendered invisible and oriented toward their family and loved ones, while simultaneously monitoring self-care activities. During the early period of reintegration, they described how they felt marginalized in terms of accessing healthcare compared to their military spouses and male veteran peers. CONCLUSIONS Our case study suggests that there are key gaps in addressing healthcare and readjustment needs for women servicemembers, a high priority VA group, as they transition into post-military life. It is important to consider innovative ways to address specific needs of women in veteran-focused policies and programs.
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Affiliation(s)
- Nicholas A Rattray
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
- Indiana University School of Medicine, Indianapolis, USA.
| | - Diana Natividad
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
| | - Katrina Spontak
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- University of Indianapolis, Indianapolis, USA
| | - Marina Kukla
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- Department of Psychology, Indiana-University-Purdue University, Indianapolis, USA
| | - Ai-Nghia L Do
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
| | - Leah Danson
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- University of Indianapolis, Indianapolis, USA
| | - Richard M Frankel
- VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, USA
| | - Gala True
- South Central MIRECC, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA
- Section of Community and Population Medicine, Louisiana State University School of Medicine, New Orleans, LA, USA
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Faith L, Wiesepape C, Kukla M, Lysaker P. Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation. Neuropsychiatr Dis Treat 2023; 19:2179-2194. [PMID: 37873532 PMCID: PMC10590553 DOI: 10.2147/ndt.s386004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
Introduction Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.
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Affiliation(s)
- Laura Faith
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Paul Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Lysaker PH, Chernov N, Moiseeva T, Sozinova M, Dmitryeva N, Makarova A, Kukla M, Myers E, Karpenko O, Kostyuk G. Contrasting Metacognitive, Emotion Recognition and Alexithymia Profiles in Bulimia, Anorexia, and Schizophrenia. J Nerv Ment Dis 2023; 211:348-354. [PMID: 37040137 DOI: 10.1097/nmd.0000000000001612] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
ABSTRACT Alexithymia, or deficits in emotion recognition, and metacognitive capacity have been noted both in psychosis and eating disorders and potentially linked to psychopathology. This study sought to compare levels of impairments in these phenomena and their associations with psychopathology in groups with eating disorders and psychosis. Participants with diagnoses of a schizophrenia spectrum disorder (SSD; n = 53), anorexia (n = 40), or bulimia (n = 40) were recruited from outpatient clinics. Alexithymia was measured with the Toronto Alexithymia Scale; emotion recognition, with the Ekman Faces Test; and metacognition, with the Metacognitive Assessment Scale-Abbreviated. Psychopathology was measured with the Eating Attitudes Test, Body Image Questionnaire, and Positive and Negative Syndrome Scale. Results indicated that the SSD group had significantly poorer metacognitive function than either eating disorder group. Metacognition was related to body image in the anorexia group and a range of different forms of general psychopathology in the bulimia group. Alexithymia was related to eating disorder behaviors in the bulimia group.
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Affiliation(s)
| | - Nikita Chernov
- Department of Psychiatry, Mental-health clinic №1 named after N.A. Alexeev, Moscow, Russia
| | - Tatyana Moiseeva
- Department of Psychiatry, Mental-health clinic №1 named after N.A. Alexeev, Moscow, Russia
| | - Marta Sozinova
- Department of Psychiatry, Mental-health clinic №1 named after N.A. Alexeev, Moscow, Russia
| | - Nadezhda Dmitryeva
- Department of Psychiatry, Mental-health clinic №1 named after N.A. Alexeev, Moscow, Russia
| | - Anastasiya Makarova
- Department of Psychiatry, Mental-health clinic №1 named after N.A. Alexeev, Moscow, Russia
| | | | | | - Olga Karpenko
- Department of Psychiatry, Mental-health clinic №1 named after N.A. Alexeev, Moscow, Russia
| | - Georgiy Kostyuk
- Department of Psychiatry, Mental-health clinic №1 named after N.A. Alexeev, Moscow, Russia
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Shue SA, Traylor M, Kukla M, Salyers MP, Rollins AL, Henry N, Eliacin J, Garabrant J, McGuire AB. Exploring Factors Impacting the Implementation of Recovery-Oriented Treatment Planning on Acute Inpatient Mental Health Units. Adm Policy Ment Health 2023; 50:283-295. [PMID: 36495371 DOI: 10.1007/s10488-022-01237-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/05/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The current literature on operationalizing and implementing recovery-oriented inpatient care in diverse settings remains limited. The present study systematically examined factors affecting the implementation of one aspect of recovery-oriented care in a large and diverse national sample of Veterans Health Administration (VHA) inpatient mental health units. METHOD VHA inpatient mental health units were scored on the Recovery-Oriented Acute Inpatient scale (RAIN). Sites scoring either one standard deviation above (n = 8; i.e., high-scoring sites) or one standard deviation below (n = 5; i.e., low-scoring sites) the mean on the RAIN factor of inpatient treatment planning subscale were included for additional analyses (N = 13). We used a qualitative approach known as emergent thematic analysis to assess the implementation of inpatient treatment planning elements (e.g., goal setting, shared decision-making) from qualitative interviews, observation notes, and chart reviews collected for the 13 sites. The analysis was guided by Normalization Process Theory. RESULTS The eleven themes that emerged across the elements of recovery-oriented inpatient treatment planning mostly represented commonalities across sites, such as a shared treatment philosophy of acute care. However, five themes emerged as "differentiators" that distinguished high- and low-scoring sites and included veteran input, elicitation of recovery goals, the value of group programming, and the purpose of family involvement. CONCLUSION Findings provide insight into contextual factors and processes that impacted the implementation of recovery-oriented treatment planning at these VHA inpatient mental health units. To further facilitate the implementation of recovery-oriented inpatient treatment planning elements, future research should examine staff's collective understanding of recovery-oriented inpatient care.
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Affiliation(s)
- Sarah A Shue
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA.
| | - Morgan Traylor
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
| | - Marina Kukla
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Angela L Rollins
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Nancy Henry
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Johanne Eliacin
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Jennifer Garabrant
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
| | - Alan B McGuire
- Center for Health Information and Communication, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, USA
- Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, USA
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Rattray NA, Miech EJ, True G, Natividad D, Laws B, Frankel RM, Kukla M. Modeling Contingency in Veteran Community Reintegration: A Mixed Methods Approach. J Mix Methods Res 2023; 17:70-92. [PMID: 36523449 PMCID: PMC9742921 DOI: 10.1177/15586898211059616] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Researchers need approaches for analyzing complex phenomena when assessing contingency relationships where specific conditions explain an outcome only when combined with other conditions. Using a mixed methods design, we paired configurational methods and qualitative thematic analysis to model contingency in veteran community reintegration outcomes, identifying combinations of conditions that led to success or lack of success in community reintegration among US military veterans. This pairing allowed for modeling contingency at a detailed level beyond the capabilities of either approach alone. Our analysis revealed multiple contingent relationships at work in explaining reintegration, including social support, purpose, cultural adjustment, and military separation experiences. This study contributes to the field of mixed methods by pairing a mathematical cross-case method with a qualitative method to model contingency.
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Affiliation(s)
- Nicholas A. Rattray
- Roudebush VA Medical Center,
Center for
Health Information and Communication
(CHIC), Indianapolis, IN, USA
- Department of Internal Medicine,
institution-id-type="Ringgold" />Indiana University School of
Medicine, Indianapolis, IN, USA
- institution-id-type="Ringgold" />Regenstrief Institute, Inc,
Indianapolis, IN, USA
| | - Edward J. Miech
- Roudebush VA Medical Center,
Center for
Health Information and Communication
(CHIC), Indianapolis, IN, USA
- Department of Internal Medicine,
institution-id-type="Ringgold" />Indiana University School of
Medicine, Indianapolis, IN, USA
- institution-id-type="Ringgold" />Regenstrief Institute, Inc,
Indianapolis, IN, USA
| | - Gala True
- South Central MIRECC Southeast Louisiana
Veterans Health Care System, New
Orleans, LA, USA
- Section of Community and Population
Medicine, Louisiana
State University School of Medicine,
New Orleans, LA, USA
| | - Diana Natividad
- Roudebush VA Medical Center,
Center for
Health Information and Communication
(CHIC), Indianapolis, IN, USA
| | - Brian Laws
- Roudebush VA Medical Center,
Center for
Health Information and Communication
(CHIC), Indianapolis, IN, USA
| | - Richard M. Frankel
- Roudebush VA Medical Center,
Center for
Health Information and Communication
(CHIC), Indianapolis, IN, USA
- Department of Internal Medicine,
institution-id-type="Ringgold" />Indiana University School of
Medicine, Indianapolis, IN, USA
- institution-id-type="Ringgold" />Regenstrief Institute, Inc,
Indianapolis, IN, USA
| | - Marina Kukla
- Roudebush VA Medical Center,
Center for
Health Information and Communication
(CHIC), Indianapolis, IN, USA
- institution-id-type="Ringgold" />IUPUI Department of Psychology,
Indianapolis, IN, USA
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McGuire AB, Flanagan ME, Myers LJ, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Hunt MG, Iwamasa GY, Carter JL, Salyers MP. Recovery-oriented inpatient mental health care and readmission. Psychiatr Rehabil J 2022; 45:331-335. [PMID: 36201808 DOI: 10.1037/prj0000533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This article examines the relationship between inpatient mental health units' adherence to recovery-oriented care and 30-day patient readmission. METHOD The sample included patients admitted to one of 34 Veterans Health Administration inpatient mental health units. Recovery-oriented care was assessed using interviews and site visits. Patient characteristics and readmission data were derived from administrative data. FINDINGS Overall recovery orientation was not associated with readmission. Exploratory analyses found higher scores on a subsample of items pertaining to inpatient therapeutic programming were associated with lower patient readmissions. Additionally, patients with more prior service use and substance abuse or personality disorders were more likely to be readmitted. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE A growing body of literature supports the association between psychotherapeutic services in inpatient units and better patient outcomes. However, further research is needed to examine this association. More work is needed to develop appropriate psychotherapy services for the inpatient setting and support their implementation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Lysaker PH, Holm T, Kukla M, Wiesepape C, Faith L, Musselman A, Lysaker JT. Psychosis and the challenges to narrative identity and the good life: Advances from research on the integrated model of metacognition. Journal of Research in Personality 2022. [DOI: 10.1016/j.jrp.2022.104267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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McGuire A, Matthias MS, Kukla M, Henry N, Carter J, Flanagan M, Bair MJ, Murphy JL. A National Survey of Patient Completion of Cognitive Behavioral Therapy for Chronic Pain: The Role of Therapist Characteristics, Attempt Rates, and Modification. Prof Psychol Res Pr 2022; 52:542-550. [PMID: 35095180 DOI: 10.1037/pro0000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The implementation of evidence-based psychotherapies, including patient-level measures such as penetration and rates of successfully completing a course of therapy, has received increasing attention. While much attention has been paid to the effect of patient-level factors on implementation, relatively little attention has been paid to therapist factors (e.g., professional training, experience). Objective The current study explores therapists' decisions to offer a particular evidence-based psychotherapy (cognitive behavioral therapy for chronic pain; CBT-CP), whether and how they modify CBT-CP, and the relationship between these decisions and patient completion rates. Methods The study utilized survey responses from 141 Veterans Affairs therapists certified in CBT-CP. Results Therapists reported attempting CBT-CP with a little less than one half of their patients with chronic pain (mean = 48.8%, s.d.=35.7). Therapist were generally split between reporting modifying CBT-CP for either very few or most of their patients. After controlling for therapist characteristics and modification, therapist-reported percentage of patients with attempted CBT-CP was positively associated with completion rates, t (111) = 4.57, p<.001. Conclusions Therapists who attempt CBT-CP more frequently may experience better completion rates, perhaps due to practice effects or contextual factors that support both attempts and completion. Future research should examine this relationship using objective measures of attempt rates and completion.
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Affiliation(s)
- Alan McGuire
- Clinical Research Psychologist at the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and an Associate Research Professor in the Department of Psychology at Indiana University-Purdue University at Indianapolis
| | - Marianne S Matthias
- Research Scientist at the Roudebush VA Medical Center and Regenstrief Institute in Indianapolis, IN, and Associate Research Professor in the Department of General Internal Medicine and Geriatrics at the Indiana University School of Medicine
| | - Marina Kukla
- Research Scientist and Clinical Psychologist at the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and an Associate Research Professor in the Department of Psychology at Indiana University-Purdue University at Indianapolis
| | - Nancy Henry
- project manager for the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication and the Department of Psychology at Indiana University-Purdue University at Indianapolis
| | - Jessica Carter
- research assistant for the Richard L. Roudebush VA Medical Center in the HSR&D Center for Health Information and Communication
| | - Mindy Flanagan
- Senior Research Scientist at Parkview Health and Research Consultant at Richard L. Roudebush VA HSR&D Center for Health Information and Communication
| | - Matthew J Bair
- Research Scientist for the Richard L. Roudebush VA Health Services Research and Development Center for Health Information and Communication, Staff Physician at Richard L. Roudebush VA Medical Center, and Regenstrief Research Scientist
| | - Jennifer L Murphy
- Director of Behavioral Pain Medicine for the Veterans Health Administration and is Master Trainer for VA's Cognitive Behavioral Therapy for Chronic Pain (CBT-CP). Dr. Murphy is Associate Professor in the University of South Florida's Morsani College of Medicine and serves on the editorial board of Pain Medicine
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Kukla M, Arellano-Bravo C, Lysaker PH. "I'd Be A Completely Different Person if I Hadn't Gone to Therapy": A Qualitative Study of Metacognitive Therapy and Recovery Outcomes in Adults with Schizophrenia. Psychiatry 2022; 85:259-269. [PMID: 34762557 DOI: 10.1080/00332747.2021.1993514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Metacognitive oriented treatments are novel therapies designed to address metacognition deficits in schizophrenia, defined as the set of mental activities that allows reflection on oneself and others, and the integration of this knowledge into sophisticated mental representations that guide adaptive responses to life's demands and to the challenges imposed by psychiatric illness. However, little is known about the first-person experiences of engaging in this treatment. Hence, the purpose of this qualitative study was to characterize first-person experiences of recovery outcomes among people with schizophrenia spectrum disorders who take part in metacognitively oriented psychotherapy. METHOD A sample of 13 adult veterans with schizophrenia or schizoaffective disorder in an outpatient setting who were receiving one form of individual metacognitively oriented therapy, Metacognitive Reflection and Insight Therapy, for a minimum of 12 months participated in an open-ended interview; 27 questions probed their experiences with therapy and the outcomes and changes they have observed within themselves as a result. Interviews were analyzed using an inductive consensus based approach. RESULTS Findings indicate that participants observed changes in their lives in five recovery domains: improvements in real world functioning, increased formation of life pursuits, enhanced interpersonal connections, emergence of self compassion, and improved quality of life and wellness. CONCLUSIONS This study sheds further light on first person experiences of people with schizophrenia and adds to the growing body of evidence supporting the use of this form of metacognitively oriented psychotherapy to promote recovery in important life domains.
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McGuire AB, Kukla M, Rollins AL, Garabrant J, Henry N, Eliacin J, Myers LJ, Flanagan ME, Hunt MG, Iwamasa GY, Bauer SM, Carter JL, Salyers MP. Recovery-oriented acute inpatient mental health care: Operationalization and measurement. Psychiatr Rehabil J 2021; 44:318-326. [PMID: 34323532 PMCID: PMC8664980 DOI: 10.1037/prj0000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. METHOD The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. RESULTS A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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McGuire AB, Flanagan ME, Kukla M, Rollins AL, Myers LJ, Bass E, Garabrant JM, Salyers MP. Inpatient Mental Healthcare before and during the COVID-19 Pandemic. Healthcare (Basel) 2021; 9:healthcare9121613. [PMID: 34946338 PMCID: PMC8701042 DOI: 10.3390/healthcare9121613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Prior studies have demonstrated disruption to outpatient mental health services after the onset of the COVID-19 pandemic. Inpatient mental health services have received less attention. The current study utilized an existing cohort of 33 Veterans Health Affairs (VHA) acute inpatient mental health units to examine disruptions to inpatient services. It further explored the association between patient demographic, clinical, and services variables on relapse rates. Inpatient admissions and therapeutic services (group and individual therapy and peer support) were lower amongst the COVID-19 sample than prior to the onset of COVID-19 while lengths of stay were longer. Relapse rates did not differ between cohorts. Patients with prior emergent services use as well as substance abuse or personality disorder diagnoses were at higher risk for relapse. Receiving group therapy while admitted was associated with lower risk of relapse. Inpatient mental health services saw substantial disruptions across the cohort. Inpatient mental health services, including group therapy, may be an important tool to prevent subsequent relapse.
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Affiliation(s)
- Alan B. McGuire
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
- Correspondence:
| | - Mindy E. Flanagan
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
| | - Marina Kukla
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Angela L. Rollins
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
- Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
| | - Laura J. Myers
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Health Services Research, Regenstrief Institute, Indianapolis, IN 46202, USA
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Emily Bass
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Jennifer M. Garabrant
- Health Services Research & Development, Richard L. Roudebush VAMC, Indianapolis, IN 46202, USA; (M.E.F.); (M.K.); (A.L.R.); (L.J.M.); (E.B.); (J.M.G.)
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
| | - Michelle P. Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA;
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Lysaker PH, Kukla M, Leonhardt BL, Hamm JA, Schnakenberg Martin A, Zalzala AB, Gagen EC, Hasson-Ohayon I. Meaning, integration, and the self in serious mental illness: Implications of research in metacognition for psychiatric rehabilitation. Psychiatr Rehabil J 2020; 43:275-283. [PMID: 32790437 DOI: 10.1037/prj0000436] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE It has been established that recovery is a common outcome for adults diagnosed with serious mental illness which involves objective and subjective phenomenon. While considerable work has examined objective aspects of recovery, it remains difficult to know how to quantify the processes which support more subjective aspects of recovery related to sense of self. This article explores the potential of recent research on metacognition to offer new avenues to measure the processes which make a sense of self available within the flow of life. METHOD Emerging definitions of metacognition using an integrative model of metacognition are reviewed. Research is presented suggesting adults diagnosed with serious mental illness are often confronted by metacognitive deficits which interfere with their ability to make sense of their psychiatric challenges and effectively direct their own recovery. FINDINGS Metacognitive capacity may be a quantifiable phenomenon which contributes to certain aspects of recovery related to meaning making, agency and self-direction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Promoting metacognitive capacity may be a previously unrecognized active element of existing rehabilitative interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Marina Kukla
- Indianapolis Center of Innovation, Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center
| | | | - Jay A Hamm
- Eskenazi Health Midtown Community Mental Health
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Matthias MS, Bair MJ, Ofner S, Heisler M, Kukla M, McGuire AB, Adams J, Kempf C, Pierce E, Menen T, McCalley S, Johnson NL, Daggy J. Peer Support for Self-Management of Chronic Pain: the Evaluation of a Peer Coach-Led Intervention to Improve Pain Symptoms (ECLIPSE) Trial. J Gen Intern Med 2020; 35:3525-3533. [PMID: 32700220 PMCID: PMC7728830 DOI: 10.1007/s11606-020-06007-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/23/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Pain self-management is an effective, evidence-based treatment for chronic pain. Peer support, in which patients serve as coaches for other patients, has been effective in other chronic conditions and is a potentially promising approach to implementing pain self-management programs using fewer clinical resources. OBJECTIVE To test a peer coach-delivered pain self-management program for chronic pain. DESIGN Randomized controlled trial. PARTICIPANTS Veterans with chronic musculoskeletal pain. INTERVENTION Intervention patients were assigned a trained peer coach for 6 months. Coaches, who were volunteers, were asked to contact their assigned patients, either by phone or in person, twice per month. Coaches and patients were given an intervention manual to guide sessions. The control group was offered a 2-hour pain self-management class. MAIN MEASURES The primary outcome was total pain, assessed by the Brief Pain Inventory (BPI). Secondary outcomes were anxiety, depression, pain catastrophizing, self-efficacy, social support, patient activation, health-related quality of life, and healthcare utilization. Outcomes were measured at baseline, 6 months, and 9 months. KEY RESULTS Two hundred fifteen patients enrolled (120 intervention, 95 control). Adherence to intervention protocol was low, with only 13% of patients reporting having at least the recommended 12 peer coach meetings over the 6-month intervention. BPI total decreased from baseline to 6 months and baseline to 9 months in both groups. At 9 months, this change was statistically significant (intervention, - 0.40, p = 0.018; control, - 0.47, p = 0.006). There was not a statistically significant difference between groups on BPI at either time point. No secondary outcomes improved significantly in either group after adjusting for multiple comparisons. CONCLUSIONS Patients randomized to peer support did not differ from control patients on primary and secondary outcomes. Other peer support models that do not rely on volunteers might be more effective. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02380690.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA. .,Regenstrief Institute, Indianapolis, IN, USA. .,Department of Medicine, Indiana University of Medicine, Indianapolis, IN, USA.
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA.,Department of Medicine, Indiana University of Medicine, Indianapolis, IN, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michele Heisler
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,VA HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Marina Kukla
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Alan B McGuire
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Carol Kempf
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Medicine, Indiana University of Medicine, Indianapolis, IN, USA
| | - Emilee Pierce
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA.,Regenstrief Institute, Indianapolis, IN, USA
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Stephanie McCalley
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Nicole L Johnson
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Lysaker PH, Chernov N, Moiseeva T, Sozinova M, Dmitryeva N, Alyoshin V, Kukla M, Wiesepape C, Karpenko O, Kostyuk G. The association of metacognition with emotion recognition and perspective taking in a Russian sample with psychosis. J Clin Psychol 2020; 77:1034-1044. [PMID: 33085987 DOI: 10.1002/jclp.23076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/10/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Schizophrenia may reflect an interactive network of disturbances in cognition. In this study we have examined the relationship between two forms of cognition: metacognition and social cognition among a sample with schizophrenia (n = 41), early episode psychosis (n = 37), and major depression (n = 30) gathered in Moscow, Russia. METHODS Metacognition was assessed with the Metacognition Assessment Scale-Abbreviated. Social cognition was assessed with the Ekman 60 Faces Test and the Interpersonal Reactivity Index. Verbal memory and global psychopathology were included as potential covariates. RESULTS Partial correlations controlling for demographics, neurocognition, and psychopathology revealed greater metacognitive capacity was linked to better facial emotion recognition and perspective taking in the prolonged schizophrenia group. Greater metacognitive capacity in the early psychosis group was linked with greater facial emotion recognition. Metacognition and social cognition were not related to one another in the depression group. CONCLUSIONS Social cognition and metacognition may be uniquely related in psychosis.
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Affiliation(s)
- Paul H Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nikita Chernov
- Mental-health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Tatyana Moiseeva
- Mental-health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Marta Sozinova
- Mental-health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | | | - Vitaliy Alyoshin
- Mental-health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Marina Kukla
- Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Courtney Wiesepape
- Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, Indiana State University, Terra Haute, Indiana, USA
| | - Olga Karpenko
- Mental-health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
| | - Georgiy Kostyuk
- Mental-health Clinic No. 1 named after N.A. Alexeev, Moscow, Russia
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15
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Kukla M, Strasburger AM, Salyers MP, Rollins AL, Lysaker PH. Psychosocial outcomes of a pilot study of work-tailored cognitive behavioral therapy intervention for adults with serious mental illness. J Clin Psychol 2020; 77:488-495. [PMID: 32860466 DOI: 10.1002/jclp.23048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many people with serious mental illness (SMI) continue to struggle with work functioning despite the receipt of supported employment (SE) services. In response, adjunctive interventions to SE have begun to be developed. One such approach, the cognitive behavioral therapy for work success (CBTw) intervention, targets cognitive and behavioral barriers to competitive work success in adults with SMI. Using a pre-post design, this pilot study examined the psychosocial outcomes of the CBTw program in 52 adults with SMI receiving SE. METHOD Recovery attitudes, work-related self-efficacy, self-esteem, and symptom domains (depression, anxiety, psychosis) were measured at baseline and after the 12-week intervention. Paired samples t-tests examined changes in outcomes over time. RESULTS At posttreatment, participants had significant improvements in recovery attitudes, self-esteem, depressive, and negative symptoms. Other psychosocial outcomes did not significantly change. CONCLUSIONS This pilot work demonstrates CBTw is a promising intervention to improve recovery and wellness in SMI.
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Amy M Strasburger
- Richard L. Roudebush VA Medical Center, Psychiatry Service, Indianapolis, Indiana, USA
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Angela L Rollins
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA.,Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA.,ACT Center of Indiana, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Psychiatry Service, Indianapolis, Indiana, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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16
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Matthias MS, Daggy J, Ofner S, McGuire AB, Kukla M, Bair MJ. Exploring peer coaches' outcomes: Findings from a clinical trial of patients with chronic pain. Patient Educ Couns 2020; 103:1366-1372. [PMID: 32044190 DOI: 10.1016/j.pec.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 02/04/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Although peer coaching can help patients manage chronic conditions, few studies have evaluated the effects of peer coaching on coaches, and no studies have systematically examined these effects in the context of chronic pain coaching. METHODS Peer coach outcomes were assessed as part of a randomized trial of peer coaching for chronic pain. In this exploratory analysis, linear mixed models were used to evaluate changes in peer coaches' pain and related outcomes from baseline to 6 and 9 months. The Šidák method was used to account for multiple comparisons. RESULTS Peer coaches (N = 55) experienced statistically significant increases in anxiety and pain catastrophizing from baseline to 6 months, which were no longer significant after adjustment. All other changes were not statistically significant. CONCLUSIONS Despite prior studies suggesting that peer coaches benefit from serving as a coach, the current study failed to support that conclusion. PRACTICE IMPLICATIONS Peer coaching remains a promising model, with high potential for implementation, for a number of chronic conditions requiring self-management. However, to maximize the benefits of such interventions, it is essential to monitor both those being coached and the coaches themselves, and not to assume that serving as a coach is inherently beneficial.
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Affiliation(s)
- Marianne S Matthias
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Department of Communication Studies, Indiana University-Purdue University, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alan B McGuire
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Marina Kukla
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Matthew J Bair
- US Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Regenstrief Institute, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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17
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Pazgan-Simon M, Zuwala-Jagiello J, Menzyk T, Bator M, Derra A, Lekstan A, Grzebyk E, Simon K, Kukla M. Serum betatrophin and irisin levels in hepatocellular carcinoma. J Physiol Pharmacol 2020; 71. [PMID: 32554846 DOI: 10.26402/jpp.2020.1.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/28/2020] [Indexed: 11/03/2022]
Abstract
Hepatocellular carcinoma (HCC) development is a complex process with well-known risk factors, however the role of betatrophin/angiopoietin-like protein 8 and irisin has been poorly investigated thus far. The aim of this study is to measure betatrophin and irisin serum levels in HCC, cirrhotic patients and controls, assess their relationship with cancer etiology and grade, metabolic abnormalities and liver dysfunction severity. Serum betatrophin and irisin concentrations were measured with commercially available ELISA kits in 69 cirrhotic patients with HCC, 24 patients with non-viral cirrhosis and 20 healthy volunteers. The severity of liver disfunction was assessed according to Child-Pugh (C-P) score, while HCC grade according to the Barcelona clinic liver cancer (BCLC) staging system. Serum betatrophin concentration was significantly higher (33.7 ± 13.4 versus 12.3 ± 2.0 ng/ml; P < 0.001), while serum irisin level significantly lower in HCC patients compared to controls (2.52 ± 1.14 versus 4.46 ± 1.34 μg/ml; P = 0.02). Betatrophin level was also significantly elevated among cirrhotic patients compared to healthy volunteers. More evident serum betatrophin increase was found in patients with viral disease (34.8 ± 12.9 versus 26.1 ± 13.8 ng/ml; P < 0.001). Serum irisin concentration was significantly decreased in more advanced HCC cases (stage A versus C according to BCLC: 3.4 ± 1.3 versus 1.89 ± 1.1 μg/ml; P = 0.02). Decline of serum irisin (A: 3.4 ± 1.2; B: 2.42 ± 0.8; C: 1.91 ± 1.19 μg/ml; P = 0.03) and up-regulation of serum betatrophin levels (A: 24.1 ± 13.8; B: 39.3 ± 11.4; C: 46.2 ± 9.4 ng/ml; P = 0.03) were observed in patients with more advanced cirrhosis according to C-P score. We concluded that betatrophin serum level increased in cirrhotic patients, compared to controls. Since there was no difference between cirrhotic patients with and without intercurrent HCC, we suppose it may have an influence on fibrosis development, however not hepatocarcinogensis. Irisin serum level decreased in HCC patients, especially with more advanced disease grade, and was inversely related to the severity of liver disfunction.
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Affiliation(s)
- M Pazgan-Simon
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland.,Department of Infectious Diseases, Regional Specialistic Hospital in Wroclaw, Wroclaw, Poland
| | - J Zuwala-Jagiello
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Wroclaw, Poland
| | - T Menzyk
- Medical University of Silesia in Katowice, Katowice, Poland
| | - M Bator
- Medical University of Silesia in Katowice, Katowice, Poland
| | - A Derra
- Medical University of Silesia in Katowice, Katowice, Poland
| | - A Lekstan
- Department of Digestive Tract Surgery, Medical University of Silesia in Katowice, Katowice, Poland
| | - E Grzebyk
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Wroclaw, Poland
| | - K Simon
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland.,Department of Infectious Diseases, Regional Specialistic Hospital in Wroclaw, Wroclaw, Poland
| | - M Kukla
- Department of Infectious Diseases, Regional Specialistic Hospital in Wroclaw, Wroclaw, Poland.,Department of Internal Medicine and Geriatrics, Jagiellonian University Medical College, Cracow, Poland.,Department of Endoscopy, University Hospital in Cracow, Cracow, Poland.
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18
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Wieczorek B, Kukla M. Biomechanical Relationships Between Manual Wheelchair Steering and the Position of the Human Body's Center of Gravity. J Biomech Eng 2020; 142:1075022. [DOI: 10.1115/1.4046501] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 11/08/2022]
Abstract
Abstract
The purpose of this investigation was to analyze the impact of differential steering of a wheelchair with a pushrim on changes in the position of the body's center of gravity. The method assumed measuring the wheelchair trajectory and the body's center of gravity and determining the transverse relocation of the measured body's center of gravity in relation to a point on the wheelchair trajectory. Twenty-seven measurement tests which demonstrated various wheelchair trajectories were carried out within the investigation. The trajectories were 10 to 15 m long and involved moving forward (test 2), reversing (test 3), turning left (test 1) and right (test 4). The factor of deviation of the center of gravity of human body from the wheelchair trajectory was determined for selected characteristic turning maneuvers. The measured values ranged from 51 to 192 mm. The impact of the wheelchair trajectory on the position of the body's center of gravity was demonstrated as a result of this investigation. Consequently, a trajectory deviation factor for relocation of the human body weight on one side of the wheelchair has been demonstrated.
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Affiliation(s)
- B. Wieczorek
- Institute of Machine Design, Poznań University of Technology, 3/424 Piotrowo Street, Poznań 60-965, Poland
| | - M. Kukla
- Institute of Machine Design, Poznań University of Technology, 3/424 Piotrowo Street, Poznań 60-965, Poland
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19
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Kukla M, Salyers MP, Strasburger AM, Johnson-Kwochka A, Amador E, Lysaker PH. Work-focused cognitive behavioral therapy to complement vocational services for people with mental illness: Pilot study outcomes across a 6-month posttreatment follow-up. Psychiatr Rehabil J 2019; 42:366-371. [PMID: 31070442 DOI: 10.1037/prj0000365] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE People with mental illness frequently have trouble obtaining and keeping competitive employment and struggle with on-the-job performance. To address these issues, the manualized, group-based, 12-session Cognitive Behavioral Therapy for Work Success (CBTw) intervention was developed and tested in an open trial. Although posttreatment work outcomes were promising, lasting effects associated with the intervention are unknown. METHOD This article presents the 6-month posttreatment work outcomes of the open trial of CBTw in 52 adults with mental illness who were concurrently receiving VA vocational services. Work outcomes included work status, hours worked and wages earned, steady work status, and work performance and effectiveness. Data were analyzed using repeated measures analysis of variances (ANOVAs) and within groups t tests. RESULTS Findings demonstrate that 75% of unemployed participants at baseline obtained competitive work during the study period. During the 6-month follow-up period, 73% of workers attained steady work status (i.e., working at least 50% of the follow-up period). In addition, during the 6-month follow-up period, working participants averaged significantly more hours of work per week and higher wages earned per hour as compared with the baseline period and the 12-week postintervention period. Finally, among workers, reports of work effectiveness remained high at 6 months and work productivity disruptions remained low at follow-up. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These findings suggest that CBTw may potentially be a useful tool to enhance the effects of vocational programs. Future work should test CBTw in a randomized controlled trial and examine strategies for implementation in real-world vocational service settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis
| | | | | | - Emily Amador
- Marian University College of Osteopathic Medicine
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20
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Buck B, Gagen EC, Luther L, Kukla M, Lysaker PH. Dynamic relationships between emotional distress, persecutory ideation, and metacognition in schizophrenia. J Clin Psychol 2019; 76:716-724. [PMID: 31777084 DOI: 10.1002/jclp.22904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Determine whether metacognitive capacity (i.e., a range of abilities that involve recognition, reflection, and integration of mental states) influences the relationships between emotional distress and persecutory ideation (PI). METHODS The present study examined emotional distress, metacognition and PI in a sample (n = 337) of individuals with schizophrenia or schizoaffective disorder and clinician-rated PI. Pearson and partial correlations were used to examine relationships between variables, as well as between-subjects analysis of variances to compare groups characterized based on emotional distress and persecutory ideation scores. RESULTS While emotional distress and PI are associated with one another, metacognition is negatively associated with PI and positively associated with emotional distress. Subgroup comparisons demonstrated that individuals with high emotional distress and low PI had significantly higher metacognitive capacity than those elevated in PI or reduced in both emotional distress and PI. CONCLUSIONS Findings suggest metacognitive capacity may relate to improved awareness of distress and reduced PI.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Emily C Gagen
- Research Service, Providence VA Medical Center, Providence, Rhode Island
| | - Lauren Luther
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Marina Kukla
- Center for Health Information and Communication, VA Health Services Research and Development, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Paul H Lysaker
- Psychosocial Rehabilitation and Recovery Center (PRRC), Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
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21
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Skladany L, Koller T, Molcan P, Vnencakova J, Zilincan M, Jancekova D, Kukla M. Prognostic usefulness of serum myostatin in advanced chronic liver disease: its relation to gender and correlation with inflammatory status. J Physiol Pharmacol 2019; 70. [PMID: 31539882 DOI: 10.26402/jpp.2019.3.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/24/2019] [Indexed: 01/24/2023]
Abstract
In hospitalized patients with advanced chronic liver disease (ACLD), we aimed to evaluate the association between myostatin and muscle mass, its relation to inflammation and to assess the added prognostic value of myostatin for survival. In a prospective single-center cohort study, inclusion criteria were: consecutive hospitalization for ACLD and Child-Pugh score ≥ 7 points. Baseline parameters were myostatin, C-reactive protein (CRP), hand-grip strength (HGS), mid-arm muscle circumference (MAC), transversal psoas muscle index (TPMI). Patients were followed-up for at least 400 days. We included 198 men, 157 women, and 40 controls, median myostatin levels in pg/ml were 1790.1 in women, 1959.4 in men, and 3850.0 and 2996.0 in healthy men and women. Myostatin positively correlated with TPMI, but weakly with MAC and HGS, and not in women. Myostatin negatively correlated with CRP in both genders. In cases with CRP 10 mg/l, regression analysis of myostatin versus HGS, MAC or TPMI showed steeper dependence curve. During follow up, 85 men and 64 women (42.9% versus 40.8%) have died, 22 men and 19 women (11.1% versus 12.1%) underwent liver transplantation. Cumulative incidence of death was higher in men with myostatin levels < 1600.0 pg/ml, but not in women. In men, MELD score and myostatin cut-off were independent predictors of worse survival but did not predict survival in women. In men, myostatin levels directly reflect the muscle mass and low levels independently predict worse survival. In women, myostatin is not associated with muscle mass or survival.
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Affiliation(s)
- L Skladany
- Hepatology, Gastroenterology and Liver Transplantation Unit (HEGITO), 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Faculty Hospital, Banska Bystrica, Slovakia
| | - T Koller
- Subdivision of Gastroenterology and Hepatology, 5th Department of Medicine, Comenius University Faculty of Medicine in Bratislava, University Hospital Ruzinov, Bratislava, Slovakia
| | - P Molcan
- Hepatology, Gastroenterology and Liver Transplantation Unit (HEGITO), 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Faculty Hospital, Banska Bystrica, Slovakia
| | - J Vnencakova
- Hepatology, Gastroenterology and Liver Transplantation Unit (HEGITO), 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Faculty Hospital, Banska Bystrica, Slovakia
| | - M Zilincan
- Department of Radiology, FD Roosevelt Faculty Hospital, Banska Bystrica, Slovakia
| | - D Jancekova
- Hepatology, Gastroenterology and Liver Transplantation Unit (HEGITO), 2nd Department of Medicine, Slovak Medical University, FD Roosevelt Faculty Hospital, Banska Bystrica, Slovakia
| | - M Kukla
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland.
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22
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Zuwala-Jagiello J, Pazgan-Simon M, Simon K, Kukla M, Murawska-Cialowicz E, Grzebyk E. Serum endocan level in diabetes mellitus of patients with cirrhosis and risk of subsequent development of spontaneous bacterial peritonitis. J Physiol Pharmacol 2019; 70. [PMID: 31539885 DOI: 10.26402/jpp.2019.3.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/28/2019] [Indexed: 11/03/2022]
Abstract
The presence of type 2 diabetes mellitus (DM) in patients with cirrhosis is associated with an increased risk of spontaneous bacterial peritonitis (SBP) which may represent an increased susceptibility to infections. Endocan is a key player in the regulation of inflammatory disorders, and a biomarker in bacteremia and sepsis. To investigate the association between both endocan and DM, and developing SBP, we conducted a retrospective cohort study. Three hundred and thirty patients (179 men, 151 women; mean age 61.0 ± 8.5 years) who were treated for liver cirrhosis were studied between January 2007 and December 2016. Univariate and multivariate analyses using age, type 2 diabetes mellitus, severity of cirrhosis (Child-Pugh or MELD score), platelet count, serum proinflammatory cytokines, procalcitonin, C-reactive protein, and endocan level were conducted to identify factors related to the development of SBP. Among 330 patients with the median follow-up of 6.0 years, the cumulative incidence of SBP at 5 years was 28.6%. On multivariate analysis, a high serum endocan level and DM were independent and significant risk factors for SBP development (hazard ratio (HR) 1.634 (95% CI: 1.012 - 2.638; P = 0.047) and 2.482 (95% CI: 1.134 - 5.412; P = 0.023), respectively). Furthermore, the cumulative incidence rate of SBP in cirrhotic patients with high endocan levels was significantly greater than that in patients with low endocan levels (P = 0.035; log-rank test). Endocan is an independent predictor of SBP development in patients with cirrhosis. Cirrhotic patients with type 2 diabetes mellitus who have a higher endocan levels should be monitored carefully for the development of spontaneous bacterial peritonitis.
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Affiliation(s)
- J Zuwala-Jagiello
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Poland.
| | - M Pazgan-Simon
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Poland
| | - K Simon
- Department of Infectious Diseases and Hepatology, Wroclaw Medical University, Poland
| | - M Kukla
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Poland
| | - E Murawska-Cialowicz
- Department of Physiology and Biochemistry, University of Physical Education, Wroclaw, Poland
| | - E Grzebyk
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Poland
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Rattray NA, True G, Natividad DM, Salyers MP, Frankel RM, Kukla M. The long and winding road to postsecondary education for U.S. veterans with invisible injuries. Psychiatr Rehabil J 2019; 42:284-295. [PMID: 31246076 PMCID: PMC6715523 DOI: 10.1037/prj0000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Veterans with "invisible injuries" (a mental health diagnosis or a traumatic brain injury) often pursue higher education to enhance employment and community reintegration, but frequently experience challenges to success. This mixed methods study examined how the educational experiences of Veterans with invisible injuries become intertwined with broader transitions between military and civilian life and the resulting implications for rehabilitation services. METHOD Thirty-eight Veterans with mental illness or a traumatic brain injury who served in a post-9/11 conflict and attended a postsecondary institution within the past 60 months completed in-depth interviews and questionnaires. We used a constant comparative approach to analyze barriers and facilitators to educational functioning and community reintegration. RESULTS Managing school-specific challenges, coping with mental and physical health problems, forming a new sense of self, and forging new career pathways were major factors influencing education experiences and reintegration. Participants discussed the challenges of balancing these processes while progressing toward an academic degree, which often resulted in a longer, nonlinear educational pathway. While some participants attempted to "compartmentalize" educational goals, separate from health and family concerns, these aims were inevitably interlaced. In addition, multiple and longer military deployments tended to lengthen the time to degree completion. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Many Veterans with invisible injuries face complex challenges stemming from military experiences, the family dynamics to which they return, and reintegration issues that demand novel forms of resilience. Collaboration between university staff and health practitioners may be important in enhancing support for student Veterans coping with invisible disabilities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Gala True
- South Central MIRECC Southeast Louisiana Veterans Health Care System
| | | | | | | | - Marina Kukla
- VA HSR&D Center for Health Information and Communication
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24
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Waluga M, Kukla M, Kotulski R, Zorniak M, Boryczka G, Kajor M, Ciupinska-Kajor M, Lekstan A, Olczyk P, Waluga E. Omentin, vaspin and irisin in chronic liver diseases. J Physiol Pharmacol 2019; 70. [PMID: 31443090 DOI: 10.26402/jpp.2019.2.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/29/2019] [Indexed: 11/03/2022]
Abstract
Omentin and vaspin are adipokines potentially considered in the development of liver pathology. Irisin is new myokin potentially participating in energy processes in the organisms. The aim of this study was to evaluate the plasma concentration of these cytokines and the relationships of them with selected parameters of laboratory tests and of histopathological changes in selected chronic liver diseases: non-alcoholic fatty liver diseases (NAFLD), primary biliary cholangitis (PBC) and alcoholic cirrhosis (AC). The plasma concentration of omentin was the highest in AC group and the lowest in control group (CG). Irisin plasma concentration was the highest in CG and the lowest in AC. Mean vaspin concentrations did not differ significantly between groups. Among many laboratory parameters, only in the AC group positive relationships were found between omentin concentration and bilirubin, as well as glucose, and negative between omentin level and the number of platelets and erythrocytes; there was a positive relationship between the concentration of vaspin and bilirubin, as well as negative between vaspin level and the number of erythrocytes or hematocrit value in this group. INR value had positive correlation with vaspin concentration and negative with irisin level in NAFLD group. No significant dependences between the concentrations of explored cytokines and laboratory tests were found in PBC group. It was found the positive correlation between the plasma concentration of irisin and fibrosis as well as inflammation in PBC group. The negative correlation between irisin level and inflammation in NAFLD was also showed. Omentin can be considered as an indicator for predicting inflammation, steatosis and balloon degeneration in NAFLD and PBC. Summarizing, it is unclear but possible that explored cytokines have some relationships with certain features of liver damage and development of chronic diseases of this organ.
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Affiliation(s)
- M Waluga
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - M Kukla
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - M Zorniak
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - G Boryczka
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Kajor
- Department of Pathomorphology and Molecular Diagnostics, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Ciupinska-Kajor
- Department of Pathomorphology and Molecular Diagnostics, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Lekstan
- Department of General, Vascular and Transplant Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - P Olczyk
- Department of Community Pharmacy, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - E Waluga
- Department of Community Pharmacy, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland
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25
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Matthias MS, Daggy J, Adams J, Menen T, McCalley S, Kukla M, McGuire AB, Ofner S, Pierce E, Kempf C, Heisler M, Bair MJ. Evaluation of a peer coach-led intervention to improve pain symptoms (ECLIPSE): Rationale, study design, methods, and sample characteristics. Contemp Clin Trials 2019; 81:71-79. [PMID: 30951837 DOI: 10.1016/j.cct.2019.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/24/2019] [Accepted: 04/02/2019] [Indexed: 01/16/2023]
Abstract
Chronic pain is prevalent, costly, and a leading cause of disability. Pain self-management (i.e., employing self-management strategies including behavioral modifications) is an effective, evidence-based treatment. However, implementation and delivery of a pain self-management model is challenging because of time and resources. Peer supported pain self-management offers a promising approach to implementing pain self-management programs using fewer clinical resources. Evaluation of a Peer Coach-Led Intervention for the Improvement of Pain Symptoms (ECLIPSE) is a randomized controlled trial testing effectiveness of peer coach-delivered pain self-management intervention versus controls receiving a class on pain and pain self-management. ECLIPSE is a Hybrid Type 1 study testing effectiveness while examining implementation factors. ECLIPSE enrolled 215 veterans randomly assigned to the peer coaching (N = 120) or control (N = 95) arm. The peer coaching intervention lasts 6 months, with patient-peer coach pairs instructed to talk twice per month. Coaches attend initial training, are provided a detailed training manual, and attend monthly booster sessions. Outcomes are assessed at baseline, 6 months, and 9 months. The primary outcome is overall pain (intensity and interference), measured by the Brief Pain Inventory (BPI). Secondary outcomes are self-efficacy, social support, pain catastrophizing, patient activation, health-related quality of life, and health care utilization. To maximize implementation potential of pain self-management, innovative delivery methods are needed that do not require additional resources from healthcare teams. A novel and promising approach is a peer-coaching model, in which patients who are successfully managing their pain offer information, ongoing support, and advice to other patients with pain. Clinical Trials Registration: NCT02380690.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States; Regenstrief Institute, Indianapolis, IN, United States; Department of Communication Studies, Indiana University-Purdue University, Indianapolis, IN, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Stephanie McCalley
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Marina Kukla
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States; Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Alan B McGuire
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States; Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Susan Ofner
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Emilee Pierce
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Carol Kempf
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Michele Heisler
- VA Center for Clinical Management Research, Ann Arbor, MI, United States; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States; Regenstrief Institute, Indianapolis, IN, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
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26
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Kukla M, Lysaker PH. Metacognition over time is related to neurocognition, social cognition, and intrapsychic foundations in psychosis. Schizophr Res Cogn 2019; 19:100149. [PMID: 31832339 PMCID: PMC6889797 DOI: 10.1016/j.scog.2019.100149] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/12/2019] [Accepted: 05/02/2019] [Indexed: 01/26/2023]
Abstract
Core impairments underlying schizophrenia encompass several domains, including disruptions in metacognition, neurocognition, social cognition, and intrapsychic foundations. Little is known about how these phenomena change over time and whether changes co-occur. The current study sought to address these gaps and examine the relationships between these cognitive domains across a 12 month period in adults with schizophrenia. Seventy-five adult outpatients with schizophrenia spectrum disorders were enrolled in a randomized trial comparing two cognitive interventions designed to improve work performance. Cognitive outcomes were measured at baseline, a 6-month follow-up and a 12-month follow-up. Multilevel linear modeling was used to understand the longitudinal relationships between metacognition and social cognition, neurocognition, and intrapsychic foundations across the 12-month follow-up. Metacognition significantly improved across 12 months. Improvements in overall neurocognition were significantly associated with increases in the metacognition domains of self-reflectivity and mastery across time. Improvements in social cognition over time were associated with improvements in total metacognition and the metacognitive domain of mastery. Improvements in intrapsychic foundations scores over 12 months were significantly associated with improvements in overall metacognition, self-reflectivity, and mastery. In conclusion, over time, improvements in metacognition across domains co-occur with other core cognitive and social capacities in persons with schizophrenia. As persons became better able to form integrated senses of themselves and adaptively use this knowledge, improvements in neurocognition, social cognition, and intrapsychic foundations were also present.
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN, USA
- Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., Indianapolis, IN 46202, USA
- Corresponding author at: 1481 W. 10th Street, 11H, Indianapolis, IN 46202, USA.
| | - Paul H. Lysaker
- Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN 46202, USA
- Indiana University School of Medicine, 340 W. 10th Street, Suite 6200, Indianapolis, IN 46202, USA
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27
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Lysaker PH, Gagen E, Wright A, Vohs JL, Kukla M, Yanos PT, Hasson-Ohayon I. Metacognitive Deficits Predict Impaired Insight in Schizophrenia Across Symptom Profiles: A Latent Class Analysis. Schizophr Bull 2019; 45:48-56. [PMID: 30321433 PMCID: PMC6293218 DOI: 10.1093/schbul/sby142] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The integrated model of insight in schizophrenia suggests that poor insight is the result of multiple factors which compromise persons' abilities to integrate streams of information into a personal awareness of psychiatric challenges, and make adaptive responses. This model hypothesizes that metacognitive deficits, or difficulties forming a complex and integrated understanding of the self and others, influence insight, regardless of other proximal causes including clinical profile. To explore this possibility, we performed a latent class analysis on 324 adults with schizophrenia or schizoaffective disorder. This analysis produced 4 groups on the basis of assessment of insight and Positive and Negative Syndrome Scale (PANSS) positive, negative, cognitive, and hostility symptoms. The resultant groups were characterized as: Good Insight/Low Symptoms (n = 71), Impaired Insight/High Negative Symptoms, (n = 43), Impaired Insight/High Positive Symptoms (n = 50) and Impaired Insight/Diffuse Symptoms (n = 160). When we compared metacognitive function as assessed with the Metacognition Assessment Scale - Abbreviated (MAS-A) across groups, we found that the good insight group had better overall metacognition as well as higher levels of self-reflectivity, awareness of the other and mastery as compared to all 3 groups with impaired insight. When controlling for total symptoms, all differences in metacognitive function between the good insight and the impaired insight groups remained significant. These results are consistent with the view that, independent of symptoms, impaired metacognition contributes to difficulties integrating information and hence impedes insight, or awareness of psychiatric challenges. Consistent with extant literature, results suggest that interventions focusing on metacognition as the target may lead to improved insight.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN,Department of Psychiatry Indiana University School of Medicine, Indianapolis, IN,To whom correspondence should be addressed; Department of Psychiatry, Richard L. Roudebush VA Medical Center, 116A, 1481 West 10th St. Indianapolis, IN 46202, US; tel: 317-988-2546, e-mail:
| | - Emily Gagen
- Department of Psychology and Neuroscience University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Abigail Wright
- Department of Psychology University of Sussex, Falmer, Sussex, UK
| | - Jenifer L Vohs
- Department of Psychiatry Indiana University School of Medicine, Indianapolis, IN
| | - Marina Kukla
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN
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28
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Lysaker PH, Hamm JA, Vohs J, Kukla M, Pattison ML, Leonhardt BL, Lysaker JT. Understanding the Course of Self-disorders and Alterations in Self- Experience in Schizophrenia: Implications from Research on Metacognition. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/1573400514666180816113159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Paul H. Lysaker
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Jay A. Hamm
- Purdue University College of Education, West Lafayette, IN 46202, United States
| | - Jenifer Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA; 2Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Michelle L. Pattison
- University of Indianapolis, College of Applied Behavioral Sciences, Indianapolis, IN 46227, United States
| | - Bethany L. Leonhardt
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - John T. Lysaker
- Emory University, Department of Philosophy, Atlanta, GA 30322, United States
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29
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Buck KD, Vertinski M, Kukla M. Metacognitive Reflection and Insight Therapy (MERIT): Application to a Long-Term Therapy Case of Borderline Personality Disorder. Am J Psychother 2018; 71:145-154. [PMID: 30400764 DOI: 10.1176/appi.psychotherapy.20180035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Impairments in metacognitive capacity-or the processes that enable individuals to access, understand, and integrate their ideas about their own and others' mental states-are a core barrier to recovery for many people with borderline personality disorder. Although therapeutic approaches that focus on metacognitive capacity are emerging, few deal with the concept of recovery at a foundational level. This article describes how a form of metacognitively oriented psychotherapy focused on recovery, metacognitive reflection and insight therapy (MERIT), assisted a patient with borderline personality disorder and initial metacognitive deficits to develop a complex understanding of himself and others and then to use that knowledge to act as an agent in the world and effectively respond to life challenges. The eight elements of MERIT that stimulate and promote metacognitive capacity are presented with an emphasis on how they were implemented to assist the patient in achieving recovery.
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Affiliation(s)
- Kelly D Buck
- Roudebush VA Medical Center, Indianapolis (Buck and Kukla); San Francisco VA Healthcare Service, San Francisco (Vertinski); Department of Psychology, Indiana University-Purdue University, Indianapolis (Kukla)
| | - Mary Vertinski
- Roudebush VA Medical Center, Indianapolis (Buck and Kukla); San Francisco VA Healthcare Service, San Francisco (Vertinski); Department of Psychology, Indiana University-Purdue University, Indianapolis (Kukla)
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis (Buck and Kukla); San Francisco VA Healthcare Service, San Francisco (Vertinski); Department of Psychology, Indiana University-Purdue University, Indianapolis (Kukla)
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30
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Ochman M, Stanjek-Cichoracka A, Latos M, Wojarski J, Kukla M, Woźniak-Grygiel E, Maruszewski M, Karolak W, Przybyłowski P, Żegleń S. Serum Adipokine Levels in Patients Considered for Lung Transplantation. Transplant Proc 2018; 50:2039-2043. [PMID: 30177105 DOI: 10.1016/j.transproceed.2018.02.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/06/2018] [Indexed: 11/27/2022]
Abstract
The aim of the study was to investigate serum concentration of visfatin, irisin, and omentin in patients diagnosed as having end-stage lung diseases who qualified for lung transplantation (LTx) and to find the relationship between adipokine levels and clinical status. MATERIAL AND METHODS The study population consisted of 23 consecutive patients (10 patients diagnosed as having cystic fibrosis, 6 patients diagnosed as having chronic obstructive pulmonary disease, and 7 patients diagnosed as having idiopathic pulmonary fibrosis) who qualified for LTx. Patients performed pulmonary function tests; visfatin, irisin, and omentin serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits. RESULTS Mean visfatin serum level was 4.99 ± 3.83 pg/mL; mean irisin serum level was 2.82 ± 0.24 ng/mL; mean omentin serum level was 389.99 ± 320.85 ng/mL. Mean distance in 6-minute walk test (6MWT) was 310.62 ± 147.09 m. Average partial pressure of oxygen (pO2) was 55.79 ± 10.33 mm Hg, forced expiratory volume (FEV1) was 26.25 ± 22.38%, and forced vital capacity (FVC) was 56.95 ± 21.91% of a due value. There was no statistically significant correlation between adipokine levels and 6MWT, pO2, FEV1, and FVC in patients waiting for LTx, regardless of underlying lung disease. Significant difference between patients was noted only in 6MWT, FEV1, and pO2 in connection to lung disease. CONCLUSION Our findings indicate that adipokines may not have a statistically significant effect on parameters of pulmonary function. Results require further investigation on a larger study group, especially comparison of adipokine serum levels between groups of overweight patients, obese patients, and patients with normal weight who qualify for LTx.
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Affiliation(s)
- M Ochman
- Department of Pharmacology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland; Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - A Stanjek-Cichoracka
- Department of Biophysics, School of Pharmacy with the Division of Laboratory Medicine, Medical University of Silesia in Katowice, Sosnowiec, Poland; Laboratory of Transplant Immunology, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - M Latos
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - J Wojarski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - M Kukla
- Department of Gastroenterology and Hepatology, Medical University of Silesia in Katowice, Katowice, Poland
| | - E Woźniak-Grygiel
- Laboratory of Transplant Immunology, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - M Maruszewski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - W Karolak
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - P Przybyłowski
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Cracow, Poland
| | - S Żegleń
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland; Department of Epidemiology in Bytom, Medical University of Silesia in Katowice, Bytom, Poland
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31
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Waluga M, Zorniak M, Fichna J, Kukla M, Hartleb M. Pharmacological and dietary factors in prevention of colorectal cancer. J Physiol Pharmacol 2018; 69. [PMID: 30149368 DOI: 10.26402/jpp.2018.3.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/30/2018] [Indexed: 01/08/2023]
Abstract
Colorectal cancer (CRC) is the third most prevalent neoplasm worldwide and fourth most frequent reason of cancer-related death throughout the world. About 70% of malignant tumors are related to lifestyle and environmental factors, and better knowledge of their significance might reduce the prevalence of CRC. The cyclooxygenase-2 (COX-2) inhibitory and other direct and indirect pathways of aspirin are translated to inhibition proliferation and enhanced apoptosis of cancer cells. Many studies showed the benefits of aspirin in reducing the risk of CRC development, cancer-related mortality and adenoma prevalence rate in general population, but not in high risk populations. The role of sulindac in CRC prevention is uncertain and the use of this drug is rather uncommon. Celecoxib - COX-2 selective inhibitor- showed efficacy in decreasing of colon adenoma recurrence only in some studies. The protective role of microelements is controversial. The beneficial effects of supplementation of selenium, calcium, folic acid, methionine, antioxidant supplements and probiotics are still not certain. A high energy diet consisting of red meat, animal fat, highly processed foods and unsaturated fats increases the risk of CRC. Carcinogenic role of fat and cholesterol depends on increased production of primary bile acids. The importance of milk and dairy products in CRC prevention is controversial. Fruits, vegetables and grain are considered to have protective effects against adenoma and CRC. Excessive alcohol consumption, smoking, physical inactivity are considered as important CRC risk factors. This article briefly summarizes current state of knowledge about the role of pharmacological and dietary prevention of colorectal cancer. Moreover, it indicates that despite many studies some aspects of this issue are not clear and require future studies.
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Affiliation(s)
- M Waluga
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - M Zorniak
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - J Fichna
- Department of Biochemistry, Medical University of Lodz, Lodz, Poland
| | - M Kukla
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Hartleb
- Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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32
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Kukla M, Bell MD, Lysaker PH. A randomized controlled trial examining a cognitive behavioral therapy intervention enhanced with cognitive remediation to improve work and neurocognition outcomes among persons with schizophrenia spectrum disorders. Schizophr Res 2018; 197:400-406. [PMID: 29422299 DOI: 10.1016/j.schres.2018.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 11/02/2017] [Accepted: 01/17/2018] [Indexed: 11/26/2022]
Abstract
This single blind, three-armed randomized controlled trial compared cognitive behavioral therapy (CBT) enhanced with cognitive remediation (CBT+CR) to CBT alone and an active control condition on work and neurocognition outcomes for persons with schizophrenia spectrum disorders. Seventy-five adult outpatients with schizophrenia or schizoaffective disorder were randomized to three study conditions (N=25 per group). The CBT intervention was the Indianapolis Vocational Intervention program (IVIP), consisting of weekly group and individual sessions focused on work-related content. Participants in the CBT+CR group received IVIP and Posit Science computer-based cognitive training. The active control group consisted of weekly vocational support groups and individual vocational support sessions. All participants were placed into a noncompetitive work assignment and were followed for 26weeks. Data collection included hours worked, weekly work performance ratings, and neurocognition assessed at baseline and 6months. Neurocognition was also assessed at 12months. Data were analyzed using multilevel linear models to account for nested, repeated measures data. Results indicate that participants in the CBT+CR condition worked significantly more hours and had a more positive trajectory of improving global work performance and work quality across the study compared with the CBT alone and vocational support condition. Compared to the other conditions, CBT+CR also had a significant increase in overall neurocognition that continued to the 12month follow-up, particularly in the domains of verbal learning and social cognition. In conclusion, CBT+CR may be an effective intervention to improve work functioning and neurocognition in persons with schizophrenia.
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN, USA; Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., Indianapolis, IN 46202, USA.
| | - Morris D Bell
- Yale University School of Medicine, 300 George St., New Haven, CT, 06511, USA; VA Connecticut Healthcare System, Psychology Service 116B, VACHS, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Paul H Lysaker
- Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Indiana University School of Medicine, 340 W. 10th Street, Suite 6200, Indianapolis, IN 46202, USA.
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Kukla M, McGuire AB, Strasburger AM, Belanger E, Bakken SK. Helping veterans achieve work: A Veterans Health Administration nationwide survey examining effective job development practices in the community. Psychiatr Rehabil J 2018; 41:103-108. [PMID: 29708368 DOI: 10.1037/prj0000297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Veterans Health Administration vocational services assist veterans with mental illness to acquire jobs; one major component of these services is job development. The purpose of this study was to characterize the nature of effective job development practices and to examine perceptions and intensity of job development services. METHOD A national mixed-methods online survey of 233 Veterans Health Administration vocational providers collected data regarding frequency of employer contacts, perceptions of job development ease/difficulty, and effective job development practices when dealing with employers. Qualitative responses elucidating effective practices were analyzed using content analysis. RESULTS Vocational providers had a modest number of job development employer contacts across 2 weeks (M = 11.0, SD = 10.6) and fewer were face-to-face (M = 7.6, SD = 8.4). Over 70% of participants perceived job development to be difficult. Six major themes emerged regarding effective job development practices with employers: using an employer-focused approach; utilizing a targeted marketing strategy; engaging in preparation and follow-up; going about the employer interaction with genuineness, resilience, and a strong interpersonal orientation; serving as an advocate for veterans and educator of employers; utilizing specific employer-tailored strategies, such as arranging a one-on-one meeting with a decision maker and touring the business, individualizing a prescripted sales pitch, connecting on a personal level, and engaging in ongoing communication to solidify the working relationship. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Respondents highlight several potentially effective job development strategies; tools and resources may be developed around these strategies to bolster job development implementation and allow opportunities for fruitful employer interactions. (PsycINFO Database Record
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center
| | - Alan B McGuire
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center
| | | | | | - Shana K Bakken
- Office of Mental Health and Suicide Prevention, Veterans Health Administration
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Budzynska A, Gawron-Kiszka M, Nowakowska-Dulawa E, Spiewak J, Lesinska M, Kukla M, Waluga M, Hartleb M. Serum neutrophil gelatinase-associated lipocalin (NGAL) correlates with clinical and endoscopic activity in ulcerative colitis but fails to predict activity in Crohn's disease. J Physiol Pharmacol 2017; 68:859-865. [PMID: 29550798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/15/2017] [Indexed: 06/08/2023]
Abstract
Serum neutrophil gelatinase-associated lipocalin (NGAL) is a low molecular weight protein released from activated neutrophils and intestine epithelium whose mRNA expression is increased in inflamed intestinal tissue. The purpose of this study was to explore the relationship between serum NGAL level and activity of inflammatory bowel diseases. A total of 120 patients, 79 with Crohn's disease (CD) and 41 with ulcerative colitis (UC) were prospectively included into the study. Serum NGAL was measured by ELISA. The inflammatory activity of UC was assessed by Mayo score and of CD by CDAI and SES-CD scoring systems. Increasing endoscopic severity of UC from remission/mild to moderate/severe was associated with increasing NGAL levels from 46.9 to 66.4 ng/ml (P = 0.002). NGAL concentrations were significantly lower in patients with complete endoscopic and histologic remission than in the active UC (46.9 versus 66.4 ng/ml, P = 0.009). Also deterioration of the clinical activity of UC patients was associated with increasing level of NGAL from 44.9 in remission/mild to 68.0 ng/ml in moderate/severe grade (P = 0.002). NGAL levels correlated with CRP (r = 0.49), ESR (r = 0.48) and iron concentrations (r = -0.63), but not with faecal calprotectin. NGAL showed ability to distinguish endoscopically active from inactive UC with AUC-ROC of 0.758 (sensitivity 96% and specificity 54%). However NGAL levels showed no significant relationship with either clinical or endoscopic activity of CD. We conclude that serum NGAL level corresponds to clinical and endoscopic activity of UC and accurately predicts disease endoscopic remission.
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Affiliation(s)
- A Budzynska
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland.
| | - M Gawron-Kiszka
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - E Nowakowska-Dulawa
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - J Spiewak
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - M Lesinska
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - M Kukla
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - M Waluga
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
| | - M Hartleb
- Department of Gastroenterology and Hepatology, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland
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Waluga M, Kukla M, Zorniak M, Kajor M, Liszka L, Dyaczynski M, Kowalski G, Zadlo D, Waluga E, Olczyk P, Buldak RJ, Berdowska A, Hartleb M. Fibroblast growth factor-21 and omentin-1 hepatic mRNA expression and serum levels in morbidly obese women with non-alcoholic fatty liver disease. J Physiol Pharmacol 2017; 68:363-374. [PMID: 28820393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
Fibroblast growth factor-21 (FGF21) and omentin-1 have been recognized as potent antidiabetic agents with potential hepatoprotective activity. The aim of this study was to evaluate hepatic FGF21 and omentin-1 mRNA expression as well as their serum levels as predictive markers of liver injury and insulin resistance in morbidly obese women with non-alcoholic fatty liver disease (NAFLD). This study included 56 severely obese women who underwent intraoperative wedge liver biopsy during the bariatric surgery. Hepatic FGF21 and omentin-1 mRNA were assessed by quantitative real-time PCR, while their serum concentrations were measured with commercially available enzyme-linked immunosorbent assays. The FGF21 serum level was significantly higher in patients with a greater extent of steatosis (grade 2 and 3) compared to those without or with mild steatosis (grade 0 and 1) (P = 0.049). Receiver Operating Characteristic analysis, however, showed poor discriminant power for the FGF21 serum levels in differentiating between more and less extensive steatosis with an AUC = 0.666. There was a tendency towards higher levels of hepatic FGF21 mRNA in patients with lobular inflammation and fibrosis and towards lower levels in the case of hepatocyte ballooning and steatosis. There was a positive mutual correlation between hepatic FGF21 and omentin-1 mRNA levels (r = 0.78; P < 0.001). Fibrosis stage was associated with serum glucose and homeostatic model assessment for insulin resistance (HOMA-IR) (P = 0.03 and P = 0.02, respectively). Serum omentin-1 was not associated with histopathological features. The hepatic omentin-1 mRNA levels showed a tendency to be lower in patients with advanced steatosis and hepatocyte ballooning. In conclusion, our study, which focused on hepatic FGF21 and omentin-1 mRNA expression, confirmed marked expression of both molecules in the liver of morbidly obese patients with NAFLD. More extensive steatosis was associated with evident changes in the serum FGF21 concentration in morbidly obese women with NAFLD, but the difference did not reach statistical significance. The vast amount of fat, both visceral and subcutaneous, in severely obese patients may be the additional source and influence the FGF21 and omentin-1 serum levels.
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Affiliation(s)
- M Waluga
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Kukla
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| | - M Zorniak
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Kajor
- Department of Patomorphology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - L Liszka
- Department of Patomorphology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - M Dyaczynski
- Department of Surgery, Municipal Hospital in Siemianowice Slaskie, Poland
| | - G Kowalski
- Department of General Surgery and Endocrinological Surgery, School of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - D Zadlo
- Department of General Surgery and Endocrinological Surgery, School of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | - E Waluga
- Department of Community Pharmacy, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
| | - P Olczyk
- Department of Community Pharmacy, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Sosnowiec, Poland
| | - R J Buldak
- Chair and Department of Biochemistry, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - A Berdowska
- Department of Microbiology and Biotechnology, Jan Dlugosz University, Czestochowa, Poland
| | - M Hartleb
- Chair and Department of Gastroenterology and Hepatology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Zuwala-Jagiello J, Simon K, Kukla M, Murawska-Cialowicz E, Gorka-Dynysiewicz J, Grzebyk E, Pazgan-Simon M. Increased circulating endocan in patients with cirrhosis: relation to bacterial infection and severity of disease. J Physiol Pharmacol 2017; 68:273-282. [PMID: 28614777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/09/2017] [Indexed: 06/07/2023]
Abstract
Life expectancy of patients with liver cirrhosis is closely linked to the degree of liver dysfunction and the occurrence of bacterial infection. An early diagnosis of infection helps to initiate adequate and timely measures and improves outcome of cirrhotic patients. Endocan is a newly recognized biomarker of sepsis. However, there have been no studies of the trends in endocan levels in cirrhotic patients with bacterial infection and their associations with markers of infection and inflammation. This study sought to assess the diagnostic value of serum levels of endocan, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) in 126 patients with cirrhosis: 51 with decompensated infected cirrhosis, 56 with decompensated uninfected and 19 with compensated uninfected cirrhosis at inclusion. We analyzed the association of endocan with clinical factors in cirrhosis by comparison with indicators of infection and inflammation. Endocan, PCT, CRP, IL-6 and TNF-α were assayed in serum samples by ELISA analyses. Serum levels of endocan, PCT, CRP and TNF-α were significantly higher in cirrhotic patients with clinically overt infections. Endocan levels were correlated to neither PCT levels nor IL-6 levels in each group of patients with cirrhosis. CRP and TNF-α levels and Child-Pugh score correlated only in the infected group of patients with endocan levels, while in the uninfected groups of cirrhotic patients no significant correlation could be detected. The diagnostic accuracy of endocan increased in advanced stage of the disease. Serum endocan levels ≥ 2.05 ng/ml had a sensitivity of 76.1% and specificity of 85% for the diagnosis bacterial infection in decompensated cirrhotic patients. The endocan measured at admission is a good clinical parameter predicting the occurrence of infection in these patients. Elevated endocan may reflect the degree of endothelial cell injury induced by a systemic inflammatory response, a pathologic process that could modify the course of advanced cirrhosis.
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Affiliation(s)
- J Zuwala-Jagiello
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Poland.
| | - K Simon
- Clinic of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Poland
| | - M Kukla
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Poland
| | - E Murawska-Cialowicz
- Department of Physiology and Biochemistry, University of Physical Education, Wroclaw, Poland
| | - J Gorka-Dynysiewicz
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Poland
| | - E Grzebyk
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Poland
| | - M Pazgan-Simon
- Clinic of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Poland
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Matthias MS, Kukla M, McGuire AB, Damush TM, Gill N, Bair MJ. Facilitators and Barriers to Participation in a Peer Support Intervention for Veterans With Chronic Pain. Clin J Pain 2017; 32:534-40. [PMID: 26340653 DOI: 10.1097/ajp.0000000000000297] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand facilitators and barriers to participation in a peer support intervention for self-management of chronic pain. METHODS After completing a pilot intervention study, peer coaches and their veteran patients took part in a qualitative, semistructured interview to explore their experiences with the intervention. Data were analyzed using an immersion/crystallization approach. RESULTS Three facilitators and 2 barriers to patient participation in a peer support intervention for veterans with chronic pain emerged. Facilitators were (1) having a shared identity as veterans, (2) being partnered with a person who also has chronic pain, and (3) support from the study staff. Barriers were (1) logistical challenges, and (2) challenges to motivation and engagement in the intervention. DISCUSSION Awareness of facilitators and barriers to participation in a peer-supported self-management program for chronic pain, as well as strategies to capitalize on facilitators and mitigate barriers, are essential for further study and ultimate clinical implementation of such a program.
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Affiliation(s)
- Marianne S Matthias
- *VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center †Regenstrief Institute Departments of ‡Communication Studies ∥Psychology, Indiana University-Purdue University §Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Rollins AL, Kukla M, Salyers MP, McGrew JH, Flanagan ME, Leslie DL, Hunt MG, McGuire AB. Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment. Adm Policy Ment Health 2017; 44:810-816. [DOI: 10.1007/s10488-016-0785-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bauer SM, McGuire AB, Kukla M, McGuire S, Bair MJ, Matthias MS. Veterans' pain management goals: Changes during the course of a peer-led pain self-management program. Patient Educ Couns 2016; 99:2080-2086. [PMID: 27516437 PMCID: PMC5571443 DOI: 10.1016/j.pec.2016.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Goal setting is a common element of self-management support programs; however, little is known about the nature of patients' goals or how goals change during pain self-management. The purpose of the current study is to explore how patients' goals and views of goal setting change over the course of a peer-led pain self-management program. METHODS Veterans (n=16) completing a 4-month peer-led pain self-management program completed semi-structured interviews at baseline and follow-up regarding their goals for their pain. Interviews were analyzed using immersion/crystallization. RESULTS Analyses revealed six themes: motivation to do something for their pain, more goal-oriented, actually setting goals, clarity of goal importance, more specific/measurable goal criteria, and more specific/measurable strategies. CONCLUSION The current analyses illustrate how participants' goals can evolve over the course of a peer-led pain self-management program. Specifically, increased motivation, more openness to using goals, greater clarity of goal importance, more specific and measurable goals and strategies, and the influence of the peer coach relationship were described by participants. PRACTICE IMPLICATIONS Pain self-management interventions should emphasize goal setting, and development of specific, measurable goals and plans. Trainings for providers should address the potential for the provider-patient relationship, particularly peer providers, to facilitate motivation and goal setting.
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Affiliation(s)
- Sarah M Bauer
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
| | - Alan B McGuire
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Marina Kukla
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Shannon McGuire
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, INC., Indianapolis, IN, USA
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Regenstrief Institute, INC., Indianapolis, IN, USA; Department of Communications Studies, Indiana University-Purdue University, Indianapolis, IN, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rollins AL, Kukla M, Morse G, Davis L, Leiter M, Monroe-DeVita M, Flanagan ME, Russ A, Wasmuth S, Eliacin J, Collins L, Salyers MP. Comparative Effectiveness of a Burnout Reduction Intervention for Behavioral Health Providers. Psychiatr Serv 2016; 67:920-3. [PMID: 27032659 DOI: 10.1176/appi.ps.201500220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Prior research found preliminary effectiveness for Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE), a daylong workshop for reducing burnout among behavioral health providers. Using a longer follow-up compared with prior research, this study compared the effectiveness of BREATHE and a control condition. METHODS Behavioral health providers (N=145) from three U.S. Department of Veterans Affairs facilities and two social service agencies were randomly assigned to BREATHE or person-centered treatment planning. Burnout and other outcomes were compared across groups over time. RESULTS Analyses yielded no significant differences between groups. However, BREATHE participants showed small but statistically significant improvements in cynicism (six weeks) and in emotional exhaustion and positive expectations for clients (six months). Participants in the control condition showed no significant changes over time. CONCLUSIONS Although it did not demonstrate comparative effectiveness versus a control condition, BREATHE could be strengthened and targeted toward both distressed providers and their organizations.
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Affiliation(s)
- Angela L Rollins
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Marina Kukla
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Gary Morse
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Louanne Davis
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Michael Leiter
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Maria Monroe-DeVita
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Mindy E Flanagan
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Alissa Russ
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Sara Wasmuth
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Johanne Eliacin
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Linda Collins
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
| | - Michelle P Salyers
- Dr. Rollins, Dr. Kukla, Dr. Flanagan, Dr. Russ, Dr. Wasmuth, Dr. Eliacin, and Ms. Collins are with the Center for Health Information and Communication, and Dr. Davis is with the Department of Research and Development, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana. Dr. Rollins is also with the Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, where Dr. Salyers is affiliated. Dr. Morse is with Places for People-Community Alternatives for Hope, Health, and Recovery, St. Louis, Missouri. Dr. Leiter is with the Department of Psychology, Acadia University, Wolfville, Nova Scotia, Canada. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Send correspondence to Dr. Rollins (e-mail: )
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Matthias MS, Kukla M, McGuire AB, Bair MJ. How Do Patients with Chronic Pain Benefit from a Peer-Supported Pain Self-Management Intervention? A Qualitative Investigation. Pain Med 2016; 17:2247-2255. [DOI: 10.1093/pm/pnw138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kukla M, McGuire AB, Salyers MP. Rural and urban supported employment programs in the Veterans Health Administration: Comparison of barriers and facilitators to vocational achievement for veterans experiencing mental illnesses. Psychiatr Rehabil J 2016; 39:129-36. [PMID: 27054902 DOI: 10.1037/prj0000184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this mixed-methods study was to compare urban and rural supported employment programs on barriers and facilitators with employment for veterans experiencing mental illnesses. METHOD A national sample of 114 supported employment staff, supervisors, and upper level managers employed by the Veteran's Health Administration were recruited. Participants completed an online survey of work barriers and facilitators, including open-ended questions regarding additional factors that impact the work success of veterans. Survey responses were compared between participants from rural (n = 28) and urban (n = 86) programs using independent groups t tests. Open-ended questions were analyzed using content analysis. RESULTS Supported employment personnel from rural programs perceived significantly more barriers to work success compared with urban personnel, particularly in the areas of access to services and a range of job-related factors, including job match and interpersonal relationships at the work site. In contrast, participants from urban programs reported greater facilitators in the domain of mental health services. Qualitative findings add depth to the quantitative findings and highlight challenges in rural supported employment programs impacting job development and job fit. Both urban and rural programs experienced unique barriers related to geography and transportation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings from this nationwide mixed-methods survey provide a comprehensive picture of the obstacles to employment success for veterans living with mental illnesses and receiving supported employment services in rural areas. Suggestions for changes in policy related to services and resource allocation are presented to address these unique barriers, particularly in rural areas. (PsycINFO Database Record
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center
| | - Alan B McGuire
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis
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Affiliation(s)
- Marina Kukla
- Dr. Kukla is with the Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs (VA) Medical Center, Indianapolis, Indiana, and with the Department of Psychology, Indiana University-Purdue University Indianapolis (e-mail: ). Ms. Strasburger and Dr. Lysaker are with the Richard L. Roudebush VA Medical Center. Dr. Lysaker is also with Indiana University School of Medicine, Indianapolis
| | - Amy M Strasburger
- Dr. Kukla is with the Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs (VA) Medical Center, Indianapolis, Indiana, and with the Department of Psychology, Indiana University-Purdue University Indianapolis (e-mail: ). Ms. Strasburger and Dr. Lysaker are with the Richard L. Roudebush VA Medical Center. Dr. Lysaker is also with Indiana University School of Medicine, Indianapolis
| | - Paul H Lysaker
- Dr. Kukla is with the Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs (VA) Medical Center, Indianapolis, Indiana, and with the Department of Psychology, Indiana University-Purdue University Indianapolis (e-mail: ). Ms. Strasburger and Dr. Lysaker are with the Richard L. Roudebush VA Medical Center. Dr. Lysaker is also with Indiana University School of Medicine, Indianapolis
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Abstract
OBJECTIVE Veterans with mental illness are at serious risk of poor work outcomes and career stagnation. Supported employment (SE) is an evidence-based model of vocational services that assists persons with mental illness to obtain competitive employment. The purpose of this study was to gain a rich understanding of barriers and facilitators related to competitive work success from the perspective of a nationwide sample of U.S. Department of Veterans Affairs (VA) SE staff, supervisors, and managers. METHODS This study utilized a mixed-methods approach in which 114 VA SE personnel completed an online questionnaire consisting of a survey of work barriers and facilitators; open-ended questions elicited additional factors affecting work success. Descriptive statistics characterized factors affecting work success, and an emergent, open-coding approach identified qualitative themes describing other key elements influencing employment. RESULTS The most prominent work facilitators were perceived veteran motivation, job match, the assistance of SE services, and veteran self-confidence. The highest rated barriers were psychological stress and a range of health-related problems. Qualitative findings revealed additional areas affecting work success, notably, the availability of resources, the capacity of frontline staff to form strong relationships with veterans and employers, the ability of staff to adapt and meet the multifaceted demands of the SE job, and the need for additional staff and supervisor training. The impact of employer stigma was also emphasized. CONCLUSIONS An array of elements influencing work success at the level of the veteran, staff, SE program, and employer was recognized, suggesting several implications for VA services.
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Affiliation(s)
- Marina Kukla
- Dr. Kukla and Dr. McGuire are with Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana (e-mail: ). They are also with the Department of Psychology, Indiana University-Purdue University Indianapolis, where Dr. Salyers is affiliated. Dr. Salyers is also with the Assertive Community Treatment Center of Indiana, Indianapolis
| | - Alan B McGuire
- Dr. Kukla and Dr. McGuire are with Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana (e-mail: ). They are also with the Department of Psychology, Indiana University-Purdue University Indianapolis, where Dr. Salyers is affiliated. Dr. Salyers is also with the Assertive Community Treatment Center of Indiana, Indianapolis
| | - Michelle P Salyers
- Dr. Kukla and Dr. McGuire are with Health Services Research and Development, Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana (e-mail: ). They are also with the Department of Psychology, Indiana University-Purdue University Indianapolis, where Dr. Salyers is affiliated. Dr. Salyers is also with the Assertive Community Treatment Center of Indiana, Indianapolis
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Bonfils KA, Bouchard LM, Kukla M, Miller AP, McGuire AB. Correlates of attendance in mental health services for individuals with psychotic disorders: A critical review. American Journal of Psychiatric Rehabilitation 2016. [DOI: 10.1080/15487768.2015.1125400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Outcalt J, Dimaggio G, Popolo R, Buck K, Chaudoin-Patzoldt KA, Kukla M, Olesek KL, Lysaker PH. Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment of substance use disorders. Compr Psychiatry 2016; 64:22-8. [PMID: 26541558 DOI: 10.1016/j.comppsych.2015.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/07/2015] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Borderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits. METHODS Concurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting. RESULTS Multiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology. CONCLUSION Insecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery.
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Affiliation(s)
| | | | | | - Kelly Buck
- Roudebush VA Medical Center, Indianapolis, IN
| | | | - Marina Kukla
- HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN; Department of Psychology, Indiana University Purdue University, Indianapolis, IN
| | | | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN.
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Kukla M, Whitesel F, Lysaker PH. An Integrative Psychotherapy Approach to Foster Community Engagement and Rehabilitation in Schizophrenia: A Case Study Illustration. J Clin Psychol 2015; 72:152-63. [PMID: 26636563 DOI: 10.1002/jclp.22248] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This case study illustrates the use of a long-term integrative psychotherapy approach with a middle- aged man with chronic schizophrenia and a mood disorder. The case of "Holst" describes a man with a history of insecure attachment and trauma who later went on to contract a serious chronic illness, precipitating the onset of psychotic symptoms, depression, and chronic suicidal ideation, resulting in multiple hospitalizations. Combining metacognition-oriented therapy with elements of cognitive behavioral therapy and psychiatric rehabilitation, this approach fostered significantly improved community functioning and attainment of personal goals over time. Through the journey of therapy, the patient also developed a more coherent narrative about his life, established a stable sense of self, and became an active agent in the world. This case illustration demonstrates that these three different approaches can be used in a sequential and complementary fashion to foster recovery in the midst of serious physical and mental illness.
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Affiliation(s)
- Marina Kukla
- Center for Health Information and Communication, Health Services Research and Development.,Richard L. Roudebush VA Medical Center.,Indiana University-Purdue University Indianapolis, Department of Psychology
| | | | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center.,Indiana University School of Medicine
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McGuire AB, Salyers MP, White DA, Gilbride DJ, White LM, Kean J, Kukla M. Factors affecting implementation of an evidence-based practice in the Veterans Health Administration: Illness management and recovery. Psychiatr Rehabil J 2015; 38:300-5. [PMID: 25844913 DOI: 10.1037/prj0000116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Illness management and recovery (IMR) is an evidence-based practice that assists consumers in managing their illnesses and pursuing personal recovery goals. Although research has examined factors affecting IMR implementation facilitated by multifaceted, active roll-outs, the current study attempted to elucidate factors affecting IMR implementation outside the context of a research-driven implementation. METHODS Semi-structured interviews with 20 local recovery coordinators and 18 local IMR experts were conducted at 23 VA medical centers. Interviews examined perceived and experienced barriers and facilitators to IMR implementation. Data were analyzed via thematic inductive/deductive analysis in the form of crystallization/immersion. RESULTS Six factors differed between sites implementing IMR from those not providing IMR: awareness of IMR, importer-champions, autonomy-supporting leadership, veteran-centered care, presence of a sensitive period, and presence of a psychosocial rehabilitation and recovery center. Four factors were common in both groups: recovery orientation, evidence-based practices orientation, perceived IMR fit within program structure, and availability of staff time. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE IMR can be adopted in lieu of active implementation support; however, knowledge dissemination appears to be key. Future research should examine factors affecting the quality of implementation.
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Affiliation(s)
- Alan B McGuire
- Health Services Research and Development, Richard L. Roudebush, Veterans Affairs Medical Center
| | - Michelle P Salyers
- Department of Psychology, Indiana University Purdue University--Indianapolis
| | - Dominique A White
- Department of Psychology, Indiana University Purdue University-Indianapolis
| | | | - Laura M White
- Department of Psychology, Indiana University Purdue University--Indianapolis
| | - Jacob Kean
- Center of Excellence on Implementing Evidence Based Practice, Richard L. Roudebush, Veterans Affairs Medical Center
| | - Marina Kukla
- Human Services Research and Development, Richard L. Roudebush, Veterans Affairs Medical Center
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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