Amy M. Strasburger

Stigma, social function and symptoms in schizophrenia and schizoaffective disorder: Associations across 6 months

Research suggests stigma is a barrier to self-esteem and the attainment of resources in schizophrenia. Less clear is the association of stigma experiences with symptoms and social function both concurrently and prospectively. To assess this, symptoms were measured using the Positive and Negative Syndrome Scale, social function was measured using the Quality of Life Scale and stigma experience was assessed using the Internalized Stigma of Mental Illness Scale among 36 persons with schizophrenia at two points, 6 months apart. Correlations found stigma was associated with concurrent levels of positive and emotional discomfort symptoms and degree of social contact. When initial stigma levels were controlled for, stigma at 6 months was predicted by baseline levels of positive symptoms. Greater initial stigma predicted greater emotional discomfort at follow-up. Results suggest internalized stigma is linked with social function and symptoms. Positive symptoms may make some persons with schizophrenia more vulnerable to ongoing stigma experience.

Reported history of child sexual abuse in schizophrenia: associations with heightened symptom levels and poorer participation over four months in vocational rehabilitation

Cross-section research suggests reported childhood abuse in schizophrenia spectrum disorders is linked with graver symptom levels and social dysfunction. To examine this prospectively, we compared biweekly ratings of positive and emotional discomfort symptoms and weekly accounts of hours worked over 4 months of rehabilitation of 12 participants with schizophrenia or schizoaffective disorder and childhood sexual abuse history and 31 with schizophrenia or schizoaffective disorder and no childhood sexual abuse history. Repeated-measures ANOVA revealed the abuse group had consistently higher levels of both symptom components and poorer participation in vocational rehabilitation. A time by group effect was observed for hours of work, with the abuse group working increasingly fewer hours over time. Participants reporting abuse also were more likely to perform poorly on a test of executive function and to have particularly higher levels of hallucinations and anxiety over time. Clinical and theoretical implications are discussed.

Participant Perspectives on Mindfulness Meditation Training for Anxiety in Schizophrenia

Mindfulness meditation training has been found to be helpful across a range of mental and physical health conditions. Research testing mindfulness-based interventions in the psychiatric rehabilitation context has been rare, however—possibly due to concerns about the potential for exacerbation of psychotic symptoms during meditation practice. Fifteen individuals diagnosed with schizophrenia spectrum disorders participated in a pilot study testing a mindfulness-based intervention to reduce anxiety. In this descriptive study of program evaluation interview responses, we examined the feedback participants had provided in face-to-face interviews to determine the degree to which individuals reported finding mindfulness training acceptable and helpful. Two raters systematically coded the data independently. The combined findings led to the identification of themes that surfaced most often overall and the context in which these themes had emerged. Outcomes mentioned most frequently by participants were relaxation, relief from psychological symptoms, cognitive changes, and focus on the present. These findings were consistent with extant literature identifying similar constructs as active ingredients of mindfulness-based interventions. Results suggested that mindfulness meditation training was acceptable to all participants; no one reported worsening of psychotic or other symptoms while meditating. We concluded that mindfulness meditation training should be further tested for its potential to be helpful in recovery from psychiatric disability.

The Scale to Assess Narrative Development: Association With Other Measures of Self and Readiness for Recovery in Schizophrenia Spectrum Disorders

While changes in self-experience have been suggested as an element of recovery from schizophrenia, little is known about how they are linked with other subjective indicators of recovery. To examine this, we have developed methods of eliciting narratives of self and illness in schizophrenia and quantitatively rating self-experience expressed within those narratives. In this study, we rated the narratives of 34 persons with schizophrenia spectrum disorder prior to entry into rehabilitation using the Scale to Assess Narrative Development (STAND). STAND scores were then correlated with concurrent assessments of self-esteem using the Rosenberg Self Esteem schedule and readiness for change using the Stages of Change Questionnaire. Results indicated that higher ratings on the STAND were associated with greater levels of self-esteem and greater overall readiness for change. This may suggest that qualities of self-experience within personal narratives of persons with schizophrenia are linked to objective and subjective assessments of recovery.

Associations of awareness of illness in schizophrenia spectrum disorder with social cognition and cognitive perceptual organization.

Although impairment in flexibility of abstract thought has been linked to poor insight in schizophrenia, little is known about the association of other cognitive processes to insight. To explore the possibility that social cognition and perceptual organizational capacity are linked to insight, we assessed awareness of illness and administered the Thematic Apperception Test and Rorschach Inkblot Test to 31 adult participants with schizophrenia. Partial correlations controlling for perseverative errors on the Wisconsin Card Sorting Test revealed that lesser capacities to organize and make sense of ambiguous stimuli, to distinguish between ones own and others perspectives, and to formulate logical accounts of behavior and social exchange predicted poorer awareness of psychiatric symptoms. With replication, results may suggest that to attain awareness of illness, some with schizophrenia may need assistance making sense of the social world and organizing the complexities of their experience of illness.

Relationship and technique in the long-term integrative psychotherapy of schizophrenia: A single case study

Abstract It has been asserted that an integrative psychotherapy can promote recovery from schizophrenia by helping clients develop and evolve a richer personal narrative of their challenges and abilities. Yet it is unclear what techniques such a therapy might employ, and how those techniques are related to the developing therapeutic relationship. To address these questions we have conducted blind qualitative and quantitative assessments of transcripts of an integrative psychotherapy over 22 months. Analyses suggest that over time the client evolved a more coherent account of his challenges and abilities, and experienced significant psychosocial improvements. The therapeutic alliance was observed to build slowly, with minimal intervention and care on the part of the therapist not to tell the story for the client. As the relationship grew stronger, the client began rapidly developing the narrative of his life, allowing for the introduction of greater levels of confrontation to enhance further the coherence ...

Subjective Experiences of the Benefits and Key Elements of a Cognitive Behavioral Intervention Focused on Community Work Outcomes in Persons With Mental Illness

Abstract New research suggests that group-based cognitive behavioral therapy (CBT) may help improve employment outcomes in persons with mental illness, yet the effects and potential key elements facilitating change in such interventions are unclear. Using a mixed methods approach, this study examined the perspectives of persons with mental illness after participating in a pilot study of the “CBT for Work Success” intervention. Findings demonstrate that participants valued the intervention and perceived that it assisted them in achieving work goals. Therapeutic effects included improved self-efficacy, work motivation, enhanced sense of self as workers, and increased beliefs that work success is attainable. CBT for Work Success elements perceived to be important in facilitating work goals included cognitive restructuring, behavioral coping strategies, problem solving work barriers, meaningful reflection on oneself as a worker, and important factors associated with the group process. The authors discuss the implications of these findings and future research directions.

Helping veterans achieve work: A Veterans Health Administration nationwide survey examining effective job development practices in the community.

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.