Louanne W. Davis

Metacognition and schizophrenia: The capacity for self-reflectivity as a predictor for prospective assessments of work performance over six months

Research has indicated that many with schizophrenia experience deficits in metacognitive capacity, defined as impairments in the ability to think about thinking. These difficulties are related to, but not reducible to symptoms and have been hypothesized to function as an independent impediment to psychosocial function. To explore the possibility that deficits in one domain of metacognition, self-reflectivity, are a barrier to effective work function, 56 participants with schizophrenia were categorized into three groups according to their capacity for self reflection based on an interview conducted prior to accepting a job placement. Blind ratings of work performance of these three groups over the next six months were then compared. Results of repeated measures ANOVA revealed that the group rated as having the highest level of metacognition, that is, able to see that their conclusions are subjective and fallible, had higher ratings of work performance over time than groups with medium and low levels of self reflectivity. These findings were found to persist even when impairment on a test of executive function was controlled for statistically. Results are interpreted as consistent with emerging models that deficits in metacognition may be key features of severe mental illness which affect function. Clinical and theoretic implications are discussed.

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.

Compassion Fatigue A Review of the Research to Date and Relevance to Cancer-care Providers

Fifty-seven studies were reviewed to identify the prevalence of compassion fatigue among cancer-care providers, instruments used to detect it and means of prevention and treatment. Conclusions were limited by an ambiguous definition of compassion fatigue that fails to adequately differentiate it from related constructs (e.g. burnout, secondary traumatic stress) and the modest number of cancer-related studies found. However, evidence suggests that compassion fatigue takes a toll not only on cancer-care providers but also on the workplace. These findings highlight the need to understand more clearly the link between the empathic sensitivity of healthcare professionals and their vulnerability to compassion fatigue.

Social function in schizophrenia and schizoaffective disorder: Associations with personality, symptoms and neurocognition

BackgroundResearch has indicated that stable individual differences in personality exist among persons with schizophrenia spectrum disorders predating illness onset that are linked to symptoms and self appraised quality of life. Less is known about how closely individual differences in personality are uniquely related to levels of social relationships, a domain of dysfunction in schizophrenia more often linked in the literature with symptoms and neurocognitive deficits. This study tested the hypothesis that trait levels of personality as defined using the five-factor model of personality would be linked to social function in schizophrenia.MethodsA self-report measure of the five factor model of personality was gathered along with ratings of social function, symptoms and assessments of neurocognition for 65 participants with schizophrenia or schizoaffective disorder.ResultsUnivariate correlations and stepwise multiple regression indicated that frequency of social interaction was predicted by higher levels of the trait of Agreeableness, fewer negative symptoms, better verbal memory and at the trend level, lesser Neuroticism (R2 = .42, p < .0001). In contrast, capacity for intimacy was predicted by fewer negative symptoms, higher levels of Agreeableness, Openness, and Conscientiousness and at the trend level, fewer positive symptoms (R2 = .67, p < .0001).ConclusionsTaken together, the findings of this study suggest that person-centered variables such as personality, may account for some of the broad differences seen in outcome in schizophrenia spectrum disorders, including social outcomes. One interpretation of the results of this study is that differences in personality combine with symptoms and neurocognitive deficits to affect how persons with schizophrenia are able to form and sustain social connections with others.

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.

Effects of cognitive behavioral therapy on work outcomes in vocational rehabilitation for participants with schizophrenia spectrum disorders

Designed to help persons with schizophrenia to persist and perform better at job placements, the Indianapolis Vocational Intervention Program (IVIP) is a program of cognitive-behavioral group and individual interventions. While its feasibility has been previously demonstrated, it is unknown whether IVIP assists persons to achieve greater levels of participation in vocational rehabilitation and higher levels of job performance. In this study, 100 participants with schizophrenia or schizoaffective disorder were offered a six month job placement and randomized to receive IVIP (n=50) or support services (n=50) matched for treatment intensity. Number of hours worked was recorded weekly and job performance was assessed biweekly using the Work Behavior Inventory with raters blind to condition. t-tests revealed that participants in the IVIP group worked a significantly greater number of weeks than those in the support condition. Also, repeated measures ANOVA revealed the IVIP group worked more hours across that 26 week period as well. And with regards to work performance, repeated measures of the 56 participants who worked for at least two-thirds of the intervention revealed that participants in the IVIP group had generally better work performance than those in the support condition. Results suggest a connection between cognitive-behavioral interventions and higher levels of work performance in people with schizophrenia.

Association of neurocognition, anxiety, positive and negative symptoms with coping preference in schizophrenia spectrum disorders.

It is recognized that persons with schizophrenia tend to cope with stress in a relatively avoidant and ineffectual manner and that this coping style is linked to poorer outcome. Less is understood, however, about the interrelationship between symptoms, deficits in neurocognition and coping style in schizophrenia. To determine the extent to which various neurocognitive deficits and symptoms are related to coping style in schizophrenia, measures of positive symptoms, negative symptoms, state and trait anxiety levels, verbal memory and executive function were correlated with self-report of preference for a range of active and avoidant coping strategies. Participants were 42 persons with schizophrenia spectrum disorders enrolled in outpatient psychiatric care. Stepwise multiple regressions indicated that greater preferences for taking action when faced with a stressor were significantly (p<.05) linked to lesser positive symptoms and lesser state anxiety while greater preferences for thinking or talking about possible solutions were linked to lesser impairments in neurocognition. A greater preference for resigning in the face of stress was significantly linked to greater levels of negative symptoms and trait anxiety, while a preference to ignore stressors was linked to both greater levels of positive symptoms and graver impairments in neurocognition. Implications for understanding the genesis of psychosocial dysfunction and for the development of rehabilitative interventions are discussed.

Attributional style and symptoms as predictors of social function in schizophrenia.

While the attributions of people with schizophrenia have been hypothesized to play a role in determining social behavior, contradictory predictions can be made about exactly what type of attributions contribute to social dysfunction. One possibility is that attributing undesirable events to internal, stable, and global factors might lead to poorer social function. An alternate possibility is that attributing events in general to internal, stable, and global factors might lead to better social function. As a test of these hypotheses, 40 participants in a post-acute phase of schizophrenia were administered the Attributional Style Questionnaire, the Positive and Negative Syndrome Scale, and the Quality of Life Scale. Stepwise multiple regressions controlling for age and education indicated that a lack of negative symptoms and the tendency to make stable attributions for life events in general predicted more frequent social contacts, a higher quality of social interaction, and better community participation on the Quality of Life Scale. Results suggest that the tendency to see life events as the result of unstable or unpredictable causes is associated with social dysfunction independent of symptom level.

Patterns of obsessive-compulsive symptoms and social function in schizophrenia

Research has alternately found that obsessive and compulsive (OC) symptoms in schizophrenia are associated with graver and lesser levels of negative symptoms. One possible explanation is that there are two distinct groups of persons with OC symptoms: those with cognitive deficits and high levels of negative symptoms and those who generally function well and have low levels of negative symptoms. To examine this question, we performed a cluster analysis on 66 persons with schizophrenia spectrum disorders on the basis of their level of obsessive-compulsive phenomena and global psychosocial function. Four groups were found: high OC/good function (n=9), non-OC/poor function (n=25), non-OC/moderate function (n=20), and high OC/poor function (n=12). A MANCOVA controlling for age found significant group differences on assessments of negative symptoms, executive function and attention among groups. As predicted, the high OC/poor function group had significantly poorer attention than any other group and poorer executive function than either non-OC group. The high OC/good function had lower levels of negative symptoms than either non-OC group. Implications for research and rehabilitation are discussed.

Enhanced cognitive-behavioral therapy for vocational rehabilitation in schizophrenia: Effects on hope and work.

To address the effects of dysfunctional cognitions on vocational outcome of people with schizophrenia spectrum disorders, we developed the Indianapolis Vocational Intervention Program (IVIP), a cognitive-behavioral program of group and individual interventions. Fifty participants with schizophrenia or schizoaffective disorder were offered 6-month work placements and randomized to receive IVIP (n = 25) or standard support services (n = 25). Hours worked were measured weekly, and work performance was assessed biweekly with the use of the Work Behavior Inventory. Hope and self-esteem were assessed at baseline and at 5 months with the Beck Hopelessness Scale and the Rosenberg Self-Esteem Schedule. Analysis of variance (ANOVA) revealed that the IVIP group worked significantly more weeks and had better average work performance than the standard support group. Repeated measures ANOVA of baseline and follow-up scores indicated that the IVIP group sustained baseline levels of hope and self-esteem through follow-up, while the standard support group experienced declines. Results provide initial evidence of the effectiveness of the IVIP.