William Bradshaw

Integrating cognitive-behavioral psychotherapy for persons with schizophrenia into a psychiatric rehabilitation program: results of a three year trial.

Emerging models of cognitive-behavioral treatment (CBT) offer promising new intervention strategies in the psychotherapy of schizophrenia. These models, however, have not been integrated into community support programs and evaluated in comparison to standard community treatments. This study examined differences in outcomes of clients who received long-term day treatment program services (DTP) compared to clients who received individual CBT that was included as part of their DTP treatment. Twenty-four clients were randomly assigned to DTP treatment or CBT/DTP treatment. Data on standardized measures of psychosocial functioning, symptomatology and rehospitalizations were collected over the course of three years of treatment. Analysis of variance with repeated measures was conducted to evaluate the effects of type of treatment (CBT/DTP and DTP) and time (dependent variable scores taken at the end of treatment years one, two and three) on the three outcome variables. Results indicate significant improvement for the CBT/DTP group compared to the DTP group in the patterns of change over time for psychosocial functioning and symptomology. In addition to this significant group/time interaction the time factor was also significant for both variables. For rehospitalizations the time factor was significant and the group/time factor was nonsignificant. Implications for service delivery to persons with schizophrenia and suggestions for future research are discussed.

Victims of severe violence meet the offender: restorative justice through dialogue

Both restorative justice in general and victim offender mediation specifically continue to be identified with primarily, if not exclusively, addressing non-violent property crimes, and perhaps even minor assaults. This article will challenge such assumptions by providing empirical evidence that suggests that many of the principles of restorative justice can be applied in crimes of severe violence, including murder. Some would even suggest that the deepest healing impact of restorative justice is to be found in addressing and responding to such violent crime. An increasing number of victims of sexual assault, attempted homicide, and survivors of murder victims, in Canada and the United States, are requesting the opportunity to meet the offender to express the full impact of the crime upon their life, to get answers to many questions they have and to gain a greater sense of closure so that they can move on with their lives. In most cases this occurs many years after the crime occurred and the actual mediation/dialogue session is typically held in a secure institution where the offender is located. This article addresses four topics. First, the case development process of victim sensitive offender dialogue (VSOD) in crimes of severe violence is described, with an emphasis of how the process is far more intensive in such cases. Second, the specific type of victim sensitive mediation employed in such cases is briefly presented. Humanistic mediation is ‘dialogue driven’ rather than ‘settlement driven’ and is essential to the application of restorative justice principles in cases of severe violence. Third, a review of the few current studies of such an intervention is offered, including preliminary data that is emerging from a two state multi-year study by the author. Fourth, two specific case studies related to the above research are presented with an emphasis upon implications for practitioners. Finally, several conclusions are offered, including a number of unanswered questions and the need for further research.

Evaluating the Effectiveness of Cognitive-Behavioral Treatment of Residual Symptoms and Impairment in Schizophrenia

This study evaluated the effectiveness of cognitive-behavioral interventions in the treatment of persons with schizophrenia who experienced significant residual symptoms and impaired functioning despite their adherence to medication. The study used an aggregated AB single-system research design across 22 participants to evaluate change in clinical outcomes. Standardized measures of psychosocial functioning, severity of symptoms, attainment of treatment goals, and severity of the impact of illness on self-concept were used to assess change during the course of 18 months of treatment. Of the clients, 86% made statistically significant improvement in psychosocial functioning; 82% of the clientsmade statistically significant reduction in severity of psychiatric symptoms. All 22 clients exceeded the expected level of attainment of treatment goals. There was a statistically significant reduction in the negative impact of illness on sense of self. Findings support the effectiveness of cognitive-behavioral interventions in schizophrenia.

Assessing Satisfaction with Victim Services: The Development and Use of the Victim Satisfaction with Offender Dialogue Scale (VSODS)

There is an increasing need for restorative justice programs to evaluate program outcomes. Victim satisfaction is one of the essential components of program evaluation. Evaluation of victim satisfaction is important because it provides a means by which victims can have input into the restorative justice process: satisfaction data can provide feedback about program services; identify problems and needs from the victim perspective; and provide data that increase knowledge about the process of mediated dialogue that results in improved victim services. Previous research on satisfaction with victim offender mediation has been limited by lack of a standardized victim satisfaction scale. The Victim Satisfaction with Offender Dialogue Scale represents a pioneer effort to measure victim satisfaction with offender dialogue through psychometric development of an instrument (VSODS). Data were obtained from 197 subjects from four victim offender mediation program sites in the United States. The data were analyzed using principal components factor analysis. The first factor derived from this solution accounted for 38% of the total variance and roughly 70% of the common variance. When items with high first factor loading were removed and the analysis repeated, no other factor accounted for as much as 6% of the total variance. To construct a briefer scale for assessing victim satisfaction with services, the factor loadings and item-total correlations of the first factor were examined. Eleven items were selected which loaded highly on the unrotated first factor and which exhibited good inter-item and item-total correlations. The coefficient alpha for the final VSODS was 0.87. This indicates the VSODS is a reliable instrument for assessing victim satisfaction with mediated dialogue. Guidelines for use of the VSODS are provided to enhance program evaluation activities.

Evaluating Cognitive-Behavioral Treatment of Schizophrenia: Four Single-Case Studies

Cognitive-behavioral treatment (CBT) has been used infrequently with persons with schizophre nia. This exploratory study delineates the use of CBT strategies, describes the process of treatment, and presents results from the single-subject A-B design (N = 4) that examined the efficacy of CBT of schizophrenia. Standardized measures of psychosocial functioning, severity of symptoms, attainment of treatment goals, and data regarding hospitalizations were used to assess change over the course of 18 months of treatment and follow-up. Analysis of data indicated that the clients experienced considerable reduction in symptomatology and rehospitalizations as well as improvement in psychosocial functioning and attainment of treatment goals. Treatment issues regarding the application of cognitive-behavioral methods with persons with schizophre nia and suggestions for future social work research and practice are discussed.

Structured Group Work for Individuals with Schizophrenia: A Coping Skills Approach

Research regarding persons with schizophrenia has been a neglected area in social work group research. This article describes the development and testing of a structured group treatment. This experimental pretest-posttest treatment control study examines the effecriveness of group coping skills training (CST) in reducing relapse in persons with schizophrenia. CST involves training in time management, managing physiological arousal, cognitive restructuring, and social skills training. Results indicate that clients in CST had fewer hospitalizations, shorter hospital stays, and significantly better achievement of treatment goals compared with clients in the treatment control group both at posttest and at six-month follow-up.

Psychodynamic Psychotherapy A Quantitative, Longitudinal Perspective

This effectiveness study examined the course of treatment longitudinally and outcomes associated with psychodynamic psychotherapy for a sample of 1,050 people undertaking this treatment in a community setting, over the course of 4 years, at 3-month intervals, using the Outcome Questionnaire (OQ)-45.2. The authors used multilevel modeling to look at the nature of change over time and at potentially meaningful moderating variables. Results show a robust general improvement, though a more moderate one than described in recent meta-analyses including primarily prospective studies. The treatment was followed by broad improvements, over time, with a general trend and few notable interaction effects. The treatment involved little deterioration, particularly in the first year. Subgroup analysis suggested that (a) clients with more initial symptom severity showed greater improvement and a unique course of recovery with (b) clients who stayed over a year constituting a potentially unique subgroup.

Evaluation of psychodynamic psychotherapy in a community mental health center.

This study describes an evaluation of the effectiveness of psychodynamic psychotherapy provided in an outpatient community mental health clinic. The study used a single group pretest-posttest design involving 78 clients. Clinical outcomes included overall psychosocial functioning and quality of life, level of subjective distress, interpersonal functioning and role functioning, measured by the Outcome Questionnaire (Lambert, Hansen, Umpress, Lunnen Okilshi, & Burlingame, 2000). Clients showed statistically significant improvement from pretest (first sessions) to completion of treatment in overall functioning, and quality of life, level of subjective distress, interpersonal functioning and role functioning. Eighty-five percent of clients made statistically and clinically significant change. Calculation of effect sizes for each outcome found moderate to strong change effects ranging from d = .4 to .9. The study illustrates a method of intervention research that therapists and agencies can use to integrate practical evaluation methods into their clinical services in order to improve mental health service to clients, to demonstrate the effectiveness of interventions, and to provide data to support coverage for needed services for clients.