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1.
BMC Health Serv Res ; 22(1): 1543, 2022 Dec 17.
Article in English | MEDLINE | ID: mdl-36528579

ABSTRACT

BACKGROUND: Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers. METHODS: A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes-no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans). RESULTS: Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good fit for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process. CONCLUSIONS: A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations.


Subject(s)
Psychiatric Rehabilitation , Veterans , United States , Humans , United States Department of Veterans Affairs
2.
Adm Policy Ment Health ; 46(2): 188-199, 2019 03.
Article in English | MEDLINE | ID: mdl-30406858

ABSTRACT

This study examined stakeholder perceptions of the "fit" between cognitive-behavioral social skills training (CBSST) and assertive community treatment (ACT) when implementing CBSST into existing community-based ACT teams. Focus group feedback was collected from a diverse set of stakeholders (i.e., clients, providers, supervisors, agency administrators, public sector representatives, and intervention developers). Results identified perceived client and provider benefits for integrating CBSST into ACT while highlighting the importance of purposeful adaptations, training, and implementation tools to facilitate structural and values fit between CBSST and ACT. Study findings will inform future endeavors to implement CBSST and other relevant EBPs into ACT. Trial Registry: ClinicalTrials.gov #NCT02254733.


Subject(s)
Cognitive Behavioral Therapy/organization & administration , Community Mental Health Services/organization & administration , Patient Care Team/organization & administration , Schizophrenia/therapy , Social Skills , Adult , Comprehensive Health Care/organization & administration , Female , Humans , Male , Mental Disorders/therapy
3.
Trials ; 25(1): 363, 2024 Jun 06.
Article in English | MEDLINE | ID: mdl-38840160

ABSTRACT

BACKGROUND: Patient participation in treatment decision making is a pillar of recovery-oriented care and is associated with improvements in empowerment and well-being. Although demand for increased involvement in treatment decision-making is high among veterans with serious mental illness, rates of involvement are low. Collaborative decision skills training (CDST) is a recovery-oriented, skills-based intervention designed to support meaningful patient participation in treatment decision making. An open trial among veterans with psychosis supported CDST's feasibility and demonstrated preliminary indications of effectiveness. A randomized control trial (RCT) is needed to test CDST's effectiveness in comparison with an active control and further evaluate implementation feasibility. METHODS: The planned RCT is a hybrid type 1 trial, which will use mixed methods to systematically evaluate the effectiveness and implementation feasibility of CDST among veterans participating in a VA Psychosocial Rehabilitation and Recovery Center (PRRC) in Southern California. The first aim is to assess the effectiveness of CDST in comparison with the active control via the primary outcome, collaborative decision-making behavior during usual care appointments between veterans and their VA mental health clinicians, and secondary outcomes (i.e., treatment engagement, satisfaction, and outcome). The second aim is to characterize the implementation feasibility of CDST within the VA PRRC using the Practical Robust Implementation and Sustainability Model framework, including barriers and facilitators within the PRRC context to support future implementation. DISCUSSION: If CDST is found to be effective and feasible, implementation determinants gathered throughout the study can be used to ensure sustained and successful implementation at this PRRC and other PRRCs and similar settings nationally. TRIAL REGISTRATION: ClinicalTrials.gov NCT04324944. Registered on March 27, 2020. Trial registration data can be found in Appendix 1.


Subject(s)
Patient Participation , Psychotic Disorders , Randomized Controlled Trials as Topic , Veterans , Humans , Psychotic Disorders/therapy , Psychotic Disorders/psychology , Veterans/psychology , Cooperative Behavior , Clinical Decision-Making , Physician-Patient Relations , Decision Making, Shared , United States , Feasibility Studies , California , Decision Making , United States Department of Veterans Affairs
4.
Psychiatr Rehabil J ; 46(1): 74-82, 2023 Mar.
Article in English | MEDLINE | ID: mdl-36809018

ABSTRACT

OBJECTIVE: People with serious mental illnesses (SMIs) are at high risk for suicidal ideation and behavior, and yet few suicide prevention interventions have been customized for this group. We describe the outcomes of a pilot trial of Mobile SafeTy And Recovery Therapy (mSTART), a four-session suicide-focused cognitive behavioral intervention for SMI, designed for the transition from acute to outpatient care and augmented with ecological momentary intervention to reinforce intervention content. METHODS: The primary objective of this pilot trial was to evaluate the feasibility, acceptability, and preliminary effectiveness of START. Seventy-eight people with SMI and elevated suicidal ideation were randomized to either: (a) mSTART or (b) START alone (i.e., without mobile augmentation). Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of mobile intervention), and 24 weeks. The primary outcome of the study was change in suicidal ideation severity. Secondary outcomes included psychiatric symptoms, coping self-efficacy, and hopelessness. RESULTS: A total of 27% of randomized persons were lost to follow-up after baseline, and engagement with mobile augmentation was variable. There was clinically significant improvement (d = 0.86) in suicidal ideation severity scores sustained over 24 weeks, with similar effects seen for secondary outcomes. Preliminary comparison indicated a medium effect size (d = 0.48) advantage at 24 weeks of mobile augmentation in suicidal ideation severity scores. Treatment credibility and satisfaction scores were high. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: START, regardless of mobile augmentation, was associated with sustained improvement in suicidal ideation severity and secondary outcomes in people with SMI at-risk for suicide in this pilot trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Subject(s)
Cognitive Behavioral Therapy , Mental Disorders , Humans , Suicide Prevention , Feasibility Studies , Suicidal Ideation
5.
Schizophr Bull ; 48(2): 359-370, 2022 03 01.
Article in English | MEDLINE | ID: mdl-34665853

ABSTRACT

OBJECTIVE: Negative symptoms and cognitive impairment in schizophrenia (SZ) remain unmet treatment needs as they are highly prevalent, associated with poor functional outcomes, and resistant to pharmacologic treatment. The current pilot randomized controlled trial examined the efficacy of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared to Goal-focused Supportive Contact (SC) on negative symptoms and cognitive performance. METHODS: Fifty-five adults with SZ or schizoaffective disorder with moderate-to-severe negative symptoms were randomized to receive 25 twice-weekly, 1-h manualized group sessions (12.5 weeks total duration) of either CBSST-CCT or SC delivered by master's level clinicians in five community settings. Assessments of negative symptom severity (primary outcomes) and neuropsychological performance, functional capacity, social skills performance, and self-reported functional ability/everyday functioning, psychiatric symptom severity, and motivation (secondary outcomes) were administered at baseline, mid-treatment, post-treatment, and 6-month follow-up. RESULTS: Mixed-effects models using baseline, mid-treatment, and post-treatment data demonstrated significant CBSST-CCT-associated effects on negative symptom severity, as assessed by the Scale for the Assessment of Negative Symptoms (p = .049, r = 0.22), with improvements in diminished motivation driving this effect (p = .037, r = 0.24). The CBSST-CCT group also demonstrated improved verbal learning compared to SC participants (p = .026, r = 0.36). The effects of CBSST-CCT appeared to be durable at 6-month follow-up. CONCLUSIONS: CBSST-CCT improved negative symptom severity and verbal learning in high-negative-symptom individuals relative to SC. CBSST-CCT warrants larger investigations to examine its efficacy in treating negative symptoms, along with other symptoms, cognition, and, ultimately, real-world functional outcomes. Clinical Trial registration number NCT02170051.


Subject(s)
Cognitive Behavioral Therapy/methods , Neuropsychological Tests/statistics & numerical data , Psychotic Disorders/therapy , Adult , Cognitive Behavioral Therapy/statistics & numerical data , Female , Humans , Male , Middle Aged , Pilot Projects , Psychotic Disorders/psychology , Social Skills , Treatment Outcome
6.
JMIR Res Protoc ; 10(2): e14378, 2021 Feb 08.
Article in English | MEDLINE | ID: mdl-33555265

ABSTRACT

BACKGROUND: People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. OBJECTIVE: The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. METHODS: A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. RESULTS: The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. CONCLUSIONS: The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14378.

7.
Suicide Life Threat Behav ; 51(5): 872-881, 2021 10.
Article in English | MEDLINE | ID: mdl-33998035

ABSTRACT

INTRODUCTION: This pilot study investigates feasibility and acceptability of Caring Cards, a suicide prevention intervention inspired by Caring Contacts and the Recovery Model, where Veteran peers create cards that are sent to Veterans recently discharged from a VA psychiatric hospitalization for suicide risk. METHODS: Caring Cards consists of: (1) a weekly outpatient group where Veterans (card makers) create cards, and (2) sending cards to recently discharged Veterans (card recipients). Feasibility for card makers was measured by attendance; acceptability (satisfaction) was examined. Card recipients were sent one caring card, one week post-discharge. Feasibility for recipients was measured by the percentage of Veterans that met eligibility and follow-up response rate; acceptability (satisfaction) was examined. RESULTS: Caring Cards is feasible and acceptable. The outpatient group had a higher attendance rate (81%) compared with other clinic groups. The percentage of eligible card recipients was 61%. Of these, 69% were reached for follow-up and 50% provided follow-up responses. Card makers and recipients both expressed positive experiences with Caring Cards. CONCLUSION: Caring Cards is a low-intensity, feasible, and acceptable intervention with potential benefits for both Veteran card makers and recipients. Additional research is needed to determine the efficacy of Caring Cards as a suicide prevention intervention.


Subject(s)
Suicide Prevention , Veterans , Aftercare , Humans , Patient Discharge , Pilot Projects
8.
Psychiatry Res ; 295: 113620, 2021 01.
Article in English | MEDLINE | ID: mdl-33290939

ABSTRACT

The current study examined the feasibility and acceptability of an integrated Cognitive-Behavioral Social Skills Training and Compensatory Cognitive Training (CBSST-CCT) intervention compared with Goal-Focused Supportive Contact (SC) in a pilot randomized controlled trial for people with schizophrenia with high negative symptom severity. The sample included 55 participants from five community settings; masters-level study clinicians delivered interventions on-site. Participants completed assessments of cognitive, functional, and psychiatric symptoms at baseline, mid-treatment, post-treatment (12.5 weeks), and 6-month follow-up. Enrollment goals were not initially met, necessitating the addition of a fifth site; however, all groups and assessments were completed on-site. Study procedures were acceptable, as evidenced by 100% enrollment and completion of baseline assessments following informed consent; however, over 1/3rd of participants dropped out. No modifications were necessary to the intervention procedures and CBSST-CCT fidelity ratings were acceptable. The intervention was deemed acceptable among participants who attended ≥1 session, as evidenced by similar attendance rates in CBSST-CCT compared to SC. Among CBSST-CCT participants, lower positive symptoms were significantly associated with better attendance. Overall, we found mixed evidence for the feasibility and acceptability of the CBSST-CCT protocol in people with schizophrenia with high negative symptoms. Challenges are highlighted and recommendations for future investigations are provided.


Subject(s)
Cognitive Behavioral Therapy/methods , Patient Acceptance of Health Care/psychology , Schizophrenia/diagnosis , Schizophrenia/therapy , Schizophrenic Psychology , Social Skills , Adult , Aged , Cognition/physiology , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pilot Projects
9.
Prof Psychol Res Pr ; 41(1): 48-56, 2010 Feb.
Article in English | MEDLINE | ID: mdl-22872783

ABSTRACT

We present a model of training in evidence-based psychosocial treatments (EBTs). The ACCESS (assess and adapt, convey basics, consult, evaluate, study outcomes, sustain) model integrates principles and findings from adult education and training literatures, research, and practical suggestions based on a community-based clinician training program. Descriptions of the steps are provided as a means of guiding implementation efforts and facilitating training partnerships between public mental health agencies and practitioners of EBTs.

10.
Psychopathology ; 42(6): 375-9, 2009.
Article in English | MEDLINE | ID: mdl-19752591

ABSTRACT

BACKGROUND: Negative beliefs regarding task performance have been shown to correlate with negative symptom severity in patients with chronic schizophrenia. We conducted a pilot study to determine whether the association also exists in individuals at ultra-high risk of psychosis. SAMPLING AND METHODS: The sample consisted of 38 individuals at ultra-high risk of psychosis and 51 controls. All participants completed the Abbreviated Dysfunctional Attitudes Scale; the ultra-high-risk participants were assessed with the Positive and Negative Syndrome Scale. RESULTS: High-risk participants endorsed negative performance beliefs to a greater extent than controls and these beliefs were associated with greater negative symptom severity, independent of depression and positive symptoms. CONCLUSIONS: The findings are consistent with previous results in chronic patients, and suggest that negative performance beliefs may be a promising psychological factor worthy of further attention in individuals at high risk of psychosis. Longitudinal research with more comprehensive assessment is needed to elucidate the potential role of negative performance beliefs in this population.


Subject(s)
Culture , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Schizophrenic Psychology , Adolescent , Adult , Analysis of Variance , Chi-Square Distribution , Cognitive Behavioral Therapy , Female , Humans , Male , Neuropsychological Tests , Pilot Projects , Psychiatric Status Rating Scales , Psychometrics , Psychotic Disorders/psychology , Risk Factors , Self Concept , Self-Assessment , Severity of Illness Index , Sex Factors , Surveys and Questionnaires
11.
J Clin Psychol ; 65(8): 815-30, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19572278

ABSTRACT

Negative symptoms account for much of the functional disability associated with schizophrenia and often persist despite pharmacological treatment. Cognitive behavioral therapy (CBT) is a promising adjunctive psychotherapy for negative symptoms. The treatment is based on a cognitive formulation in which negative symptoms arise and are maintained by dysfunctional beliefs that are a reaction to the neurocognitive impairment and discouraging life events frequently experienced by individuals with schizophrenia. This article outlines recent innovations in tailoring CBT for negative symptoms and functioning, including the use of a strong goal-oriented recovery approach, in-session exercises designed to disconfirm dysfunctional beliefs, and adaptations to circumvent neurocognitive and engagement difficulties. A case illustration is provided.


Subject(s)
Cognitive Behavioral Therapy/methods , Schizophrenia/physiopathology , Adult , Anecdotes as Topic , Humans , Male , Psychotherapy , Schizophrenia/therapy
12.
Schizophr Bull ; 45(4): 752-762, 2019 06 18.
Article in English | MEDLINE | ID: mdl-30281086

ABSTRACT

Psychosocial interventions for serious mental illness are resource intensive and poorly accessible. Brief interventions (eg, single session) that are augmented by follow-on automated mobile health intervention may expand treatment access. This was a randomized single-blind controlled trial with 255 individuals diagnosed with schizophrenia or bipolar disorder. Participants were randomized to one of three conditions: CBT2go, which combined one individual session of cognitive behavioral therapy with automated thought challenging/adaptive behavior delivered through mobile devices; Self-Monitoring (SM), which combined single-session illness psychoeducation with self-monitoring of symptoms; and treatment-as-usual (TAU). Participants were assessed at baseline, 6 weeks (midpoint), 12 weeks (posttreatment), and 24 weeks (follow-up) with our primary outcome global psychopathology (Brief Psychiatric Rating Scale-expanded version [BPRS-24]), and secondary outcomes community functioning (Specific Level of Function; SLOF) and defeatist performance beliefs (DPBs). We also collected data on adverse events. Outcome analyses on the primary outcome, BPRS Total score, indicated a significant time (0-24 wk) by group interaction with significant but modest improvement comparing two active conditions (CBT2go and SM) relative to TAU. Effects of CBT2go were not different from SM. There was a significant time Ɨ group interaction with better SLOF scores in CBT2go across 24 weeks, but not in SM. There were no time-by-group effects on DPBs. DPBs decreased in the CBT2go condition but not in SM. These results indicated that single intervention augmented by mobile intervention was feasible and associated with small yet sustained effects on global psychopathology and, when inclusive of CBT, community function compared with usual care.


Subject(s)
Bipolar Disorder/therapy , Cognitive Behavioral Therapy , Outcome Assessment, Health Care , Patient Education as Topic , Psychotherapy, Brief , Psychotic Disorders/therapy , Schizophrenia/therapy , Telemedicine , Adult , Cognitive Behavioral Therapy/methods , Ecological Momentary Assessment , Female , Follow-Up Studies , Humans , Male , Middle Aged , Psychotherapy, Brief/methods , Single-Blind Method , Telemedicine/methods
13.
Schizophr Bull ; 33(3): 831-42, 2007 May.
Article in English | MEDLINE | ID: mdl-16956985

ABSTRACT

BACKGROUND: The relationship between negative symptoms, early visual information-processing deficits, and effortful processing resource allocation was investigated. METHODS: Older patients with chronic schizophrenia (n = 58) and healthy controls (n = 71) participated. Pupillary responses were recorded during performance of the span of apprehension task (blocks of 3- and 10-letter arrays) as an index of resource allocation or mental effort during the task. RESULTS: Patients and controls showed larger pupillary responses in higher relative to lower processing loads both during array processing and just prior to array onset (preparation). Both groups, therefore, invested more cognitive effort preparing for and then processing larger arrays. A subgroup of patients with abnormally small pupillary responses and impaired performance showed greater negative symptom severity relative to a subgroup of patients with normal pupillary responses. Smaller pupillary responses in the patients were also significantly correlated with greater negative symptom severity, independent of positive symptom severity. Patients with reduced effortful resource allocation, therefore, exhibited greater negative symptomatology. A subgroup of patients with normal pupillary responses still showed impaired detection accuracy relative to controls, suggesting that reduced cognitive effort or resource allocation problems cannot account for impairments in early visual information processing in this subgroup. CONCLUSIONS: The study illustrates important relationships between cognitive effort and performance that can impact conclusions about the nature of cognitive impairments and associations between negative symptoms and neurocognition in schizophrenia.


Subject(s)
Attention , Cognition Disorders/diagnosis , Depression/diagnosis , Pattern Recognition, Visual , Physical Exertion , Psychomotor Performance , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Schizophrenic Psychology , Adult , Aged , Arousal , Chronic Disease , Cognition Disorders/psychology , Depression/psychology , Discrimination Learning , Female , Field Dependence-Independence , Humans , Male , Middle Aged , Psychotic Disorders/psychology , Reaction Time , Reference Values , Reflex, Pupillary , Statistics as Topic
15.
Dialogues Clin Neurosci ; 18(2): 171-83, 2016 06.
Article in English | MEDLINE | ID: mdl-27489457

ABSTRACT

The functional impairment associated with serious mental illness (SMI) places an immense burden on individuals and society, and disability often persists even after efficacious treatment of psychopathologic symptoms. Traditional methods of measuring functioning have limitations, and numerous obstacles reduce the reach and impact of evidence-based interventions developed to improve functioning in SMI. This review describes the potential of technological innovations for overcoming the challenges involved in both functional assessment and intervention in people with SMI. Ecological momentary assessment (EMA), which involves the repeated sampling of naturalistic behaviors and experiences while individuals carry out their daily lives, has provided a new window through which the determinants of day-to-day function in SMI can be observed. EMA has several advantages over traditional assessment methods and has in recent years evolved to use mobile-based platforms, such as text messaging and smartphone applications, for both assessment and promotion of self-management in people with SMI. We will review promising data regarding the acceptability, adherence, and efficacy of EMA-based mobile technologies; explore ways in which these technologies can extend the reach and impact of evidence-based psychosocial rehabilitative interventions in SMI; and outline future directions for research in this important area.


El deterioro funcional asociado con la enfermedad mental grave (EMG) implica una inmensa carga para los individuos y la sociedad, y la discapacidad persiste aun despuĆ©s de tratamientos exitosos de los sĆ­ntomas psicopatolĆ³gicos. Los mĆ©todos tradicionales para medir funcionamiento tienen limitaciones y hay numerosos obstĆ”culos que reducen el alcance e impacto de intervenciones basadas en la evidencia que se han desarrollado para mejorar el funcionamiento en las EMG. Esta revisiĆ³n describe el potencial de las innovaciones tecnolĆ³gicas para superar los desafĆ­os involucrados tanto en la evaluaciĆ³n funcional como en las intervenciones en las EMG. La evaluaciĆ³n ecolĆ³gica instantĆ”nea (EEI), que consiste en el muestreo repetido de conductas y experiencias naturalĆ­sticas mientras los sujetos desarrollan su vida diaria, ha aportado una nueva ventana a travĆ©s de la cual se pueden observar los determinantes del funcionamiento dĆ­a a dĆ­a en las EMG. La EEI tiene algunas ventajas sobre los mĆ©todos de evaluaciĆ³n tradicional y ha evolucionado en los Ćŗltimos aƱos hacia el empleo de plataformas en base a mĆ³viles, como mensajes de texto y aplicaciones de telĆ©fonos inteligentes, tanto para la evaluaciĆ³n como para la promociĆ³n del auto-manejo de personas con EMG. Se revisan datos prometedores en relaciĆ³n con la aceptabilidad, adherencia y eficacia de tecnologĆ­as mĆ³viles basadas en la EEI; se exploran vĆ­as en las que estas tecnologĆ­as pueden extender el alcance e impacto de las intervenciones de rehabilitaciĆ³n psicosocial basada en la evidencia en la EEI, y se describen las futuras direcciones de la investigaciĆ³n en esta importante Ć”rea.


Le handicap fonctionnel liĆ© aux maladies mentales graves impose un immense fardeau aux individus et Ć  la sociĆ©tĆ© et l'invaliditĆ© persiste souvent mĆŖme aprĆØs un traitement efficace des symptĆ“mes psychopathologiques. Les mĆ©thodes traditionnelles de mesure du fonctionnement ont des limites et de nombreux obstacles diminuent la portĆ©e et l'incidence des interventions basĆ©es sur des preuves dĆ©veloppĆ©es pour amĆ©liorer le fonctionnement des personnes atteintes de maladies mentales graves. Cet article explique comment les innovations technologiques peuvent permettre de surmonter les dĆ©fis liĆ©s Ć  l'Ć©valuation et Ć  l'intervention fonctionnelles chez les personnes atteintes de maladies mentales graves. L'Ć©valuation Ć©cologique momentanĆ©e (EEM), qui comporte des Ć©chantillonnages rĆ©pĆ©tĆ©s d'expĆ©rience et de comportements naturalistes, les individus continuant Ć  vivre leur vie quotidienne, permet d'observer les dĆ©terminants du fonctionnement quotidien des personnes atteintes de maladies mentales graves. L'EEM prĆ©sente plusieurs avantages sur les mĆ©thodes d'Ć©valuation traditionnelles et a rĆ©cemment Ć©voluĆ© pour utiliser des platesformes mobiles, comme les SMS et les applications pour smartphone, pour l'Ć©valuation et la promotion d'une gestion autonome des personnes atteintes de maladies mentales graves. Nous analyserons les donnĆ©es prometteuses concernant l'acceptabilitĆ©, l'observance et l'efficacitĆ© des technologies mobiles basĆ©es sur l'EEM; nous explorerons la faƧon dont ces technologies peuvent prolonger la portĆ©e et l'incidence des interventions de rĆ©habilitation psychosocial basĆ©es sur des preuves des personnes atteintes de maladies mentales graves; et nous donnerons les grandes lignes des axes de recherche Ć  venir dans ce domaine important.


Subject(s)
Disease Management , Mental Disorders/diagnosis , Mental Disorders/therapy , Self Care/methods , Humans , Mental Disorders/psychology , Psychotherapy/methods , Psychotherapy/trends , Self Care/trends , Treatment Outcome
16.
Schizophr Res ; 172(1-3): 195-200, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26948502

ABSTRACT

Despite the increasing attention to social appraisals in suicide risk, the interpersonal correlates of suicidal thoughts and behavior in schizophrenia are not well understood. Ecological momentary assessment could reveal whether dysfunctional social appraisals and behavior are evident in people with schizophrenia with suicidal ideation. A total of 93 outpatients with diagnoses of schizophrenia with (n=18, 19%) and without (N=75; 81%) suicidal ideation participated in one week of intensive daily monitoring via mobile devices, generating real-time reports on the quantity of social interactions and appraisals about them, as well as information concerning concurrent affect and symptoms. The presence of suicidal ideation was not associated with the quantity of social interactions or time spent alone, but it was associated with the anticipation of being alone as well as greater negative and lower positive affect when alone. Despite this aversive experience of being alone, people with suicidal ideation reported negative appraisals about the value of recent and potential social interactions. These findings suggest that suicidal ideation in schizophrenia may not be associated with the quantity of social interactions, but with negative expectations about the quality of social interactions coupled with an aversive experience of being alone. Cognitive therapy interventions that address negative expectations and pleasure about social interactions, especially when alone, may reduce suicidal ideation.


Subject(s)
Schizophrenia , Schizophrenic Psychology , Social Behavior , Suicidal Ideation , Adult , Cell Phone , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales
17.
Am J Psychiatry ; 162(3): 520-9, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15741469

ABSTRACT

OBJECTIVE: The number of older patients with chronic schizophrenia is increasing. There is a need for empirically validated psychotherapy interventions for these patients. Cognitive behavioral social skills training teaches cognitive and behavioral coping techniques, social functioning skills, problem solving, and compensatory aids for neurocognitive impairments. The authors compared treatment as usual with the combination of treatment as usual plus cognitive behavioral social skills training. METHOD: The randomized, controlled trial included 76 middle-aged and older outpatients with chronic schizophrenia, who were assigned to either treatment as usual or combined treatment. Cognitive behavioral social skills training was administered over 24 weekly group sessions. Blind raters assessed social functioning, psychotic and depressive symptoms, cognitive insight, and skill mastery. RESULTS: After treatment, the patients receiving combined treatment performed social functioning activities significantly more frequently than the patients in treatment as usual, although general skill at social functioning activities did not differ significantly. Patients receiving cognitive behavioral social skills training achieved significantly greater cognitive insight, indicating more objectivity in reappraising psychotic symptoms, and demonstrated greater skill mastery. The overall group effect was not significant for symptoms, but the greater increase in cognitive insight with combined treatment was significantly correlated with greater reduction in positive symptoms. CONCLUSIONS: With cognitive behavioral social skills training, middle-aged and older outpatients with chronic schizophrenia learned coping skills, evaluated anomalous experiences with more objectivity (achieved greater cognitive insight), and improved social functioning. Additional research is needed to determine whether cognitive insight mediates psychotic symptom change in cognitive behavior therapy for psychosis.


Subject(s)
Cognitive Behavioral Therapy/methods , Schizophrenia/therapy , Schizophrenic Psychology , Social Adjustment , Activities of Daily Living/psychology , Adaptation, Psychological , Age Factors , Aged , Ambulatory Care , Female , Humans , Interpersonal Relations , Male , Middle Aged , Psychiatric Status Rating Scales , Psychotherapy, Group/methods , Psychotic Disorders/psychology , Psychotic Disorders/rehabilitation , Psychotic Disorders/therapy , Schizophrenia/rehabilitation , Treatment Outcome
18.
Trials ; 16: 438, 2015 Sep 30.
Article in English | MEDLINE | ID: mdl-26424639

ABSTRACT

BACKGROUND: Schizophrenia leads to profound disability in everyday functioning (e.g., difficulty finding and maintaining employment, housing, and personal relationships). Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning. Psychosocial evidence-based practices (EBPs) improve functioning, but these EBPs are not available to most people with schizophrenia. The field must close the research and service delivery gap by adapting EBPs for schizophrenia to facilitate widespread implementation in community settings. Our hybrid effectiveness and implementation study represents an initiative to bridge this divide. In this study we will test whether an existing EBP (i.e., Cognitive Behavioral Social Skills Training (CBSST)) modified to work in practice settings (i.e., Assertive Community Treatment (ACT) teams) commonly available to persons with schizophrenia results in better consumer outcomes. We will also identify key factors relevant to developing future CBSST implementation strategies. METHODS/DESIGN: For the effectiveness study component, persons with schizophrenia will be recruited from existing publicly funded ACT teams operating in community settings. Participants will be randomized to one of the 2 treatments (ACT alone or ACT + Adapted CBSST) and followed longitudinally for 18 months with assessments every 18 weeks after baseline (5 in total). The primary outcome domain is psychosocial functioning (e.g., everyday living skills and activities related to employment, education, and housing) as measured by self-report, testing, and observation. Additional outcome domains of interest include mediators of change in functioning, symptoms, and quality of services. Primary analyses will be conducted using linear mixed-effects models for continuous data. The implementation study component consists of a structured, mixed qualitative-quantitative methodology (i.e., Concept Mapping) to characterize and assess the implementation experience from multiple stakeholder perspectives in order to inform future implementation initiatives. DISCUSSION: Adapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs. As part of the implementation learning process training materials and treatment workbooks have been revised to promote easier use of CBSST in the context of brief community-based ACT visits. TRIAL REGISTRATION: ClinicalTrials.gov NCT02254733 . Date of registration: 25 April 2014.


Subject(s)
Cognitive Behavioral Therapy/methods , Community Mental Health Services , Schizophrenia/therapy , Schizophrenic Psychology , Social Behavior , Activities of Daily Living , Adaptation, Psychological , California , Clinical Protocols , Delivery of Health Care , Humans , Linear Models , Psychiatric Status Rating Scales , Research Design , Schizophrenia/diagnosis , Time Factors , Treatment Outcome
19.
Schizophr Res ; 69(2-3): 307-16, 2004 Aug 01.
Article in English | MEDLINE | ID: mdl-15469202

ABSTRACT

Improving real-life community functioning in patients with severe mental illness has been an important recent focus of treatment outcome research. Few studies, however, have examined psychosocial functioning in older psychotic patients. The Independent Living Skills Survey (ILSS) is a measure of the basic functional living skills of individuals with severe and persistent mental illness. The self-report version of the ILSS was administered to 57 middle-aged and older community dwelling outpatients with schizophrenia and 40 age-comparable nonpsychiatric participants. Regardless of whether patients resided in assisted living or independent settings, they showed significantly impaired functioning on a majority of the functional areas assessed by the ILSS. No consistent relationship was found between symptom severity and functioning. With certain modifications, the ILSS appears to be a sensitive indicator of functional impairment in this older sample of community-dwelling outpatients with schizophrenia. Information provided by the instrument might be useful to guide rehabilitation efforts and measure functioning changes in response to treatment in this population.


Subject(s)
Activities of Daily Living , Outpatients , Schizophrenia/physiopathology , Schizophrenic Psychology , Social Behavior , Activities of Daily Living/psychology , Aged , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Quality of Life , Statistics, Nonparametric
20.
Schizophr Bull ; 39(1): 43-51, 2013 Jan.
Article in English | MEDLINE | ID: mdl-21622849

ABSTRACT

The deficit syndrome was proposed over 20 years ago as a separate negative symptom syndrome within schizophrenia with a distinct neurobiological pathophysiology and etiology. Recent research, however, has indicated that psychological factors such as negative attitudes and expectancies are significantly associated with the broad spectrum of negative symptoms. Specifically, defeatist beliefs regarding performance mediate between neurocognitive impairment and both negative symptoms and functional outcome. Additionally, asocial beliefs predict asocial behavior and negative expectancies regarding future pleasure are associated with negative symptoms. The present study explored whether these dysfunctional beliefs and negative expectancies might also be a feature of the deficit syndrome. Based on a validated proxy method, 22 deficit and 72 nondeficit patients (from a pool of 139 negative symptom patients) were identified and received a battery of symptom, neurocognitive, and psychological measures. The deficit group scored significantly worse on measures of negative symptoms, insight, emotion recognition, defeatist attitudes, and asocial beliefs but better on measures of depression, anxiety, and distress than the nondeficit group. Moreover, the deficit group showed a trend for higher scores on self-esteem. Based on these findings, we propose a more comprehensive formulation of deficit schizophrenia, characterized by neurobiological factors and a cluster of psychological attributes that lead to withdrawal and protect the self-esteem. Although the patients have apparently opted-out of participation in normal activities, we suggest that a psychological intervention that targets these negative attitudes might improve their functioning and quality of life.


Subject(s)
Attitude , Schizophrenia/physiopathology , Schizophrenic Psychology , Adult , Anxiety Disorders/epidemiology , Anxiety Disorders/physiopathology , Brief Psychiatric Rating Scale , Comorbidity , Depressive Disorder/epidemiology , Depressive Disorder/physiopathology , Female , Humans , Male , Neuropsychological Tests , Psychiatric Status Rating Scales , Schizophrenia/epidemiology , Severity of Illness Index , Syndrome
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