The use of the social skills performance assessment (SSPA) among persons with serious mental illness: psychometric assessment and network analysis.

Background: Challenges in social functioning are a major obstacle in the recovery process of persons with serious mental illness. Majority of social functioning measures use self-report assessments.Aims: To validate the use of a performance based measure and examine a network analysis that explores the centrality of items. In addition, to explore the distinctiveness between the social skills performance assessment (SSPA), and a self-report measure of social quality of life (SQoL).Method: One hundred fifty eight participants were administrated with the SSPA and SQoL scale. Intra-class correlation, Pearson correlation and Network analysis were performed.Results: A differentiation between the SQoL items and the SSPA items appeared. The strongest nodes in the network were social appropriateness (7.413), focus (7.763) and clarity (7.438) from the SSPA measure. The nodes rated highest on the betweenness measure were affect from the SSPA and satisfaction with getting along with other people from the SQoL scale.Conclusions: Interventions should target the skills of focus, clarity and social appropriateness as they present the central items in the network.

Neuro-cognition and social cognition elements of social functioning and social quality of life.

Previous studies have shown that deficits in social cognition mediate the association between neuro-cognition and functional outcome. Based on these findings, the current study presents an examination of the mediating role of social cognition and includes two different outcomes: social functioning assessed by objective observer and social quality of life assessed by subjective self-report. Instruments measuring different aspects of social cognition, cognitive ability, social functioning and social quality of life were administered to 131 participants who had a diagnosis of a serious mental illness. Results showed that emotion recognition and attributional bias were significant mediators such that cognitive assessment was positively related to both, which in turn, were negatively related to SQoL. While one interpretation of the data suggests that deficits in emotion recognition may serve as a possible defense mechanism, future studies should re-assess this idea.

The Special Challenges of Psychotherapy with Persons with Psychosis: Intersubjective Metacognitive Model of Agreement and Shared Meaning.

Agreement between client and therapist is an essential part of the therapeutic alliance. While there are general challenges to the creation of agreement and shared meaning in all psychotherapies, there are specific challenges while working with persons with psychosis. These challenges include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias. Here we present a metacognitive intersubjective model as a framework for the understanding and resolutions of these challenges. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Goal consensus, agreement and shared meaning are essential for a collaborative process and positive outcome in psychotherapy. Challenges to psychotherapy with persons with psychosis include the different narratives of the client and the therapist with regard to their roles and the description of the condition or problem, as well as possible stigmatic views and theoretical bias. In the intersubjective exchange, the concepts of metacognition and empathy can act as a framework for navigating between the possible challenges and the desired shared meaning and agreement.

Agreement between clients with schizophrenia and mental health workers on clients' social quality of life: The role of social cognition and symptoms.

OBJECTIVE: Studies have showed that therapists and mental health workers of persons with schizophrenia tend to estimate their patients' social quality of life (SQoL) as poorer than the clients' own estimation. This study explores the hypothesis that this discrepancy is related to clients' social cognition and symptomatology. DESIGN: Cross-sectional assessment of both clients and their mental health workers. METHODS: Ninety persons with schizophrenia and 12 persons who were formal care providers participated in the study. All responded to a parallel version (client and clinician) of social quality-of-life scales. Clients' emotion identification, theory of mind and symptoms were also assessed. RESULTS: Low social cognitive abilities of persons with schizophrenia, as well as negative symptomatology and having children, may be related to the negative bias of mental health workers, with regard to their client's SQoL. CONCLUSIONS: While more severe levels of negative symptoms and more deficits of social cognition were related to reduced levels of agreement, paradoxically, a relatively normative family life that includes parenting was also related to lower levels of agreement. PRACTITIONER POINTS: Attention should be given to low agreement between clients with schizophrenia and clinicians with regard to the client's quality of life, as it is central to alliance and outcome. Clinicians tend to estimate clients' social quality of life as poorer than the clients' own estimation when those clients have low social cognition, high negative symptomatology and children. There is a need to identify additional factors that contribute to agreement and alliance in therapy. Longitudinal assessment during therapy can trace the process of construction of agreement.

Metacognitive and social cognition approaches to understanding the impact of schizophrenia on social quality of life.

While some studies view metacognition and social cognition as representing the same phenomenon, others suggest that they represent distinctive sets of abilities that are related to different outcomes. The current study used a cross-sectional design that includes samples of persons with schizophrenia (N=39) and healthy individuals (N=60) to further explore the distinction between social cognition and metacognition and their associations with social quality of life. The Face Emotion Identification Task (FEIT), Faux-Pas Task, Indiana Psychiatric Illness Interview (IPII), Metacognition Assessment Scale - Abbreviated (MAS-A), and Social Quality of Life Scale were administrated to all participants. Correlations, t-tests and regressions were conducted. Results showed that persons with schizophrenia performed more poorly on all measures than healthy controls. Social cognition and metacognition measures were related for the combined total sample, but only a few associations were found among both sub-samples. A diagnosis of schizophrenia and metacognitive capacity, but not social cognition, predicted social quality of life. Self-reflectivity had a negative relationship to social quality of life while understanding of others' minds had a positive relation to social quality of life. The current study provides evidence that many with schizophrenia experience deficits in both social cognition and metacognition and that those deficits may be distinct and have different kinds of relationships with social quality of life. Clinical implications include the need to emphasize narrative aspects of psychotherapy in order to promote metacognition.

Affective and cognitive empathy and social quality of life in schizophrenia: a comparison between a parallel process model and an integrative meditation model.

Two alternative models of impaired cognitive and affective processing that may underlie reduced social quality of life (SQoL) of persons with schizophrenia, were examined. According to the parallel process model, impaired cognitive empathy and affective empathy make relatively independent contributions to the symptoms of schizophrenia and to the consequent reduction in SQoL. According to the integrative mediation model, the symptoms of schizophrenia and the reduction in SQoL associated with these symptoms are the products of a process by which impairments of cognitive empathy are contingent on impairments of affective empathy. 90 persons with schizophrenia were assessed for SQoL, symptoms and cognitive and affective empathy. Results support the integrative mediation model only for cognitive empathy and negative psychiatric symptoms. Only the negative links between cognitive empathy and negative symptoms served to mediate the positive relation between affective empathy and SQoL. Positive symptoms had a limited negative impact on SQoL and did not play a role in the paths that linked affective empathy to SQoL. Age had a statistically significant and negative indirect relationship to SQoL. Results are consistent with recent approach that distinguish between cognitive and affective empathy and specify how these two processes are integrated.

Metacognition in schizophrenia and schizotypy: relation to symptoms of schizophrenia, traits of schizotypy and Social Quality of Life.

OBJECTIVE: The current study examined a mediation model in which symptoms of schizophrenia and schizotypy traits mediate the positive relations between metacognition and Social Quality of Life (SQoL) among persons with schizophrenia and persons without mental illness. METHOD: 39 persons diagnosed with schizophrenia and 60 persons without a severe mental illness diagnosis participated in this study. Instruments included the Metacognition Assessment Scale-Abbreviated (MAS-A), the SQoL scale of the QLI-MH, the PANSS scale and the O-LIFE self-report questionnaire that assesses schizotypy traits. RESULTS: Persons with schizophrenia exhibit lower SQoL and metacognitive abilities than persons without mental illness. For persons with schizophrenia, negative symptoms mediate the positive relation between the ability to understand other persons' minds and SQoL. However, although for persons without mental illness, understanding other minds was found to correlate negatively with introvertive anhedonia and SQoL, a mediation model was not confirmed. DISCUSSION: Understanding of others' minds seems relevant to the SQoL for both samples. In addition, negative symptoms of schizophrenia and introvertive anedonia traits are also related to SQoL among persons with schizophrenia and among persons without mental illness respectively. The lack of support for a mediation model for persons without mental illness is consistent with the theories that claim schizotypy is not a mirror image of schizophrenia and, therefore, may not necessarily lead to schizophrenia. Limitations of this study and suggestions for future research are discussed.

Attitudes toward the sexuality of persons with physical versus psychiatric disabilities.

OBJECTIVE: Research has shown that attitudes toward different disabilities form a hierarchy, with observers exhibiting more positive attitudes toward persons with physical disabilities than toward persons with psychiatric disabilities. In addition, investigations of attitudes toward persons with a disability indicate that they are often perceived as asexual. The current study examined whether involvement of persons with either a physical or psychiatric disability in a sexual relationship moderates the relation between their type of disability and attitudes toward them. METHOD: After reading one of six randomly assigned vignettes, university students (N = 195) filled out a semantic differential-based attitude scale (Katz & Shurka, 1977; Kravetz, Katz, & Albez, 1994). The six vignettes consisted of a male with a physical disability/with a psychiatric disability/without a disability, who was either involved/not involved in a sexual relationship. RESULTS: An interaction between type of disability and involvement in a sexual relationship was found for two subscales of the attitudes scale, occupation and intelligence. Involvement in a sexual relationship was found to generate more positive attitudes when the target person had a physical disability but more negative attitudes when he had a psychiatric disability. CONCLUSIONS: Involvement in a sexual relationship seems to work in favor of persons with a physical disability because of the association of such a relationship with normality and adaptation. However, attributing such a relationship to persons with a psychiatric disability seems to be stigmatic.

Nature adventure rehabilitation for combat-related posttraumatic chronic stress disorder: a randomized control trial.

Chronic combat-related posttraumatic stress disorder (CR-PTSD) is a condition with many treatment barriers. Nature Adventure Rehabilitation (NAR) as a second line or as a supplemental intervention has the potential to overcome some of these barriers and incorporate aspects of successful treatment modalities for PTSD within an experiential learning paradigm. In a pre-post controlled trial, CR-PTSD veterans (n=22) underwent a 1-year NAR intervention compared to a waiting list (WL) control group (n=20). Posttraumatic symptoms (PTS), depression, functional problems, quality of life, perceived control over illness (PCI) and hope were measured by self report measures. PTS, emotional and social quality of life, PCI, hope and functioning improved significantly. Change in PTS was contingent upon change in PCI. The current study is the first to present NAR as a promising supplemental intervention for chronic CR-PTSD. NAR seems to work through a process of behavioral activation, desensitization, gradual exposure to anxiety evoking situations and gaining control over symptomatology.

Measuring the internalized stigma of parents of persons with a serious mental illness: the factor structure of the parents' internalized stigma of mental illness scale.

Research has revealed that approximately one third of persons with a serious mental illness (SMI) experience elevated internalized stigma, which is associated with a large number of negative outcomes. Family members of persons with SMI are also often subject to stigma, but the degree to which these experiences are internalized and lead to self-stigma has rarely been studied. The present study investigated the factor structure of a modification of the Internalized Stigma of Mental Illness (ISMI) scale by Ritsher, Otilingam, and Grajales (Psychiatry Res 121:31-49, 2003). A central assumption of this investigation was that the factor structure of the Parents' Internalized Stigma of Mental Illness (PISMI) scale would be similar to the factor structure of the ISMI scale. A total of 194 parents of persons with SMI completed the PISMI scale. The results revealed that the PISMI scale has high internal consistency and that it is made up of three distinctive factors: discrimination experience, social withdrawal and alienation, and stereotype endorsement. These factors are similar, but not identical, to the factors that underlie the ISMI scale. This study's findings also indicate that parents' prominent reaction to self-stigma is stereotype endorsement.

Self perception of empathy in schizophrenia: emotion recognition, insight, and symptoms predict degree of self and interviewer agreement.

Many with schizophrenia have been found to experience difficulties recognizing a range of their own mental states including memories and emotions. While there is some evidence that the self perception of empathy in schizophrenia is often at odds with objective observations, little is known about the correlates of rates of concordance between self and rater assessments of empathy for this group. To explore this issue we gathered self and rater assessments of empathy in addition to assessments of emotion recognition using the Bell Lysaker Emotion Recognition Task, insight using the Scale to Assess Unawareness of Mental Disorder, and symptoms using the Positive and Negative Syndrome Scale from 91 adults diagnosed with schizophrenia spectrum disorders. Results revealed that participants with better emotion recognition, better insight, fewer positive symptoms and fewer depressive symptoms produced self ratings of empathy which were more strongly correlated with assessments of empathy performed by raters than participants with greater deficits in these domains. Results suggest that deficits in emotion recognition along with poor insight and higher levels of positive and depressive symptoms may affect the degree of agreement between self and rater assessments of empathy in schizophrenia.

A narrative evaluation of a psychoeducation and a therapeutic alliance intervention for parents of persons with a severe mental illness.

Most attempts to study the impact of psychosocial interventions on parents of persons with severe mental illness (SMI) are quantitative. The purpose of the present study was to investigate the subjective experience of parents of persons with SMI who participated in either a psychoeducational intervention which emphasized providing information on the illness and support, or a therapeutic alliance focused intervention (TAFI) which emphasized the alliance between the group members and group leaders. Ninety-three parents, who participated in either one of these two interventions, were interviewed using the Narrative Evaluation of Intervention Interview. Results show that participants found both interventions to be beneficial with no statistical differences in the level of perceived change. Themes describing change in relating to illness were significantly more frequently mentioned by participants in the TAFI group, whereas significantly more participants in the family psychoeducation interventions reported that implementation and information provided contributed to positive change. Also participants in the TAFI reported significantly more often that group regulation contributed to change. As both interventions were perceived as contributing, the findings support the relationship orientation to psychosocial interventions, which stresses the quality of the social support and interpersonal interaction as the source of positive outcomes of intervention.

Recovery in Israel: a legislative recovery response to the needs-rights paradox.

This paper uses the framework of the applied social science needs/rights antinomy to describe the efforts of Israel's mental health system in transforming a hospital-based orientation to services for individuals with a severe mental illness, to a community-based recovery orientation. On the one hand, a rationale for the provision of services to individuals with a severe mental illness that stresses these individuals' needs can justify the allocation of society's limited resources by referring to an objectively determinable set of psychiatric needs. However, this rationale may establish an inherent asymmetry between the adequate help provider and deficient help user. On the other hand, a rationale for providing psychiatric rehabilitation services that stresses the fundamental symmetry between the help provider and the help user is empowering, thus consistent with the recovery approach. However, this rationale does not provide a mechanism for negotiating the vague boundary between mental health and mental illness. Israel's mental health system has operationalized a policy that emphasizes rights as well as needs by legislating for a comprehensive set of rehabilitation services that individuals meeting the eligibility criteria may receive. This paper discusses this approach's achievements, challenges and implications for future policy, research, and practice.

Family psychoeducation and therapeutic alliance focused interventions for parents of a daughter or son with a severe mental illness.

This study compared the effectiveness of a family psychoeducational intervention (FPEI) and a therapeutic alliance focused intervention (TAFI) for parents of daughters and sons with severe mental illness (SMI). A process-outcome model was used to compare the effectiveness of the two interventions and to evaluate how they achieved their outcomes. Extent of effectiveness was assessed in terms of the family burden (FB) of the parents and the quality of life (QoL) and psychiatric symptoms of the daughters and sons. This study did not uncover a difference in effectiveness between the two interventions. However, at post-treatment, the participants in both interventions reported statistically significant less FB and attributed more QoL and less psychiatric symptoms to their daughters and sons than at pre-treatment. In addition, these pre- and post-treatment differences were mediated by specific mediating variables. These results are discussed in terms of the great psychotherapy debate (Wampold, 2001) as to the relative effectiveness of technique oriented interventions as compared to context oriented interventions.

Insight into mental illness, self-stigma, and the family burden of parents of persons with a severe mental illness.

BACKGROUND: Parents of persons with severe mental illness (SMI) often experience burden due to the illness of their daughter or son. In the present study, the possibility that parents' self-stigma moderates the relationship between the parents' insight into a daughter's or son's illness and the parents' sense of burden was investigated. METHODS: Levels of insight into a daughter's or son's mental illness, parent self-stigma, and parent burden of 127 parents of persons with an SMI were assessed. Regression analysis was used to test the putative moderating role of parents' self-stigma. RESULTS: Self-stigma was found to mediate rather than moderate the relationship between insight and burden. Accordingly, parent insight into the mental illness of a daughter or son appears to increase parent burden because it increases parent self-stigma. CONCLUSIONS: The implications of these findings for practice, theory, and future research are discussed.

The relationship between consumer insight and provider-consumer agreement regarding consumer's quality of life.

This study examined the relationship between insight and mental health consumers and providers agreement regarding consumers rated quality of life (QoL). Seventy mental health consumers and their 23 care providers filled-out parallel questionnaires designed to measure consumer QoL. Consumers' insight was also assessed. For most QoL domains, agreement between consumers and providers was higher for persons with high insight. For the Psychological well being dimension a negative correlation was uncovered for persons with low insight indicating disagreement between consumer and provider. These findings are discussed within the context of the literature on insight and agreement between consumer and provider as related to the therapeutic alliance.

Assessing psychiatric rehabilitation service (PRS) outcomes in Israel: conceptual, professional and social issues.

Since the implementation of the legislation in Israel concerning rehabilitation of people with psychiatric disabilities in the community in 2001, an increasing number of individuals, currently estimated at nearly 15,000, have been receiving the psychiatric rehabilitation "basket of services." A systematic investigation of the extent to which these services have had a positive impact on the intended outcome is required, to evaluate the effectiveness of the newly developed psychiatric rehabilitation basket of services. This evaluation has become a priority item on the mental health agenda in Israel. This opinion paper, based on a conceptual analysis and selective review of the relevant literature, discusses concepts and principles that seem important for the development of strategies to constructively assess the outcome of psychiatric rehabilitation services (PRS) in Israel. More specifically, several fundamental issues related to outcome monitoring are reviewed, such as what outcome domains should be assessed, who should conduct the assessments and from whom should data be collected and with whom and how should it be shared. The complexity of these issues are reviewed and possible strategies to deal with them are discussed.

Metacognitive and interpersonal interventions for persons with severe mental illness: theory and practice.

Communication and interpersonal deficits are major stumbling blocks that stand between persons with severe mental illness (SMI) and such recovery goals as quality of life (QoL) and community integration. Not only do these deficts have a direct and negative impact on the QoL and community integration of persons with SMI but they also may reduce these persons' ability to take advantage of major interventions in which communication and interpersonal relationships play a central role (i.e., psychotherapy, recovery programs, illness management and recovery). Recent theories of schizophrenia and other SMI attribute these communication and interpersonal limitations of persons with SMI to impairments of metacognition (i.e., empathy, theory of mind [ToM], mind reading). Within a dialogical framework of metacognition that differentiates between empathy and ToM, this paper reviews two interventions for persons with SMI, Metacognitive Training (MCT) and Social Cognition and Integration Training (SCIT), that were recently developed to improve communication and interpersonal skills of persons with schizophrenia. These interventions are based on the above described theories of schizophrenia and SMI. Although preliminary research has produced favorable results for these interventions, additional investigations using more critical research designs are required to establish their efficacy. Furthermore, this paper suggests that adding dialogical elements to these interventions might improve their effectiveness.

Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders.

Controversy exists as to the cognitive, emotional and behavioral consequences of lack of insight for persons with schizophrenia. This study tested a mediation model of the relations between insight into mental illness, hope, and the aspects of quality of life of persons with schizophrenia. According to this model, insight into mental illness may impact negatively on the quality of life of persons with schizophrenia by reducing these persons' hope. Sixty persons with schizophrenia or schizoaffective disorder completed questionnaires that assessed their insight, quality of life, and hope. The study's results show that for six of seven aspects of quality of life and for general awareness of illness, the above-hypothesized mediation model was confirmed. These results suggest that increasing the hope of persons with schizophrenia may directly and positively increase both their quality of life and the usefulness of their insight into their illness.