Evaluation of a mentored self-help intervention for the management of psychotic symptoms

218 Pages·2016·3.03 MB·English

by  Willa Jeanne Casstevens

Florida International University
FIU Digital Commons
FIU Electronic Theses and Dissertations University Graduate School
3-30-2006
Evaluation of a mentored self-help intervention for
the management of psychotic symptoms
Willa Jeanne Casstevens
Florida International University
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FLORIDA INTERNATIONAL UNIVERSITY
Miami, Florida
EVALUATION OF A MENTORED SELF-HELP INTERVENTION FOR THE
MANAGEMENT OF PSYCHOTIC SYMPTOMS
A dissertation submitted in partial fulfillment of the
requirements for the degree of
DOCTOR OF PHILOSOPHY
in
SOCIAL WELFARE
by
Willa Jeanne Casstevens
2006
To: Interim Executive Dean Ray Thomlison
College of Health and Urban Affairs
This dissertation, written by Willa Jeanne Casstevens, and entitled Evaluation of a
Mentored Self-Help Intervention for the Management of Psychotic Symptoms, having
been approved in respect to style and intellectual content, is referred to you for judgment.
We have read this dissertation and recommend that it be approved.
Marian Dumaine
Frederick L. Newman
Nan Van Den Bergh
David Cohen, Major Professor
Date of Defense: March 30, 2006
The dissertation of Willa Jeanne Casstevens is approved.
Interim Executive Dean Ray Thomlison
College of Health and Urban Affairs
Interim Dean Stephan L. Mintz
University Graduate School
Florida International University, 2006
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C Copyright 2006 by Willa Jeanne Casstevens
All rights reserved.
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DEDICATION
This dissertation is dedicated to my parents, Tom and Jeanne Casstevens, and my
sons, Russell and Richard Kaufman, without whom it would never have come to pass.
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ACKNOWLEDGMENTS
This study would not have been possible without the participation of members
of Fellowship House: Many thanks for your commitment to and patience with the
investigative process. Thank you also to Fellowship House staff, for your active
support, and particularly to Publio Santana, Cindy Swartz, Genna Marx, Habsi Kaba,
Rosemary Smith-Hoel and Jonelle Doughery, without whom the study could not have
manifested. Many thanks to my research assistants, Constanza Bade, Ann J. Galinanes
and Danielle Vandenbent, for your careful attention to detail with both data collection
and data entry. I greatly appreciate your time and efforts.
I wish to thank my committee members, Drs. David Cohen, Fred Newman, Nan
Van Den Bergh and Marian Dumaine for their consistent support, feedback and
commitment. I am indebted to Marian Dumaine especially for connecting me with
Fellowship House and to Nan Van Den Bergh for instrumental support during a crucial
interval. I would like to thank Fred Newman for numerous introductions and
recommendations as well as for statistical guidance, consultation, and invariably prompt
feedback; without his consistent endorsement the study would not exist. I cannot thank
David Cohen enough for his willingness to supervise this study and for bringing
Coleman and Smith's (1997) workbook to my attention. His multi-faceted expertise
combined with a consistent refusal to accept less than my best work resulted in this
finished product.
I wish to thank Dr. Steve Wong, who originally brought the connection between
schizophrenia and cognitive behavioral therapy (CBT) to my attention. Thank you, Dr.
Eric Wagner, for your advice, guidance related to research protocols, and referral to the
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Beck Institute for CBT training. Thanks also go to the Florida International University
Graduate Student Association for funding assistance on two occasions. I would like to
thank Dr. Jordan Kosberg for early support during the doctoral program, and Dr. Rita
Wik for support, guidance and encouragement without which I would not have begun
the doctoral process.
Thank you, Gayle Bluebird, for introducing me to the role of consumer advocate.
Thank you also for opening my mind to the self-help perspective in mental health, and
thereby shifting this study's focus. Thank you, Kathryn Vanderwater Piercy, for your
holiday time one sunny Florida day, when you trained me and Jolae Brocato in the use
of the Hoosier Assurance Plan Inventory - Adult instrument. Thank you, Dr. Jolae
Brocato, for your time and friendly support during the initial phases of the study. And
thank you, Harold Casstevens, for your on-line assistance with citations.
I am grateful to my friends in the Baha'i Faith, especially Theodore Aupperle,
Hank Markot and Dr. Heidi Melius, and in Art of Living, especially Spencer Snyder
and Melissa Weisfenning. Thanks go also to Dr. Larry Billion and Meredith St. Pierre
for their ongoing support. A very special thank you goes to Lillie Wichinsky for her
friendship and persistent support and encouragement throughout.
I greatly appreciate my family-of-origin's tolerance, understanding, patience,
and the very concrete parental support involved with getting me through the doctorate.
Also and most especially, thank you, Russell and Richard, for your support throughout
this seven-year process: We watched one another grow and change. I love you dearly
and you gave me a reason for being.
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ABSTRACT OF THE DISSERTATION
EVALUATION OF A MENTORED SELF-HELP INTERVENTION FOR THE
MANAGEMENT OF PSYCHOTIC SYMPTOMS
by
Willa Jeanne Casstevens
Florida International University, 2006
Miami, Florida
Professor David Cohen, Major Professor
Cognitive behavioral therapy has been shown to be promising for the treatment
of individuals experiencing psychotic symptoms, who are often diagnosed with
schizophrenia. Using a non-random non-equivalent comparison group design (n = 26),
this study explores whether an individually mentored self-help and self-paced
intervention based upon cognitive behavioral approaches to auditory hallucinations or
"hearing voices" makes a significant positive difference for individuals with major
mental disorder diagnoses and psychotic symptoms who are residing in the community
and receiving community mental health services. The mentored self-help intervention
uses a workbook (Coleman & Smith, 1997) that stemmed from the British psychiatric
survivor and "voice hearers"' movements and from cognitive behavioral approaches to
treating psychotic symptoms. Thirty individuals entered the study. Pre- and post-
intervention assessments of 15 participants in the intervention group and 11 participants
in the comparison group were carried out using standardized instruments, including the
Rosenberg Self-Esteem Scale, the Brief Psychiatric Rating Scale, and the Hoosier
Assurance Plan Inventory - Adult. Four specific research questions address whether
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levels of self-esteem, overall psychotic symptoms, depression-anxiety, and disruption in
life improved in the intervention group, relative to the comparison group. Pre- and post-
assessment scores were analyzed using repeated measures analysis of variance. Results
showed no significant difference on any measure, with the exception of the Brief
Psychiatric Rating subscale for Anxious Depression, which showed a statistically
significant pre-post difference with a strong effect size. A conservative interpretation of
this single positive result is that it is due to chance. An alternative interpretation is that
the mentored self-help intervention made an actual improvement in the level of
depression-anxiety experienced by participants. If so, this is particularly important
given high levels of depression and suicide among individuals diagnosed with
schizophrenia. This alternative interpretation supports further research on the
intervention utilized in this study.
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TABLE OF CONTENTS
CHAPTER PAGE
I. INTRODUCTION .............................................................................................. 1
Changing Approaches to Care and Labeling ..................................................... 4
Psychiatric Surviviors: From Inmate to Consumer................ 4
Self-Help and Mental Health ................................................................. 6
Pychosis, Psychotic Symptoms and Hallucinations ............................................ 9
P sy ch o sis................................................................................................. . 9
Psychotic Symptoms, Disorders and the DSM ........................................ 9
Hallucinations and Hearing "Voices".................................................... 11
The "Schizophrenia" Diagnosis and the Medical Model.................................. 13
The "Schizophrenia" Diagnosis............................................................. 13
Validity of the "Schizophrenia" Diagnosis........................................... 16
Explicit Criteria for "Schizophrenia" ................................................... 17
The Medical Model in Psychiatry......................................................... 18
Community Mental Health in America ............................................................. 19
M edications.......................................................................................... . 22
Antipsychotic Medications ........................................................ 22
Adjunctive Medications............................................................. 24
Psychological Interventions.................................................................. 25
Out-patient Treatment and Programs.................................................... 26
Case Management and Service Coordination........................................ 27
Residential Options............................................................................... 28
Summary ............................................................................................................... 29
II. LITERATURE REVIEW : CBT OF PSYCHOSIS........................................... 32
Cognitive Behavioral Therapy........................................................................... 32
C B T of P sychosis............................................................................................... 35
Fo cu sin g ................................................................................................. . 36
Normalizing and Decatastrophization .................................................... 36
Coping Strategy Enhancement............................................................. 37
Modifying "Delusions"......................................................................... 38
Empirical Support for CBT of Psychosis .......................................................... 39
CBT and Focusing/reattribution Strategies........................................... 39
CBT and a Normalizing Rationale......................................................... 40
C B T and C SE ......................................................................................... 4 1
CBT with Verbal Challenge and Reality Testing .................................. 41
Combination CBT.................................................................................. 42
Summarizing RCTs of CBT of Psychosis ............................................. 46
Coleman and Smith's Workbook...................................................................... 48
P artnership .......................................................................................... . . 48
Introductory Workbook Pages ............................................................... 49
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