Kim T Mueser

Boston University, Boston, Massachusetts, United States

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Publications (390)1203.9 Total impact

  • Kim T Mueser
    The Lancet Psychiatry 06/2015; 2(6). DOI:10.1016/S2215-0366(15)00100-5
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    ABSTRACT: People vary in the amount of control they want to exercise over decisions about their healthcare. Given the importance of patient-centered care, accurate measurement of these autonomy preferences is critical. This study aimed to assess the factor structure of the Autonomy Preference Index (API), used widely in general healthcare, in individuals with severe mental illness. Data came from two studies of people with severe mental illness (N=293) who were receiving mental health and/or primary care/integrated care services. Autonomy preferences were assessed with the API regarding both psychiatric and primary care services. Confirmatory factor analysis was used to evaluate fit of the hypothesized two-factor structure of the API (decision-making autonomy and information-seeking autonomy). Results indicated the hypothesized structure for the API did not adequately fit the data for either psychiatric or primary care services. Three problematic items were dropped, resulting in adequate fit for both types of treatment. These results suggest that with relatively minor modifications the API has an acceptable factor structure when asking people with severe mental illness about their preferences to be involved in decision-making. The modified API has clinical and research utility for this population in the burgeoning field of autonomy in patient-centered healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    06/2015; DOI:10.1016/j.psychres.2015.06.004
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    ABSTRACT: Cognitive impairment presents a serious and common obstacle to competitive employment for people with severe mental illness, including those who receive supported employment. This study evaluated a cognitive enhancement program to improve cognition and competitive employment in people with mental illness who had not responded to supported employment. In a randomized controlled trial, 107 people with severe mental illness (46% with schizophrenia or schizoaffective disorder) who had not obtained or kept competitive work despite receiving high-fidelity supported employment were assigned to receive either enhanced supported employment (with specialized cognitive training of employment specialists) or enhanced supported employment plus the Thinking Skills for Work program, a standardized cognitive enhancement program that includes practice of computer cognitive exercises, strategy coaching, and teaching of coping and compensatory strategies. Research assistants tracked competitive employment weekly for 2 years, and assessors blind to treatment assignment evaluated cognitive functioning at baseline, at the end of cognitive enhancement training, and 12 and 24 months after baseline. Participants in the Thinking Skills for Work group improved more than those in the enhanced supported employment only group on measures of cognitive functioning and had consistently better competitive employment outcomes during the follow-up period, including in jobs obtained (60% compared with 36%), weeks worked (23.9 compared with 9.2), and wages earned ($3,421 compared with $1,728). The findings suggest that cognitive enhancement interventions can reduce cognitive impairments that are obstacles to work, thereby increasing the number of people who can benefit from supported employment and competitive work.
    American Journal of Psychiatry 05/2015; DOI:10.1176/appi.ajp.2015.14030374 · 13.56 Impact Factor
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    ABSTRACT: Current efforts to reduce the increased risk of premature death from preventable cardiovascular disease among adults with serious mental illness (SMI) through lifestyle change have had limited success. Engaging informal support systems to promote healthy behaviors in everyday life may increase the effectiveness of health promotion interventions targeting this at-risk population. In-depth semistructured interviews were conducted with 10 fitness trainers serving adults with SMI in a health promotion program at community mental health centers to explore their perspectives on the potential of enlisting support from significant others for health behavior change. Trainers reported that the majority of participants had a relative or significant other who influenced their health behaviors, and they saw potential value in involving them in efforts to improve health outcomes by extending support into participants' daily lives. They did not feel qualified to work with families of individuals with mental illness, but they were willing to partner with providers who had experience in this area. Social workers who practice with families could play a critical role on health promotion teams addressing cardiovascular risk in adults with SMI by using their skills and experiences to engage families in supporting a relative through the process of health behavior change.
    Health & social work 04/2015; 40(2). DOI:10.1093/hsw/hlv006 · 0.94 Impact Factor
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    ABSTRACT: Although many studies have reported higher rates of trauma exposure and posttraumatic stress disorder (PTSD) among persons with severe mental illness, the screening, diagnosis, and treatment of PTSD in public mental health centers remain at a suboptimal level and PTSD is often overlooked and untreated. This study used routine PTSD screening and service use data in electronic medical records to determine the association of PTSD, psychiatric symptoms, and service use in a sample of individuals with serious mental illness in a community-based treatment setting. The sample included 1,834 active clients between January 2007 and November 2010 who were screened for PTSD and who completed the 24-item Behavior and Symptom Identification Scale (BASIS-24). Service data included services provided a year before and a year after the screening date. PTSD was associated with more severe psychiatric symptoms and increased no-show rates but not with increased service use or use of high-intensity services. PTSD likelihood interacted with race in accounting for elevated scores among African Americans on the psychosis domain of the BASIS-24. PTSD screening is feasible and recommended in service environments and may contribute significantly to better understanding of racial-ethnic and other differences in service use and diagnostic practices.
    Psychiatric services (Washington, D.C.) 04/2015; DOI:10.1176/appi.ps.201400192 · 1.99 Impact Factor
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    ABSTRACT: Background A cognitive-behavioural therapy (CBT) programme designed for post-traumatic stress disorder (PTSD) in people with severe mental illness, including breathing retraining, education and cognitive restructuring, was shown to be more effective than usual services. Aims To evaluate the incremental benefit of adding cognitive restructuring to the breathing retraining and education components of the CBT programme (trial registration: clinicaltrials.gov identifier: NCT00494650). Method In all, 201 people with severe mental illness and PTSD were randomised to 12- to 16-session CBT or a 3-session brief treatment programme (breathing retraining and education). The primary outcome was PTSD symptom severity. Secondary outcomes were PTSD diagnosis, other symptoms, functioning and quality of life. Results There was greater improvement in PTSD symptoms and functioning in the CBT group than in the brief treatment group, with both groups improving on other outcomes and effects maintained 1-year post-treatment. Conclusions Cognitive restructuring has a significant impact beyond breathing retraining and education in the CBT programme, reducing PTSD symptoms and improving functioning in people with severe mental illness. © The Royal College of Psychiatrists 2015.
    The British journal of psychiatry: the journal of mental science 04/2015; 206(6). DOI:10.1192/bjp.bp.114.147926 · 7.34 Impact Factor
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    ABSTRACT: Comprehensive coordinated specialty care programs for first-episode psychosis have been widely implemented in other countries but not in the United States. The National Institute of Mental Health's Recovery After an Initial Schizophrenia Episode (RAISE) initiative focused on the development and evaluation of first-episode treatment programs designed for the U.S. health care system. This article describes the background, rationale, and nature of the intervention developed by the RAISE Early Treatment Program project-known as the NAVIGATE program-with a particular focus on its psychosocial components. NAVIGATE is a team-based, multicomponent treatment program designed to be implemented in routine mental health treatment settings and aimed at guiding people with a first episode of psychosis (and their families) toward psychological and functional health. The core services provided in the NAVIGATE program include the family education program (FEP), individual resiliency training (IRT), supported employment and education (SEE), and individualized medication treatment. NAVIGATE embraces a shared decision-making approach with a focus on strengths and resiliency and on collaboration with clients and family members in treatment planning and reviews. The NAVIGATE program has the potential to fill an important gap in the U.S. health care system by providing a comprehensive intervention specially designed to meet the unique treatment needs of persons recovering from a first episode of psychosis. A cluster-randomized controlled trial comparing NAVIGATE with usual community care has recently been completed.
    Psychiatric services (Washington, D.C.) 03/2015; DOI:10.1176/appi.ps.201400413 · 1.99 Impact Factor
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    ABSTRACT: The premise of the National Institute of Mental Health Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) is to combine state-of-the-art pharmacologic and psychosocial treatments delivered by a well-trained, multidisciplinary team in order to significantly improve the functional outcome and quality of life for first-episode psychosis patients. The study is being conducted in non-academic (ie, real-world) treatment settings, using primarily extant reimbursement mechanisms. We developed a treatment model and training program based on extensive literature review and expert consultation. Our primary aim is to compare the experimental intervention to "usual care" on quality of life. Secondary aims include comparisons on remission, recovery, and cost-effectiveness. Patients 15-40 years old with a first episode of schizophrenia, schizoaffective disorder, schizophreniform disorder, psychotic disorder not otherwise specified, or brief psychotic disorder according to DSM-IV and no more than 6 months of treatment with antipsychotic medications were eligible. Patients are followed for a minimum of 2 years, with major assessments conducted by blinded, centralized raters using live, 2-way video. We selected 34 clinical sites in 21 states and utilized cluster randomization to assign 17 sites to the experimental treatment and 17 to usual care. Enrollment began in July 2010 and ended in July 2012 with 404 subjects. The results of the trial will be published separately. The goal of the article is to present both the overall development of the intervention and the design of the clinical trial to evaluate its effectiveness. We believe that we have succeeded in both designing a multimodal treatment intervention that can be delivered in real-world clinical settings and implementing a controlled clinical trial that can provide the necessary outcome data to determine its impact on the trajectory of early phase schizophrenia. ClinicalTrials.gov identifier: NCT01321177. © Copyright 2015 Physicians Postgraduate Press, Inc.
    The Journal of Clinical Psychiatry 03/2015; 76(3):240-6. DOI:10.4088/JCP.14m09289 · 5.14 Impact Factor
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    ABSTRACT: Treatment guidelines suggest distinctive medication strategies for first-episode and multiepisode patients with schizophrenia. To assess the extent to which community clinicians adjust their usual treatment regimens for first-episode patients, the authors examined prescription patterns and factors associated with prescription choice in a national cohort of early-phase patients. Prescription data at study entry were obtained from 404 participants in the Recovery After an Initial Schizophrenia Episode Project's Early Treatment Program (RAISE-ETP), a nationwide multisite effectiveness study for patients with first-episode schizophrenia spectrum disorders. Treatment with antipsychotics did not exceed 6 months at study entry. The authors identified 159 patients (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these, 8.8% received prescriptions for recommended antipsychotics at higher than recommended dosages; 32.1% received prescriptions for olanzapine (often at high dosages), 23.3% for more than one antipsychotic, 36.5% for an antipsychotic and also an antidepressant without a clear indication, 10.1% for psychotropic medications without an antipsychotic, and 1.2% for stimulants. Multivariate analysis showed evidence for sex, age, and insurance status effects on prescription practices. Racial and ethnic effects consistent with effects reported in previous studies of multiepisode patients were found in univariate analyses. Despite some regional variations in prescription practices, no region consistently had different practices from the others. Diagnosis had limited and inconsistent effects. Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve prescription practices for first-episode schizophrenia patients.
    American Journal of Psychiatry 03/2015; 172(3):237-48. DOI:10.1176/appi.ajp.2014.13101355 · 13.56 Impact Factor
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    ABSTRACT: Objective The onset of psychosis typically occurs during adolescence or early adulthood and can have a detrimental impact on social and cognitive development. Cognitive behavioural therapy (CBT) shows promise in reducing the risk of psychosis. Teaching families to apply CBT with their offspring may bolster therapeutic gains made in time-limited treatment. We developed a comprehensive group-and-family-based CBT (GF-CBT) program that aims to facilitate psychosocial recovery, decrease symptoms and prevent transition to psychosis in youth at risk. GF-CBT is grounded in ecological systems and cognitive theories, resilience models and research on information processing in delusions. The theoretical rationale and description of GF-CBT are presented together with a pilot study that evaluated the program's feasibility and explored participants' outcomes.Methods Youth ages 16–21 at risk for psychosis and their families participated in an open trial with pre, post and 3-month follow-up assessments conducted by an independent evaluator. The Comprehensive Assessment of At-Risk Mental States was the primary clinical outcome measure.ResultsAll enrolled participants (n = 6) completed GF-CBT and all remitted from at-risk mental state (ARMS). As a group participants showed statistically significant decreases in attenuated psychotic symptoms, negative symptoms, depression, cognitive biases and improvements in functioning. Family members showed significant improvements in use of CBT skills, enhanced communication with their offspring, and greater confidence in their ability to help. Gains were maintained at follow-up.ConclusionsGF-CBT may delay or prevent transition to psychosis in youth at risk, and potentially facilitate recovery from ARMS. More rigorous, controlled research is needed to further evaluate this program.
    Early Intervention in Psychiatry 02/2015; DOI:10.1111/eip.12204 · 1.74 Impact Factor
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    ABSTRACT: Social factors predict use of cessation treatment among those with mental illness•Explicit and implicit social factors play a unique role in influencing treatment•Future research should explore social networks and smoking in this population
    Addictive Behaviors 02/2015; 41. DOI:10.1016/j.addbeh.2014.10.020 · 2.44 Impact Factor
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    ABSTRACT: A growing body of research shows that cognitive remediation (COG REM), consisting of drill-and-practice and/or strategy training in neurocognitive functions, produces moderate improvements in neurocognition. These improvements generalize to functioning when COG REM is provided with other rehabilitation interventions (Wykes et al., 2011). The number of studies using COG REM as an adjunct to other behavioral-based rehabilitation interventions however remains small and consists of widely varying interventions with few active control conditions. This study compared the effects of an extended (6-month), standardized, computer-assisted cognitive remediation intervention, administered along with a standardized program of social skills-training (SST), with those of an active control condition that included participation in the same SST program and a computer skills training program (Computer Skills). Sixty-four individuals with schizophrenia recruited from two treatment sites were randomly assigned to one of two conditions and were assessed by blinded raters on neurocognitive measures, performance-based measures of social skill, and ratings of psychosocial function before and after treatment. Results revealed that the COG REM group improved significantly more in attention, working memory, and empathy than the Computer Skills group, but there were no differences between groups on other measures of psychosocial functioning or skills. Taken together, these findings suggest that COG REM used in the context of other evidence-based psychosocial interventions (SST) improves working memory in schizophrenia and suggests that this effect may generalize to improved empathy. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 01/2015; 162(1-3). DOI:10.1016/j.schres.2015.01.020 · 4.43 Impact Factor
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    ABSTRACT: Objective: This study is the first to examine duration of untreated psychosis (DUP) among persons receiving care in community mental health centers in the United States. Methods: Participants were 404 individuals (ages 15-40) who presented for treatment for first-episode psychosis at 34 nonacademic clinics in 21 states. DUP and individual- and site-level variables were measured. Results: Median DUP was 74 weeks (mean=193.5±262.2 weeks; 68% of participants had DUP of greater than six months). Correlates of longer DUP included earlier age at first psychotic symptoms, substance use disorder, positive and general symptom severity, poorer functioning, and referral from outpatient treatment settings. Conclusions: This study reported longer DUP than studies conducted in academic settings but found similar correlates of DUP. Reducing DUP in the United States will require examination of factors in treatment delay in local service settings and targeted strategies for closing gaps in pathways to specialty FEP care.
    Psychiatric services (Washington, D.C.) 01/2015; DOI:10.1176/appi.ps.201400124 · 1.99 Impact Factor
  • 01/2015; DOI:10.1007/s13142-015-0313-4
  • Kim T Mueser, Judith A Cook
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    ABSTRACT: This editorial reviews the challenges of treating people who first experience a psychotic episode, and the core elements of effective programs for these individuals. It then describe the NIMH Recovery After Initial Schizophrenia Episode (RAISE) initiative, and other related developments in the U.S., and their implications for psychiatric rehabilitation practitioners. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
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    ABSTRACT: The fact that individuals with schizophrenia have high cardiovascular morbidity and mortality is well established. However, risk status and moderators or mediators in the earliest stages of illness are less clear.
    JAMA Psychiatry 10/2014; 71(12). DOI:10.1001/jamapsychiatry.2014.1314 · 12.01 Impact Factor
  • Kim T. Mueser, Shirley M. Glynn
    10/2014; 13(3). DOI:10.1002/wps.20160
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    ABSTRACT: Objective: The individual placement and support model of supported employment has been shown to be more effective than other vocational approaches in improving competitive work over 1-2 years in persons with severe mental illness. The authors evaluated the longer-term effects of the model compared with traditional vocational rehabilitation over 5 years., Method: A randomized controlled trial compared supported employment to traditional vocational rehabilitation in 100 unemployed persons with severe mental illness. Competitive work and hospital admissions were tracked for 5 years, and interviews were conducted at 2 and 5 years to assess recovery attitudes and quality of life. A cost-benefit analysis compared program and total treatment costs to earnings from competitive employment. Results: The beneficial effects of supported employment on work at 2 years were sustained over the 5-year follow-up period. Participants in supported employment were more likely to obtain competitive work than those in traditional vocational rehabilitation (65% compared with 33%), worked more hours and weeks, earned more wages, and had longer job tenures. Reliance on supported employment services for retaining competitive work decreased from 2 years to 5 years for participants in supported employment. Participants were also significantly less likely to be hospitalized, had fewer psychiatric hospital admissions, and spent fewer days in the hospital. The social return on investment was higher for supported employment participants, whether calculated as the ratio of work earnings to vocational program costs or of work earnings to total vocational program and mental health treatment costs. Conclusions: The results demonstrate that the greater effectiveness of supported employment in improving competitive work outcomes is sustained beyond 2 years and suggest that supported employment programs contribute to reduced hospitalizations and produce a higher social return on investment.
    American Journal of Psychiatry 08/2014; 171(11). DOI:10.1176/appi.ajp.2014.13070857 · 13.56 Impact Factor
  • K T Mueser, S R McGurk
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    ABSTRACT: The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.
    L Encéphale 06/2014; DOI:10.1016/j.encep.2014.04.008 · 0.60 Impact Factor
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    ABSTRACT: Objective: Despite the large number of Latinos living in the United States, little research has evaluated the effectiveness of different vocational rehabilitation programs for individuals with severe mental illness in this rapidly growing minority population. This article presents a secondary analysis of a randomized, controlled trial comparing supported employment with 2 other vocational rehabilitation programs in 3 ethnic/racial groups of participants with severe mental illness: Latinos, non-Latino African Americans, and non-Latino Whites. Method: The data were drawn from a previously published randomized, controlled trial comparing supported employment with standard vocational rehabilitation services and a psychosocial clubhouse program in persons with severe mental illness (Mueser et al., 2004), including 64 Latinos, 91 non-Latino African Americans, and 43 non-Latino Whites. Comparisons were made between the 3 groups at baseline on demographic characteristics, clinical and psychosocial functioning, and quality of life. Within each ethnic/racial group, competitive employment and all paid employment outcomes were compared between the 3 vocational rehabilitation programs over the 2-year study period. Results: At baseline, the Latino participants had lower levels of education and disability income, were less likely to have worked competitively over the previous 5 years, had more severe symptoms, and worse psychosocial functioning than the non-Latino African American or non-Latino White participants. Latinos randomized to supported employment had better competitive and all-paid work outcomes than those assigned to either standard services or the psychosocial clubhouse program, similar to the non-Latino consumers. Rates of competitive work for consumers in supported employment were comparable across all 3 racial/ethnic groups. Discussion: Supported employment is effective at improving competitive work in Latinos with severe mental illness. Efforts should be made to increase access to supported employment in the growing population of Latinos with severe mental illness. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychiatric Rehabilitation Journal 06/2014; 37(2):113-122. DOI:10.1037/prj0000062 · 0.75 Impact Factor

Publication Stats

17k Citations
1,203.90 Total Impact Points

Institutions

  • 2012–2015
    • Boston University
      • • Center for Psychiatric Rehabilitation
      • • Department of Occupational Therapy
      Boston, Massachusetts, United States
  • 2013
    • Simon Fraser University
      • Faculty of Health Sciences
      Burnaby, British Columbia, Canada
    • National Cheng Kung University Hospital
      臺南市, Taiwan, Taiwan
  • 1997–2013
    • Dartmouth College
      • Department of Psychiatry
      Hanover, New Hampshire, United States
    • University of Maryland, College Park
      • Department of Psychology
      College Park, MD, United States
  • 1995–2013
    • Geisel School of Medicine at Dartmouth
      • • Department of Psychiatry
      • • Psychiatric Research Center
      Hanover, New Hampshire, United States
  • 2009
    • University of Connecticut
      • School of Social Work
      Storrs, CT, United States
    • Harvard Medical School
      • Department of Psychiatry
      Boston, MA, United States
  • 2008
    • University of Birmingham
      Birmingham, England, United Kingdom
    • Argosy University
      Phoenix, Arizona, United States
  • 2007
    • University of Wollongong
      City of Greater Wollongong, New South Wales, Australia
  • 2005–2007
    • University of California, Los Angeles
      • Department of Psychiatry and Biobehavioural Sciences
      Los Angeles, CA, United States
  • 2006
    • Medical University of South Carolina
      • Department of Psychiatry and Behavioral Sciences
      Charleston, South Carolina, United States
  • 2004
    • Mount Sinai School of Medicine
      • Department of Psychiatry
      Manhattan, NY, United States
  • 2003
    • University of North Carolina at Chapel Hill
      • Department of Psychology
      Chapel Hill, NC, United States
  • 2002
    • Laval University
      Québec, Quebec, Canada
  • 1999
    • Indiana University-Purdue University Indianapolis
      • Department of Psychology
      Indianapolis, Indiana, United States
  • 1998
    • University of New Mexico
      • Department of Psychology
      Albuquerque, NM, United States
  • 1997–1998
    • Duke University
      Durham, North Carolina, United States
  • 1996–1998
    • University of Maryland, Baltimore
      • Department of Psychiatry
      Baltimore, Maryland, United States
    • Illinois Institute of Technology
      Chicago, Illinois, United States
  • 1991–1996
    • Philadelphia ZOO
      Filadelfia, Pennsylvania, United States
    • Northwestern University
      Evanston, Illinois, United States
  • 1993
    • University of Pittsburgh
      • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
  • 1986–1993
    • Pennsylvania Psychiatric Institute
      Arkansas, United States
  • 1990
    • University of California, San Diego
      • Department of Psychology
      San Diego, California, United States
  • 1987
    • University of Wisconsin - Parkside
      Somers, Wisconsin, United States
  • 1981
    • University of Illinois at Chicago
      • Department of Psychology
      Chicago, IL, United States