Hope, Awareness of Illness, and Coping in Schizophrenia Spectrum Disorders

Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 05/2005; 193(5):287-92. DOI: 10.1097/01.nmd.0000161689.96931.0f
Source: PubMed


Controversy exists regarding whether awareness of schizophrenia is linked with healthier or poorer psychosocial function. This study examined whether hope might interact with insight to affect function at the level of active versus avoidant coping preferences among 96 persons with schizophrenia spectrum disorders. Factorial multivariate analysis of variance comparing groups classified on the basis of hope and insight scores revealed a significant interaction between hope and insight (Wilks lambda = 2.7; p< 0.05). Post hoc analyses indicated that persons with high insight and high hope demonstrated the most adaptive coping preferences, whereas those with high insight and lower hope demonstrated the least.

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Available from: Paul H Lysaker, Jun 08, 2015
    • "Alternatively, individual vulnerability to development of post-traumatic intrusions may influence the onset and maintenance of psychotic symptoms (Smith & Steel, 2009). Given the central role of metacognition, selective attention, working memory, and inhibitory control in cognitive–emotional processing (Chambers, Gullone, & Allen, 2009; Garety & Freeman, 2013; Kerns, Nuechterlein, Braver, & Barch, 2008; Lysaker, Campbell, & Johannesen, 2005; Schaefer, Giangrande, Weinberger, & Dickinson, 2013), individuals with schizophrenia may rely on more maladaptive cognitive emotion regulation strategies (O'Driscoll, Laing, & Mason, 2014) and are likely to interact in maintaining pathological processes. For example, diminished emotional expression is considered to be a core negative symptom in schizophrenia, and efforts to suppress internal stimuli and avoidance of external stimuli associated with traumatic events are the criteria for diagnosis of PTSD (American Psychiatric Association, 2013). "
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    ABSTRACT: Objective Therapeutic alliance, modality, and ability to engage with the process of therapy have been the main focus of research into what makes psychotherapy successful. Individuals with complex trauma histories or schizophrenia are suggested to be more difficult to engage and may be less likely to benefit from therapy. This study aimed to track the in-session ‘process’ of working alliance and emotional processing of trauma memories for individuals with schizophrenia.DesignThe study utilized session recordings from the treatment arm of an open randomized clinical trial investigating trauma-focused cognitive behavioural therapy (TF-CBT) for individuals with schizophrenia (N = 26).Method Observer measures of working alliance, emotional processing, and affect arousal were rated at early and late phases of therapy. Correlation analysis was undertaken for process measures. Temporal analysis of expressed emotions was also reported.ResultsWorking alliance was established and maintained throughout the therapy; however, agreement on goals reduced at the late phase. The participants appeared to be able to engage in emotional processing, but not to the required level for successful cognitive restructuring.Conclusion This study undertook novel exploration of process variables not usually explored in CBT. It is also the first study of process for TF-CBT with individuals with schizophrenia. This complex clinical sample showed no difficulty in engagement; however, they may not be able to fully undertake the cognitive–emotional demands of this type of therapy. Clinical and research implications and potential limitations of these methods are considered.Practitioner pointsThis sample showed no difficulties engaging with TF-CBT and forming a working alliance.However, the participants may not have achieved a level of active involvement required for successful cognitive restructuring of trauma memories.This discrepancy may relate to the mediating role of both working alliance and cognitive–emotional processing.The results underscore the importance of therapists understanding the relationship between alliance and other process factors which may be implicit in facilitating change.
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    • "Some have argued that stronger hope and self-esteem might lead to less avoidance, more problem-oriented strategies and more social interaction [2]. Previous research has shown that persons with more hope and insight in their illness use more problem-oriented and less avoidant coping strategies [22] and that poor confidence is connected to using avoidant strategies [23]. These findings are in line with the present study, which also illustrates Bandura’s idea of self-efficacy [24]. "
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    ABSTRACT: Several hospitals in Norway provide short self-referral inpatient treatment to patients with severe mental diagnosis. No studies have compared the experiences of patients who have had the opportunity to self-refer to inpatient treatment with patients who have received treatment as usual. This qualitative study was nested within a randomised controlled trial investigating the effect of self-referral to inpatient treatment. The aim was to explore how patients with severe mental diagnosis coped four months after signing a contract for self-referral, as compared to patients receiving treatment as usual. Data was collected using qualitative individual interviews with patients with severe mental diagnosis, conducted four months after being randomised either to a contract for self-referral (intervention group) or to treatment as usual (control group). Twenty-five patients participated in interviews - 11 from the intervention group and 14 from the control group. Results four months after randomisation showed that patients with a contract for self-referral appeared to have more confidence in strategies to cope with mental illness and to apply more active cognitive strategies. Patients with a contract also expressed less resignation, hopelessness and powerlessness than patients without a contract. In addition, patients with a contract seemed to be closer to the ideal of living a "normal" life and being a "normal" person. The results indicate that the patients who had a contract for self-referral had come further in the recovery process and should possibly be better off during treatment.
    Full-text · Article · Aug 2014 · BMC Health Services Research
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    • "The exact nature of this relationship remains unclear [8,10]. The relationship between depression and insight is thought to be mediated by internalized stigma: insight is only associated with depression in patients who hold stigmatizing beliefs about mental illness [12,13]. "
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    ABSTRACT: Insight is impaired in a majority of people with schizophrenia. Impaired insight is associated with poorer outcomes of the disorder. Based on existing literature, we developed a model that explains which processes may possibly play a role in impaired insight. This model was the starting point of the development of REFLEX: a brief psychosocial intervention to improve insight in schizophrenia. REFLEX is a 12-sessions group training, consisting of three modules of four sessions each. Modules in this intervention are: "coping with stigma", "you and your personal narrative", and "you in the present". REFLEX is currently evaluated in a multicenter randomized controlled trial. Eight mental health institutions in the Netherlands participate in this evaluation. Patients are randomly assigned to either REFLEX or an active control condition, existing of cognitive remediation exercises in a group. In a subgroup of patients, fMRI scans are made before and after training in order to assess potential haemodynamic changes associated with the effects of the training. REFLEX is one of the few interventions aiming specifically to improving insight in schizophrenia and has potential value for improving insight. Targeting insight in schizophrenia is a complex task, that comes with several methodological issues. These issues are addressed in the discussion of this paper. Current Controlled Trials: ISRCTN50247539.
    Full-text · Article · Oct 2011 · BMC Psychiatry
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