Social function in schizophrenia and schizoaffective disorder: Associations with personality, symptoms and neurocognition

BACKGROUND: Research has indicated that stable individual differences in personality exist among persons with schizophrenia spectrum disorders predating illness onset that are linked to symptoms and self appraised quality of life. Less is known about how closely individual differences in personality are uniquely related to levels of social relationships, a domain of dysfunction in schizophrenia more often linked in the literature with symptoms and neurocognitive deficits. This study tested the hypothesis that trait levels of personality as defined using the five-factor model of personality would be linked to social function in schizophrenia. METHODS: A self-report measure of the five factor model of personality was gathered along with ratings of social function, symptoms and assessments of neurocognition for 65 participants with schizophrenia or schizoaffective disorder. RESULTS: Univariate correlations and stepwise multiple regression indicated that frequency of social interaction was predicted by higher levels of the trait of Agreeableness, fewer negative symptoms, better verbal memory and at the trend level, lesser Neuroticism (R(2 )= .42, p < .0001). In contrast, capacity for intimacy was predicted by fewer negative symptoms, higher levels of Agreeableness, Openness, and Conscientiousness and at the trend level, fewer positive symptoms (R(2 )= .67, p < .0001). CONCLUSIONS: Taken together, the findings of this study suggest that person-centered variables such as personality, may account for some of the broad differences seen in outcome in schizophrenia spectrum disorders, including social outcomes. One interpretation of the results of this study is that differences in personality combine with symptoms and neurocognitive deficits to affect how persons with schizophrenia are able to form and sustain social connections with others

Clinical and Psychological Correlates of Two Domains of Hopelessness in Schizophrenia

Hopelessness is a widely observed barrier to recovery from schizophrenia spectrum disorders. Yet little is known about how clinical, social, and psychological factors independently affect hope. Additionally, the relationships that exist between these factors and different kinds of hope are unclear. To explore both issues, we correlated two aspects of hope, expectations of the future and agency, with stigma, clinical symptoms, anxiety, and coping preferences in 143 persons with a schizophrenia spectrum disorder. Multiple regressions revealed that hope for the future was predicted by lesser alienation, lesser preference for ignoring stressors, and lesser emotional discomfort and negative symptoms, accounting for 43% of the variance. A greater sense of agency was linked to lesser endorsement of mental illness stereotypes, fewer negative symptoms, lesser social phobia, and lesser preference for ignoring stressors, accounting for 44% of the variance. Implications for research and interventions are discussed

Preliminary Report on a Spiritually-Based PTSD Intervention for Military Veterans

Military veterans can experience spiritual/religious struggles such as weakening of beliefs, loss of meaning, increased guilt, difficulty forgiving, and moral challenges as a result of military trauma. While mainstream treatments (e.g., exposure therapy) have been shown to be effective for many, they often fail to address these issues adequately. This paper describes an 8-session spiritually-based group intervention designed to treat trauma-related spiritual wounds among military veterans. A program evaluation conducted with 24 veterans revealed significant reductions in PTSD symptoms, spiritual injury, and negative religious coping from pretest to posttest. The findings support the need for additional PTSD treatment approaches

Self-stigma in PTSD: Prevalence and correlates

Self-stigma is the internalization of negative societal stereotypes about those with mental illnesses. While self-stigma has been carefully characterized in severe mental disorders, like schizophrenia, the field has yet to examine the prevalence and correlates of self-stigma in post-traumatic stress disorder (PTSD). Thus, we assessed self-stigma in veterans diagnosed with PTSD and compared with veterans with schizophrenia. We further examined associations between PTSD, depressive symptoms and self-stigma in the PTSD sample. Data came from two larger studies of people with PTSD (n = 46) and schizophrenia-spectrum disorders (n = 82). All participants completed the Internalized Stigma of Mental Illness Scale (ISMIS). Results revealed that people with schizophrenia report more experiences of discrimination as a result of stigma than do those with PTSD, but these diagnostic groups did not differ for other subscales. In the PTSD group, feelings of alienation positively correlated with PTSD and depressive symptoms; other subscales positively correlated with depressive symptoms only. Taken together, results suggest a significant level of self-stigma exists among veterans with PTSD, and that self-stigma has an effect on PTSD and commonly comorbid symptoms, like depression. Future work should investigate whether current self-stigma interventions for other groups could be applicable for those with PTSD

Evaluation of Stepped Care for Chronic Pain (ESCAPE) in Veterans of the Iraq and Afghanistan Conflicts A Randomized Clinical Trial

IMPORTANCE: Despite the prevalence and the functional, psychological, and economic impact of chronic pain, few intervention studies of treatment of chronic pain in veterans have been performed. OBJECTIVE: To determine whether a stepped-care intervention is more effective than usual care, as hypothesized, in reducing pain-related disability, pain interference, and pain severity. DESIGN, SETTING, AND PARTICIPANTS: We performed a randomized clinical trial comparing stepped care with usual care for chronic pain. We enrolled 241 veterans from Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn with chronic (>3 months) and disabling (Roland Morris Disability Scale score, ≥7) musculoskeletal pain of the cervical or lumbar spine or extremities (shoulders, knees, and hips) in the Evaluation of Stepped Care for Chronic Pain (ESCAPE) trial from December 20, 2007, through June 30, 2011. The 9-month follow-up was completed by April 2012. Patients received treatment at a postdeployment clinic and 5 general medicine clinics at a Veterans Affairs medical center. INTERVENTIONS: Step 1 included 12 weeks of analgesic treatment and optimization according to an algorithm coupled with pain self-management strategies; step 2, 12 weeks of cognitive behavioral therapy. All intervention aspects were delivered by nurse care managers. MAIN OUTCOMES AND MEASURES: Pain-related disability (Roland Morris Disability Scale), pain interference (Brief Pain Inventory), and pain severity (Graded Chronic Pain Scale). RESULTS: The primary analysis included 121 patients receiving the stepped-care intervention and 120 patients receiving usual care. At 9 months, the mean decrease from baseline in the Roland Morris Disability Scale score was 1.7 (95% CI, -2.6 to -0.9) points in the usual care group and 3.7 (95% CI, -4.5 to -2.8) points in the intervention group (between-group difference, -1.9 [95% CI, -3.2 to -0.7] points; P=.002). The mean decrease from baseline in the Pain Interference subscale score of the Brief Pain Inventory was 0.9 points in the usual care group and 1.7 points in the intervention group (between-group difference, -0.8 [95% CI, -1.3 to -0.3] points; P=.003). The Graded Chronic Pain Scale severity score was reduced by 4.5 points in the usual care group and 11.1 points in the intervention group (between-group difference, -6.6 [95% CI, -10.5 to -2.7] points; P=.001). CONCLUSIONS AND RELEVANCE: A stepped-care intervention that combined analgesics, self-management strategies, and brief cognitive behavioral therapy resulted in statistically significant reductions in pain-related disability, pain interference, and pain severity in veterans with chronic musculoskeletal pain

Testing Adaptations of Cognitive-Behavioral Conjoint Therapy for PTSD: A Randomized Controlled Pilot Study with Veterans

Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) have well-documented relationship problems and many wish to include their intimate partners in treatment. This pilot study randomly assigned 46 couples (Veterans with clinician-administered PTSD scale confirmed PTSD diagnosis and their intimate partners) to one of two groups. The treatment group received a modified mindfulness-based version of cognitive-behavioral conjoint therapy for PTSD (CBCT; Monson & Fredman, 2012) that included all three phases of the mindfulness-based cognitive behavioral conjoint therapy (MB-CBCT). The control group received a modified version of CBCT that included communication skills training from Phases 1 and 2 of CBCT (CBCT-CS) without PTSD-specific content. Modified CBCT Phases 1 and 2 content was delivered to both groups during weekend retreats in multicouple group sessions. The postretreat protocol for MB-CBCT included nine individual couple sessions: a transition session following the retreat, and CBCT Phase 3. For CBCT-CS, two additional monthly multicouple group sessions reviewed communication skills. No statistically significant pre- to posttreatment differences were detected for primary outcomes between groups: Clinician-Administered PTSD Scale for Veterans (mean change difference, −1.4, 95% CI [−16.0 to 13.2]); Dyadic Adjustment Scale for Veterans (mean change difference, −1.0, 95% CI [−13.2 to 11.2]); and Dyadic Adjustment Scale for Partners (mean change difference, −0.4, 95% CI [−8.9 to 8.1]). However, within group pre- to posttreatment effect sizes were medium to large for both MB-CBCT and CBCT-CS on all three primary outcomes. Findings suggest that Veterans returning from recent conflicts and their partners may benefit from both modifications of CBCT

Symptoms Improve After a Yoga Program Designed for PTSD in a Randomized Controlled Trial With Veterans and Civilians

Objective: Although yoga shows promise as a treatment for posttraumatic stress disorder (PTSD), there are few randomized controlled trials that demonstrate significant benefits for individuals with PTSD. The present study addresses this need by comparing the effects of a holistic yoga program (HYP) to that of a wellness lifestyle program (WLP) on PTSD symptom severity with a randomized clinical trial. Method: The sample consisted of 209 participants (91.4% veterans; 66% male; 61.7% White) who met diagnostic criteria for PTSD at baseline. Participants were randomly assigned to attend one of the 2 weekly interventions for 16 weeks. The HYP consisted of yoga instruction, while the WLP consisted of didactics, discussions, and walking. PTSD severity was measured using the Clinician Administered PTSD Scale (CAPS-5) and the PTSD Checklist (PCL-5). Results: Analyses revealed that the HYP reduced PTSD severity measured by the CAPS-5 significantly more than the WLP at treatment end (mean difference = −5.4, effect size = 0.46, p < .001), but not at 7-month follow up (mean difference = −0.9, p = .603). Similarly, the HYP reduced PTSD severity measured by the PCL-5 significantly more than the WLP at treatment end (difference = −6.0, p = .001), but not at 7-month follow up (mean difference = −1.0, p = .682). Conclusion: Yoga may be an effective intervention for PTSD in addition to standard treatments. Future yoga trials should consider adding a social component to interventions or booster classes to maintain effects long term