Illness representations among parents of children and adults with serious mental disorders:A systematic review and theoretical model

Objective: Cognitive representations of an illness have an important impact on psychological outcomes. The current systematic review explored 1) the characteristics of illness representations held by parents of children and adults with serious mental illness (SMI), and 2) the associations of these representations with both parents' and patients' psychological outcomes. Method: PSYINFO and PUBMED were screened for eligible studies published between January 2000 and August 2018. Selection was based on PRISMA guidelines. Reference lists of these papers were checked for additional references. Two independent coders extracted all relevant data. Results: The search resulted in 31 relevant studies, which were divided, by type of methodology, into three sections: quantitative, qualitative, and mixed quantitative-qualitative. In each section, findings were divided in accordance with the two research questions. Conclusion: Parents struggle to make meaning of their child's illness, often holding stigmatizing ideas about the illness and blaming themselves for its existence. More longitudinal studies that include both of the child's parents, as well as interventional studies, are needed to expand our knowledge of ways to help parents construct more beneficial representations of their children's illnesses. (c) 2019 Elsevier Masson SAS. All rights reserved

Longitudinal assessments of therapeutic alliance predict work performance in vocational rehabilitation for persons with schizophrenia

OBJECTIVES: To promote functional recovery in persons diagnosed with a psychotic disorder, vocational interventions have emerged over the last few decades which range from sheltered employment to supported employment in the community.DESIGN: Using data from a 6-month vocational rehabilitation programme, we examined whether assessments of the therapeutic alliance were related to the quality of work performed in this work placement. Our first hypothesis was that stronger alliances would be related to better work performance. Second, we expected that client assessments of the TA would better predict outcomes than therapist assessments. Third, we expected that the discrepancy between assessment scores from the client and therapist (client rating minus therapist rating) would be a better predictor for outcome than individual assessments by the therapists or clients.RESULTS: Clients systematically rated the alliance higher than therapists. Modelling the data longitudinally, we found both therapist and client ratings predictive of outcome, though client assessments over time were inversely related to work performance.CONCLUSIONS: Discrepancy in scores was also shown to be predictive of work performance during the program. Clinicians are advised to routinely assess the therapeutic alliance from both client and therapist perspectives and calculate the discrepancy between them as they may indicate ruptures are occurring and thus hamper the intervention.PRACTITIONER POINTS: Clinicians are advised to regularly assess the therapeutic alliance from both their own and the client's perspective. Growing discrepancy in scores may impede intervention effectiveness. Therapeutic alliance may help buffer against work stresses experienced by participants in a vocational programme. Be aware that therapists tend to rate the alliance lower than their clients.</p

Subjective Experience and Perceived Benefits in Clients with Schizophrenia Following Participation in Metacognition Reflection and Insight Therapy (MERIT)

Schizophrenia spectrum disorders involve disturbances in the experience of the self, which are related to limited metacognitive ability. The aim of metacognition-based therapies is to improve metacognitive ability and, subsequently, self-management and recovery. Adding to the quantitative findings from a trial on the effectiveness of Metacognition Reflection and Insight Therapy (MERIT), in the current study, we report on a qualitative assessment of MERIT’s subjective perceived contribution. Twenty-seven patients with schizophrenia were interviewed after completing MERIT. Content analysis based on grounded theory was conducted by two independent raters. Most participants were satisfied with the therapy and reported improvement mainly in self-experience domains. The main contributors to perceived improvement pertained to the intervention process (e.g., therapeutic alliance and therapist interventions) as well as to the patient being an active agent of change. Perceived outcomes are particularly important among this cohort, as they often cope with limited metacognitive abilities, expressed by challenges in reflecting on themselves and others. The current study supports MERIT as a treatment that enhances positive outcomes for people with schizophrenia

Emotional experience and metacognition among people with schizophrenia: Analysis of session by session and outcome of metacognitive-oriented psychotherapy

Background: Research suggests that in-session emotional experiences in psychotherapy promote both session and treatment outcomes across different clinical samples and treatment approaches. However, little is known about how this notion applies to clients with schizophrenia, who experience particular deficits related to emotional experience. To explore this question, we investigated the association between clients' emotional experience and their session outcome evaluations and metacognitive growth in a metacognitively-oriented treatment, Metacognitive Reflection and Insight Therapy (MERIT). MERIT is a recovery-oriented treatment approach for psychosis that focuses on recapturing a coherent sense of self and personal agency by enhancing metacognitive capacity. Method: Five-hundred-and-sixty-three sessions of 37 clients with schizophrenia who took part in an ongoing MERIT trial were analyzed. The Emotional Experience Self-Report (EE-SR) and Outcome Rating Scale (ORS) were collected on a session-by-session basis. Levels of metacognition ware assessed pre- and post-treatment using the Metacognitive Assessment Scale-Abbreviated (MAS-A) coding system. We used multilevel modeling to test our session-level predictions, and linear regression analysis for treatment-level predictions. Results: Greater emotional experience, expression, and regulation within a session were associated with better session outcome. Regarding treatment level, greater emotional experience was associated with improvement in metacognitive mastery. Conclusions: Our findings reveal that experiencing emotions in MERIT has significant implications for clients' subjective well-being during therapy sessions and for their ability to respond to psychological challenges using metacognitive knowledge. These findings lend weight to the idea that emotional experience is a key mechanism of change in metacognitive therapy for schizophrenia

Examining the associations between difficulties in emotion regulation and symptomatic outcome measures among individuals with different mental disorders

BackgroundDifficulties in emotion regulation (ER) abilities have been found to play a central role in different psychiatric disorders. However, researchers rarely compare ER across different diagnostic groups. In the current study, we examined ER and its relation to functional and symptomatic outcome among three distinct diagnostic groups: people with schizophrenia (SCZ), people with emotional disorders (EDs; i.e., depression and/or anxiety), and individuals without any psychiatric diagnosis (controls).MethodsParticipants in this study comprised 108 adults who requested psychotherapy at a community clinic in the year 2015 and between 2017 and 2019. Clients were interviewed and filled out questionnaires measuring depression, distress, and difficulties in ER abilities.ResultsResults showed that individuals with psychiatric diagnoses reported higher levels of difficulties in ER abilities than did controls. Moreover, there were very few differences in levels of ER difficulty between SCZ and EDs. Further, the associations between maladaptive ER and psychological outcomes were significant in each diagnostic group, and especially for SCZ.ConclusionOur study indicates that difficulties in ER abilities partially have a transdiagnostic nature, and that these difficulties are associated with psychological outcomes among both clinical populations and controls. There were very few differences in levels of ER ability difficulties between SCZ and EDs, suggesting that the two groups share difficulties in relating and responding to emotional distress. The associations between difficulties in ER abilities and outcome were more robust and stronger among SCZ than the other groups, highlighting the potential contribution of targeting ER abilities in the treatment of schizophrenia