Religion/Spirituality as a Predictor of Attrition from a Culturally Informed Family Treatment for Schizophrenia that Targets Religious Coping

Symposium Title: The Integration of Religion/Spirituality into Culturally-Informed, Cognitive-Behavioral Mental Health Treatments Chair: Kayla K. Thayer, Ph.D., Nova Southeastern University Discussant: Stevan Lars Nielsen, Ph.D., Brigham Young Universit

Self-conscious emotions, general emotional distress, and expressed emotion in family members of patients with schizophrenia

This study examined the association of self-conscious emotions (shame and guilt) with general emotional distress (GED) and expressed emotion (EE) in family members of patients with schizophrenia. Fifty-seven relatives were given the test of self-conscious affect Tangney et al., 1989, The Test of Self-Conscious Affect. Fairfax, VA: George Mason University) to evaluate their proneness to shame and guilt and the Depression Anxiety Stress Scale Lovibond and Lovibond, 1995. Behav Res Ther. 33:335-343) to assess GED. Participants were also interviewed using the Camberwell Family Interview to measure EE. Consistent with Tangney's theory of self-conscious emotions and with study hypotheses, simultaneous regression analyses indicated that increasing shame proneness was strongly and positively associated with caregivers' reported GED whereas increasing guilt proneness was negatively associated with GED. Expressed emotion was not found to relate to self-conscious emotions nor to GED when rated as a dichotomous variable (high vs. low). However, greater shame proneness was associated with lower ratings of emotional overinvolvement, one component of EE. Study implications are discussed

Denial and Acceptance Coping Styles and Medication Adherence in Schizophrenia

Antipsychotics are often the first line of treatment for individuals with schizophrenia (Fialko et al., 2008). One challenge to effective treatment is lack of adherence to prescribed medication. Lower rates of adherence are associated with considerably higher rates of relapse and poorer course of illness. Therefore studying characteristics that may be related to medication adherence is important. Coping styles may be one such factor. Individuals utilize a variety of coping mechanisms to manage and navigate difficult life events, including mental illness (Cooke et al., 2007). In the present study, forty individuals with schizophrenia were assessed regarding their coping styles and medication adherence practices. As hypothesized, it was found that denial coping was inversely related to medication adherence. However, contrary to expectations, acceptance coping was not related to medication adherence. These findings suggest that targeting denial coping strategies in treatment may help foster more optimal strategies for managing schizophrenia

Acculturation and expressed emotion in Caucasian, Latino, and black relatives of patients with schizophrenia

High expressed emotion (high EE) in family members (high levels of criticism, emotional overinvolvement, and/or hostility) has been found to be predictive of a poorer course of illness for patients with schizophrenia in many different cultures. Acculturation has also been found to relate to symptom severity and clinical course in a number of disorders (e.g., substance abuse, schizophrenia). There is reason to believe that acculturation may interact with EE, however, this relationship has yet to be examined systematically. The present study evaluated the relationship between acculturation and EE in a sample of 57 Caucasian, Latino, and black caregivers of patients with schizophrenia. Drawing from earlier research, it was hypothesized that more acculturated Caucasian and Latino relatives and less acculturated black relatives would be designated as high EE. Hypotheses were partially supported as results demonstrated that greater acculturation was associated with high EE for Latinos and low EE for blacks

Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs

Incorporating Religion/Spirituality Into Treatment for Serious Mental Illness

This paper examines whether religion and spirituality (R/S) should be incorporated into treatment for patients with serious mental illness. This question merits attention, especially in light of the strong presence of R/S in the United States and, in particular, among members of ethnic minorities. While the literature is somewhat mixed, prior research supports the view that incorporating adaptive R/S elements into treatment for patients with serious mental illness is beneficial, particularly for patients who do not exhibit severe psychotic symptoms. Drawing from our experiences in developing a family-focused Culturally-Informed Therapy for Schizophrenia (CIT-S), we will also highlight the importance of addressing spiritual issues within minority populations. In the second half of this paper, we will present several case illustrations of how R/S issues were used in CIT-S to help patients make sense of adverse situations and obtain much-needed support and coping resources outside the treatment room. Findings from this study indicate that religion and spirituality can often be incorporated into treatment in a way that coalesces with patients’ values and enhances treatment gains. Future research should investigate how therapists’ own R/S values interact with those of their clients, and whether congruency in R/S values has any impact on treatment efficacy

Acculturation and mental health: Current findings and recommendations for future research

Results of existing literature suggest that the relationship between acculturation and mental health is complex. Some studies have found a beneficial association between increased acculturation and mental health, whereas others have found a detrimental association or no relationship at all. We reviewed literature on acculturation and mental health in Hispanics/Latino Americans, Asians/Asian Americans, and other ethnic groups. Results indicate that greater acculturation is associated with increased substance use and abuse. Findings for other disorders and symptoms demonstrate considerable heterogeneity and potential reasons for this variation are provided. Acculturation involves a complex set of processes that appear to have differential impact on mental health outcomes. Critical issues in the measurement of acculturation are discussed, and recommendations for future research are offered

Expressed emotion and interdependence in White and Latino/Hispanic family members of patients with schizophrenia

This study examined associations among ethnicity, expressed emotion (EE) and interdependence in a sample of 41 Latino/Hispanic and White family members of patients with schizophrenia. EE was assessed using both the Camberwell Family Interview (CFI) and the Five Minute Speech Sample (FMSS). These measures were found to be highly concordant for rating EE. However, the CFI appears to identify high EE more often than does the FMSS. Whites were designated as high EE significantly more often than were Latinos/Hispanics, regardless of assessment method. Using the interdependence subscale of the Self-Construal Scale, we found a strong trend for Latino/Hispanics to report a more interdependent self-construal than did Whites. However, contrary to expectations, interdependence was not found to mediate the relationship between ethnicity and EE. EE and interdependence may both play a role in the better course of illness observed for patients from traditional cultures. However, these two constructs may relate to patient functioning through different mechanisms