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Leonhardt BL, Visco AC, Hamm JA, Vohs JL. A Recovery-Oriented Approach: Application of Metacognitive Reflection and Insight Therapy (MERIT) for Youth with Clinical High Risk (CHR) for Psychosis. Behav Sci (Basel) 2024; 14:325. [PMID: 38667121 PMCID: PMC11047690 DOI: 10.3390/bs14040325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
Clinical High Risk for psychosis (CHR) refers to a phase of heightened risk for developing overt psychosis. CHR often emerges during adolescence or early adulthood. CHR has been identified as a group to target for intervention, with the hope that early intervention can both stave off prolonged suffering and intervene before mental health challenges become part of an individual's identity. However, there are few treatment modalities that can address some of the specific needs of CHR. Metacognitive Reflection and Insight Therapy (MERIT) is an integrative psychotherapy that can be applied to the CHR population. MERIT offers unique advantages to working with the CHR population as it aims to improve self-direction and recovery through stimulation of metacognitive capacity, a phenomenon that has been associated with recovery. This paper explores unique aspects of the CHR population and how MERIT can address barriers to recovery for individuals experiencing psychosis-like symptoms. Several case examples and a clinical vignette using MERIT to support patients with CHR are offered to exemplify this approach. MERIT offers a way to assist persons with CHR to address barriers to their personal recovery and to develop nuanced understandings of ways to master challenges.
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Affiliation(s)
- Bethany L. Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
| | - Andrew C. Visco
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
| | - Jay A. Hamm
- Sandra Eskenazi Mental Health Center, Indianapolis, IN 46202, USA;
- College of Pharmacy Practice, Purdue University, West Lafayette, IN 47907, USA
| | - Jenifer L. Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; (A.C.V.); (J.L.V.)
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Hamm JA, Leonhardt BL. Reading fiction together to support reflective practice and recovery in serious mental illness: The value of book club. Psychiatr Rehabil J 2023; 46:293-298. [PMID: 38166255 DOI: 10.1037/prj0000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
OBJECTIVE To illustrate the value of reading fiction as a group supervision practice focused on supporting recovery-oriented psychotherapy for individuals experiencing serious mental illness (SMI). METHOD Detailed practical description of the practice and conceptual analysis of the proposed value of using fiction as a group supervision method. FINDINGS Authors suggest that the supervisory practice is a novel component of clinical supervision, and offers value in its ability to promote reflective practice, to establish intersubjectivity among peers and supervisory relationships, and may serve for some to counter risks of clinician burnout. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Participating in a book club that reads fiction as an adjunctive experience to supervision can promote recovery-oriented psychotherapy in four key ways: including its promotion of reflection on self, patients, and the experience of therapy for psychosis, its promotion of reflection on recovery and barriers to recovery, its ability to offer an experiential model of intersubjectivity, and its value in supporting peer consultation and helping offset clinician burnout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Jay A Hamm
- Eskenazi Health, Sandra Eskenazi Mental Health Center
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Hamm JA, Carrera JS, Van Fossen JA, Key KD, Woolford SJ, Bailey SB, McKay AS, Evans LB, Calhoun KD. Conceptualizing Trust and Distrust as Alternative Stable States: Lessons from the Flint Water Crisis. Ecol Soc 2023; 28:14. [PMID: 38179152 PMCID: PMC10766421 DOI: 10.5751/es-14410-280314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Despite the universally recognized importance of fostering trust and avoiding distrust in governance relationships, there remains considerable debate on core questions like the relation between (dis)trust and the evaluations of the characteristics that make a governance agent appear (un)worthy of trust. In particular, it remains unclear whether levels of (dis)trust simply follow levels of (dis)trustworthiness-such that building trust is primarily a question of increasing evidence of trustworthiness and avoiding evidence of distrustworthiness, or if their dynamics are more complicated. The current paper adds novel theory for thinking about the management of trust and distrust in the governance context through the application of principles borrowed from resilience theory. Specifically, we argue that trust and distrust exist as distinct, self-reinforcing (i.e., stable) states separated by a threshold. We then theorize as to the nature of the self-reinforcing processes and use qualitative data collected from and inductively coded in collaboration with Flint residents as part of a participatory process to look for evidence of our argument in a well-documented governance failure. We conclude by explaining how this novel perspective allows for clearer insight into the experience of this and other communities and speculate as to how it may help to better position governance actors to respond to future crises.
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Affiliation(s)
| | | | | | - K D Key
- Michigan State University, College of Human Medicine, Department of Public Health
| | | | | | | | - L B Evans
- Community Based Organization Partners and Anders & Associates
| | - K D Calhoun
- Michigan Institute for Clinical and Health Research
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Ridenour JM, Hamm JA, Wiesepape CN, Lysaker PH. Integrating Loss and Processing Grief in Psychotherapy of Psychosis. Psychiatry 2023; 86:173-186. [PMID: 36688824 DOI: 10.1080/00332747.2022.2161261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: While recovery from psychosis is possible, recovery is a multidimensional construct driven by various factors. One relevant factor to recovery from psychosis that has often been overlooked in the psychotherapy literature is the importance of facing loss and processing grief in relation to psychosis. Methods: A review of the existing empirical literature on grief associated with psychosis was conducted. Clinicians with significant therapeutic experience working with persons with psychosis reviewed cases to examine the losses the patients had suffered and how they responded to these losses. The clinicians considered essential principles that are relevant when helping patients with psychosis integrate loss and process grief. Results: Persons who have experienced psychosis often experience the loss of role functioning, interpersonal relationships, cognition, and self-concept. However, when these losses are not fully integrated into the person's identity, it can result in either more losses due to denial and metacognitive impairments or increased hopelessness and depression due to internalized stigma. Five elements in psychotherapy of psychosis were identified that can facilitate the integration of loss and processing of grief: understand the personal experience of the psychotic episode, attend to feelings of grief and the primary loss, explore the meaning of psychotic symptoms and identity implications, integrate psychotic vulnerabilities into the sense of self, and foster realistic hope in the face of an uncertain future. Conclusion: Psychotherapy can enable persons with psychosis to make meaning of their losses, process their grief, integrate their psychotic vulnerability into their sense of self, and develop realistic hope.
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Ridenour JM, Hamm JA, Neal DW, Hillis JD, Gagen EC, Zalzala AB, Lysaker PH. Navigating an Impasse in the Psychotherapy for Psychosis. J Contemp Psychother 2022. [DOI: 10.1007/s10879-022-09571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hamm JA, Leonhardt BL, Wiesepape C, Lysaker PH. Supervision of psychotherapy for psychosis: A meaning-making approach. Psychol Serv 2022; 20:326-334. [PMID: 35604696 DOI: 10.1037/ser0000677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite its importance in the provision of mental health treatment, the availability of high-quality clinical supervision faces numerous threats in the public sector. Access to high-quality supervision may be especially important for therapists providing services to persons with psychosis. Here, we detail one supervisory approach that has been developed with these considerations in mind; namely, the supervision approach associated with the recovery-oriented integrative therapy metacognitive reflection and insight therapy. We detail three aspects of this approach that have broad appeal and could be easily incorporated into other psychotherapy approaches which include (a) reflecting with supervisees about their experience of the patient, themselves, and the therapeutic relationship, (b) helping supervisees respond to patients' pain and fragmentation with interventions that promote challenge and joint meaning-making, and (c) dealing with threats to this process from both internal pressures within supervisees as well as those posed externally from their agencies. Limitations of this approach and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Wasmuth S, Wilburn VG, Hamm JA, Chase A. Comparing narrative-informed occupational therapy in adult outpatient mental health to treatment as usual: A quasi-experimental feasibility study with preliminary treatment outcomes. Occup Ther Ment Health 2021; 37:56-71. [PMID: 34744219 DOI: 10.1080/0164212x.2020.1845276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper describes implementation of a narrative-informed occupation-based service in an outpatient community mental health setting that addressed several gaps, including 1) the need for outcome data on occupational therapy in this setting; 2) an ongoing mental health provider shortage; and 3) a need for innovative approaches to supporting mental health. We found a significant improvement from baseline to post-intervention in occupational participation, and dose of occupational therapy was significantly related to improvements in the areas of roles, habits, values, long-term goals, social environment, and readiness for change. This study suggests future, larger effectiveness studies of narrative-informed occupation-based interventions delivered by occupational therapists in outpatient community mental health are warranted.
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Affiliation(s)
- Sally Wasmuth
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
| | - Victoria G Wilburn
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
| | - Jay A Hamm
- Sandra Eskenazi Mental Health Center, Eskenazi Health, Indianapolis, IN 46202, United States College of Pharmacy, Purdue University, West Lafayette, IN 47907
| | - Anthony Chase
- Indiana University School of Health and Human Sciences, Department of Occupational Therapy, 1140 W. Michigan Street, Indianapolis, IN 46202
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Firmin RL, Zalzala AB, Hamm JA, Luther L, Lysaker PH. How psychosis interrupts the lives of women and men differently: a qualitative comparison. Psychol Psychother 2021; 94:704-720. [PMID: 33215851 DOI: 10.1111/papt.12317] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 07/15/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Psychosis disrupts how persons experience themselves and their lives. Despite knowledge that gender differences have been noted in presentation and course of psychosis symptoms, little is known about differences in how men and women experience these disruptions. METHOD The narratives of 26 men and 27 women diagnosed with psychosis, matched on age, education, and race, of the impact of psychosis on one's life, were compared. Using secondary data from semi-structured interviews, themes were identified using inductive, phenomenological qualitative analyses. RESULTS Women and men discussed psychosis-related interruptions to the roles and relationships that shape their identity. Both genders discussed the impact of psychosis on their sense of self, work, and relationships. Nuanced gender differences emerged, informing unique areas of challenge related to (1) parenting and loss of parenting roles, (2) work and loss or changes in work trajectories, (3) isolation and strain on interpersonal relationships, and (4) manifestations of stigma. CONCLUSIONS Psychosis may disrupt distinct aspects of life for men and women. Each gender faces the intersection of socially informed expectations that impact one's experiences of stigma, expectations of others, and manifestations of losses felt in one's role and sense of identity. Findings inform important considerations for therapy and other services. PRACTITIONER POINTS Gender-based socialized expectations, losses, and challenges that accompany psychosis are important areas for therapeutic consideration. Current treatments may neglect challenges that are more commonly experienced by women with psychosis.
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Affiliation(s)
- Ruth L Firmin
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, Rhode Island, USA.,Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Aieyat B Zalzala
- Department of Psychiatry, The Institute of the Living at Hartford Hospital, Hartford, Connecticut, USA
| | - Jay A Hamm
- Midtown Community Mental Health Center, Eskenazi Hospital, Indianapolis, Indiana, USA
| | - Lauren Luther
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul H Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Roudebush VA Medical Center, Indianapolis, Indiana, USA
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Hamm JA, Rutherford S, Wiesepape CN, Lysaker PN. Community Mental Health Practice in the United States: Past, Present and Future. Consortium Psychiatricum 2020. [DOI: 10.17650/2712-7672-2020-1-2-7-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Similar to trends in Europe, approaches to mental illness in colonial America and recorded in early United States history were commonly characterized by incarceration and the removal of individuals from communities. In the mid-20th century, a major shift began in which treatment was offered in the community with the aim of encouraging individuals to rejoin their communities. In this paper, we will provide a brief history of community mental health services in the United States, and the forces which have influenced its development. We will explore the early antecedents of community-based approaches to care, and then detail certain factors that led to legislative, peer and clinical efforts to create Community Mental Health Centers. We will then provide an overview of current community mental health practices and evolving challenges through to the present day, including the development of services which remain focused on recovery as the ultimate goal.
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Lysaker PH, Kukla M, Leonhardt BL, Hamm JA, Schnakenberg Martin A, Zalzala AB, Gagen EC, Hasson-Ohayon I. Meaning, integration, and the self in serious mental illness: Implications of research in metacognition for psychiatric rehabilitation. Psychiatr Rehabil J 2020; 43:275-283. [PMID: 32790437 DOI: 10.1037/prj0000436] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE It has been established that recovery is a common outcome for adults diagnosed with serious mental illness which involves objective and subjective phenomenon. While considerable work has examined objective aspects of recovery, it remains difficult to know how to quantify the processes which support more subjective aspects of recovery related to sense of self. This article explores the potential of recent research on metacognition to offer new avenues to measure the processes which make a sense of self available within the flow of life. METHOD Emerging definitions of metacognition using an integrative model of metacognition are reviewed. Research is presented suggesting adults diagnosed with serious mental illness are often confronted by metacognitive deficits which interfere with their ability to make sense of their psychiatric challenges and effectively direct their own recovery. FINDINGS Metacognitive capacity may be a quantifiable phenomenon which contributes to certain aspects of recovery related to meaning making, agency and self-direction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Promoting metacognitive capacity may be a previously unrecognized active element of existing rehabilitative interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Marina Kukla
- Indianapolis Center of Innovation, Health Services Research and Development, Richard L. Roudebush Veterans Affairs Medical Center
| | | | - Jay A Hamm
- Eskenazi Health Midtown Community Mental Health
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Ridenour JM, Hamm JA, Neal DW, Lysaker PH. From Fragmentation to Coherence: Psychodynamic Psychotherapy for Psychosis through the Lens of Metacognition. Psychodyn Psychiatry 2020; 48:455-476. [PMID: 33779223 DOI: 10.1521/pdps.2020.48.4.455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Psychoanalysis has produced important theories that help explain the radical alterations in self-experience central for persons experiencing psychosis. These concepts have led to important clinical developments, case studies, and some research on the efficacy of psychodynamic psychotherapy for psychosis (Gottdiener, 2006). However, psychodynamic psychotherapy has struggled to produce operationalized constructs to measure how it enhances self-development and the therapeutic mechanisms of action that facilitate these changes. Outside of psychoanalysis, some researchers have focused on the construct of metacognition (i.e. thinking about thinking) and its relevance to understanding psychosis. Proponents of this paradigm have created an integrative, exploratory therapy (MERIT, Lysaker & Klion, 2017) that blends various therapeutic traditions that overlap with psychodynamic psychotherapy and mentalization (Ridenour, Knauss, & Hamm, 2019). In this paper, we will present a short-term intensive case study of psychodynamic psychotherapy with a young man experiencing psychosis in residential treatment and then analyze the therapy through the lens of metacognition to provide constructs that illustrate the ways that it promotes recovery and self-integration.
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Affiliation(s)
- Jeremy M Ridenour
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, MA
| | - Jay A Hamm
- Midtown Community Mental Health, Eskenazi Health, and College of Pharmacy, Purdue University, Indianapolis, IN
| | - David W Neal
- Midtown Community Mental Health, Eskenazi Health, and College of Pharmacy, Purdue University, Indianapolis, IN
| | - Paul H Lysaker
- Erikson Institute for Education and Research, Austen Riggs Center, Stockbridge, MA
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Pec O, Lysaker PH, Probstova V, Leonhardt BL, Hamm JA, Bob P. The Psychotherapeutic Treatment of Schizophrenia: Psychoanalytical Explorations of the Metacognitive Movement. J Contemp Psychother 2020. [DOI: 10.1007/s10879-020-09452-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
| | - Jay A. Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN, USA
| | - Meg Czaja
- Center for Motivation and Change, New Marlborough, MA, USA
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Lysaker PH, Dimaggio G, Hamm JA, Leonhardt BL, Hochheiser J, Lysaker JT. Disturbances in Self-Experience in Schizophrenia: Metacognition and the Development of an Integrative Recovery-Oriented Individual Psychotherapy. Psychopathology 2019; 52:135-142. [PMID: 30537720 DOI: 10.1159/000495297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Disturbances in first person experience is a broadly noted feature of schizophrenia, which cannot be reduced to the expression of psychopathology. Yet, though categorically linked with profound suffering, these disturbances are often ignored by most contemporary treatment models. METHODS In this paper, we present a model, which suggests that deficits in metacognition and their later resolution parsimoniously explain the development of self-disturbance and clarify how persons can later recover. We define "metacognition" as processes integral to the availability of a sense of self and others within the flow of life and report research suggesting its contribution to schizophrenia and link to self-disturbance. RESULTS We describe a newly emerging integrative form of psychotherapy, Metacognitive Reflection and Insight Therapy (MERIT), designed to target metacognition and enhance the recovery of healthy self-experience. We describe eight measurable core elements that allow MERIT to be operationalized and discuss about how to address disturbances in self-experience. CONCLUSIONS We detail research that provides evidence of the feasibility, acceptability, and effectiveness of MERIT across a broad range of patients, including those who might not otherwise be offered psychotherapy. MERIT represents one form of psychotherapy that may address self-disorders among adults with schizophrenia.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA,
| | | | - Jay A Hamm
- Department of Psychiatry, Midtown Mental Health Center, Purdue University, Indianapolis, Indiana, USA
| | - Bethany L Leonhardt
- Department of Psychiatry, Midtown Mental Health Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jesse Hochheiser
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - John T Lysaker
- Department of Philosophy, Emory University, Atlanta, Georgia, USA
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Lysaker PH, Hamm JA, Vohs J, Kukla M, Pattison ML, Leonhardt BL, Lysaker JT. Understanding the Course of Self-disorders and Alterations in Self- Experience in Schizophrenia: Implications from Research on Metacognition. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/1573400514666180816113159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Paul H. Lysaker
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Jay A. Hamm
- Purdue University College of Education, West Lafayette, IN 46202, United States
| | - Jenifer Vohs
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA; 2Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - Michelle L. Pattison
- University of Indianapolis, College of Applied Behavioral Sciences, Indianapolis, IN 46227, United States
| | - Bethany L. Leonhardt
- Indiana University School of Medicine, Department of Psychiatry, Indianapolis, IN 46202, United States
| | - John T. Lysaker
- Emory University, Department of Philosophy, Atlanta, GA 30322, United States
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Abstract
Recovery for many people with serious mental illness is more than symptom remission or attainment of certain concrete milestones. It can also involve recapturing a previously lost coherent and cohesive sense of self. The authors review several case studies of integrative metacognitive psychotherapy offered to adults with broadly differing clinical presentations. In all the cases, patients demonstrated significant subjective gains and objective improvements-for example, in negative symptoms, in substance use, and in overcoming a history of childhood sexual abuse. By applying this method to various problems-issues consistent with the realities faced in actual clinics-the authors explore how integrative metacognitive psychotherapy is able to address more subjective aspects of recovery by stimulating gains in the experience of agency that lead to the development of more cohesive self-experience, regardless of objective markers of recovery.
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Affiliation(s)
- Jay A Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis (Hamm); Department of Psychiatry, Roudebush Department of Veterans Affairs Medical Center, Indianapolis (Lysaker), and Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Lysaker)
| | - Paul H Lysaker
- Eskenazi Health, Midtown Community Mental Health, Indianapolis (Hamm); Department of Psychiatry, Roudebush Department of Veterans Affairs Medical Center, Indianapolis (Lysaker), and Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Lysaker)
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Hamm JA, Leonhardt BL, Ridenour J, Lysaker JT, Lysaker PH. Phenomenological and recovery models of the subjective experience of psychosis: discrepancies and implications for treatment. Psychosis 2018. [DOI: 10.1080/17522439.2018.1522540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jay A. Hamm
- Midtown Community Mental Health, Eskenazi Health, Indianapolis IN, USA
- College of Pharmacy, Purdue University, Indianapolis IN, USA
| | - Bethany L. Leonhardt
- Midtown Community Mental Health, Eskenazi Health, Indianapolis IN, USA
- School of Medicine, Indiana University, Indianapolis IN, USA
| | | | | | - Paul H. Lysaker
- School of Medicine, Indiana University, Indianapolis IN, USA
- Roudebush VA Medical Center, Indianapolis IN, USA
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Abstract
Recent developments in the research and clinical literatures have highlighted the importance of focusing on higher-order cognitive processes in the treatment of psychotic disorders. A particular emphasis has been placed on how impairments in self-monitoring and the ability to form mental representations of others uniquely manifest in psychosis. At the same time, the recovery movement has influenced clinical innovations by emphasizing the importance of subjective domains of recovery that privilege the individual's phenomenological experience. In this column, we outline 2 emerging approaches to the treatment of psychosis, Metacognitive Reflection and Insight Therapy and Mentalization-based Therapy for Psychosis, highlighting the ways that each approach targets higher-order cognitive processes as a focused point of intervention, while maintaining a collaborative treatment approach that values the patient's agency.
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Affiliation(s)
- Daniel Knauss
- KNAUSS and RIDENOUR: The Austen Riggs Center, Stockbridge, MA HAMM: Midtown Community Mental Health, Eskenazi Health, Indianapolis, IN PLAKUN: The Austen Riggs Center, Stockbridge, MA
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Lysaker PH, Zalzala AB, Ladegaard N, Buck B, Leonhardt BL, Hamm JA. A Disorder by Any Other Name: Metacognition, Schizophrenia, and Diagnostic Practice. Journal of Humanistic Psychology 2018. [DOI: 10.1177/0022167818787881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Humanistic psychology has made us aware that any understanding of schizophrenia must see persons diagnosed with this condition as whole persons who are making sense of what wellness and recovery mean to them. This has raised questions about what the diagnosis of schizophrenia means and whether the diagnostic label of schizophrenia is helpful when we try to conceptualize the actions and aims of treatment. To examine this issue we propose it is essential to consider what is systematically occuring psychologicaly in recovery when persons experience, interpret and agentically respond to emerging challenges. We then review how the integrated model of metacognition provides a systematic, person-centered, evidence-based approach to understanding psychological processes which impact recovery, and discuss how this guides a form of psychotherapy, metacognitive reflection and insight therapy, which promotes metacognitive abilities and support recovery. We suggest this work indicates that metacognitive capacity is something that can be diagnosed without stigmatizing persons. It can be used to meaningfully inform clinical practice across various theoretical models and offers concrete implications for rehabilitation.
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Affiliation(s)
- Paul H. Lysaker
- Roudebush VA Medical Center, Indianapolis IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Aieyat B. Zalzala
- Roudebush VA Medical Center, Indianapolis IN, USA
- Purdue University, West Lafayette, IN, USA
| | | | - Benjamin Buck
- Puget Sound VA Health Care System, Seattle, WA, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bethany L. Leonhardt
- Indiana University School of Medicine, Indianapolis, IN, USA
- Eskenazi Health—Midtown Community Mental Health, Indianapolis, IN, USA
| | - Jay A. Hamm
- Purdue University, West Lafayette, IN, USA
- Eskenazi Health—Midtown Community Mental Health, Indianapolis, IN, USA
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Hamm JA, Buck KD, Leonhardt BL, Luther L, Lysaker PH. Self-directed recovery in schizophrenia: Attending to clients’ agendas in psychotherapy. Journal of Psychotherapy Integration 2018. [DOI: 10.1037/int0000070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lysaker PH, Hamm JA, Hasson-Ohayon I, Pattison ML, Leonhardt BL. Promoting recovery from severe mental illness: Implications from research on metacognition and metacognitive reflection and insight therapy. World J Psychiatry 2018; 8:1-11. [PMID: 29568726 PMCID: PMC5862649 DOI: 10.5498/wjp.v8.i1.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/04/2017] [Accepted: 01/07/2018] [Indexed: 02/05/2023] Open
Abstract
Research indicates that individuals with schizophrenia recover. Recovery, however means different things to different individuals and regardless of what kind of experiences define recovery, the individual diagnosed with the serious mental illness must feel ownership of their recovery. This raises the issue of how mental health services should systematically promote recovery. This paper explores the practical implications for research on metacognition in schizophrenia for this issue. First, we present the integrated model of metacognition, which defines metacognition as the spectrum of activities which allow individual to have available to themselves an integrated sense of self and others as they appraise and respond to the unique challenges they face. Second, we present research suggesting that many with schizophrenia experience deficits in metacognition and that those deficits compromise individuals’ abilities to manage their lives and mental health challenges. Third, we discuss a form of psychotherapy inspired by this research, Metacognitive Reflection and Insight Therapy which assists individuals to recapture the ability to form integrated ideas about themselves and others and so direct their own recovery. The need for recovery oriented interventions to focus on process and on patient’s purposes, assess metacognition and consider the intersubjective contexts in which this occurres is discussed.
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Affiliation(s)
- Paul Henry Lysaker
- Department of Psychiatry, Roudebush VA Med Ctr and the Indiana Univeristy School of Medicine, Indianapolis, IN 46254, United States
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46254, United States
| | - Jay A Hamm
- Department of Psychiatry, Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
| | - Ilanit Hasson-Ohayon
- Department of Psychology, Hasson-Ohayon, I, Bar Ilan Univ, Dept Psychol, Ramat Gan 5290002, Israel
| | - Michelle L Pattison
- Department of Psychology, University of Indianapolis, College of Applied Behavioral Sciences, Indianapolis, IN 46227, United States
| | - Bethany L Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46254, United States
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN 46202, United States
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Abstract
IN BRIEF Patients with serious mental illness (SMI) have markedly higher mortality rates than those without SMI. A large portion of this disparity is explained by higher rates of diabetes and cardiovascular illness, highlighting the need for people with diabetes and SMI to have access to the highest quality diabetes care. This article applies principles of patient-centered diabetes care to those with SMI, exploring a novel approach to diabetes care embedded within a community mental health setting.
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Affiliation(s)
- Jay A. Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN
- Purdue University, College of Pharmacy, West Lafayette, IN
| | - Kelly D. Buck
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Jasmine D. Gonzalvo
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN
- Purdue University, College of Pharmacy, West Lafayette, IN
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Leonhardt BL, Huling K, Hamm JA, Roe D, Hasson-Ohayon I, McLeod HJ, Lysaker PH. Recovery and serious mental illness: a review of current clinical and research paradigms and future directions. Expert Rev Neurother 2017; 17:1117-1130. [PMID: 28885065 DOI: 10.1080/14737175.2017.1378099] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways: as an objective outcome versus a subjective process. Areas covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one's experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI.
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Affiliation(s)
- Bethany L Leonhardt
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - Kelsey Huling
- c School of Psychological Sciences , University of Indianapolis , Indianapolis , IN , USA
| | - Jay A Hamm
- b Midtown Community Mental Health , Eskenazi Health , Indianapolis , IN , USA
| | - David Roe
- d Department of Community Mental Health, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | | | - Hamish J McLeod
- f Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana University School of Medicine , Indianapolis , IN , USA.,g Department of Psychiatry , Richard L. Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA
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Hasson-Ohayon I, Arnon-Ribenfeld N, Hamm JA, Lysaker PH. Agency before action: The application of behavioral activation in psychotherapy with persons with psychosis. ACTA ACUST UNITED AC 2017; 54:245-251. [PMID: 28691835 DOI: 10.1037/pst0000114] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Incorporating behavioral activation into psychotherapy with persons with psychosis requires adaptation in its conceptualization and application owing to special deficits in the self-experience. Persons with psychosis often experience a diminished or disorganized sense of self, and have deficits in coherently narrating the experience of the self and in the ability to make sense of how to take action and direct their own lives. Based on a metacognitive model of disability in psychosis, the current paper presents a therapy process of a woman coping with schizophrenia using Metacognitive Reflection and Insight Therapy (Lysaker and Dimaggio, 2014) in the framework of an intersubjective model for psychotherapy with persons with psychosis presented by Hasson-Ohayon, Kravetz, and Lysaker (2016a). The case in point and its following discussion highlight the important significance of metacognitive encouragement as a first step of behavioral activation. (PsycINFO Database Record
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Affiliation(s)
| | | | - Jay A Hamm
- Eskenazi Health, Midtown Community Mental Health
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Hamm JA, Buck B, Leonhardt BL, Wasmuth S, Lysaker JT, Lysaker PH. Overcoming fragmentation in the treatment of persons with schizophrenia. Journal of Theoretical and Philosophical Psychology 2017. [DOI: 10.1037/teo0000054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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26
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Leonhardt BL, Kukla M, Belanger E, Chaudoin-Patzoldt K, Buck KD, Minor KS, Vohs J, Hamm JA, Lysaker PH. Emergence of psychotic content in psychotherapy: An exploratory qualitative analysis of content, process, and therapist variables in a single case study. Psychother Res 2016; 28:264-280. [DOI: 10.1080/10503307.2016.1219421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Bethany L. Leonhardt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Marina Kukla
- Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Elizabeth Belanger
- School of Psychological Sciences, University of Indianapolis, Indianapolis, IN, USA
| | | | | | - Kyle S. Minor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
| | - Jenifer L. Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Psychotic Disorders Program, Indianapolis, IN, USA
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Jay A. Hamm
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, IN, USA
| | - Paul H. Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Roudebush VA Medical Center, Indianapolis, IN, USA
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Hamm JA, Buck KD, Vohs J, Westerlund RJ, Lysaker PH. Interpersonal stance and dialogue in psychotherapy for schizophrenia: A supervisory approach. The Clinical Supervisor 2016. [DOI: 10.1080/07325223.2016.1140102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hamm JA, Lysaker PH. Psychoanalytic phenomenology of schizophrenia: Synthetic metacognition as a construct for guiding investigation. Psychoanalytic Psychology 2016. [DOI: 10.1037/a0038949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hamm JA, Leonhardt BL. The Role of Interpersonal Connection, Personal Narrative, and Metacognition in Integrative Psychotherapy for Schizophrenia: A Case Report. J Clin Psychol 2015; 72:132-41. [PMID: 26662610 DOI: 10.1002/jclp.22247] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The recovery movement has not only challenged traditional pessimism regarding schizophrenia but also presented opportunities for the possibilities for psychotherapy for people with the disorder. Though in the past psychotherapy models were often pitted against one another, recently there have been emergent reports of a range of integrative models sharing an emphasis on recovery and a number of conceptual elements. These shared elements include attention to the importance of interpersonal processes, personal narrative, and metacognition, with interest in their role in not only the disorder but also the processes by which people pursue recovery. This article explores one application of this framework in the psychotherapy of a woman with prolonged experience of schizophrenia and significant functional impairments.
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Affiliation(s)
- Jay A Hamm
- Midtown Community Mental Health Center, Eskenazi Health
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30
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Buck KD, Buck BE, Hamm JA, Lysaker PH. Martin Buber and evidence-based practice: Can the lion really lie down with the lamb? Psychosis 2015. [DOI: 10.1080/17522439.2015.1055783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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31
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Lysaker PH, Hamm JA. Phenomenological models of delusions: concerns regarding the neglect of the role of emotional pain and intersubjectivity. World Psychiatry 2015; 14:175-6. [PMID: 26043329 PMCID: PMC4471968 DOI: 10.1002/wps.20207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center and Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jay A Hamm
- Eskenazi Health Midtown Community Mental Health, Indianapolis, IN, USA
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Leonhardt BL, Hamm JA, Fogley RL, Buck KD, Roe D, Lysaker PH. Allowing for Psychosis to be Approachable and Understandable as a Human Experience: A Role for the Humanities in Psychotherapy Supervision. Am J Psychother 2015; 69:35-51. [PMID: 26241798 DOI: 10.1176/appi.psychotherapy.2015.69.1.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bethany L. Leonhardt
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jay A. Hamm
- Midtown Community Mental Health Center, Indianapolis, Indiana
| | - Rebecca L. Fogley
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana
| | - Kelly D. Buck
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, Indiana
| | | | - Paul H. Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
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Hamm JA, Leonhardt BL, Fogley RL, Lysaker PH. Literature as an exploration of the phenomenology of schizophrenia: disorder and recovery in Denis Johnson's Jesus' Son. Med Humanit 2014; 40:84-89. [PMID: 24567424 DOI: 10.1136/medhum-2013-010464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
When read as a fictional psychosis narrative, Jesus' Son, a collection of short stories by Denis Johnson, reveals important elements of the phenomenology of schizophrenia and recovery. It is possible that Jesus' Son, as a work of fiction, may be able to uniquely add depth and nuance to an understanding of the phenomenology of schizophrenia involving a state of psychological fragmentation, an ever-changing interpersonal field and a loss of personal agency. In addition, by following the protagonist in Jesus' Son as he begins to resolve some of his difficulties, the book also offers an individualised account of recovery. The authors detail how the book reveals these insights about schizophrenia and recovery and suggest that these elements are intertwined in such a manner that leads to a profound disruption of self-experience, characterised by a collapse of metacognitive processes. Jesus' Son may add depth to our understanding of the subjective experience of schizophrenia and recovery, and also may serve as one example in which the study of humanities offers an opportunity to explore the human elements in the most profound forms of suffering.
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Affiliation(s)
- Jay A Hamm
- Midtown Community Mental Health Center, Eskenazi Health, Indianapolis, Indiana, USA
| | - Bethany L Leonhardt
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA
| | - Rebecca L Fogley
- School of Psychological Sciences, University of Indianapolis, Indianapolis, Indiana, USA
| | - Paul H Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, Indiana, USA Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Leonhardt BL, Hamm JA, Belanger EA, Lysaker PH. Childhood sexual abuse moderates the relationship of self-reflectivity with increased emotional distress in schizophrenia. Psychosis 2014. [DOI: 10.1080/17522439.2014.968858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lysaker PH, Leonhardt BL, Brüne M, Buck KD, James A, Vohs J, Francis M, Hamm JA, Salvatore G, Ringer JM, Dimaggio G. Capacities for theory of mind, metacognition, and neurocognitive function are independently related to emotional recognition in schizophrenia. Psychiatry Res 2014; 219:79-85. [PMID: 24863863 DOI: 10.1016/j.psychres.2014.05.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/28/2014] [Accepted: 05/04/2014] [Indexed: 12/28/2022]
Abstract
While many with schizophrenia spectrum disorders experience difficulties understanding the feelings of others, little is known about the psychological antecedents of these deficits. To explore these issues we examined whether deficits in mental state decoding, mental state reasoning and metacognitive capacity predict performance on an emotion recognition task. Participants were 115 adults with a schizophrenia spectrum disorder and 58 adults with substance use disorders but no history of a diagnosis of psychosis who completed the Eyes and Hinting Test. Metacognitive capacity was assessed using the Metacognitive Assessment Scale Abbreviated and emotion recognition was assessed using the Bell Lysaker Emotion Recognition Test. Results revealed that the schizophrenia patients performed more poorly than controls on tests of emotion recognition, mental state decoding, mental state reasoning and metacognition. Lesser capacities for mental state decoding, mental state reasoning and metacognition were all uniquely related emotion recognition within the schizophrenia group even after controlling for neurocognition and symptoms in a stepwise multiple regression. Results suggest that deficits in emotion recognition in schizophrenia may partly result from a combination of impairments in the ability to judge the cognitive and affective states of others and difficulties forming complex representations of self and others.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bethany L Leonhardt
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA
| | - Martin Brüne
- Research Department of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital, Bochum, Germany
| | - Kelly D Buck
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA
| | - Alison James
- Indiana State University, Department of Psychology, Terre Haute, IN, USA
| | - Jenifer Vohs
- Indiana University School of Medicine, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Michael Francis
- Indiana University School of Medicine, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Jay A Hamm
- Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA
| | | | - Jamie M Ringer
- Roudebush VA Medical Center (116H), 1481 West 10th Street, Indianapolis, IN, USA
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36
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Lysaker PH, Vohs J, Hamm JA, Kukla M, Minor KS, de Jong S, van Donkersgoed R, Pijnenborg MHM, Kent JS, Matthews SC, Ringer JM, Leonhardt BL, Francis MM, Buck KD, Dimaggio G. Deficits in metacognitive capacity distinguish patients with schizophrenia from those with prolonged medical adversity. J Psychiatr Res 2014; 55:126-32. [PMID: 24811777 DOI: 10.1016/j.jpsychires.2014.04.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/20/2014] [Accepted: 04/10/2014] [Indexed: 12/31/2022]
Abstract
Research has suggested that many with schizophrenia experience decrements in synthetic metacognition, or the abilities to form integrated representations of oneself and others and then utilize that knowledge to respond to problems. Although such deficits have been linked with functional impairments even after controlling for symptoms and neurocognition, it is unclear to what extent these deficits can distinguish persons with schizophrenia from others experiencing significant life adversity but without psychosis. To explore this issue we conducted logistic regression analysis to determine whether assessment of metacognition could distinguish between 166 participants with schizophrenia and 51 adults with HIV after controlling for social cognition and education. Metacognition was assessed with the Metacognitive Assessment Scale Abbreviated (MAS-A), and social cognition with the Bell Lysaker Emotion Recognition Test. We observed that the MAS-A total score was able to correctly classify 93.4% of the schizophrenia group, with higher levels of metacognition resulting in increased likelihood of accurate categorization. Additional exploratory analyses showed specific domains of metacognition measured by the MAS-A were equally able to predict membership in the schizophrenia group. Results support the assertion that deficits in the abilities to synthesize thoughts about oneself and others into larger representations are a unique feature of schizophrenia.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA; Indiana University School of Medicine Indianapolis, IN, USA.
| | - Jenifer Vohs
- Indiana University School of Medicine Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA
| | - Jay A Hamm
- Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA
| | - Marina Kukla
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Steven de Jong
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands; Department of Clinical and Experimental Psychopathology, Rijksuniversiteit Groningen, The Netherlands
| | - Rozanne van Donkersgoed
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Marieke H M Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands; Department of Clinical and Experimental Psychopathology, Rijksuniversiteit Groningen, The Netherlands
| | - Jerillyn S Kent
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Sean C Matthews
- Indiana University, Department of Psychological and Brain Sciences, Bloomington, IN, USA
| | - Jamie M Ringer
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Bethany L Leonhardt
- University of Indianapolis, School of Psychological Science, Indianapolis, IN, USA
| | - Michael M Francis
- Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA; Indiana University School of Medicine Indianapolis, IN, USA
| | - Kelly D Buck
- Roudebush VA Med Center (116H), Roudebush VA Medical Center, 1481 West 10th St, Indianapolis, IN 46202, USA
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Hamm JA, Hasson-Ohayon I, Kukla M, Lysaker PH. Individual psychotherapy for schizophrenia: trends and developments in the wake of the recovery movement. Psychol Res Behav Manag 2013; 6:45-54. [PMID: 23950665 PMCID: PMC3741082 DOI: 10.2147/prbm.s47891] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Although the role and relative prominence of psychotherapy in the treatment of schizophrenia has fluctuated over time, an analysis of the history of psychotherapy for schizophrenia, focusing on findings from the recovery movement, reveals recent trends including the emergence of the development of integrative psychotherapy approaches. The authors suggest that the recovery movement has revealed limitations in traditional approaches to psychotherapy, and has provided opportunities for integrative approaches to emerge as a mechanism for promoting recovery in persons with schizophrenia. Five approaches to integrative psychotherapy for persons with schizophrenia are presented, and a shared conceptual framework that allows these five approaches to be compatible with one another is proposed. The conceptual framework is consistent with theories of recovery and emphasizes interpersonal attachment, personal narrative, and metacognitive processes. Implications for future research on integrative psychotherapy are considered.
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Affiliation(s)
- Jay A Hamm
- Richard L Roudebush VA Medical Center, Department of Psychiatry, Indianapolis, IN, USA
| | | | - Marina Kukla
- Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Paul H Lysaker
- Richard L Roudebush VA Medical Center, Department of Psychiatry, Indianapolis, IN, USA
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Hamm JA, Renard SB, Fogley RL, Leonhardt BL, Dimaggio G, Buck KD, Lysaker PH. Metacognition and social cognition in schizophrenia: stability and relationship to concurrent and prospective symptom assessments. J Clin Psychol 2012; 68:1303-12. [PMID: 22886716 DOI: 10.1002/jclp.21906] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Schizophrenia has been linked with deficits in the ability to form complex representations about oneself and others. Less clear is whether these deficits are stable over time, and whether they are related to symptoms. METHOD We assessed metacognition capacity, affect recognition, executive function, and symptoms at baseline and 6 months later for 49 adults with schizophrenia. RESULTS Paired t tests revealed assessments of metacognition and affect recognition were stable across measurements points. Metacognition was related to concurrent assessments of positive, negative and disorganized symptoms. Multiple regressions revealed metacognition was related to prospective assessments of negative symptoms after controlling for baseline negative symptoms and executive function. CONCLUSIONS Metacognitive deficits are a stable feature of schizophrenia related with negative symptoms.
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Affiliation(s)
- Jay A Hamm
- University of Indianapolis, Indiana, USA
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Lysaker PH, McCormick BP, Snethen G, Buck KD, Hamm JA, Grant M, Nicolò G, Dimaggio G. Metacognition and social function in schizophrenia: associations of mastery with functional skills competence. Schizophr Res 2011; 131:214-8. [PMID: 21745724 DOI: 10.1016/j.schres.2011.06.011] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 06/10/2011] [Accepted: 06/15/2011] [Indexed: 11/16/2022]
Abstract
Research has suggested that many with schizophrenia experience deficits in the ability to form complex ideas about their own mental states and those of others and to use that in the service of responding to the challenges of both everyday life and the illness itself. Preliminary evidence suggests that deficits in such metacognitive and social cognitive functions are a predictor of function independent of other aspects of schizophrenia. In this study, we explored whether the domain of metacognition that reflects the ability to form knowledge about one's own mental states and those of others and to use that knowledge to respond to psychological challenges, known as Mastery, was related to performance on a test of functional skills competence. Participants were 40 adults with schizophrenia spectrum disorders in a non-acute phase of illness. Metacognitive Mastery was assessed using the Metacognitive Assessment Scale (MAS) and skills competence was assessed using the UCSD Performance-Based Skills Assessment Battery (UPSA). Symptoms were also assessed using the Positive and Negative Syndrome Scale and executive function was assessed with the Wisconsin Card Sorting Test. Correlations revealed a significant relationship between Mastery and the UPSA comprehension/planning subscale. This relationship persisted even after controlling for symptoms and executive function in a regression analysis. Results are consistent with the possibility that the ability to use metacognitive knowledge to respond to daily life is uniquely linked with certain forms of functional competence among persons with schizophrenia, independent of the effects of illness severity.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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