A preliminary classification system for homeless veterans with mental illness.

The purpose of this study was that of defining psychiatric profiles among veterans based on a structured interview of 3,595 individuals administered by outreach mental health clinicians to individuals who were presently or recently homeless. The interview included ratings of presence or absence of current psychiatric disorders; alcoholism, drug abuse, psychosis, mood disorders, personality disorders, PTSD, and adjustment disorders. We identified three subgroups using cluster analysis each showing different diagnostic profiles that were characterized as "addiction" (n = 3,061), "psychosis" (n = 218), and "personality" disorders (n = 54). Cluster membership was related to demographic characteristics, living situation, length of homelessness, and symptoms and complaints including cognitive difficulties, suicidality, violence, and depression. Group comparison statistics were used to compare intercluster differences in demographics, homeless situation, symptoms, and subjective complaints. There were no major intercluster differences in socioethnic, demographic, and homeless situation variables. Differences occurred in complaints of depression, positive symptoms of psychosis, and suicidality. It was concluded that despite the disproportionate sizes of the clusters homeless veterans with mental illness are nevertheless heterogeneous with regard to their psychiatric profiles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pilot study of a health-focused day program on improving health behaviors, clinical functioning, and perceived wellness in individuals with severe mental illness.

Persons with severe mental illness (SMI) have poor physical health and high rates of premature death. There is limited research on health interventions for this population. This pilot study compares the health behaviors and perceived improvement of 2 day programs and comments on conducting research in health intervention in community-based persons with SMI. Nineteen individuals with SMI from a health-focused day program (HFP) and treatment-as-usual day program (TAU) were assessed for clinical functioning, health behaviors, and perceived improvement by using a semistructured interview and the Brief Psychiatric Rating Scale. The special features of the HFP included special dietary planning, a well-equipped gym, staff instruction, supervision of exercise programs, and limited time for smoking. HFP participants reported higher fruit and vegetable intake and greater perceived improvement in confidence than those at the TAU. There were no differences in the amount of exercise and rates of smoking between the programs. Methodological implications for further research in this area are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The comparative effectiveness of cognitive processing therapy for male veterans treated in a VHA posttraumatic stress disorder residential rehabilitation program.

Objective: To examine the effectiveness of group cognitive processing therapy (CPT) relative to trauma-focused group treatment as usual (TAU) in the context of a Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) residential rehabilitation program. Method: Participants were 2 cohorts of male patients in the same program treated with either CPT (n = 104) or TAU (n = 93; prior to the implementation of CPT). Cohorts were compared on changes from pre- to posttreatment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993) and other measures of symptoms and functioning. Minorities represented 41% of the sample, and the mean age was 52 years (SD = 9.22). The CPT group was significantly younger and less likely to receive disability benefits for PTSD; however, these variables were not related to outcome. Results: Analyses of covariance controlling for intake symptom levels and cohort differences revealed that CPT participants evidenced more symptom improvement at discharge than TAU participants on the PCL, F(3, 193) = 15.32, p     

Multifamily group treatment for veterans with traumatic brain injury.

A common clinical problem encountered by clinicians treating veterans who incurred traumatic brain injury (TBI) while serving in Afghanistan in support of Operation Enduring Freedom (OEF) or in Iraq in support of Operation Iraqi Freedom (OIF) is lack of knowledge about TBI on the part of the veterans' family members. Insufficient information can exacerbate marital or family conflict and lead to psychological distress and social isolation for the veteran and family, and suboptimal illness management for the veteran. To address this problem, we adapted Multifamily Group Treatment (MFGT), an evidence-based practice for treatment of serious mental illness (SMI), for treatment of OEF/OIF veterans with TBI and their families. We have implemented the adapted treatment (MFG-TBI) in four groups of veterans and families (N = 20 veterans and 20 family members) across two sites: the Durham VA Medical Center (VAMC) in North Carolina and the JJ Peters VAMC in the Bronx, New York. Adaptations focused on contents and format of the educational components, specification of a protocol for conjugal couples, and the addition of an ecomap to identify support systems during the joining (i.e. assessment) phase, a shorter (9 months) intervention duration, and a more active clinician role including use of motivational enhancement, intersession support, and coordination with other service providers. Biweekly group sessions were supervised and rated for adherence. We illustrate how MFG-TBI both educates and builds problem-solving skills with clinical examples. Suggestions for effective use of problem-solving skills with this population are offered. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Use of family focused therapy in rehabilitation for veterans with traumatic brain injury.

Objective: Military personnel returning from Iraq and Afghanistan with traumatic brain injury (TBI) present with a complex array of stressors encountered during combat as well as upon re-entry, often with additional physical and mental health comorbidities. This requires an intensive approach to treatment that includes family intervention as a part of rehabilitation. There is a small but growing literature addressing the needs of families when a family member has sustained a TBI. An established treatment intervention for individuals with serious mental illness, such as family focused therapy (FFT), is uniquely suited to address the complexity of issues presented by returning military personnel, and may be adapted for moderate to severe TBI populations. In this article, we discuss the rationale for adapting this family intervention for this population and present a case vignette illustrating adaptations for TBI. Conclusions: The adaptation of an existing family intervention for a chronic condition that focuses on enhancing both individual and family functioning is a useful starting point. With further research to modify FFT for this unique population and establish feasibility, this approach may supplement existing models of family intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premature termination in couple therapy with veterans: Definitions and prediction of long-term outcomes.

Premature termination (PT) has been identified as widespread in individual, family, and couple therapy. Unfortunately, research on PT utilizes numerous definitions of PT without providing guidance on which definition may be most clinically useful. The current study investigated seven definitions of PT (three based on therapist ratings and four based on quantitative measures) utilizing a sample of 177 couples seeking treatment at two Department of Veterans Affairs medical centers. Results indicated that PT occurred in 50–80% of couples; however, agreement between the definitions of PT was generally only in the slight to fair range, making it difficult to determine whether a particular couple was ready to terminate treatment. Additionally, many commonly used definitions of PT were unrelated to level or maintenance of relationship functioning following treatment. In contrast, two definitions of PT (ending treatment in the distressed range and therapist-rated likelihood of future unhappiness) significantly predicted larger decreases in relationship satisfaction during the 18 months following therapy, as well as lower levels of satisfaction and relationship stability 18 months after termination. Additionally, long-term relationship functioning was especially poor when both these definitions of PT were met, suggesting that both qualitative and quantitative definitions should inform decisions about termination in couple therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Exiting homelessness without a voucher: A comparison of independently housed and other homeless veterans.

Studies that have shown the superiority of housing voucher programs over standard care for homeless adults with mental illness have also incidentally shown that many are able to obtain independent housing without subsidies. The current study examined how individuals obtain housing without a voucher and whether greater employment earnings or better clinical outcomes were associated with such housing success. Data from an experimental evaluation of the Housing and Urban Development-Veterans Affairs Supportive Housing program were used for an observational study that compared participants who, at 3 months, were: (1) Independently Housed Without a Voucher (n = 96), (2) Independently Housed With a Voucher (n = 93), (3) Housed In Another Individual's Place (n = 60), or (4) Not Yet Housed (n = 170). Participants who obtained independent housing without a voucher worked more days and had higher employment income than those who did use a voucher, but they were less satisfied with their housing. About a third of participants who lived in independent housing without a voucher had others living with them. Homeless veterans with mental illness are able to use employment and shared housing as naturalistic ways to obtain independent housing. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Coercion and empowerment in the treatment of individuals with serious mental illness: A preliminary investigation.

Recently, treatment approaches for individuals with serious mental illness (SMI) have sought to increase autonomy to prevent frequent hospitalizations. Two of these strategies are coercive treatment and empowerment. Both coercive treatment and empowerment attempt to increase an individual's freedom from illness as well as rehospitalization. In the literature coercion is viewed as a barrier to empowerment, yet the long-term goals of both approaches are similar. Thus, coercive treatment may not serve as a barrier to empowerment. This study is a preliminary investigation of the empirical relationship between and among coercion, functioning, and empowerment. Participants were recruited from treatment centers in Mississippi and were at varying stages of treatment including inpatient and outpatient (N = 64). Variables of interest were measured with the MacArthur Admissions Experience Survey, Brief Symptom Inventory, Multnomah Community Ability Scale, MacArthur Competence Assessment Tool-Treatment, and Empowerment Scale. In this sample, only functioning was predictive of empowerment, suggesting that empowerment is dependent on an individual's level of functioning. In addition, coercion may not necessarily disempower individuals with SMI. Implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Developing an inpatient practicum program for patients with serious and persistent mental illness.

Training psychology students to treat patients with serious and persistent mental illness (SPMI) can provide an excellent opportunity for psychologists to help an historically disenfranchised and ignored population. With proper training, psychologists can play an important role in the development, provision, and administration of services to people with SPMI. We outline some of the issues to be considered in developing such a training program for practicum students, discuss the clinical skills and systemic issues that need to be mastered at the graduate level, and delineate the process by which this can be achieved in an inpatient, acute-care setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group composition and group therapy for complicated grief.

This prospective study investigated the impact of group composition on the outcome of 2 forms of time-limited, short-term group therapy (interpretive, supportive) with 110 outpatients from 18 therapy groups, who presented with complicated grief. The composition variable was based on the patient's level of quality of object relations. The higher the percentage of patients in a therapy group who had a history of relatively mature relationships, the better the outcome for all patients in the group, regardless of the form of therapy or the individual patient's quality of object relations score. The findings have direct clinical implications for composing short-term therapy groups for outpatients with complicated grief and possibly for other types of group therapies and patient problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening for principal versus comorbid conditions in psychiatric outpatients with the Psychiatric Diagnostic Screening Questionnaire.

In examining the performance of screening scales, a distinction should be made between principal and additional diagnoses. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a brief, psychometrically strong self-report scale designed to screen for the most common Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Axis I disorders encountered in outpatient mental health settings. In the present report, the authors compared the performance of the PDSQ in identifying principal and comorbid disorders. Seven hundred ninety-nine psychiatric outpatients completed the PDSQ and were interviewed with the Structured Clinical Interview for DSM-IV. The sensitivity and negative predictive values of the PDSQ subscales were similar for principal and additional diagnoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group climate development in cognitive and interpersonal group therapy for social phobia.

This study was designed as a longitudinal study of 80 participants in cognitive group therapy (RCT, n = 40) and interpersonal group therapy (RIPT, n = 40) for social phobia during 10 weeks of residential therapy. The aim was to investigate the patterns of group climate development and its impact on treatment outcome. Data were collected using MacKenzie's Group Climate Questionnaire (GCQ) 4 times during treatment, and a multilevel (mixed) model approach was used in the analyses. Engagement in RCT groups showed a linear increase during treatment in contrast to a linear decline among patients in RIPT groups. This divergence might be explained by the focus on extragroup and intragroup relationships in RCT and RIPT, respectively. Neither conflict nor avoidance followed the expected pattern, nor did their mean levels influence outcome. However, when 6 extreme values of conflict were removed, there was support for a low–high–low pattern of conflict. In general, these results do not support MacKenzie's generic model of group climate development but suggest that sample characteristics, treatment models, and setting can play major roles in determining the group climate. Of the group climate variables, only the mean level of engagement predicted a change in social anxiety over the course of treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Predicting attendance and expectations for group therapy.

Inconsistent membership is one of the leading problems in groups. Group therapy participants (N=310) from 2 university counseling centers were studied over a period of 7 years to examine interpersonal style, expectations, and attendance in group therapy. The Group Therapy Questionnaire (R. R. MacNair & J. Corazzini, 1994; R. R. MacNair-Semands, 1996, 1997, 2001) assessed client goals, substance use, and interpersonal problems in relation to expectations for group and attendance. A discriminant analysis demonstrated that angry hostility and social inhibition were predictive of low attendance. Additionally, clients with previous therapy reported more positive expectations about group, whereas those reporting greater substance use and more somatic symptoms had fewer positive expectations about group. Implications for treatment decisions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of antisocial personality characteristics on anger management treatment for veterans with PTSD.

Using multilevel modeling, the authors examined the impact of antisocial personality characteristics on the effectiveness of cognitive–behavioral anger management group treatment among 86 veterans with posttraumatic stress disorder. A wide range of forms of anger, as well as use of physical aggression, decreased during treatment. As predicted, antisocial personality characteristics were associated with smaller decreases in trait anger, anger expression, and use of physical aggression during treatment. Conversely, these characteristics were associated with a greater decrease in state anger. Mechanisms of action and implications for the role of anger and antisocial personality in treatment are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Solution-oriented therapy for chronic and severe mental illness.

Reviews the book, Solution-oriented therapy for chronic and severe mental illness by Tim Rowan and Bill O'Hanlon (see record 2001-01051-000). This book presents clever and compelling interventions that are very informed, caring, egalitarian, and anchored in what we now know that clients with severe mental illness (SMI) want. The first eight chapters are extraordinarily good. They cover hopeful approaches for demoralized patients, methods of challenging beliefs such as the impossibility of change, ideas that blame, and ideas that disempower or invalidate clients or families. The last four chapters, however, lacked innovation, were too short and too basic, and simply did not have much to say. The cases the authors presented suggested that the clients they were working with were high functioning people with SMI. The authors do not appear to address the patients with neurocognitive deficits, lower IQs, poor verbal skills, and deficits in basic life skills. Also, the reference list is very brief and ignores most of the work that has appeared in the last 10 years or so. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A school-based group activity therapy intervention with at-risk high school students as it relates to their moral reasoning.

The main goal of this study was to examine whether group therapy is useful for developing moral reasoning in at-risk youth. This research compared the impact of 10 weeks of group activity therapy (n = 27) and group talk therapy (n = 34) on the moral reasoning of at-risk ninth grade students. Group activity therapy is the developmentally appropriate extension of child centered play therapy for adolescents. Using pretest and posttest scores on the Maintaining Norms Schema subscale of the Defining Issues Test 2 (DIT-2; Rest, Narvaez, Thoma, & Bebeau, 1999), an analysis of covariance indicated significant difference between groups. Implications for counselors who work with this population are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using positive psychology with special mental health populations.

In our clinical practice, we have attempted to use a positive psychology approach in working with people with schizophrenia and youths with behavioral disorders. We present three clinical applications that use a positive psychology approach with these populations: group treatment with persons with schizophrenia; individual cognitive stimulation therapy with persons with schizophrenia; and computer-facilitated dialogue and therapy with persons with schizophrenia and adolescents with behavioral disorders. These three clinical applications using positive psychology are consistent with those traditional treatment goals that aim to increase clients' functioning and improve their quality of life. Given that many people with long-standing emotional "problems" have difficulties initiating change or internalizing feedback regarding their behavioral deficits, the therapeutic environment and clinical interactions need to focus equally on clients' strengths and skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model for home-based psychology from the veterans health administration.

The changing healthcare environment is creating opportunities for psychologists to practice in non-traditional settings. This paper describes a Veterans Health Administration (VA) initiative to integrate psychologists into its Home Based Primary Care (HBPC) program. As psychologists new to HBPC are learning, the home offers opportunities and challenges not routinely encountered in the traditional office setting. Home-based psychology offers improved access to mental health services, more effective treatment planning, and more accurate assessments in an underserved patient population. Psychologists practicing in this setting also encounter challenges in dealing with patient confidentiality, distractions, role confusion and boundaries, time management, safety, and professional competency. The VA experience is an instructive case example for psychologists considering this growing field of practice. This paper offers lessons learned from this VA initiative and discusses strategies for dealing with potential challenges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)