Browsing by Author "Firmin, Ruth L."

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    Additional Support for the Cognitive Model of Schizophrenia: Evidence of Elevated Defeatist Beliefs in Schizotypy
    (Elsevier, 2016-07) Luther, Lauren; Salyers, Michelle P.; Firmin, Ruth L.; Marggraf, Matthew P.; Davis, Beshaun; Minor, Kyle S.; Department of Psychology, School of Science
    Objectives The cognitive model of poor functioning in schizophrenia posits that defeatist performance beliefs—overgeneralized negative beliefs about one's ability to perform tasks—develop prior to the onset of psychosis and contribute to the development and maintenance of negative symptoms and poor functioning. Although several studies with schizophrenia samples have provided support for the model, there is a paucity of research investigating these beliefs in individuals with schizotypy—those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had two aims: to examine whether defeatist performance beliefs (1) are elevated in schizotypy compared to controls and (2) are associated with decreased quality of life and working memory and increased negative but not positive schizotypy traits in the schizotypy group. Methods Schizotypy (n = 48) and control (n = 53) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. Results Analyses revealed that the schizotypy group reported significantly more defeatist performance beliefs than the control group. Within the schizotypy group, increased defeatist performance beliefs were significantly associated with greater negative schizotypy traits and lower quality of life. No significant associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. Conclusions Results generally support the theoretical validity of the cognitive model of poor functioning in schizophrenia and suggest that elevated defeatist performance beliefs may contribute to the manifestation of subclinical negative symptom traits and reduced quality of life among those with a latent vulnerability for schizophrenia.
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    Appreciative Inquiry as Organizational Change in a Community Mental Health Setting
    (Office of the Vice Chancellor for Research, 2013-04-05) Firmin, Ruth L.; Salyers, Michelle P.; Gerhart, Timothy; Frankel, Richard M.; Avery, Elizabeth
    Appreciative Inquiry (AI) is an approach to organizational change that focuses on the strengths of an organization – discovering what is working well, and generating ideas within the organization for building on those strengths. AI has been applied in a variety of contexts including education, social work, health care, and academia. Little to no research, however, has applied AI to mental health contexts. The current study reports themes from staff member interviews conducted in the early phases of AI applied in a community mental health center (CMHC); these themes paint a picture of this CMHC “at its best” and will be fed-back to employees to lay the foundation for change and enhancing morale among staff. Interviews were conducted by 11 staff who volunteered from various departments and were trained by research staff at an all-day training. Appreciative Interviews first involved asking staff to describe a time they were at their best at this organization. Next, participants were asked to share what it was about themselves, others, and the setting that contributed to this experience. Additionally, interviewees were asked to “dream into the future” and to describe what they wish to see for this organization. Interviews were audio recorded, transcribed, and de-identified. Iterative, consensus-based coding was conducted by a multidisciplinary team that included CMHC staff. Several consistent themes emerged among participants’ stories. Staff at their best frequently reported feeling effective and seeing success in working with consumers. Other themes included working as a team, communicating well, and trusting one another. Stories also involved feeling valued and supported by their supervisors and coworkers. A foundational aspect involved believing in and caring about consumers with whom they work. Themes from participants’ interviews reflect perceptions of this community mental health center at its best and are consistent with tenets self-determination theory and future study.
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    Clarifying the Overlap Between Motivation and Negative Symptom Measures in Schizophrenia Research: A Meta-Analysis
    (Elsevier, 2019-04) Luther, Lauren; Fischer, Melanie W.; Firmin, Ruth L.; Salyers, Michelle P.; Psychology, School of Science
    Motivation and negative symptom research has recently been hampered by a series of inconsistent findings, leading to calls for a greater consensus on the type of measures used across studies. To inform this issue, we conducted a meta-analysis that quantified the association between motivation measures (self-report, performance-based) and clinician-rated negative symptom measures as well as a series of moderator analyses to develop a greater understanding of the measurement factors impacting this relationship. Forty-seven eligible studies with people with schizophrenia-spectrum disorders were included. Using a random-effects meta-analytic model, a small but significant overall effect size emerged between motivation and clinician-rated negative symptoms (r = −.18). Several significant moderators were identified, including the generation of negative symptom measures such that there was a significantly stronger relationship between motivation and second-generation (r = −.38) than first-generation negative symptom measures (r = −.17). Further, the type of performance-based measure used moderated the relationship, with effort discounting tasks most strongly related to negative symptoms (r = −.44). The domain of motivation assessed (intrinsic, extrinsic, amotivation) also moderated the relationship. These findings help to identify sources of inconsistencies observed in prior studies and point to both second-generation and effort discounting tasks as the most promising types of measures, particularly for those interested in validating motivation measures or assessing the effectiveness of motivation treatments. Although additional research is needed, our results suggest that using these measures may help to reduce inconsistencies across studies and move the field forward.
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    Consumer Outcomes After Implementing CommonGround as an Approach to Shared Decision Making
    (APA, 2017-03) Salyers, Michelle P.; Fukui, Sadaaki; Bonfils, Kelsey A.; Firmin, Ruth L.; Luther, Lauren; Goscha, Rick; Rapp, Charles A.; Holter, Mark C.; Psychology, School of Science
    Objective: The authors examined consumer outcomes before and after implementing CommonGround, a computer-based shared decision-making program. Methods: Consumers with severe mental illness (N=167) were interviewed prior to implementation and 12 and 18 months later to assess changes in active treatment involvement, symptoms, and recovery-related attitudes. Providers also rated consumers on level of treatment involvement. Results: Most consumers used CommonGround at least once (67%), but few used the program regularly. Mixed-effects regression analyses showed improvement in self-reported symptoms and recovery attitudes. Self-reported treatment involvement did not change; however, for a subset of consumers with the same providers over time (N=83), the providers rated consumers as more active in treatment. Conclusions: This study adds to the growing literature on tools to support shared decision making, showing the potential benefits of CommonGround for improving recovery outcomes. More work is needed to better engage consumers in CommonGround and to test the approach with more rigorous methods.
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    Correlates of observer-rated active involvement in psychiatric treatment visits
    (Elsevier, 2017-10) Bonfils, Kelsey A.; Luther, Lauren; Fukui, Sadaaki; Adams, Erin L.; Dreison, Kimberly C.; Firmin, Ruth L.; Salyers, Michelle P.; Department of Psychology, School of Science
    Among people with serious mental illness, increased patient activation has been linked to a range of key recovery outcomes. To date, patient activation has been measured largely through self-report. The present study investigated correlates of a new tool that assesses active involvement through rating audio-recordings of treatment visits. The key domains of patient activation assessed in visits included: patients asking questions, discussing with providers instances of being active in managing illness outside the session, talking about goals, bringing up concerns, making evaluative statements about treatment, setting the agenda for the visit, and making requests about the course of treatment. The new coding scheme proved to be a feasible and reliable method for identifying multi-faceted behavioral indicators of patient activation. Contrary to our hypotheses, in a sample of 166 people diagnosed with severe mental illnesses, self-reported activation and observer-rated indices of activation were often not correlated or correlated in unexpected directions with the new behavioral measure of patient activation. This suggests the nature of patient activation may be complex and work is needed to understand how observer-rated and self-rated activation may predict differential recovery outcomes.
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    The development and validation of a new measure of stigma resistance
    (2016) Firmin, Ruth L.; Salyers, Michelle P.
    STUDY 1: Objective: Stigma resistance is consistently linked with key recovery outcomes, yet theoretical work is limited. This study explored stigma resistance from the perspective of individuals with serious mental illness (SMI). Methods: Twenty-four individuals with SMI who were either peer-service-providers (those with lived experience providing services; n = 14) or consumers of mental health services (n = 10) engaged in semi-structured interviews regarding experiences with stigma, self-stigma, and stigma resistance, including key elements of this process and examples of situations in which they resisted stigma. Results: Stigma resistance is an ongoing, active process that involves using one’s experiences, knowledge, and sets of skills at the 1) personal, 2) peer, and 3) public levels. Stigma resistance at the personal level involves a) not believing stigma or catching and challenging stigmatizing thoughts, b) empowering oneself by learning about mental health and recovery, c) maintaining one’s recovery and proving stigma wrong, and d) developing a meaningful identity beyond mental illness. Stigma resistance at the peer level involves using one’s experiences to help others fight stigma and at the public level, resistance involved a) education, b) challenging stigma, c) disclosing one’s lived experience, and d) advocacy work. Discussion: Findings present a more nuanced conceptualization of resisting stigma, grounded in the experiences of people with SMI. Interventions should consider focusing on personal stigma resistance early on and increasing the incorporation of peers into services. STUDY 2: Background: Despite strong links between stigma resistance and recovery outcomes, limitations of existing measures of stigma resistance have contributed to this construct remaining largely under-studied. This study sought to develop and validate an improved measure of mental illness stigma resistance, grounded in the perspectives of people with lived experience. Method: An item pool was developed from qualitative interviews (Study 1) and items were piloted in an online MTurk sample with people self-reporting a mental illness diagnosis (n=489). Best performing items were selected and preliminary factor structure was examined using exploratory factor analysis in a subset of the sample (30%, n=161). The new measure was then administered to individuals at two state mental health consumer recovery conferences (n=202) and confirmatory factor analyses were conducted to assess factor structure and refine the measure. Validity of the new scale was then examined through correlations with theoretically relevant measures. Results: The EFA suggested possible models of either 1, 3, or 5 factors. CFA demonstrated that the 5-factor model best fit the remaining MTurk data (n=328) and this was replicated in the conference sample; these samples were then combined to refine the measure across a heterogeneous sample (n=530). The final 20-item measure demonstrated good internal consistency for the total score (.93) and each of the 5 subscales (.71 - .88), good test-retest reliability (.74), and strong construct validity. Discussion: This study produced an improved measure of stigma resistance with strong psychometric properties and construct validity. Use of this new measure will allow for a more nuanced assessment of stigma resistance across important domains of recovery.
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    Expectations of Success as a Predictor of Negative Symptom Reduction over 18 months in Individuals with Schizophrenia
    (Elsevier, 2015-09) Luther, Lauren; Fukui, Sadaaki; Firmin, Ruth L.; McGuire, Alan B.; White, Dominique A.; Minor, Kyle S.; Salyers, Michelle P.; Department of Psychology, School of Science
    Negative symptoms are often enduring and lead to poor functional outcomes in individuals with schizophrenia. The cognitive model of negative symptoms proposes that low expectancies of success contribute to the development and maintenance of negative symptoms; however, longitudinal investigations assessing these beliefs and negative symptoms are needed. The current study examined whether an individual’s baseline expectancies of success – one’s beliefs about future success and goal attainment – predicted negative symptoms reduction over 18 months in individuals with schizophrenia-spectrum disorders (n=118). Data were collected at baseline, 9 months, and 18 months as part of a randomized controlled trial of Illness Management and Recovery. A mixed effects regression analysis revealed a significant reduction in negative symptoms over time, with a significant interaction effect between time and baseline expectancies of success. After controlling for baseline negative symptoms, demographic variables, and treatment conditions, those with high and moderate baseline expectancies of success evidenced a significant reduction in negative symptoms at 18 months, while those with low baseline expectancies of success did not evidence reduced negative symptoms. Findings support the cognitive model of negative symptoms and suggest that expectancies of success may be a useful treatment target for interventions aimed at reducing negative symptoms.
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    Greater Metacognition and Lower Fear of Negative Evaluation: Potential Factors Contributing to Improved Stigma Resistance among Individuals Diagnosed with Schizophrenia
    (2017-01) Firmin, Ruth L.; Luther, Lauren; Salyers, Michelle P.; Buck, Kelly D.; Lysaker, Paul H.; Psychology, School of Science
    Stigma resistance, one's ability to block the internalization of stigma, appears to be a key domain of recovery. However, the conditions in which one is most likely to resist stigma have not been identified, and models of stigma resistance have yet to incorporate one's ability to consider the mind of others. The present study investigated the impact of the interaction between metacognition, or one's ability to form an integrated representation of oneself, others, and the world, and fear of negative evaluation on one's ability to resist stigma.Narratives of encounters with stigma shared by 41 persons with schizophrenia or schizoaffective disorders were first coded for spontaneous expressions of fear of negative evaluation from others. Two-step cluster analyses were then conducted in order to test the hypothesis that metacognition and fearing negative evaluation from others are important, interacting pathways which contribute to resisting stigma.Those with high (n = 11; 26.8%), intermediate (n = 9; 22.0%), and low metacognition (n = 21; 51.2%) significantly differed on stigma resistance (F = 9.49, p<0.001) and the high metacognition group was most likely to resist stigma. Those with high and low metacognition did not express fear of negative evaluation, while those with intermediate metacognition did express fear of negative evaluation.
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    Helping Behaviors and Recovery in Severe Mental Illness
    (Office of the Vice Chancellor for Research, 2014-04-11) Firmin, Ruth L.; Luther, Lauren; Salyers, Michelle P.
    Background: Despite recent interest in peer-support workers in recovery-oriented services, little is known about how helping behaviors may affect recovery from severe mental illness (SMI). The current study is a mixed-methods approach to understanding self-motivated helping behaviors and their relationship with recovery outcomes among persons with SMI. Method: Forty-six participants with schizophrenia-spectrum disorders completed a narrative interview and standardized measures of recovery, positive and negative symptoms, hope, patient activation, and illness management. Interviews were coded using modified grounded theory. We compared individuals who (unprompted) mentioned helping behaviors in their interview to those who did not on recovery-related outcomes. Results: Sixteen participants (35%) reported unprompted self-motivated helping behaviors, including a desire to tell others their story, teach others recovery-promoting tools, become a peer-support worker, give back to society, and be more active family members. Those who discussed helping others in narrative interviews scored significantly higher on scales assessing recovery, illness management, patient activation, hope, functioning, insight and lower overall symptom severity, negative symptoms, and thought disorder than those who did not discuss helping behaviors. Discussion: Findings suggest that helping others may contribute to recovery from SMI. Implications include focusing on meaningful work/volunteerism and expanding roles for peer-support in recovery-oriented services.