Browsing by Author "Minor, Kyle"
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Item Addressing Formal Thought Disorder in Psychosis through Novel Assessment and Targeted Intervention(2020-08) Marggraf, Matthew P.; Minor, Kyle; Salyers, Michelle; Lysaker, Paul; Stewart, JesseFormal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD.Item Afraid of AIDS: AIDS Panic and Gay Discrimination through State of Indiana v. Herb Robbins(2024-09) Gackle, Dalton; Haberski, Raymond J.; Guiliano, Jennifer; Minor, KyleIn 1988 Herb J. Robbins, a 17-year-old male prostitute, murdered prominent Indianapolis attorney Donald L. Jackson. Robbins then used a “fear of AIDS” defense in court to escape murder charges. This defense highlighted the discrimination faced by gay men and the heightened fear of acquired immunodeficiency syndrome (AIDS) then a little-understood disease. This story fits into larger discussions about AIDS and our cultural and governmental response to it. For Indiana’s population in the 1980s, a fear of AIDS meant a fear of gay men, as gay men were the first people identified with AIDS – in 1981 and 1982 AIDS was known as GRID: gay-related immunodeficiency disease. This opened the door for discrimination in all facets of society – including in the courts – leading to the successful ‘fear of AIDS’ defense in 1988. That ingrained discrimination has had lasting effects on Indiana’s residents and especially on its gay communities including, but not limited to, the criminalization of persons with human immunodeficiency virus (HIV). In 1985, many states, including Indiana responded to HIV in the blood supply by closing blood banks and passing laws making it illegal for people with HIV/AIDS to donate. The Food and Drug Administration, as well, banned gay or bisexual men from donating blood for fear they might have HIV/AIDS. Indiana also passed a law requiring people with HIV to notify any potential sexual partner about their HIV positive status. The laws criminalizing people living with HIV were created in direct response to a fear of AIDS in the blood supply, which was only amplified by Ryan White’s infamous story. Connecting gay and bisexual men in Indiana’s HIV laws and the FDA’s policy on HIV/AIDS only further stigmatized gay men and people living with HIV by associating them with criminal activity, including the criminalization of Donald Jackson when Herb Robbins testified that he killed Jackson for fear he could have gotten AIDS from him. This paper seeks to understand 1) Why was Indianapolis a place where this “fear of AIDS” defense could succeed? and 2) How does this defense reflect broader discrimination and stigmatization directed toward the gay community?Item California Dreaming: Place and Persona in the Essays of Joan Didion and Eve Babitz(2019-12) Christoff, Claire Elizabeth; Rebein, Robert; Kovacik, Karen; Minor, KyleJoan Didion, a native of Sacramento, California, is the author of many acclaimed collections of journalism and memoir, the first of which were Slouching Towards Bethlehem (1968) and The White Album (1979). Eve Babitz, a lifelong resident of Los Angeles, has produced two such volumes: Eve’s Hollywood (1974) and Slow Days, Fast Company: The World, The Flesh, and L.A. (1977). While much critical ink has been spilled over Didion’s oeuvre, Babitz was, until the recent reprinting of the aforementioned titles, known best as an artist and muse. Perhaps due to this disparity in recognition and renown, no extant critical piece serves to compare the nonfiction of Didion and Babitz, despite their close geographic and social proximity. In viewing their early work side by side, the Golden West of the 1960s and ’70s emerges as the clearest point of comparison; however, the ways in which Didion and Babitz use place and time in their work often differ due to the marked contrasts in the identities they convey. In characterizing herself as a journalist and an observer, Didion offers a perspective that feels objective but is, at turns, wry and cool. Babitz, writing in a manner that was, at one time, considered autofiction, positions herself as the freewheeling focal point around which Hollywood’s dizzying cultural landscape unfolds. By manipulating the constructs of place and persona, these writers are better equipped to tell the story at hand and analyze their places within it, cementing their work in California’s literary canon.Item Examining the Role of Dysfunctional Beliefs in Individuals with Schizotypy(2015) Luther, Lauren; Salyers, Michelle; Minor, Kyle; Rand, KevinIn accord with the cognitive model of poor functioning in schizophrenia, defeatist performance beliefs, or overgeneralized negative beliefs about one’s ability to perform tasks, have been linked to poor functional outcomes, cognitive impairment, and negative symptoms in schizophrenia and are a suggested therapeutic target in Cognitive Therapy for Schizophrenia. However, there is a paucity of research investigating these beliefs in schizotypy, or those exhibiting traits reflecting a putative genetic liability for schizophrenia. This study had three aims: to examine whether defeatist performance beliefs 1) are elevated in schizotypy compared to non-schizotypy, 2) are associated with functioning-related outcomes (i.e., quality of life, working memory, negative schizotypy traits), and 3) mediate the relationships between working memory and both negative schizotypy traits and quality of life. Schizotypy (n = 43) and non-schizotypy (n = 45) groups completed measures of schizotypy traits, defeatist performance beliefs, quality of life, and working memory. Results revealed that the schizotypy group reported significantly more defeatist performance beliefs than the non-schizotypy group. Within the schizotypy group, defeatist performance beliefs were significantly positively associated with negative schizotypy traits and significantly inversely associated with quality of life. No associations were observed between defeatist performance beliefs and positive schizotypy traits and working memory. Further, defeatist performance beliefs did not mediate the relationships between working memory and either quality of life or negative schizotypy traits. Findings are generally consistent with the cognitive model of poor functioning in schizophrenia and suggest that defeatist performance beliefs may be an important therapeutic target in early intervention services.Item Nutrition Enhancement in Early Psychosis (Neep): A Feasibility Trial of Enhanced Nutrition with Text Messaging and a Dietary Tracking Mobile Application(2022-08) Fischer, Melanie W.; Salyers, Michelle; Minor, Kyle; Stewart, Jesse; Rivera, Rebecca; Leonhardt, BethanyBackground. People with psychotic disorders tend to die earlier than the general population, primarily due to preventable cardiovascular disease. Behavioral risk factors, such as poor diet, have been identified as major contributors. Given the importance of prevention, the early stages of psychosis have been described as a “critical” time to intervene on health behaviors. As such, a mobile-based intervention, Nutrition Enhancement in Early Psychosis (NEEP) was created to improve diet quality in persons with early psychosis. This study has three aims: (1) assess the feasibility of the intervention, (2) examine preliminary outcomes, and (3) investigate mechanisms associated with dietary change. Methods. NEEP incorporates a combination of nutrition education, goal setting, and mobile technology (i.e., a mobile application for dietary tracking, as well both automated and personalized text-messages). Given the pilot nature of the study, all participants (N=15) received the intervention. Feasibility was assessed through different metrics related to recruitment and adherence to the dietary tracking application, as well as self-report responses regarding acceptability. Preliminary outcomes (i.e., two measures of diet quality) and potential mechanisms of change (i.e., self-efficacy and motivation) were also evaluated using paired sample t-tests. Qualitative interviews were conducted following study participation. Given the emphasis on feasibility with a small sample, all significance tests were set at p <.10, and Hedges g was used to examine effects over time. Results. 15 participants were enrolled in the study and 12 participants completed follow-up assessments. Evaluative measures of feasibility suggest that the majority of those who were screened enrolled in this intervention and regularly engaged with the mobile tracking device to record their dietary consumption. In addition, participants enjoyed the intervention and found it to be useful in improving their diet. Preliminary evidence also suggests this intervention may improve diet quality. As such, one indicator of improvement in diet quality was considered significant (Rapid Eating Assessment for Participants- Shortened; p=.084), and both measures of diet quality suggested improvement in diet at the end of the 28-day intervention with small to medium effect sizes (REAP-S g=.44; Heathy Eating Index-2015 g=.69). Contrary to hypotheses, self-efficacy significantly decreased after the intervention (p=.028) and motivation remained relatively stable. Conclusion. Results suggest that NEEP is feasible as a low-cost, low-resource mobile intervention that is well-tolerated and may improve diet quality in people with early psychosis; however, mechanisms of change require further exploration.Item The Relationship Between Working Alliance, Patient Activation, Hope, and Depression in Community Mental Health Care(2021-08) Bass, Emily L.; Salyers, Michelle P.; Minor, Kyle; Rand, KevinObjectives: Previous research suggests an association between working alliance, the collaborative and affective bond between patient and therapist, and improved therapeutic treatment outcomes within treatment of severe mental illness (SMI). However, little is known about the mechanisms through which working alliance improves outcomes in this population. Through investigating key elements of recovery within SMI, two possible mediators—patient activation and hope—appear particularly relevant to the relationship between working alliance and improved treatment outcomes. The current study aimed to examine patient activation and hope as potential mediators in the relationship between working alliance and improved depression in individuals with SMI. Additionally, the current study investigated whether or not the patient’s evaluation of which provider is most important to their recovery significantly moderated the relationship between working alliance and patient activation/hope. Methods: The current study was a secondary analysis of longitudinal (baseline, 6-month, and 12-month) data comparing two interventions aimed at reducing treatment provider burnout in community mental health settings primarily serving individuals with SMI. Participants (maximum N for analyses = 346) completed measures of working alliance with a linked provider on their treatment team, patient activation, hope, and depression at baseline, 6 months, and 12 months. Using moderated mediation analysis, 6-month patient activation and 6-month hope were examined as mediators in the relationship between baseline working alliance and 12-month improved depression (change score between 12-month and baseline depression). Additionally, whether or not the patient deemed their linked provider as most important to their recovery was tested as a moderator in the relationship between baseline working alliance and 6-month patient activation/hope. Results: Overall, the current study’s hypothesized model was not supported. Baseline working alliance did not significantly predict improved depression 12 months later. Further, both patient activation and hope measured at month 6 in the study did not significantly mediate the relationship between working alliance quality at baseline and improved depression at month 12. Additionally, whether or not the patient believed their linked provider was most important to their recovery did not significantly moderate the relationship between baseline working alliance and 6-month patient activation or 6-month hope. However, results indicate that better quality working alliance at baseline did significantly predict higher patient activation at 6 months. Lastly, the current study found a significant positive correlation between importance of provider and baseline working alliance. Discussion: Results suggest that improvement in depression may not be a key SMI treatment outcome that relates to working alliance, patient activation, and hope. Further, fostering a positive working alliance (e.g., collaboratively developing goals/tasks in-session) may increase patient’s ability, willingness, and confidence in managing their own mental health care. Additionally, a positive working alliance may also contribute to how important the patient believes the provider is to their recovery. However, those that have seen their provider for longer (e.g., more chronically ill) may be less active in managing their own mental health care. Limitations and possible future directions are discussed.Item Veterans with early psychosis: a comparison of veterans and non-veterans(2018) White, Dominique A.; Salyers, Michelle; McGuire, Alan; Zapolski, Tamika; Minor, KyleAim: Early psychosis has been identified as period during which rapid identification and treatment can lead to significant improvement in clinical and functional outcomes. Despite increased research, no studies have examined early psychosis in Veteran populations. It is unknown whether Veterans differ from non-Veterans at this stage of the disorder, and if the treatments offered to non-Veterans are appropriate to implement in Veteran Affairs Medical Centers. Given differences that appear between Veterans and non-Veterans in chronic psychosis, additional work is necessary to determine the best way to approach specialized treatment for Veterans experiencing early psychosis. Methods: The current study is a secondary analysis of assessment batteries collected at a community-based early intervention program and at a local Veteran Affairs Medical Center. Assessment results were compared for Veterans’ and non-Veterans’ background characteristics, symptoms, and neurocognitive deficits. Results: Significant differences were found between the two samples on age of illness onset, marital status, education level, positive symptoms of psychosis, and neurocognitive functioning. Logistic regression analyses identified age of onset as a potential underlying factor. Conclusions: While some aspects of illness presentation appear similar between Veterans and non-Veterans, there are important differences between these populations. Pre-existing treatment interventions, such as Social Skills Training, cognitive remediation approaches and cognitive behavior therapy for psychosis may be appropriate to implement with Veterans. Others– such as family based interventions or supported employment services – may need to be tailored to maximize the benefit for Veterans.