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UBC Theses and Dissertations

Development and evaluation of an affective problem solving program for chronic psychiatric patients Malkin, Pamela Cramond


Apparent maladjustment in the lower prognosis patient who suffers grave psychiatric difficulties and frequently is hospitalized may be due to a lack of availability of relevant Problem-Solving strategies. Recent developments in cognitive-behavioural programs designed to enhance acquisitions of Problem-Solving skills such as Interpersonal Cognitive Problem-Solving Skills Training (ICPS) have been directed with some success towards the chronic psychiatric patient population. (Siegel and Spivack, 1976). However, many of these cognitively-oriented programs may not be recognizing the full range of skill deficits that are so commonly associated with the poorer prognosis patient. Factors such as misconceptions about the nature of treatment, patient externalization of problems, inability to recognize and define problems of an intrapsychic nature and lack of reflection in decision-making are common characteristics of the low prognosis, lower socio-economic patient who enters treatment. Further, current ICPS training models promote a lock-step, sequenced Problem-Solving process that may not be familiar or meaningful to this patient group. ICPS training programs directed at chronic psychiatric patients may also lack the emphasis on-problem recognition and accurate problem definition, may fail to teach specificity and concreteness in problem expression, may ignore the minimal levels of affective vocabulary of the lower prognosis patient and ignore the importance of "discovery methods" and search strategies in emotional Problem-Solving . In this research, an emotional Problem-Solving training program based on client-centered theory, the Process Orientation Procedure (POP), was developed and compared to a traditional ICPS (PS) training program. The POP focuses primarily upon affect, attention to process and a more general Problem-Solving orientation whereas the PS program to which it was compared focuses on cognitions and sequential steps in Problem-Solving. These two programs were field tested with a sample of 73 chronic male and female hospitalized psychiatric patients, a population that has been traditionally viewed as having a high probability of relapse and as resistant to change. Five wards of chronic psychiatric care facility (Crease Unit, Riverview Provincial Mental Hospital, Coquitlam, B.C., Canada), were utilized in a two-by-five (treatment-by-ward / therapist) fully crossed factorial design. Measures of focusing ability (the Post-Focusing Questionaire and the Post-Focusing Checklist), means-ends problem-solving ability (the Means-Ends Problem-Solving Procedure), anxiety (the STATE and Trait Anxiety Inventories), and severity of symptoms (Global Severity of Symptom Index, SCL-90) were examined as dependent variables. Indications of one non-valid treatment condition led to the discarding of one ward. A 4 x 2 fixed effects analysis of covariance, using the SCL-90 Global Severity Index (GSI) as covariate, was performed on each of the post measures of the seven dependent variables. Only one significant result was obtained: the Global Severity Index of the SCL-90 was found to be significantly different in favour of the POP treatment conditions. Because of lack of controls in a field setting, the result can be judged as a promising but tentative finding. Certainly, this research indicates development of an affectively-oriented program that stresses skill-building in the utilization of the individual's internal experience of an emotionally-based problem may have as much value for this difficult clinical population as the more conventional step-by-step Problem-Solving process used in cognitively-oriented ICPS programs.

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