Friday Factoids: Mandatory Psychological Testing for Disability Claims?

A new report from the Institute of Medicine (IOM) recommends broader standardized psychological testing for applicants that are submitting claims for mental health disabilities to the U.S. Social Security Administration (SSA) with the belief that incorporating additional psychological testing could improve both the accuracy and the consistency of disability determinations. In 2012 the SSA provided disability benefits to approximately 15 million adults and children. Proponents contend that mandatory psychological testing, validity based measures in particular, would result in significantly lower application approval rate, resulting in a substantial cost savings.

 

At the present, state agencies determine eligibility for disability based on medical records in addition to other evidence deemed relevant in an applicant’s case record. Standardized psychological tests that have been conducted are considered to be eligible material permitted for review within an applicant’s case file. Tests assessing validity can be used in conjunction with standardized psychological tests in order to assess whether the individual being evaluated is exerting a genuine effort and/or providing an accurate portrayal of their symptoms. While the SSA recognizes that utility and validity of psychological testing, it currently only requires testing to be conducted in cases pertaining to intellectual disability (ID), as an intelligence quotient (IQ) score is required in order to determine ID eligibility criteria.

 

Currently, SSA policy prevents requiring an applicant to submit psychological testing, but applicants (and their representatives) are permitted to submit psychological testing in support of their claims. It was recommended by the IOM that the SSA adopt a policy that incorporates mandatory standardized, non-cognitive psychological testing for all applicants that purport non-cognitive related impairments. It is their contention that testing should be required when the purported symptoms is based primarily on an applicant’s self-reported symptoms in the absence of objective medical evidence or longitudinal medical records that are considered sufficient to make a determination for disability. At the present, the IOM is gathering more information in order to more accurately offer an approximation of the cost savings that may be gained through mandatory incorporation of psychological testing in disability claims.

 

Faisal Roberts, M.A.

WKPIC Doctoral Intern

 

Nauert PhD, R. (2015). Report Urges More Psychological Testing to Determine Disability Claims. Psych Central. Retrieved on April 13, 2015, from http://psychcentral.com/news/2015/04/13/recommendation-expand-psychological-testing-to-better-determine-disability-status/83466.html

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Accreditation News!

WKPIC is elated to announce that we discovered this on APA’s website today, thanks to former intern David Wright:

 

Western Kentucky Psychology Internship Consortium – Hopkinsville, KY – Effective December 9, 2014
Next site visit 2021

At its meeting on March 19-22, 2015, the APA Commission on Accreditation reviewed the psychology internship program at theWestern Kentucky Psychology Internship Consortium and voted to approve initial accreditation, with the next site visit scheduled 7 years from the date of the program’s last site visit. The 7 year decision is based on CoA’s professional judgment of compliance or substantial compliance with all domains of the Guidelines and Principles for Accreditation (G&P). No serious deficiencies.

 

Reaching for Success

 

 

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Friday Factoids: Are Mental Practice Exercises Beneficial for Individuals that Have Experienced a Stroke?

 

 

Results yielded from a new study conducted by Georgia State University indicates that a person recovering from a recent stroke should undergo both physical therapy and mental practice (also known as motor imagery) in order to gain the most optimal results. Motor imagery is a mental rehearsal of a motor action without actually performing the action (while physical therapy involves using repetitive, task-oriented training on the body part that is impaired). The combination of physical therapy and motor imagery should be used to improve motor movement, balance, and coordination in individuals that have suffered a recent stroke.

 

For participants, the researchers employed the use of 13 older stroke survivors in addition to 17 healthy control participants. The participants from the stroke group were placed in two groups: 1) motor imagery only; or, 2) motor imagery and physical therapy. The treatment was given within 14 to 51 days of the participants’ stroke; each participant experienced 60 total hours of rehabilitation. To assess the effectiveness of each treatment, the participants in the stroke group and the control group underwent functional magnetic resonance imaging (fMRI) scans before and after each treatment.

 

During normal brain functioning, there are multiple cortical areas of the brain that communicate with each other; however, following a stroke, these interactions are disrupted. After a stroke, there is damage to brain cells; it can take a long time for the neurons to grow back, if they grow back at all. Dr. Butler, a faculty member at Georgia State University, stated that when attempting physical therapy many stroke patients are unable to move at all. Therefore the treatment teams often incorporate motor imagery, as if the stroke patients simply think about moving that area of the body, it helps keep the neurons active near the area that died in the brain.  Results obtained from this study indicated that the individuals in the stroke group that participated in both physical therapy and motor imagery had a significant increase in the flow of information between several brain regions.

 

It’s interesting that simply thinking about something can produce such beneficial and even tangible outcomes. What other areas of health can this notion be applied towards?

 

Faisal Roberts, M.A.

WKPIC Doctoral Intern

 

Pedersen, T. (2015). Both Physical Therapy, Mental Practice Important in Stroke Recovery. Psych Central. Retrieved on April 13, 2015, from http://psychcentral.com/news/2015/04/13/both-physical-therapy-mental-practice-important-in-stroke-recovery/83468.html

 

 

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Friday Factoids: An Influence in making Doctor Appointments: Loneliness?

 

A new study conducted by researchers at the University of Georgia’s College of Public Health found that the frequency of physician visits correlated with chronic loneliness in the elderly population. These findings are suggestive that creating interventions for elderly loneliness may significantly reduce physician visits and, correspondingly, health care costs. That begs the question of why. Is it that loneliness is detrimental to one’s health? Is it that if someone is lonely “reasons” to visit the physician may be influenced simply by to sheer longing for human contact? Perhaps a combination of the two? Or perhaps something else entirely?

 

The study examined senior citizens living in the general community and not those in a retirement community. The study relied on data collected in 2008 and 2012 by the University of Michigan’s Health and Retirement Study, a national survey of Americans that were over the age of 50. In order to assess loneliness, participants completed a survey examining their feelings regarding lack of companionship and social/emotional isolation. To meet the criteria for “chronic loneliness,” participants had to be identified as lonely in both years of the study (2008 and 2012, respectively).  The researchers reviewed responses from 3,530 of adults over the age of 60 that lived in the general community. The results are suggestive that chronic loneliness was significantly associated with the number of visits to the physician, although it did not appear to correlate with hospitalizations. 

 

These findings may implicate that the actual loneliness (as opposed to the detrimental impact of loneliness on health) plays a role, as the participants may have made an appointment with their physician because it is usually someone that they have known for years–and with whom they have built a relationship–therefore providing an element of sought after socialization. (As opposed to going to a hospital in which one typically does not know the staff there or which doctor they will be assigned). That is not to proclaim that the members of the elderly population malinger their symptoms in order to have an excuse to socialize with their physician; rather, it may be a confluence of variables, including the possibility of subconsciously generating reasons to visit a physician in order to alleviate loneliness. What do you make of these findings? Do you have any theories to explain it? Finally, hopefully we are spurred to facilitate meeting needs and helping a population to improve quality of life – can you think of any interventions to target loneliness in the elderly population?

 

Faisal Roberts, M.A.

WKPIC Predoctoral Intern

 

Nauert, R. (2015). Loneliness Drives Elders to Physician Offices. Psych Central. Retrieved on April 3, 2015, from http://psychcentral.com/news/2015/04/03/loneliness-drives-elders-to-physician-offices/83119.html

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Changing the expectations of those with mental illness

 

 

It is important to ask the question, do we BELIEVE that the person we are working with can live a productive life?  At times it can be hard to do so.  The amount of trauma some individuals have faced in their lives, along with illnesses once thought to be disabling, add to the thoughts of some that maybe, just maybe, the best this person can do is stay out of the hospital.

 

The thought process connected to this must change in order to best serve the patient.  As a Peer Support Specialist, I go into it with the memories of the once overwhelming and nearly incapacitating effects of Bipolar Disorder I and PTSD.  I remember the long road and struggle to get well after diagnoses.  The bouncing back and forth from stable to symptomatic was frustrating until I found the right combination of medication. I also look at my life now and know that I can live a productive life.  If I can, why can’t other patients in this hospital?

 

A “productive” life can look differently to every individual.  Productive to some might mean volunteering; to others the word might mean staying sober.  Others may return to work and pursue a career like Kay Redfield Jamison, a well-known psychologist and author who writes about her own journey with Bipolar Disorder.  My victory was getting my degree and returning to employment.  I’m not cured by any means.  I still must work at it, as I tell the patients (peers) with whom I speak.  I go to my psychiatrist, my therapist, I watch my sleep patterns, and I try to manage my stress levels.

 

To some the goal may be to simply stay out of the hospital, but we must believe they can achieve beyond that.  Rebuilding their self-image and instilling hope may help make them realize that there IS life after diagnoses.  Others have done it successfully. A mental illness can become a small part of a person’s life.

 

Rebecca Coursey, KPS

Peer Support Specialist

 

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Effective Listening and Peer Support

Effective Listening and Peer Support Services The Peer Support Specialist uses “Effective Listening” techniques when working with his or her peers (patients).  According to the Kentucky Peer Support training, the difference between listening and “effective” listening is that we know what we are listening for; there are cues that guide the questions we will ask.  We try to discern the person’s current self-image, what the person thinks would improve his or her life and what he or she thinks is standing in the way of those goals.  Self-image, goals, and barriers are simple things to listen for actively.

 
It can be hard to really listen.  We try to interrupt with advice, judgments, criticisms, or comparative stories of our own, or even feel the need to one-up the person.  Effective listening means there may be moments of silence.  That is okay.  The Peer Support person’s role is to guide the peer into listening to his or her own inner truth with open, honest questions.  These questions go by the old rules of journalism: who, what, where, when, how…but “why” is never involved.  “Why” can make people defensive.  Honest questions mean that one doesn’t already know the answer.  The patient may feel his or her intelligence insulted by such questions.

 
The next time you have a conversation with a friend, try using these techniques.  It can be difficult!  Try to do as a Peer Specialist and don’t fix, save, advise, judge, or set the person straight.  Just listen and ask honest, non-judgmental questions.  It is interesting how much people really appreciate it.

 

Rebecca Coursey, KPS
Peer Support Specialist

 

“Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

SAMHSA

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Article Review: Group CBT for Psychosis

 

 

Cognitive Behavior Therapy for Psychosis (CBTp) is considered an effective intervention that is recommended for the treatment of schizophrenia (American Psychological Association, 2004). With that said, offering treatment during an acute episode, while in an inpatient facility proves challenging. Even still, group intervention for psychosis has shown to increase outreach and streamline treatment (Owen et al., 2015).

 

Though there is support for group CBTp, evidence is not definitive.  More specifically, the literature indicates mixed results in the effectiveness of group CBTp as compared to other interventions (i.e., social skills training, psychoeducation). Consequently, due to no clear heterogeneity within CBTp models or use of outcome measures, it is difficult to compare results across studies.  Furthermore, other limitations emerge when attempting a controlled trial in an inpatient setting.  For example, the timing of interventions (individuals are typically in a crisis), uncertainty of the length of stay, and typical medication changes upon admission are noteworthy concerns (Owen et al., 2015).

 

While considering the limitations, research shows positive findings for group CBTp through improvement in one’s wellbeing and reduced readmission rates (Svensson, Hansson, & Nyman, 2000; as cited in Owen et al., 2015).  Furthermore, these positive result are aligned with a recovery model, in that gains are not signified through the reduction of psychotic symptoms, but are more so related to the functional gains made by the individual (e.g., increased confidence, understanding, and improved quality of life; Owen et al., 2014). As noted by Owen et al. (2015), improvements related to recovery are influential in determining discharge; in other words, the ability to cope effectively may be more important than a reduction in symptoms (Owen et al., 2015).

 

Consistent with a recovery model, Owen et al. (2015) created a quasi-experimental design to assess the effects of CBTp within an inpatient setting. The program attempted to balance the reduction of symptoms and the empowerment of individuals by increasing control and understanding of experiences.  Thus, they hypothesized that participants receiving group CBTp would show reductions in distress, improvements in confidence about their mental health, and a reduction in positive symptoms of psychosis compared to Treatment as Usual (TAU).

 

Briefly, Owen et al. (2015) compared two groups of participants from acute inpatient units, one group received a four-week group on CBTp and the other group received TAU.  There were 113 participants (80 men, 33 women) between the ages of 19 and 66, with the majority classified as “White British,” and from an impoverished geographic area.  Participants included individuals experiencing psychotic symptoms (e.g., hallucinations, delusions, paranoia). Groups were conducted for 1.5 hours, over four consecutive weeks.  CBTp groups were co-facilitated by a clinical psychologist, a “service user,” a person with personal experience of psychosis and recovery, and unit staff.  Groups consisted of no more than eight participants and were closed.  They collected data over three periods:  at baseline, post-intervention, and a one-month follow-up.  Individuals discharged during the group were invited back to attend, and if discharged before the one-month follow-up, they were sent the measures for data collection.

 

The group intervention was based on Clarke and Pragnell’s (2008) inpatient group CBTp program.  The program consisted of four sessions with different topics, handouts, and homework (Owen et al., 2015).  Session one focused on group rules, psychoeducation of psychotic experiences, normalization, and monitoring skills.  Session two addressed the understanding of experiences within a CBT model. Specifically, session two introduced the use of a continuum for shared and personal experiences as related to symptom monitoring, worked on the identification of triggers, and discussed how the interpretation of events influence emotions and behaviors.   Session three focused on coping skills, differences in distractions and focusing, and introduced mindfulness and breathing.  Finally, session four explored how to make sense of experiences, introduced the stress-vulnerability model, and understanding psychosis.

 

Findings indicated encouraging results regarding the effects of group CBTp.  First, participants in the CBTp group showed greater reductions in distress at follow-up.  Though this finding was not consistent overall, the results remain consistent with a recovery model.  For individuals in the CBTp group, confidence improved from baseline to post-intervention, and at follow-up.  The author’s noted that insufficient data were collected to measure reduction in positive symptoms, but data indicated a trend, in that individuals in the CBTp group showed a decrease in symptoms overtime (Owen et al., 2015).

Qualitative analyses conducted by Owen et al. (2015) further indicated positive gains from the CBTp group.  Many participants reported feeling more positive, confident, and hopeful about the future.  They reported increased coping strategies and acknowledgment that the group helped some understand their experiences differently.  Again, such results are consistent with a recovery model for psychosis, in that the CBTp group demonstrated an increase in confidence more so than a mere reduction in symptoms (Owen et al., 2015).  In essence, the group members were learning how to “cope with, and accept, difficult and frightening experiences, rather than attempting to reduce their occurrence” (Owen et al., 2015, p. 83).

 

Further analyses indicate a positive correlation for this sample between distress and type of admission, noting that individuals first admitted voluntarily, and later adjusted to involuntary status showed the most distress (Owen et al., 2015).  Though distress can decrease over time, regardless of intervention, the findings indicate that group intervention during the crisis period helped some maintain improvement in distress after the crisis subsided and possibly during discharge (Owen et al., 2015).

 

Limitations of a high drop-out rate (62.8%), inability to randomize participants into groups, and unit staff noted to be more interested in helping with the CBTp group than TAU may have mitigated the results of the study (Owen et al., 2015).  Furthermore, the authors acknowledged that due to the limitations in design and high attrition rates, the findings should be considered interesting and not definitive (Owen et al., 2015).  Overall, Owen et al.’s (2015) results indicate that CBTp may decrease distress and enhance confidence for individuals suffering from psychosis.  They note that the intervention used was feasible, acceptable, as well as, valued by the participating staff.

 

Though limited by design due to constraints of an inpatient facility (e.g., discharge, acute/crisis presentation, medication changes) the results indicate group CBTp to be consistent with a recovery model and particularly focused on hope, normalization, and overall improvement in quality of life.

 

References
American Psychological Association. (2004). Practice Guidelines for the Treatment of Patients with Schizophrenia (2nd ed.). Retrieved from http://psychiatryonline.org/guidelines

 

Clarke, I., & Pragnell, K. (2008). The Woodhaven ‘What is real and what is not?’ group programme: A psychosis group in four sessions for an impatient unit.  Retrieved from http://www.isabelclarke.org/psychology/index.htm#CBT

 

Owen, M., Sellwood, W., Kan, S., Murray, J., & Sarsam, M. (2015). Group CBT for psychosis: A longitudinal controlled trial with inpatients. Behaviour Research and Therapy, 65, 76-85. doi: 10.1016/j.brat.2014.12.008

 

Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
WKPIC Practicum Trainee

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Friday Factoids: Cambodians Have No Word for Depression

Mental health issues are a part of our existence and are experienced globally. The descriptions, terms, and phrases used to communicate these experiences are influenced by culture and often altered by the process of translation.

 

For example, Haitians who are feeling anxious or depressed may use the phrase reflechi twop, which means “thinking too much.” In the Cambodian Khmer language, there is not a direct translation for depression, so someone suffering from depression may instead say thelea tdeuk ceut, which literally means “the water in my heart has fallen.”

 

The World Health Organization has made global access to mental healthcare one of its key goals. As these services become more widely available and embraced by different cultures, providers should become increasingly mindful of cultural nuances that can color the ways in which people approach and respond to treatment.

 

Reference
Singh, M. (2015). Why Cambodians Never Get Depressed.

 

Graham Martin, MA
WKPIC Doctoral Intern

 

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Congratulations to Our 2014-2015 Leadership Graduates!

WKPIC would like to extend a hearty hurrah to this year’s graduates of the WSH/PMHC Leadership Forum. These folks did a lot of reading, studying, and homework-ing! Good job, all. Special nod to those three on the left, who just happen to be our current interns.

 

 

 

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Friday Factoid: Schizophrenia . . . Or Malingering?

Recently, the man charged with murdering Chris Kyle, a U.S. Navy sniper whose autobiography inspired the film American Sniper, was said to have faked schizophrenia.  Yet, the defense expert witness testified that the accused had paranoid schizophrenia and exhibited signs that could not be faked (Herskovitz, 2015).

 

So the question arises, how does one distinguish feigned psychosis from the authentic experience of psychotic disturbance?

 

First, it is important to understand that malingering is an intentional and voluntary deception for secondary gain by fabricating or grossly exaggerating psychiatric symptoms (American Psychiatric Association [APA], 2013).  Also, becoming familiar with the diagnostic criteria for Schizophrenia Spectrum and Other Psychotic Disorders is needed to recognize thought-disorder-based psychosis.  Additionally, understanding the cluster of symptoms and how they contribute to psychosocial impairment is necessary when assessing psychosis (Richter, 2014).

 

Malingered psychosis is skewed to the presentation of positive rather than negative symptoms of schizophrenia (Resnick & Knoll, 2008).  Specifically, those who malinger are found to show higher proclivity of bogus symptoms, suicidal ideation, visual hallucination, and memory problems (Cornell & Hawk, 1989, as cited in Richter, 2014).  A sudden onset of positive symptoms, with no history of negative or chronic symptoms may indicate possible malingering (Richter, 2014).

 

With schizophrenia, the experiences of tactile and olfactory hallucinations are rare, tend to be intermittent and correlate with existing delusions (Richter, 2014).  Possible malingering is suspected when hallucinations are “continuous or not associated with delusions” (Richter, 2014, p. 216).  Also, no indications of developed coping strategies for hallucinations are common with malingered psychosis (Richter, 2014).  Individuals who malinger report visual hallucinations more often (Richter, 2014).  Of note, genuine visual hallucinations tend to be in color, are of normal sized people, may appear suddenly, and do not change if eyes are open or closed (Caldwell, 2009; Resnick, 1997; as cited in Richter, 2014).  Auditory hallucinations are most common in schizophrenia, and usually are clear, with both familiar and unfamiliar voices of male and female type (Richter, 2014).  Malingered command hallucinations are presented as terrifying and overpowering, with the inability to resist compliance (Richter, 2014).  They are also characterized as being dramatic, with stilted language, as well as continuous and presented without association to delusional thought (Richter, 2014).

 

Delusions as presented by the malingering person often have a sudden onset or termination and the individual eagerly discusses the content (Richter, 2014).  Malingering is suspected when disclosure of persecutory nature occurs in the absence of paranoid behavior (Richter, 2014) and when bizarre, atypical delusions are presented without disorganized thought (Resnick & Knoll, 2005; as cited in Richter, 2014).  In general, the absence of disorganized thinking is often associated with malingering (Richter, 2014).

 

Furthermore, individuals who malinger initially show treatment compliance, yet become difficult, often accusing the clinician of believing their symptoms are being faked (Resnick & Knoll, 2008).  Moreover, highly social behavior is largely inconsistent with the negative symptoms of schizophrenia and would suggest malingering if observed.  Overall, the negative symptoms (anhedonia, alogia, avolition) are often not consistent with malingered psychosis, but are replaced by bizarre positive symptoms (Richter, 2014).  The above material offers a brief synopsis of characteristics consistent with malingered psychosis, for a more comprehensive review and discussion of assessment strategies please see Richter’s (2014) article listed below.

 

References:
American Psyciatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Herskovitz, J. (2015, February 20). Accused in U.S. sniper’s murder faked schizophrenia:  psychologist. Reuters, retrieved from http://news.yahoo.com/accused-u-snipers-murder-faked-schizophrenia-psychologist-172922927.html

Richter, J. G. (2014). Assessment of malingered psychosis in mental health counseling.  Journal of Mental Health Counseling, 36(3), 208-227.

 

Dannie Harris, M.A., M.A., M.A.Ed., Ed.S.,
WKPIC Practicum Trainee

 

 

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