SelfReflection and Progress in Treatment

1
Self-Reflection and Progress in Treatment

• Professor Geoffrey Stephenson
• Nikos Zygouris
• Kim Smith

2
Acknowledgements

• Clients of PROMIS
• Dr Samantha Haylett
• Sue Jones
• Dr Lefever and The PROMIS Recovery Centre

3
Overview

• Diary research at PROMIS
• Introduction of Weekly Evaluation Sheets (WES)
• Effects of Small WES Intervention
• Effects of Big WES Intervention
• Controlled comparisons of the Big WES
• Discussion

4
Little WES The WES Questions

• How would you summarise what X was trying to
  say in the daily feelings diary during the week?
  What are the main points X was trying to make?
• How do you hope X has changed since these
  entries were written? Do you think these changes
  have happened?
• Whats your view about how things are going for
  X?

5
Little WES Design
Post- Intervention (2 weeks)
Pre- Intervention Control (2 weeks)
Pre- Control (2 weeks)
Intervention
Comparison
n 12
6
Effects of Little WES

• Increased self focus
• Changing character of narratives
• Increased Positivity
• Predictiveness of increases in Positivity-Negativi
  ty ratio

7
Big WES The Matching
Pre-Intervention
Intervention
Post-Intervention

• Ben (37, m, alc) Bob (39, m, alc) Bill
  (37, m, alc)
• Jen (25, F, dr.) Josie (28, F, dr.) Jill
  (26, F, dr.)
• Pip (31, F, e.d.) Penny (29, F, e.d.) Pat
  (29, F, e.d.)
• . . .
• . . .
• . . .
• . . .
• . . .
• 29. Mark (53, M, alc.) Mike (55, M, alc.)
  Matt (52, M, alc.)
• 30. Niki (23, F, dr.) Nelly (25, F, dr.)
  Nancy (25, F, dr.)

8
Big WES The WES Questions

• How would you summarise what X was trying to
  say in the daily feelings diary during the week?
  What are the main points X was trying to make?
• How do you hope X has changed since these
  entries were written? Do you think these changes
  have happened?
• Whats your view about how things are going for
  X?

9
Characterisation of Big WES over whole time period
10
Main WES Points
11
Clients Model of Progress
Accommodating New Circumstances
Personal Understanding and Social Awareness
Character Building
Pragmatic Focus and Constructive Change
12
Conscientiousness
13
12-Step Programme Salience
14
Treatment Programme Coherence
The intervention group
15
Treatment Programme Coherence (cont.)

• The two control groups

16
Themes in the last weeks of intervention
Control Condition
Intervention Condition
Replacement Themes Alternative Building Drugs
Old Themes Step Group
17
Big WES Diaries Thematic Analysis

• Alternative
• Feeling really full of the joys of life
  partly as I didnt drink despite plenty of
  opportunity and temptation, but also spiritually
  fulfilled, wouldnt recommend spending time with
  a group of drinkers during early treatment

18
Big WES Diaries Thematic Analysis (cont.)

• Building
• We decided that we need to start to build a
  relationship and get to know each other properly
  and truthfully. This could be the building blocks
  for a deeper relationship
• Anyhow, today had to be good, because the
  Reunion pushed aside the usual mental confusion
  and gave me focus. This is of course perfectly
  normal, so Im OK thanks

19
Big WES Diaries Thematic Analysis (cont.)

• Building (cont.)
• I had a good process because I found my peer
  evaluation very valuable. It is easier to let go
  of control than it is to let go of emotions. I
  know it will come with time. I have to start
  changing my behaviour to make it effective

20
Big WES Diaries Thematic Analysis (cont.)

• Drugs
• She reminded me of the insanity of going from
  one pharmacy to another all over London for
  laxatives, never going to the same one in case
  I'd get found out."
• " I am proud of coming off the drugs.  Pat came
  back and I was horrified to hear that she was on
  3 Valium a day."
• "Pity, had the need to go to the Co-op to buy
  tobacco. I have owned up to this and made
  amends."

21
Conclusions

• WES as a therapeutic intervention
• The principle of self-change
• An effective commitment strategy
• Produces positive emotions
• Increases resources for coping
• WES in context of Positive Psychology
• Applying character strengths as a means for
  self-change
• Treatment as a journey towards new character
  strengths

22
References

• Epstein, S (1998) Constructive Thinking the key
  to emotional intelligence, London Praeger.
• Fredrickson, B.L. (2000) Cultivating Positive
  Emotions to optimize health and well-being.
  Prevention and Treatment, vol. 3 Article 0001a
  posted March 7, 2000.
• Klingemann H., Sobell J. et al (2001) Promoting
  Self-change from Substance Use practical
  implications for policy, prevention and
  treatment, London Kluwer
• Orford J. (2001) Excessive Appetites a
  psychological view of addictions (2nd edition).
  Chichester Wiley.
• Peterson C. Seligman M.E.P. (2004) Character
  Strengths and Virtues A Handbook and
  Classification. New York American Psychological
  Association and Oxford University Press.
• Rosenqvist P., Blomqvist J., Koski-Jannes A.,
  Ojesjo L. (2004) Addiction and Life Course
  Helsinki Nordic Council for Alcohol and Drug
  Research (NAD Publication 44). Obtainable
  direct www.nad.fi

23
References (cont.)

• Seligman M.E.P., Steen T.A., Park N., and
  Peterson C. (2005) Positive Psychology Progress
  Empirical validation interventions. American
  Psychologist 60, 410 421.
• Stephenson, G.M, Haylett, S.A. (2000) Self
  Narrative Framing The effects of systematic
  written reflections on personal progress in
  twelve step facilitation therapy. Journal of
  Constructivist Psychology, 13 (4), 313-319.
• Stephenson, G.M., Laszlo, J., Ehmann, B.,
  Lefever, R.M.H. Lefever, R. (1997) Diaries of
  Significant Events Socio-linguistic correlates
  of therapeutic outcomes in patients with
  addiction problems. Journal of Community and
  Applied Social Psychology, 7(5), 389-411.
• Trapnell, P.D., Campbell, J.D. (1999) Private
  self-consciousness and the Five-Factor Model of
  Personality Distinguishing Rumination from
  Reflection. Journal of Personality and Social
  Psychology, 76, 284-304.
• Tuchfield BS (1981) Spontaneous remission in
  alcoholics Empirical observations and
  theoretical implications. Journal of Studies on
  Alcohol 42, 626-641.