Self-Reflection 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
ve -ve Both ve -ve
Question 1 (Past) 16 21 63
Question 2 (Present) 63 4 33
Question 3 (Future) 47 8 45
10
Main WES Points
1st WES (Day 1) Trying to be positive, Accepting principles/PROMIS, Hope for recovery/Future
2nd WES (Day 8) Increases confidence/understanding, Awareness of feelings learning to deal with them, Identifying, Honesty Sharing, Gratitude Acceptance
3rd WES (Day 15) Determination, Hopeful, Facing the past, Trust, Honesty, Focus on oneself, Liking oneself, Change old behaviour, Unerstanding addiction, world around them
4th WES (Day 22) Dealing with issues, Look at positive in negative situations, Building confidence, Less self-pity, Realizing where work is needed
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
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• Fredrickson, B.L. (2000) Cultivating Positive
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• Klingemann H., Sobell J. et al (2001) Promoting
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23
References (cont.)

• Seligman M.E.P., Steen T.A., Park N., and
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