published_or_final_version / Humanities / Doctoral / Doctor of Philosophy

This research program represents the first systematic exploration of the subjective experience of alogia, anhedonia, attention problems, avolition, and emotional blunting, and its relation to other objective and subjective factors in schizophrenia. Using a combined rational-empirical approach, a vulnerability-stress-coping model of adjustment to the 5 negative symptoms was developed and tested. Three aspects of appraisal were examined, the primary appraisals of symptom severity and distress, and the secondary appraisal of control. The dimensions of coping with individual symptoms were initially examined using a rational approach, and then empirically using exploratory factor analyses. The Appraisal and Coping with Negative Symptoms Interview Schedule (ACNSIS) was developed for use in Study 1. Both qualitative and quantitative appraisal and coping data were examined for 20 people with negative symptoms. Responses to the ACNSIS demonstrated that appraisals and coping responses varied across participants and individual negative symptoms. Previously employed categorisations of coping behaviour were used to examine and quantify coping. Negative symptom-specific differences were found in awareness of negative symptom presence, degree of agreement with objective ratings, appraisals, reliance on different types of coping, and relations with participant characteristics. Participant coping responses from Study 1 were used to construct the self-report measure used in subsequent studies. Study 2 involved the development, administration, and evaluation of the selfreport Appraisal and Coping with Negative Symptoms Questionnaire (ACNSQ). Both an electronic and paper version of the ACNSQ were developed. The ACNSQ was administered to 120 people with schizophrenia or schizoaffective disorder. Participants were required to make severity, distress and control appraisals for each negative symptom they believed they were suffering from. Following symptom appraisals, a number of symptom-specific and general coping items were presented for each negative symptom. In Study 2A, the multidimensionality of coping responses and the nature of empirically derived subscales were explored individually for each negative symptom. Factor analyses of data from 119 participants resulted in 3 underlying coping dimensions for each symptom. These dimensions, which formed the basis of the ACNSQ coping subscales, were labelled as active, emotional, or avoidant forms of coping. Coping subscales were found to be moderately similar across symptoms. The subscales were shown to be internally consistent and largely independent within symptoms. It was found that the degree of reliance on particular coping subscales was negative symptom-specific, although participant coping was related across symptoms. In Study 2B, the nature of negative symptom appraisals and the psychometric properties of the ACNSQ were examined. There was evidence that the nature of appraisals varied according to negative symptom. Retest reliability analyses indicated that overall, ACNSQ appraisals had a low to moderate degree of reliability while coping subscales demonstrated a moderate to high degree of reliability. Differential associations between appraisal and coping and a range of theoretically related variables provided evidence of the construct validity of the ACNSQ. Study 3 used exploratory techniques to conduct cross-sectional tests of a vulnerability-stress-coping model of adjustment to individual negative symptoms based on the data of the 119 participants. Associations between the objective indicator of negative symptom stressor level, and the subjective experience variables of insight, appraisal and coping were examined in relation to adjustment using a multidimensional approach. Two models of the relations between negative symptom predictors and 3 separate domains of adjustment were investigated. Study 3A provided moderate support for a direct effects model for each of the 5 negative symptoms. Objective negative symptom level, insight, primary appraisals and coping subscales all had significant direct effects on one or more domains of adjustment. In general, higher objective negative symptom levels, higher severity and distress appraisals, and greater reliance on avoidant forms of coping were associated with poorer adjustment. The direct effects of active and emotional forms of coping were less consistent and varied across symptoms and adjustment domains. Study 3B extended these findings by providing a limited amount of support for a mediated effects model. Appraisal and coping were found to act as mediators in some of the relations between objective indicators and subjective experience variables for alogia, attention problems and avolition. There was evidence that the impact of insight on coping was partly mediated by control appraisals. Coping partly mediated the relation between stress and adjustment, and appraisal and adjustment. Overall, this series of exploratory studies make a unique contribution to understanding the subjective experience of the negative symptoms of schizophrenia. The proposed vulnerability-stress-coping model demonstrated utility in identifying variables important in the prediction of adjustment to individual negative symptoms, and in delineating the nature of associations between variables. Further research is required to improve the psychometric properties of the ACNSQ. However, it offers promise as an instrument with which to assess negative symptom appraisals and coping responses, in both clinical and research settings. The present findings have important theoretical and clinical implications concerning the role of subjective and objective factors involved in adjustment to the negative symptoms of schizophrenia. This research program provides a valuable foundation for future research to test the vulnerability-stress-coping model in its entirety.

This research program represents the first systematic exploration of the subjective experience of alogia, anhedonia, attention problems, avolition, and emotional blunting, and its relation to other objective and subjective factors in schizophrenia. Using a combined rational-empirical approach, a vulnerability-stress-coping model of adjustment to the 5 negative symptoms was developed and tested. Three aspects of appraisal were examined, the primary appraisals of symptom severity and distress, and the secondary appraisal of control. The dimensions of coping with individual symptoms were initially examined using a rational approach, and then empirically using exploratory factor analyses. The Appraisal and Coping with Negative Symptoms Interview Schedule (ACNSIS) was developed for use in Study 1. Both qualitative and quantitative appraisal and coping data were examined for 20 people with negative symptoms. Responses to the ACNSIS demonstrated that appraisals and coping responses varied across participants and individual negative symptoms. Previously employed categorisations of coping behaviour were used to examine and quantify coping. Negative symptom-specific differences were found in awareness of negative symptom presence, degree of agreement with objective ratings, appraisals, reliance on different types of coping, and relations with participant characteristics. Participant coping responses from Study 1 were used to construct the self-report measure used in subsequent studies. Study 2 involved the development, administration, and evaluation of the selfreport Appraisal and Coping with Negative Symptoms Questionnaire (ACNSQ). Both an electronic and paper version of the ACNSQ were developed. The ACNSQ was administered to 120 people with schizophrenia or schizoaffective disorder. Participants were required to make severity, distress and control appraisals for each negative symptom they believed they were suffering from. Following symptom appraisals, a number of symptom-specific and general coping items were presented for each negative symptom. In Study 2A, the multidimensionality of coping responses and the nature of empirically derived subscales were explored individually for each negative symptom. Factor analyses of data from 119 participants resulted in 3 underlying coping dimensions for each symptom. These dimensions, which formed the basis of the ACNSQ coping subscales, were labelled as active, emotional, or avoidant forms of coping. Coping subscales were found to be moderately similar across symptoms. The subscales were shown to be internally consistent and largely independent within symptoms. It was found that the degree of reliance on particular coping subscales was negative symptom-specific, although participant coping was related across symptoms. In Study 2B, the nature of negative symptom appraisals and the psychometric properties of the ACNSQ were examined. There was evidence that the nature of appraisals varied according to negative symptom. Retest reliability analyses indicated that overall, ACNSQ appraisals had a low to moderate degree of reliability while coping subscales demonstrated a moderate to high degree of reliability. Differential associations between appraisal and coping and a range of theoretically related variables provided evidence of the construct validity of the ACNSQ. Study 3 used exploratory techniques to conduct cross-sectional tests of a vulnerability-stress-coping model of adjustment to individual negative symptoms based on the data of the 119 participants. Associations between the objective indicator of negative symptom stressor level, and the subjective experience variables of insight, appraisal and coping were examined in relation to adjustment using a multidimensional approach. Two models of the relations between negative symptom predictors and 3 separate domains of adjustment were investigated. Study 3A provided moderate support for a direct effects model for each of the 5 negative symptoms. Objective negative symptom level, insight, primary appraisals and coping subscales all had significant direct effects on one or more domains of adjustment. In general, higher objective negative symptom levels, higher severity and distress appraisals, and greater reliance on avoidant forms of coping were associated with poorer adjustment. The direct effects of active and emotional forms of coping were less consistent and varied across symptoms and adjustment domains. Study 3B extended these findings by providing a limited amount of support for a mediated effects model. Appraisal and coping were found to act as mediators in some of the relations between objective indicators and subjective experience variables for alogia, attention problems and avolition. There was evidence that the impact of insight on coping was partly mediated by control appraisals. Coping partly mediated the relation between stress and adjustment, and appraisal and adjustment. Overall, this series of exploratory studies make a unique contribution to understanding the subjective experience of the negative symptoms of schizophrenia. The proposed vulnerability-stress-coping model demonstrated utility in identifying variables important in the prediction of adjustment to individual negative symptoms, and in delineating the nature of associations between variables. Further research is required to improve the psychometric properties of the ACNSQ. However, it offers promise as an instrument with which to assess negative symptom appraisals and coping responses, in both clinical and research settings. The present findings have important theoretical and clinical implications concerning the role of subjective and objective factors involved in adjustment to the negative symptoms of schizophrenia. This research program provides a valuable foundation for future research to test the vulnerability-stress-coping model in its entirety.

This research program represents the first systematic exploration of the subjective experience of alogia, anhedonia, attention problems, avolition, and emotional blunting, and its relation to other objective and subjective factors in schizophrenia. Using a combined rational-empirical approach, a vulnerability-stress-coping model of adjustment to the 5 negative symptoms was developed and tested. Three aspects of appraisal were examined, the primary appraisals of symptom severity and distress, and the secondary appraisal of control. The dimensions of coping with individual symptoms were initially examined using a rational approach, and then empirically using exploratory factor analyses. The Appraisal and Coping with Negative Symptoms Interview Schedule (ACNSIS) was developed for use in Study 1. Both qualitative and quantitative appraisal and coping data were examined for 20 people with negative symptoms. Responses to the ACNSIS demonstrated that appraisals and coping responses varied across participants and individual negative symptoms. Previously employed categorisations of coping behaviour were used to examine and quantify coping. Negative symptom-specific differences were found in awareness of negative symptom presence, degree of agreement with objective ratings, appraisals, reliance on different types of coping, and relations with participant characteristics. Participant coping responses from Study 1 were used to construct the self-report measure used in subsequent studies. Study 2 involved the development, administration, and evaluation of the selfreport Appraisal and Coping with Negative Symptoms Questionnaire (ACNSQ). Both an electronic and paper version of the ACNSQ were developed. The ACNSQ was administered to 120 people with schizophrenia or schizoaffective disorder. Participants were required to make severity, distress and control appraisals for each negative symptom they believed they were suffering from. Following symptom appraisals, a number of symptom-specific and general coping items were presented for each negative symptom. In Study 2A, the multidimensionality of coping responses and the nature of empirically derived subscales were explored individually for each negative symptom. Factor analyses of data from 119 participants resulted in 3 underlying coping dimensions for each symptom. These dimensions, which formed the basis of the ACNSQ coping subscales, were labelled as active, emotional, or avoidant forms of coping. Coping subscales were found to be moderately similar across symptoms. The subscales were shown to be internally consistent and largely independent within symptoms. It was found that the degree of reliance on particular coping subscales was negative symptom-specific, although participant coping was related across symptoms. In Study 2B, the nature of negative symptom appraisals and the psychometric properties of the ACNSQ were examined. There was evidence that the nature of appraisals varied according to negative symptom. Retest reliability analyses indicated that overall, ACNSQ appraisals had a low to moderate degree of reliability while coping subscales demonstrated a moderate to high degree of reliability. Differential associations between appraisal and coping and a range of theoretically related variables provided evidence of the construct validity of the ACNSQ. Study 3 used exploratory techniques to conduct cross-sectional tests of a vulnerability-stress-coping model of adjustment to individual negative symptoms based on the data of the 119 participants. Associations between the objective indicator of negative symptom stressor level, and the subjective experience variables of insight, appraisal and coping were examined in relation to adjustment using a multidimensional approach. Two models of the relations between negative symptom predictors and 3 separate domains of adjustment were investigated. Study 3A provided moderate support for a direct effects model for each of the 5 negative symptoms. Objective negative symptom level, insight, primary appraisals and coping subscales all had significant direct effects on one or more domains of adjustment. In general, higher objective negative symptom levels, higher severity and distress appraisals, and greater reliance on avoidant forms of coping were associated with poorer adjustment. The direct effects of active and emotional forms of coping were less consistent and varied across symptoms and adjustment domains. Study 3B extended these findings by providing a limited amount of support for a mediated effects model. Appraisal and coping were found to act as mediators in some of the relations between objective indicators and subjective experience variables for alogia, attention problems and avolition. There was evidence that the impact of insight on coping was partly mediated by control appraisals. Coping partly mediated the relation between stress and adjustment, and appraisal and adjustment. Overall, this series of exploratory studies make a unique contribution to understanding the subjective experience of the negative symptoms of schizophrenia. The proposed vulnerability-stress-coping model demonstrated utility in identifying variables important in the prediction of adjustment to individual negative symptoms, and in delineating the nature of associations between variables. Further research is required to improve the psychometric properties of the ACNSQ. However, it offers promise as an instrument with which to assess negative symptom appraisals and coping responses, in both clinical and research settings. The present findings have important theoretical and clinical implications concerning the role of subjective and objective factors involved in adjustment to the negative symptoms of schizophrenia. This research program provides a valuable foundation for future research to test the vulnerability-stress-coping model in its entirety.

Using the Early Childhood Longitudinal Study (Kindergarten Class), this research explored the developmental trajectories of internalizing and externalizing behaviors during the elementary school years, with an emphasis on the connections between these behaviors, how they are embedded in social structural settings defined by broad stratification systems, and what their implications are for the future. Specifically, this study was organized around three aims: (1) To estimate trajectories of internalizing and externalizing behaviors (e.g., co-occurrence and dynamic interplay); (2) To explore variations in those trajectories across segments of the population (e.g., race/ethnicity); and (3) To examine the links between children's internalizing and externalizing pathways in elementary school and their 8th grade academic functioning, as well as possible group variation in those links. Four analytical techniques -- growth curve analysis, latent class growth analysis, cross-lagged modeling and regression analysis -- were used. Results indicated a low incidence of internalizing and externalizing symptoms in the whole sample as well as small incremental changes over time and small differences across groups. More in-depth investigation revealed that children of Black parents and boys were at greater risk for present and future problematic behaviors, and boys and children of immigrants were at greater risk for future academic failure when their earlier overall combined symptom trajectories fell in the risky category. In addition, the general patterns of children's internalizing symptoms serving as protective factors for future externalizing symptoms and of externalizing symptoms serving as risk factors for future internalizing symptoms tended to be most consistent among children of White parents and children of non-immigrants. Moreover, findings revealed that what matters about the symptom trajectories in relation to later school functioning is not just the initial level of symptoms but also the change in levels from kindergarten through fifth grade. Overall, this study suggested that intervention efforts need to take into account both the symptomatic child's initial (and overall) levels of symptoms as well as over-time change of symptoms when putting together a specific intervention plan for the affected individual. Finer prevention and intervention efforts are also needed for boys and for children of immigrants to facilitate positive academic functioning. / text

Proyecto de investigación 2017-2019, financiado por la Universidad Peruana de Ciencias Aplicadas (UPC).

No description available.

No description available.

The overall aim of this project was to investigate the nature and structure of the physiological symptoms of panic attacks and the relationship between these symptoms and use of the health care system by people with a clinical diagnosis of panic disorder. Cioffi's model of somatic interpretation was explored in relation to this issue as it had been previously applied to predominantly physiological conditions and appeared to offer a potentially useful framework for understanding the behaviour of people with panic disorder.The first study consisted of a principal components analysis of 153 panic attack symptom checklists from the Anxiety Disorders Interview Schedule - Third Edition - Revised (ADIS-III-R).Five separate physiological components emerged from the analysis which mirrored common medical conditions. A cluster analysis of the symptoms of 153 individuals indicated that the sample formed five separate groups corresponding to the five physiological components identified. The results of this study supported suggestions put forward in the literature regarding the possible clustering of the physiological symptoms of panic attacks. The study also found evidence to suggest that individuals with panic disorder can be identified in distinct sub-groups according to the most predominant physiological symptoms reported.The second study was made up of two parts. Part one investigated the health utilisation behaviour and associated costs for people with panic disorder and compared them with people with social phobia. Significantly higher costs and rates of utilisation were found for the panic disorder group compared to the group with social phobia. Part two of this study investigated the relationship between a person with panic disorder's most predominant physiological panic symptoms and the type of medical specialists consulted. Fifty three individuals with panic disorder ++ / were included in the study and the proposed relationship was analysed using a bi-partial regression analysis. The respiratory group was significantly related to the type of specialist seen.The third study was aimed at clarifying the interpretation of ambiguous symptoms in panic disorder. Thirty eight people with panic disorder completed a questionnaire requiring them to give explanations as to the cause of a number of ambiguous somatic sensations. It was hypothesised that there would be a relationship between the persons highest component score (as identified in the first study) and the interpretation of threat made in response to the items on the questionnaire. No such relationship was found although significantly more threat-interpretations were made when the individual's cognitive threat schema was activated.Study four investigated the influence of the type of panic recording measure upon the severity and number of panic symptoms reported. A secondary aim was to compare panic symptoms recorded following a panic provocation procedure in the clinic with those recorded following naturally occurring panic attacks. Thirty seven people with panic disorder recorded the symptoms of panic attacks experienced in the natural environment and those induced via hyperventilation in the clinic. It was hypothesised that there would be an effect for recording measure on the dependent variables of symptom severity and number. This hypothesis was supported with the structured recording measure producing significantly more symptoms of a greater severity than the unstructured or descriptive measure. An interaction effect was found for the neurological group of symptoms whereby the severity of symptoms was significantly higher in the clinic setting than in the natural environment with the descriptive measure resulting in significantly greater severity ratings.The final study ++ / investigated the efficacy of information-giving as an intervention for panic disorder. Forty individuals with panic disorder were randomly assigned to either receive two sessions of information-giving as well as self-monitoring of their symptoms or self-monitoring only. As hypothesised the group receiving information as well as self- monitoring had significantly lower levels of general anxiety and depression as well as anticipatory anxiety at the end of the intervention period.Several important implications emerge from these results. The finding that people with panic disorder can be identified according to the predominant set of physiological symptoms they report provides some useful information for identification of the problem in general medical settings. This project demonstrated the need for a screening measure for panic disorder in Australian medical settings as well as the potential effectiveness of the provision of information relating to anxiety and panic. In addition, Cioffi's model of somatic interpretation was found to be a useful framework with which to consider underlying processes relating to the interpretation of panic sensations.

The present study investigated the causal predominance of cognition on anxiety, depression, paranoia, phobia and somatic concern over three time waves of self reported data measured every six months over one year, of 145 cases experiencing their first episodes of psychosis. In turn the symptoms of anxiety, depression, paranoia, phobia and somatic concern were examined for their cross-influential effects on cognition. Cognition was examined under a causal predominance hypothesis as the lead symptom because of its influence recognised in the literature under the neurodevelopmental hypothesis. These longitudinal effects were examined using structural equation modelling. Prior to this investigation, the research was able to demonstrate a stable 6-factor measurement model with these symptoms between two independent samples of early psychosis cases that met guidelines of treatment under the Australian national early psychosis treatment guidelines. This measurement model demonstrated good internal reliability and construct validity. Most symptoms over each time wave had a "domino effect" where the symptom prior to the next wave of assessment had an influence. This is known as a mediation effect. Somatic concern and depression demonstrated a "snow ball" or direct effect where the extent of the condition at time one influenced directly the condition at time three. Structural models, which examined the cross-influential effect between cognition and the other symptoms, demonstrated an effect between paranoia and cognition. This effect demonstrated that paranoia at Time 2 (i.e., 6 months after stabilisation of symptoms), had a crossinfluential effect on cognition at Time 3 (ie, 12 months after stabilisation of symptoms). / It was argued that poor thinking styles that lead to distortion in feelings of mistrust evident in the paranoia symptom, in turn led to deterioration in cognition. Other symptoms did not demonstrate a cross influential effect. Previous research suggesting that symptoms act independently of each other over time supports the results of independence of the other symptoms. Further research was suggested by linking different levels of psychosis research of the aetiological factors (e.g. genetic factors), neuropathology (e.g., reduced synapse density) and phenomenology (e.g., positive and negative symptoms) into an integrative framework. It was suggested that structural equation modelling as exemplified in the thesis could be used as a technique to examine how these differing levels could be investigated under a unified theory of psychosis based upon the neurodevelopmental hypothesis.