Self-Reflection and Progress in TreatmentProfessor Geoffrey StephensonNikos ZygourisKim Smith
AcknowledgementsClients of PROMIS
Dr Samantha HaylettSue Jones
Dr Lefever and The PROMIS Recovery Centre
OverviewDiary research at PROMISIntroduction of Weekly Evaluation Sheets (WES)Effects of Small WES InterventionEffects of Big WES InterventionControlled comparisons of the Big WESDiscussion
Little WES: The WES QuestionsHow 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?
Little WES DesignPost-Intervention(2 weeks)Pre-Intervention Control(2 weeks)Pre-Control(2 weeks)Interventionn = 12Comparison
Effects of Little WESIncreased self focusChanging character of narrativesIncreased PositivityPredictiveness of increases in Positivity-Negativity ratio
Big WES: The MatchingBen (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.)Pre-InterventionInterventionPost-Intervention
Big WES: The WES QuestionsHow 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?
Characterisation of Big WES over whole time period
+ve-veBoth +ve & -veQuestion 1(Past)16%21%63%Question 2(Present)63%4%33%Question 3(Future)47%8%45%
Main WES Points
1st WES(Day 1)Trying to be positive, Accepting principles/PROMIS, Hope for recovery/Future2nd WES(Day 8)Increases confidence/understanding, Awareness of feelings & learning to deal with them, Identifying, Honesty & Sharing, Gratitude & Acceptance3rd WES(Day 15)Determination, Hopeful, Facing the past, Trust, Honesty, Focus on oneself, Liking oneself, Change old behaviour, Unerstanding addiction, world around them4th WES(Day 22)Dealing with issues, Look at positive in negative situations, Building confidence, Less self-pity, Realizing where work is needed
Clients Model of Progress
Accommodating New Circumstances Personal Understandingand Social Awareness Character BuildingPragmatic Focus andConstructive Change
12-Step Programme Salience
Treatment Programme CoherenceThe intervention group:
Treatment Programme Coherence (cont.)The two control groups:
Themes in the last weeks of interventionOld ThemesStepGroupReplacement ThemesAlternativeBuildingDrugsControl ConditionIntervention Condition
Big WES Diaries: Thematic AnalysisAlternative: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
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 relationshipAnyhow, 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
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
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."
WES as a therapeutic intervention:The principle of self-changeAn effective commitment strategyProduces positive emotionsIncreases resources for coping
WES in context of Positive Psychology:Applying character strengths as a means for self-changeTreatment as a journey towards new character strengths
ReferencesEpstein, 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: KluwerOrford 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]
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