Self-Reflection and Progress in Treatment

Professor Geoffrey StephensonNikos Zygouris

Kim Smith

Acknowledgements

Clients of PROMIS

Dr Samantha Haylett Sue Jones

Dr Lefever and The PROMIS Recovery Centre

Overview

Diary research at PROMISIntroduction of Weekly Evaluation

Sheets (WES) Effects of Small WES Intervention Effects of Big WES Intervention Controlled comparisons of the Big

WES Discussion

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?

What’s your view about how things are going for “X”?

Little WES Design

Post-Intervention(2 weeks)

Pre-Intervention

Control(2 weeks)

Pre-Control

(2 weeks)Intervention

n = 12

Comparison

Effects of Little WES

Increased self focus Changing character of narratives Increased Positivity Predictiveness of increases in

Positivity-Negativity ratio

Big WES: The Matching

1. Ben (37, m, alc) Bob (39, m, alc) Bill (37, m, alc)2. Jen (25, F, dr.) Josie (28, F, dr.) Jill (26, F, dr.)3. 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-Intervention Intervention Post-Intervention

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?

What’s your view about how things are going for “X”?

Characterisation of Big WES over whole time period

+ve -veBoth +ve

& -ve

Question 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/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

Clients’ ‘Model’ of Progress

Accommodating New Circumstances

Personal Understandingand Social Awareness

Character Building

Pragmatic Focus andConstructive Change

Conscientiousness

0

1000

2000

3000

4000

5000

6000

Average No. of Words

Pre-Intervention

Intervention

Post-Intervention

0

5

10

15

20

25

30

35

40

No of Days when DiariesWritten

Pre-Intervention

Intervention

Post-Intervention

12-Step Programme Salience

0

0.005

0.01

0.015

0.02

0.025

0.03

Average Step Usage

Pre-Intervention

Intervention

Post-Intervention

0

0.005

0.01

0.015

0.02

0.025

0.03

Average God/HP Usage

Pre-Intervention

Intervention

Post-Intervention

Treatment Programme Coherence

The intervention group:

Treatment Programme Coherence (cont.)

The two control groups:

Themes in the last weeks of intervention

Old Themes

Step

Group

Replacement Themes

Alternative

Building

Drugs

Control Condition Intervention Condition

Big WES Diaries: Thematic Analysis

Alternative:

“Feeling really full of the joys of life – partly as I didn’t drink despite plenty of opportunity and temptation, but also spiritually fulfilled, wouldn’t 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 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 I’m 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."

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

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]

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.