Heterogeneity in Behavioral Treatment Response in Severe Mental Illness

Abstract

An exploratory investigation of behavioral treatment response during inpatient rehabilitation for severe mental illness is presented. Archival data from 26 weeks of behavioral contingency management (CM) programs targeting treatment nonadherence for 2 cohorts of participants were analyzed. For cohort 1 (N = 39), a multivariate analysis of longitudinal behavioral data identified 4 qualitatively and quantitatively distinct patterns of CM response and these groups differed in verbal memory ability. Analysis of cohort 2 (N = 45) replicated the finding of 4 patterns of CM response. We further clarified behavioral heterogeneity in cohort 2 by using hierarchical linear modeling with neurocognitive and social cognitive covariates. Results indicated that memory, attention, and a high external locus of control (LOC) were associated with level of nonadherence at baseline. Reductions in external locus of control were associated with greater CM response during the course of rehabilitation. Implications for understanding individual responses to the rehabilitation process are discussed.

Role of learning potential in cognitive remediation: Construct and predictive validity

“…The present study replicated these findings, particularly for predicting CR-associated change in verbal memory, and extended previous findings by demonstrating construct validity of LP assessment and its domain specificity for predicting skill acquisition. Overall, the data support important theoretical points in dynamic assessment and CR, specifically: 1) treatment response is heterogeneous, and treatment development and individualization require looking beyond the mean change score for treatment vs. control (Peer et al, 2008); 2) LP scores add to the understanding of this heterogeneity only in the context of a learning opportunity (Grigorenko, 2009); 3) consistent with the existence of different learning styles and types of learning, LP may not measure “general learning potential” but may instead be domain-specific (Kozhevnikov, 2007; Nadel and Hardt, 2011; Squire, 1992), and 4) the predictive utility of LP assessment is likely dependent not only on the relationship between LP domain and outcome, but also psychometric considerations of how the LP score is computed (Fiszdon and Johannesen, 2010). …”

Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence?

“…The “control heuristic” model suggests perceived control increases when: (a) people believe that their actions are connected with an outcome; (b) the outcome is desirable; (c) the action was intended to produce the outcome; and (d) positive reinforcement is frequent (Thompson et al, 2004; Thompson, Armstrong, & Thomas, 1998). CM may thus foster a sense of control due to clearly communicated, consistent connection between participant behavior and contingencies, presumed desire and intention on the part of participants to obtain the outcomes (e.g., housing in the current study), and frequent administration of positive reinforcers (Peer, Strachan, & Spaulding, 2008). As reduced perceived control is associated with stress reactions, increased perceived control may help reduce PTSD-related anxiety (for a review, see Benight & Bandura, 2004) in addition to assisting maintenance of abstinence.…”

What Can Dynamic Systems Models of Development Offer to the Study of Developmental Psychopathology?

“…However, research on psychopathology has consistently revealed the problems of heterogeneity and comorbidity (Beauchaine, 2003;Lilienfeld, 2007;Spencer, Biederman, & Mick, 2007). Within particular categories of disorder, there is heterogeneity in the forms of behavior named by the category (Waschbusch et al, 2004), the causal underpinnings of those patterns (Barry, Golmaryami, & Rivera-Hudson, 2013;Nandi, Beard, & Galia, 2009); and the effects of intervention (Carter et al, 2012;Peer, Strachan, & Spaulding, 2008). A common approach to addressing such heterogeneity is to search for subtypes within particular diagnostic categories (Herman et al, 2012).…”