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Metacognitive Strategies and Problem-Solving with an Adult Subject Living Witb Chronic Psychiatrie Iliness

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Metacognitive Strategies and Problem-Solving with an Adult Subject Living Witb Chronic Psychiatrie Iliness University of Alberta Metacognitive Strategies And Problem-Solving With An Adult Subject Living Witb Chronic Psychiatrie Iliness Keina Allan O A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfiliment of the requirements for the degree of Master of Education Department of Educational Psychology Edmonton, Alberta Spring 2000 National Library Bibliothbque nationale 1+1 ,-da du Canada Acquisitions and Acquisitions et Bibliographie Services seMcas bibliographiques The author has granted a non- L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant à la National LI* of Canada to Bibliotheque nationale du Canada de reproduce, loan, distnie or sell reproduire, prêter, distriiuer ou copies of this thesis in microform, vendre des copies de cette thèse sous paper or electronic formats. la forme de microfiche/nlm, de reproduction sur papier ou sur format électroniqye. The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts &om it Ni la thèse ni des extraits substantiels may be printed or otherwise de celle-ci ne doivent être imprimés reproduced without the author's ou autrement reproduits sans son permission. autorisation. Abstract This midy examined the efiectiveness of the Strategies Program for Effective Leaming and Thinking (SPELT) in facilitating the maintenance and generalization of problem-solving skills in an adult subject who lives with Bipolar Disorder. The research used a single case design. Problem-solving skills were taught over a period of twenty-two sessions, approximately 90 minutes each, using the SPELT instructional process. Pretests and pomests were adrninistered and al1 instructional sessions were tape recorded. Pretest and posttest data were analyzed quantitatively and compared to detemine if there had been any sipificant change. The transcripts from the recorded data were analyzed deductively and inductively. Results from both analyses were compared for discrepancies. The conclusion of this study is that the SPELT instnictional system did facilitate maintenance and generalization of problem-solving skills for the participant. The recommendation of this study is that fbrther research should be undertaken using the SPELT instnictional method to teach problem-solving skilis to a more diverse psychiatrie population. Dedication To my children, Elayna and Aaron, with love. Acknowledgements 1 would like to thank those people who, through their support and participation, have assisted me in the completion of this thesis. To Dr. R. F. Mulcahy, my supervisor, for dl his help and support and for inspiring my trust. Thank you for king one of the "good guys." To Elaine, for her enthsiastic participation and for her willingness to share her To Dr. C. Kreber, who served as my extemal examiner, for ber willingness to always be honest with me and for her ongoing support. To Dr. L. Wilgosh, for her constructive questions and great editing. To Dr. J. DaCosta, for his patience and for his "palatable" feedback. To Tonya Colbourne Ward, for the many houn spent helping me with graphies. To Rosemary Anderson, a true fkiend, who, through the years, has always been a great souce of personal support. To Dale Blue, another true friend, who is a clear mirror. Table Of Contents Page Chapter One: Introduction Statement of the Problem Pwose Research Questions Design and Rationale Definition of Terms Limitations and Significance Organization of the Thesis Chapter Two: Litemture Review Problem-Solving Skills and Mental Illncss Self-Efficacy, Roblem-Solving, and Mental Health Results of Recent Research Using a Problem-Solving Approach Affective Disorders Suicidal Ideation Schizophrenia Brain Injury Heterogeneous Groups The SPELT Instructional System Summary Chapter Three: Methods Rationale Participant Consent and Ethics Requirements Instruments Data Collection Data Analysis Chapter Four: Results and Discussion Pretests and Posttests The Adult Self-Perception Profile The Coopenmith Self-Esteem Inventory The Problem-Solving Inventory Rotter's IntemaVExtenial Locus of Control Journal Notes Deductive Andysis of Transcripts Self-Concept Problem-Sol Wig Locus of Control SMs SPELT Effects Causal Conditions and ActionAnteractional Strategies Inductive Analysis of Transcripts s-ary Do these results support Further research with the SPELT system? Chapter Five: Recommendations and Conclusions Factors to Consider Participant Factors Data Factors Conchsions Reached Recommendations Appendix A: Client Consent Fonn 85 Tables Page Figure 1: Fiowchart Illustration of Session &der and Content 36 Figure 2: Changes in Adult SelCPerception Profile 44 Figure 3: Changes in ProblemSolWig Inventory 49 Chapter One Introduction Statement of the Ptoblem The Canadian Mentai Health Association (CMHA)~centiy released the following mental health statistics for 1999 (representative of CMH& personal communication, December 6,1999). One in five Canadians (both children and adults) will be diagnosed with a mental illness in hisher lifetime. This year absenteeism due to some form of mental illness (most fiequently stress) will cost the Canadian economy 5 billion dollars. Also, this year 9,000 Canadians will take their own lives or die fiom complications related to mental illness (the CMHA adds that this figure may actually be higher). Finally, the statistics on depression are especially relevant to this research. Nearly two-thirds of people who an mentally il[, particularly with depression, do not receive adequate treatment. According to the CMHq 80% of those diagnosed with depression can recover if effective treatment is given. Effective treatment consists of psychosocial interventions in addition to psychopharmacological intervention Economic pressures and the development of a variety of more effective psychopharmacological treatmenfi have lead to a decrease in the length of hospital stays for patients diagnosed with mental illness. Consequently, immediate symptoms are treated pharmacologically and psychosocid treatments are not always addressed. Without thcsc additionai treatments, patients' cognitions, behavior, and &kt remain the meand the integrated change necessary for recovery or optimal management of illness does not occur. This results in more fresuent visits to pnmary cmphysicians, which puts a further drain on the health care system (Gath, Anastasiades, Bond, Day, & Hall, -7 1991). It also results in a poorer quality of life and nsk of suicide for those patients who rrçeivr minimum or no intervention at the khavioral md/or psychosocid level. The litcrature supports the w of instruction in probleiii-solving skilis as: ri prumising aiternative to this predicament The iiterature suggests that there is a relationship bewen a deficiency in pro biem-solving abiiities, poor sociai adjusmient and psyc hopathology (Nezu Br Pem,1989j. Prewous research tnto the use of problem-solving aaining as a therapeutic intervention has shown promising resuits for a range of psychiatnc populations. Positive effects have been seen in individuals diagnosed wirh affective disorden, suicidai ideation, and schizophrenia in addition, posinve eEects have been seen in individuals who have expenenced brain trauma and subsequently developed problem-soiving disorders. However, the problem-solving interventions with these populations has, in moa cases, been primarily focused on the immediate instniction of methods and heuristics. Generaliy, this has had positive results within the aeatment environment but generalization and maintenance efiëcts have oniy been seen for limited penods of time. The long terrn effect of this can be a fading of skills which ieads to a decrease in the ability IO bction, and this necessitates funher intervention- Given the chronicity of many menui disorders, and the fact that probtem-soiving skiils are one of the fim casualties of chronic mental iihess (Trower, Bryant, & Argyle, 19781, the maintenance and generalization of these skills should be of panunount importance. Purwse The purpose of this midy was to explore the efiiveness of The Strategies Program For Efliecfive L-@Thinking" (SPELT)in supportmg anci ebcingthe 3 generdization and maintenance of problem soiving skills to daily living. SPELT is an embedded strategy-based instructional model which, when used in conjunction with a tive step problem soimg cumculum, promises to be a viable tool for improving cognitive performance in daily problem-solving over the long term. Researcb Ouestions One generd question was the focus of this research: Does the SPELT approach to problem-solving instruction support the maintenance and generalization of problem-solwng skills to daily Iiving, for a climcally stable, adult psychiatnc patient wth chronic mental illness? There were four specific subquestions: 1. Has there been improvement in ~el~perception,self-esteem, problem-solving skills, and locus of control? 2. Have problem-solwng skills been genenilized and maintatned? 3. If so, has the SPEiJ method of instruction facilitated these efiects? 4. Do these results support funher research with the SPELT system? Desi~nand Rationale Due to the exploratory nature of the midy, a single case design was used. Data were analyzed using both quantitative and qualitative methods in order to investigate issues fkom multiple perspectives. The quantitative data were measured using a pretedpomen cornparison of four insmunents: (a) the Aduit Self-Perception Profile
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