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The Lived Experience of Hallucinations in Adults with a Diagnosis of Schizophrenia: A Phenomenological Study
Full text linkThe purpose of this phenomenological research study was to explore the lived experience of hallucinations in adults with a diagnosis of schizophrenia. The literature review introduces hallucinations as a symptom of schizophrenia and their related treatment. It presents first-hand accounts of schizophrenia and hallucinations and identifies phenomenological research of schizophrenia and hallucinations. It introduces art therapy use in the case of schizophrenia, and art therapy research of schizophrenia with evidence that there is a lack of qualitative studies of hallucinations in schizophrenia that utilize art as a means of data collection.
Two participants were recruited for this study from an outpatient mental health facility in Philadelphia, PA. One participant was male and one female. Both identified as African American, were between the ages of 18-55, and had experienced hallucinations related to their diagnosis of schizophrenia. Data was collected through a brief demographic survey, three drawing directives, and an open-ended interview. Art directives included “Draw what the experience of hallucinating is like for you” on a blank page, “Consider this figure an outline of you, and draw the experience of hallucinating in relation to the figure,” on a horizontal or vertical sheet with figure template, and “Fill the circle with what you would like to” on a page with mandala template. The open-ended interview focused on thoughts and feelings related to the first experience of hallucinations, content, frequency and modality experienced in, disclosure to others, management and treatment, and what it was like to express the experience in drawing.
Data was analyzed using phenomenological research methods outlined by Moustakas (1994). The following aspects were prominent in an analysis of interviews and drawings: 1) Confusion, doesn’t make sense and want to figure it out 2) Desire to escape and to isolate away from others 3) Difficulty in communicating about the experience 4) Extra perceptions in addition to perceptions of a shared reality 5) Flexible and ambiguous content 6) Involvement of different senses and/or multiple senses 7) Loss of ability to fully orient to a shared reality 8) Loss of autonomy requiring assistance and care 9) Medication and coping strategies 10) Past experiences effect on quality of hallucinations 11) Rarely talked about because of fear of judgment from others 12) Problem and something wrong/illness/punishment 13) Unpredictability, sometimes leading to paranoia.
The synthesis of these aspects suggests that time and space can be altered by the intrusion of hallucinations. They affect most senses and exist as extra perceptions in addition to those that others may share. Hallucinations can be disorienting, confusing, distracting, and scary. The content of hallucinations can vary given past experiences. There can be a desire to figure out the content of the experience. There is also a tendency to want to escape from the experience and also isolate and go away from others.
It is hard for individuals with a diagnosis of schizophrenia to communicate about their hallucinations given their complex and bizarre nature. Uncertainty about the experience and fear of stigma contribute to the limitation of expression.
Support from others is crucial for the health of individuals diagnosed with schizophrenia who are experiencing hallucinations. It is relieving for individuals to speak about the experience with someone who they can trust. Mental health professionals, peers, family, friends, can help individuals cope with the experience and stay oriented to a shared reality, treat with medication, be empathetic to loss of autonomy, and explore thoughts of wanting to escape including thoughts of dying.M.A., Art Therapy and Counseling -- Drexel University, 201
A Prospective Investigation of Risk Factors for Weight Gain and Increases in Loss of Control Eating
Full text linkBackground: Repeated overeating and binge eating are widespread problems in the United States, are associated with poorer psychosocial and physical health outcomes, and pose increased risk for the development of obesity and eating disorders. Individuals who are obese or engage in recurrent binge eating exhibit elevated hedonic drives for eating, impaired cognitive ability to inhibit impulsive responses to familiar stimuli (inhibitory control), and deficits in both physiological and emotional interoceptive awareness (e.g., accurate detection of satiety cues, visceral sensations such as heartbeat, and emotions). Few studies to date have examined whether these observed deficits precede and contribute to the subsequent development of binge eating and weight gain (potentially leading to obesity), or whether they develop concurrently with progressive worsening of dysregulated eating. Methods: The present study explored the extent to which inhibitory control (measured through a response inhibition task), hedonic hunger (as measured by the Power of Food Scale), impaired interoceptive sensitivity (measured via the Heart Beat Perception Task), and alexithymia (as measured by the Toronto Alexithymia Scale), predict weight gain and changes in LOC among a sample of undergraduate women, who are at elevated risk for such outcomes. Participants (N = 102) were assessed at the beginning of the academic year; 93 participants returned for follow-up seven months later (retention: 91%). It was hypothesized that: (1) weight gain would be negatively predicted by inhibitory control performance, and positively predicted by hedonic hunger, physiological interoceptive deficits, and alexithymia; and (2) increases in LOC eating would be negatively predicted by inhibitory control performance, but positively predicted by hedonic hunger, interoceptive deficits, and alexithymia. Results: For a majority of participants, weight and LOC eating behavior remained relatively stable during the study period. Results from multiple linear regression indicated that the predictors of interest were only weakly associated with weight gain and increases in LOC eating severity. Moreover, individuals who gained or lost substantial amounts of weight (> 3.0 lbs.) did not differ from their weight-stable peers on the predictors of interest at baseline. Compared to participants who experience no binge eating, individuals who endorsed binge episodes at either time point exhibited elevations in LOC severity and hedonic hunger at baseline and follow-up. However, they did not demonstrate significant or meaningful baseline differences on any other predictors of interest. Discussion: Results suggest that undergraduate women experience relative stability in weight and eating habits in the short term. Moreover, hedonic hunger, inhibitory control, interoceptive deficits, and alexithymia, are poor predictors of weight gain and changes in LOC eating severity among those who do experience change. Implications for these null findings among a nonclinical sample are discussed.M.S., Psychology -- Drexel University, 201
Can neuropsychology inform violence risk assessment?: A prospective incremental validity study in an incarcerated sample
Full text linkMuch work has focused on the understanding, prediction, and management of antisocial behavior. The prediction of antisocial behavior is particularly relevant in correctional settings, where the assessment of inmates is used for classification, placement, and intervention purposes. This process has been greatly informed by violence risk assessment (VRA), which is designed to develop estimations of risk for specific antisocial behaviors and strategies to reduce this risk. Neuropsychology represents a promising theoretical and empirical basis for enhancing the predictive accuracy of VRA, and therefore its validity in clinical and legal decision making. A prospective incremental validity study was conducted to investigate the ability of neuropsychological measures to predict antisocial behavior in an incarcerated sample. Most of the screening and executive functioning measures did not demonstrate the ability to predict program failure due to major program violation; however, measures conceptualized to assess impulsivity demonstrated predictive validity for program failure, independent of the influence of substance use, and over and above a traditional risk assessment measure. Incarcerated individuals may represent a distinct neuropsychological population of interest for researchers and clinical practitioners. Future research should thus be carried out to more fully understand the relationship between executive dysfunction and antisocial behavior.Ph.D., Psychology -- Drexel University, 201
Resilient arts organizations: The growth of performing arts organizations through the 2008 economic recession
Full text linkThis thesis explores the impact that the 2008 U.S. economic recession has had on performing arts organizations. Through my research process, I compiled case studies of three mid-sized performing arts organizations based in the Mid-Atlantic for the greater purpose of examining traits successful arts organizations possessed during this economic downturn. My initial literature reviewed showed that organizations that were quick to adapt new and emerging trends and remained flexible in terms of changing market demands were the organizations which emerged the most successful through this time. However, the information I discovered through the case studies found that rather than emerging trends being utilized by successful organizations, calculated decisions such as merging organizations, hiring dedicated development staff, and transitioning board from working to governance, had instead led to the organizations’ overall sustainability and growth. This paper does not serve as a guide on how to build a successful performing arts organization, as this topic can never be answered in its entirety. It instead describes some of the best practices that have been adopted by specific organizations that have allowed for their success.M.S., Arts Administration -- Drexel University, 201
Objectification Theory and the Family: The Effect of Attachment Insecurity on Self-Objectification and Attentional Bias toward Eating Disorder Stimuli
Full text linkEating disorders (EDs) and disordered eating represent a serious public health issue among young adolescent and adult populations. EDs are predominately a problem for girls and women. Approximately 90% of people who develop EDs are female (Harvard Health Publications, 2012). Objectification theory (Frederickson & Roberts, 1997) posits that internalization of sexualized media messages (self-objectification) and social pressures lead to ED behaviors. Not all females exposed to objectifying stimuli experience ED behaviors. This study explored insecurity in family relationships as a risk factor; specifically, whether women who have greater attachment insecurity are more prone to self-objectification and ED-specific attentional bias. Components of Frederickson et al.'s (1998) and Tiggemann & Boundy’s (2008) experimental designs were replicated. This design has shown that (1) self-objectification can be heightened by context, and (2) self-objectification induces feelings of body shame, which promote ED behaviors. To test attachment insecurity as a risk factor in the objectification framework, a repeated measures experimental design was conducted with women (n = 107), between the ages of 18 and 35. This study utilized a repeated measures, experimental design where each participant either viewed an image set reinforcing the thin-ideal or a control image set of products (no people). Participants were assigned to one of four groups using the minimization method (high attachment insecurity and control images; low attachment insecurity and control images; high attachment insecurity and experimental images; low attachment insecurity and experimental images). Groups were balanced on race, type of insecurity (anxious, avoidant, both), and level of insecurity (over a standard deviation above the mean). The study involved deception in that participants were told that the purpose was to understand women’s attitudes towards advertising. Participants took a screening measure online to assess inclusion and exclusion criteria and then were invited to an in-person session. During in-person data-collection sessions, participants filled out outcome-specific, exploratory and deception self-report measures, viewed the experimental or control image set, and took a cognitive processing test with ED-specific stimuli. Using a factorial MANCOVA, the following hypotheses were tested while controlling for self-esteem (SISE) and parental psychological control (PCS-YSR): 1) Exposure to objectifying stimuli will cause higher levels of state self-objectification (TST) and greater attentional bias towards ED-salient stimuli (ED-specific stroop test); and 2) Exposure to objectifying stimuli will cause higher levels of state self-objectification and greater attentional bias towards ED-salient stimuli for the high attachment insecurity (ECR-RS) group. These hypotheses were tested within a sample of racially and ethnically diverse women. Results demonstrated that those in the high attachment insecurity group demonstrated more attentional bias towards ED-specific stimuli regardless of condition. Implications for family therapists and research limitations are discussed.Ph.D., Couple and Family Therapy -- Drexel University, 201
Fiscal sponsorship & dance: How sponsorship is affecting the Dance community
No full textThis paper explores how the rise of fiscal sponsorship has impacted the field of dance, and the benefits and drawbacks of fiscal sponsorship for dance-makers compared to the more traditional business structures of 501(c)(3). The development of fiscal sponsorship over the past sixty years has paved the way for a new method of working for dance-makers, and has helped to create a vibrant, thriving and sustainable dance industry. Sponsor programs reduce the amount of resources and funding required to begin working, provide the critical ability to fundraise, and create a way to incubate into a 501(c)(3) over time. The efficiency, flexibility, and education provided by fiscal sponsorship is supporting dance-makers in the development of strong, sustainable arts organizations and programs. This paper uncovers critical feedback and the long-term impact of fiscal sponsorship through interviews with five dance-making entities who have, or currently use fiscal sponsorship.M.S., Arts Administration -- Drexel University, 201
On Individual and Community-Level Determinants of Pertussis Incidence and Vaccination
Full text linkThe association between vaccination and vaccine-preventable infectious diseases is well established. Vaccines are often highly effective at preventing disease not only in an individual, but also in a community. Despite the overall high coverage of vaccination in the United States, there has been a recent resurgence of new and existing infectious diseases. In particular, incident pertussis (whooping cough) has dramatically increased over the last decade, both nationally and locally in Philadelphia, where 2012 saw a doubling of the number of cases compared to the prior year. Possible causative agents include waning immunity from the Diphtheria, Tetanus, and acellular Pertussis vaccine and an increase in vaccination exemptions. This dissertation examined the recent increase in pediatric pertussis in Philadelphia through three aims. In the first aim, we examined risk factors for pertussis at both individual and contextual (neighborhood) levels, and hypothesized neighborhoods with a greater number of day cares would report more cases of pertussis. In the second aim, we challenged the traditional notion of vaccination uptake defined by the up-to-date status of an individual, and instead propose using the number of doses as a better predictor in etiologic analyses. In the third aim, we quantified misclassification of pertussis as a result of the changing case definition in 2014 (addition of infant apnea) and demonstrated that in vaccine effectiveness studies, the measure of association is likely attenuated when the investigator does not re-case classify reported cases or consider underreporting of the disease.Ph.D., Epidemiology -- Drexel University, 201
Exploring the Nature of Walking in Dance/Movement Therapy: An Artistic Inquiry
No full textReferences to the use of walking, not only as a basic total body action but also as an expressive element, are abundant in dance/movement therapy (DMT) literature. The researcher’s intent was to generate descriptions of its range of use in DMT practice and to find possible symbolic or psychological meanings of walking in this therapeutic medium. In order to so, the researcher used an artistic inquiry methodology. Four dance/movement therapists participated in a data collection workshop. They were asked to think of a time they used a walking intervention in a session, embody a client who walked in that session and then to create a movement motif based on this walking intervention. Then, participants performed their motifs, taught their motifs to the researcher and then wrote a brief poetic narrative about what they saw, felt or experienced. A focus group followed wherein these participants were asked to discuss ways they have used walking in their clinical practice. The researcher analyzed data that emerged from the workshop using theater and dance techniques and then generated a final creative synthesis in the form of a solo performance video. The video created was in response to the research question, “how is walking used in dance/movement therapy? And what are the sensations, emotions, themes and meanings that emerge from the use of walking in dance/movement therapy practice?” After the exploring the range of uses, sensations, emotions, themes and meanings that emerged from the data collected in this study, five major categorical themes were crystallized. These themes include, shifting awareness/grounding/opening, instability/stability, walking as a bridge to dance/movement, walking as a metaphor/relational process, and transforming disability into ability.M.A., Dance/Movement Therapy and Counseling -- Drexel University, 201
Family Therapy Supervisors’ Sexual Attraction Towards Supervisees
Full text linkUsing sexual scripts theory, this web-based quantitative cross-sectional survey research study was designed to examine the associations among supervisors’ sexual scripts, comfort, training, and supervisors’ management of sexual attraction towards supervisees in a sample of 174 marriage and family therapy supervisors. Approximately half of the participants were females (54%) and most participants identified themselves as heterosexual (88.5%), White (78.7%) and Christian (55.7%). The participants’ ages were distributed as follows: 19% were less than 39 years old; 21.8% were between 40 and 49 years old; 23% were between 50 and 59; 25.9% were between 60 and 69 years old, 6.3% were older than 70 years old; 7 participants did not identify their age in the survey. Approximately 60% identified their theoretical style of supervision as “integrative”, approximately 20% reported their style as post-modern, and approximately 5% each identified their styles as Bowenian, Structural, Strategic, or Contextual. The experience of the participants (in years) as clinical supervisors was as follows: 35.6% had less than 10 years experience; 41.4% had between 11 and 21 years experience; 15.5% had 22 to 30 years experience; 6.3% had more than 31 years of clinical experience; and 2 participants did not complete this part of the survey. Finally, the self-reported sexual scripts of participants were as follows: 59.2% reported being liberal; 24.7% reported being traditional; 10.9% reported being conservative or religious; and 9 participants did not complete this part of the survey. Participants completed one survey for this study. The survey included questions about supervisors’ demographic information, sexual scripts (values), and experiences with sexual attraction in supervision. Survey questions were designed to explore supervisors’ levels of comfort with sexual attraction, the role of “self of the therapist” training in increasing supervisors’ awareness of their own sexual scripts, and abilities to make sound clinical decisions. The survey also examined how supervisors’ awareness of socio-cultural messages (cultural sexual scripts) influence their comfort (i.e., less emotional reactivity) with being sexually attracted to supervisees; and the resources (e.g., training, codes of ethics, or supervision) that have helped supervisors manage sexual attraction to supervisees. The results of the study demonstrated poor reliability of measure and very weak associations among supervisors’ sexual scripts, comfort, training and management of sexual attraction towards supervisees. The psychometrics of this study was not sound. Furthermore, in order to determine whether supervisors’ sexual scripts, comfort, or training were directly associated with their management of sexual attraction towards supervisees, the variables which had the highest correlations with five management parameters were analyzed in linear regression models. Nevertheless, the results produced very low r-squared values (ranging from .07 to .057), indicating little, if any, explanation of the variance in the management parameters. As a result, linear regression models could not be used to predict how supervisors manage their sexual attraction towards supervisees. In future studies, other variables may be explored in lieu of or in combination with the variables addressed in this study to improve the predictability of management through regression models with a reliable valid survey and a representative sample (probability) of AAMFT approved supervisors.Ph.D., Couple and Family Therapy -- Drexel University, 201
Effectiveness of Impairment-Specific Exercises to Improve Balance and Reduce Fall Risk in Community-Dwelling Older Adults
Full text linkPh.D., Rehabilitation Sciences -- Drexel University, 201