Psychology, Department of


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Elizabeth A Cook, "Peer Support for Consumers with Psychosis" (October, 2013). PhD dissertation, University of Nebraska - Lincoln.


A DISSERTATION Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy, Major: Psychology, Under the Supervision of Professor William D. Spaulding. Lincoln, Nebraska: October, 2013

Copyright (c) 2013 Elizabeth A. Cook


The purposes of this project were: 1) to collaboratively adapt an existing cognitive-behavioral intervention for consumers with serious mental illness (SMI) so that it could be provided by peers, and 2) to evaluate the feasibility of the resulting group intervention and perform a preliminary analysis of its effectiveness. Focus groups consisting of 7 consumers with SMI and 9 peer providers assisted in the determination of group content and structure. Results from the focus groups suggested significant overlap between topics covered and educational strategies utilized in traditional psychosocial interventions and preferences for the peer-based group. However, participants expressed a preference for support strategies and nuances in language that differentiated the group from more traditional interventions. Consumers and peer providers also offered helpful suggestions about how to keep individuals engaged in the group, how to address complicated decisions such as when to breach confidentiality, and how to select peer providers to lead the group. After assembling a treatment manual based on group feedback, we conducted a feasibility study with 17 consumers and 3 peer providers during which we monitored fidelity, repeatedly assessed functional outcomes, and collected data related to treatment engagement, personal reactions to the treatment, and adverse events. Results from the feasibility study demonstrated that peer providers did not attain acceptable fidelity ratings, but this was more likely an artifact of the fidelity measure than a reflection of provider ability. With respect to outcomes, the study demonstrated that consumers experienced an improvement in some domains of psychiatric symptoms and social functioning, but did not experience a change in stigma beliefs. Contrary to our expectation, there was no observed relationship between stigma beliefs and treatment engagement. Finally, consumers and peer providers provided positive ratings of the intervention, and few adverse events were reported during the study period. This study is significant in that it represents a key step toward the integration of the mental health professional and consumer communities for the betterment of those affected by SMI.

Adviser: William D. Spaulding