Self-Reflection and Progress in Treatment

1. Self-Reflection and Progress in Treatment Professor Geoffrey Stephenson Nikos Zygouris Kim Smith

2. Acknowledgements • Clients of PROMIS • Dr Samantha Haylett • Sue Jones • Dr Lefever and The PROMIS Recovery Centre

3. Overview • Diary research at PROMIS • Introduction of Weekly Evaluation Sheets (WES) • Effects of Small WES Intervention • Effects of Big WES Intervention • Controlled comparisons of the Big WES • Discussion

4. 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”?

5. Little WES Design Pre- Control (2 weeks) Pre- Intervention Control (2 weeks) Post- Intervention (2 weeks) Comparison Intervention n = 12

6. Effects of Little WES • Increased self focus • Changing character of narratives • Increased Positivity • Predictiveness of increases in Positivity-Negativity ratio

7. Big WES: The Matching Pre-Intervention Intervention Post-Intervention • Ben (37, m, alc) Bob (39, m, alc) Bill (37, m, alc) • Jen (25, F, dr.) Josie (28, F, dr.) Jill (26, F, dr.) • 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.)

8. 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”?

9. Characterisation of Big WES over whole time period

10. Main WES Points

11. Clients’ ‘Model’ of Progress Accommodating New Circumstances Personal Understanding and Social Awareness Character Building Pragmatic Focus and Constructive Change

12. Conscientiousness

13. 12-Step Programme Salience

14. Treatment Programme Coherence The intervention group:

15. Treatment Programme Coherence (cont.) The two control groups:

16. Themes in the last weeks of intervention Control Condition Intervention Condition Replacement Themes Alternative Building Drugs Old Themes Step Group

17. 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”

18. 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”

19. 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”

20. 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."

21. 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

22. 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]

23. 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.