Practice recommendations for addressing racism: A content analysis of the counseling psychology literature.

Although racism persists as a significant public health issue that adversely impacts the mental health of people of color (U.S. Department of Health and Human Service, 2001), there has been very little systematic guidance for mental health professionals to address racism through practice (S. Harrell, 2000). Therefore, we conducted a content analysis of the peer reviewed counseling psychology literature-the first of its kind-to provide a summary and critique of the extant practice recommendations and facilitate the development and enhancement of practice efforts aimed at addressing racism. We reviewed racism-related articles published in the Journal of Counseling Psychology, The Counseling Psychologist, and Counseling Psychology Quarterly and identified 73 relevant articles, of which 51 provided practice recommendations. Based on our review of this literature, we identified eight general categories of recommendations for addressing racism: psychoeducation, validation, self-awareness and critical consciousness, critical examination of privilege and racial attitudes, culturally responsive social support, developing positive identity, externalize/minimize self-blame, and outreach and advocacy. We found that most recommendations within each category were at the individual level with far fewer at the group and systemic level. A critique of recommendations is provided along with suggestions for developing and bolstering practice, research, and consultation efforts aimed at addressing racism. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Dysfunctional attitudes and expectancies in deficit syndrome schizophrenia.

The deficit syndrome was proposed over 20 years ago as a separate negative symptom syndrome within schizophrenia with a distinct neurobiological pathophysiology and etiology. Recent research, however, has indicated that psychological factors such as negative attitudes and expectancies are significantly associated with the broad spectrum of negative symptoms. Specifically, defeatist beliefs regarding performance mediate between neurocognitive impairment and both negative symptoms and functional outcome. Additionally, asocial beliefs predict asocial behavior and negative expectancies regarding future pleasure are associated with negative symptoms. The present study explored whether these dysfunctional beliefs and negative expectancies might also be a feature of the deficit syndrome. Based on a validated proxy method, 22 deficit and 72 nondeficit patients (from a pool of 139 negative symptom patients) were identified and received a battery of symptom, neurocognitive, and psychological measures. The deficit group scored significantly worse on measures of negative symptoms, insight, emotion recognition, defeatist attitudes, and asocial beliefs but better on measures of depression, anxiety, and distress than the nondeficit group. Moreover, the deficit group showed a trend for higher scores on self-esteem. Based on these findings, we propose a more comprehensive formulation of deficit schizophrenia, characterized by neurobiological factors and a cluster of psychological attributes that lead to withdrawal and protect the self-esteem. Although the patients have apparently opted-out of participation in normal activities, we suggest that a psychological intervention that targets these negative attitudes might improve their functioning and quality of life.

Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia.

CONTEXT: Low-functioning patients with chronic schizophrenia have high direct treatment costs and indirect costs incurred due to lost employment and productivity and have a low quality of life; antipsychotic medications and psychosocial interventions have shown limited efficacy to promote improved functional outcomes. OBJECTIVE: To determine the efficacy of an 18-month recovery-oriented cognitive therapy program to improve psychosocial functioning and negative symptoms (avolition-apathy, anhedonia-asociality) in low-functioning patients with schizophrenia. Design, Setting, and PARTICIPANTS: A single-center, 18-month, randomized, single-blind, parallel group trial enrolled 60 low-functioning, neurocognitively impaired patients with schizophrenia (mean age, 38.4 years; 33.3% female; 65.0% African American). INTERVENTIONS: Cognitive therapy plus standard treatment vs standard treatment alone. MAIN OUTCOME MEASURES: The primary outcome measure was the Global Assessment Scale score at 18 months after randomization. The secondary outcomes were scores on the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms at 18 months after randomization. RESULTS: Patients treated with cognitive therapy showed a clinically significant mean improvement in global functioning from baseline to 18 months that was greater than the improvement seen with standard treatment (within-group Cohen d, 1.36 vs 0.06, respectively; adjusted mean [SE], 58.3 [3.30] vs 47.9 [3.60], respectively; P = .03; between-group d = 0.56). Patients receiving cognitive therapy as compared with those receiving standard treatment also showed a greater mean reduction in avolition-apathy (adjusted mean [SE], 1.66 [0.31] vs 2.81 [0.34], respectively; P = .01; between-group d = -0.66) and positive symptoms (hallucinations, delusions, disorganization) (adjusted mean [SE], 9.4 [3.3] vs 18.2 [3.8], respectively; P = .04; between-group d = -0.46) at 18 months. Age was controlled in the analyses, and there were no meaningful group differences in baseline antipsychotic medications (class or dosage) or in medication changes during the course of the trial. CONCLUSION: Cognitive therapy can be successful in promoting clinically meaningful improvements in functional outcome, motivation, and positive symptoms in low-functioning patients with significant cognitive impairment. Trial Registration  clinicaltrials.gov Identifier: NCT00350883.