UT Southwestern School of Health Professions
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Welcome to the UT Southwestern School of Health Profession’s electronic theses and dissertations (ETD) collection. (Note: The school was previously named the UT Southwestern School of Allied Health Sciences.)
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Browsing UT Southwestern School of Health Professions by Author "Casenave, Gerald W."
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Item Demoralization as a Factor in a Vocational Rehabilitation Population Using the Demoralization Scale (RCd) of the MMPI-2-RF(2012-08-15) Wishart, Alfred B.; Casenave, Gerald W.; Turner, Mary; Whitfill, TravisBACKGROUND: Demoralization has come to be recognized as an essential element of psychological health. Its prevalence and role as a factor in discreet populations has been studied such as with medical and psychiatric populations though not in the field of Vocational Rehabilitation (VR). In most of this research, the Demoralization Scale (RCd) of the MMPI-2-RF was not used. This study looks at the prevalence of demoralization in a VR population using the RCd. SUBJECTS: The subjects for this study (N = 54) were evaluated for vocational potential by the University Rehabilitation Services (URS) in the Department of Rehabilitation Counseling at the Southwestern School of Health Professions. They were referred by the Department of Assistive and Rehabilitative Services (DARS) of Texas except for one client who was self-referred. METHOD: Basic demographic data (age, ethnicity, IQ, and gender), along with the scores of the MMPI-2-RF scales were gathered. Comparisons were made between the study population and normative populations for the prevalence and degree of demoralization. Further, two correlation analyses were run. The first was for intercorrelations between the RCd and the other Restructured Clinical Scales (RCS) of the MMPI-2-RF and the Clinical Scales (CS) of the MMPI-2. The second, was for intercorrelations between the RCd and other, selected scales of the MMPI-2. RESULTS: The prevalence of demoralization in the study population was higher than in the general population. There were data to suggest that the degree of demoralization in the study population was greater than in the general population, though further research is needed to confirm this. The data on the intercorrelations between the RCd, the RCS, and the CS replicated earlier research; variations are discussed. Unexpected correlations between the RCd and selected scales for the study population were noted and discussed. DISCUSSION: The higher prevalence of demoralization in the study population than in the normative population bears particular significance for VR. Research has shown that demoralization is a key factor in psychological health and in VR. The degree of demoralization in the study population is high and further research is needed to determine if there is are greater degrees of demoralization in a VP population as compare to a normative population. For correlations of the RCd to other scales, there were several unexpected differences in the intercorrelations between the RCd, the RCS, the CS. These data suggest that the study population may have a higher prevalence of somatic symptoms and antisocial traits, and a lower prevalence of cynicism. The strong correlation between the RCd and the WRK scale suggests that demoralization may be a key factor in VR. The absence of recent data on the prevalence of demoralization in the general population diminished the generalizability of the findings. However, the results of this study revealed gaps in the literature that provide direction for future investigations.Item Effect of Physical Activity on Community Participation among Breast Cancer Patients(2015-08-31) Dean, Victoria Nicole; Casenave, Gerald W.; Chiu, Chung-Yi; Rose, LindseyBACKGROUND: Breast cancer patients who engage in physical activity are shown to have a reduction in difficulties during daily living as a result of treatment side effects; however, it is unknown if participation in physical activity will reduce the limitations experienced by these individuals while participating in community activities. SUBJECTS: Female breast cancer patients, with a mean age of 51.81(SD = 7.88, range 30-64), diagnosed with stage 1 (n = 16, 21.3%), stage II (n = 37, 49.3%), stage III (n = 15, 20.0%) cancer who have completed chemotherapy (n = 63, 84.0%), are undergoing chemotherapy (n = 9, 12.0%), or have not yet started chemotherapy (n = 1, 1.3%). The majority of the participants were individuals were employed full time (n = 39, 52.0%), employed part time (n = 13, 17.3%). The majority of these women were married (n = 49) or divorced (n = 11). These women were college graduates (n = 30) or finished some graduate school (n = 20). These participants were European American (n = 34, 45.3%) and African American (n = 13, 17.3%). The BMI of these participants had a mean of 27.28 with a range from 16.30 to 44.81(SD = 5.35). Some of these individuals (n = 53) reported co-occuring medical conditions such as high cholesterol, high blood pressure, diabetes, and being overweight. METHOD: We recruited female breast cancer patients between the age of 18-66, with stage I, II, or III cancer, who are starting, in the process of, or have completed chemotherapy. Participants who met the inclusion criteria were selected to participate. Research assistants invited these patients to volunteer the survey study. For the current study purpose, we analyzed the association between the International Physical Activity Questionnaire (IPAQ) and the World Health Organization Disability Assessment Scale version 2.0 (WHODAS 2.0), using the Pearson product-moment correlation at the level of statistical significance at .05. The survey packages were sent to the participants through the United States Postal Service. Once the surveys were returned by mail the participants received a $10 gift card for compensation. RESULTS: A significant negative association was observed between limitations in participation in society (r = -.31, p =.004, medium effect size) and walking. Significant negative associations were also discovered between the limitations in life activities and vigorous activity (r = -.24, p = .023, small to medium effect size), along with walking (r = -.23, p = 0.25, small to medium effect size). Lastly, a significant negative association was seen between the limitations in communication and understanding and walking (r = -.20, p = .046, small to medium effect size). DISCUSSION: Engaging in physical activity decreases the limitations in understanding and communication, life activities, and participation in society an individual encounters. Vigorous activity is not required to experience reductions in community limitations. Simply engaging in light physical activity, like walking, produces results.Item The Effectiveness of Biopsychosocial Interventions at the Dallas Spinal Rehabilitation Center: Applying the NIDRR Logic Model(2013-09-10) Siles, Melisa Garcia; Chiu, Chung-Yi; Wolf, Tina; Casenave, Gerald W.BACKGROUND: The National Institute on Disability and Rehabilitation Research has developed a program evaluation framework, the NIDRR logic model describing and assessing the relationship between planning, implementing, and evaluating outcomes in rehabilitation service environments, such as the Dallas Spinal Rehabilitation Center. Standard primary care facilities have treated chronic pain with narcotic medications; however, controversies surrounding the lack of long-term efficacy, risk of addiction, and the physical and psychological side effects of these medications continue to be heavily debated. There is strong evidence to support a biopsychosocial treatment approach for chronic pain which reduces narcotic dependence and restores daily functioning. The purpose of this study is to assess the effectiveness of the comprehensive interdisciplinary pain rehabilitation (IPR) program at the DSRC based on the NIDRR logic model. SUBJECTS: A total of 226 patients (131 males [58%] and 95 females [42%]) with chronic pain were admitted to the IPR program at the DSRC between January 2010 and December 2012. Among the 226 patients, 150 patients required medication tapering at admission. The average age of patients was 47 years old (SD= 9.74). The DSRC assigned patients to one of two groups after assessing the severity of their chronic pain curbing their ADL limitations, their social functioning, and their individualized treatment goals; 60 patients were in the chronic pain program, and 166 patients were in the functional restoration program. Patients attended between 80 hours to 160 hours of treatment that included medication management, physical therapy, cognitive-behavioral therapy with psychoeducation and biofeedback, and vocational counseling. METHOD: The current study is a descriptive design. All patients completed self-report measures assessing their current level of pain, functioning, depression, anxiety, and fear-avoidance beliefs at pre- and post-treatment. A dependent paired-samples t-test was used to assess the significance of treatment effect. RESULTS: Overall, significant improvements were seen among patients in the areas of independent functioning, depression, anxiety, fear-avoidance beliefs, medication tapering, and return to work status. Physical demand level, assessing independent functioning, improved significantly, t(225)=27.79, p=.000, among all patients. Results indicated significant improvements in depression scores, t(225)=13.38, p= .000, and anxiety scores, t(225)= 12.94, p= .000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(225)= 13.68, p= .000, as did those beliefs pertaining to work, t(223)= 15.33, p= .000. Additionally, 93% of patients successfully returned to work after completion of the program, and 96% of patients who required tapering at admission successfully tapered or discontinued their medication use. Improvements were also found within each treatment group. Physical demand level in the chronic pain program improved significantly, t(59)=12.19, p.000. Results indicated significant improvements in depression scores, t(59)= 5.79, p= .000, as well as anxiety scores, t(59)= 5.83, p=.000. Average fear-avoidance beliefs pertaining to physical activity improved significantly, t(59)= 7.16, p= .000, as did those beliefs pertaining to work, t(59)=8.77, p= .000. Forty-four (73%) patients in the chronic pain program successfully returned to work. Of the 45 patients that required medication tapering at admission, 101 (96%) tapered or discontinued their medications. DISCUSSION: The NIDRR logic model has provided an excellent framework to assess treatment effectiveness in rehabilitation centers. Findings suggest that a biopsychosocial approach for chronic pain (e.g., the IPR program) is effective and efficient in diminishing overall distress and corroborating more biopsychosocial long-term effects than a short term quick fix of narcotic medications.Item Personal Psychotherapy and the Professional Development of Trainee Therapists(2015-08-31) Abrams, Ian Christopher; Casenave, Gerald W.; Davis, Carlos; Asay, TedThis paper aims to synthesize the literature on personal psychotherapy and graduate training in the helping professions to determine whether personal therapy should belong to the standard set of activities and competencies required of trainee psychotherapists. Though personal psychotherapy has a long history as a training tool, it is seldom formally required or recommended in programs today. Benefits to the clinician have been widely reported; whether clients benefit is a subject of ongoing debate. It appears that most psychotherapists eventually do enter therapy at some point in their career, but not necessarily in training. The paper attempts to determine what is of value to the trainee therapist and how it can be integrated with the goals of training programs.Item Psychometric Properties and Clinical Utility of the Texas Functional Living Scale Short Form in Individuals with Schizophrenia(2013-09-10) Rogers, Kathryn Rayne; Casenave, Gerald W.; Hester, Andrea; Chiu, Chung-YiBACKGROUND: Schizophrenia is a chronic mental disorder presenting with psychotic and cognitive symptoms that lead to impairments in independent living and psychosocial functioning. Individuals with schizophrenia demonstrate cognitive deficits in areas of attention, executive functioning, memory, and language. Additionally, schizophrenia has been associated with impairments in activities of daily living (ADLs) such as toileting and the ability to feed one’s self and instrumental activities of daily living (IADLs) such as taking medication, financial management, communication, and transportation. METHODS: Twenty-six participants diagnosed with schizophrenia or schizoaffective disorders were recruited from the University of Texas Southwestern Medical Center’s Division of Translational Neuroscience of Schizophrenia’s IRB approved Database Registry for Psychotic Disorders and completed a neuropsychological test battery which included the Texas Functional Living Scale (TFLS) and University of California San Diego (UCSD) Performance-based Skills Assessment (UPSA). IBM SPSS Statistics (SPSS v. 19.0) was used to perform Pearson correlation coefficients and multiple regression analyses to identify which subscale(s) of the TFLS had the highest predictive ability for examining IADLs to create a possible short form and to identify which subscales of the TFLS long form have the strongest correlation to neurocognitive measures used in the study. The present pilot study used the Type I error rate at .10; a 90% confidence interval. RESULTS: Results of the analysis indicated that the Time and Money Calculation subscales of the TFLS long form significantly correlated with more neurocognitive measures than the UPSA. Specifically, these two subscales had a higher number of moderate to strong correlations with the neurocognitive measures compared to the UPSA. Results also indicated the TFLS short form to have a stronger correlation with the UPSA (r =.59, p < .003) compared to baseline correlations of the TFLS long form and the UPSA (r = .34, p < .112), which suggests that the Time and Money Calculations subscales of the TFLS can be used as a valid short form of the TFLS in the assessment of IADLS in schizophrenia. DISCUSSION: Overall, the short form of the TFLS appears to be a valuable addition to standard neuropsychological assessment batteries given its numerous correlations with neurocognitive measures. Results also suggest that the TFLS short form is a stronger measure for detecting IADL impairments compared to its original long form and the UPSA.Item Resilience Profile Among People with Spinal Cord Injury: A Cluster Analysis(2013-12-30) White, Brian Dale; Chiu, Chung-Yi; Driver, Simon; Casenave, Gerald W.BACKGROUND: Resilience is considered as an important coping attribute for people adjusting from trauma and loss such as spinal cord injury. Resilience has been found that it has moderate to high correlations with multiple psychosocial characters such as coping strategies, spiritual belief, and life satisfaction as well as mental health. However it is unclear if resilience could have developmental phases when people have adjusted to their trauma and distress over time, or if there are different types of resilience based on a person’s psychosocial characters. Therefore the present study aimed to explore if there are some phases of resilience among people with spinal cord injury (SCI). SUBJECTS: The 93 inpatients with SCI who were undergoing rehabilitation at Baylor Institute of Rehabilitation, Dallas, TX, 58 males (62.4%) and 35 females (37.6%), 77 Caucasians (82.8%) and other races (17.2%; i.e., African American, Hispanic), with mean age of the sample was 44.2 years (SD = 16.2), and the mean months since onset was 16.14 months (SD = 62.12). METHODS: Patients completed the Connor-Davidson Resilience Scale, Personal Health Questionnaire- 9, Satisfaction with Life Scale, Intrinsic Spirituality Scale at any time point since being hospitalized to discharge. Using SPSS 19.0, a hierarchical cluster analysis was performed to preliminarily explore optimal patterns of resilience based on the psychosocial evaluations. Further a two-step cluster was used as a post hoc test of cluster quality and predictor importance. ANOVA and chi-squared test were used to identify any differences of the above psychosocial components of resilience and related demographic characters between the identified patterns of resilience. RESULTS: A hierarchical cluster analysis found three clusters with appropriate differentiable dendrogram distance labeled Spontaneous Resilience (SR; n=28, 35.9%), Evolving Resilience (ER; n=28, 35.9%) and Rebounding Resilience (RR; n=22, 28.2%). Further using a two-step cluster analysis as a post hoc testing, the silhouette measure of cohesion and separation indicated that the cluster quality was fair (0.40). The predictor importance for the cluster formation showed spirituality had an importance of 1.00, the most important predictor, with depression and SWL each showing a predictor importance score of 0.46. The ANOVA found significant differences between groups on resilience, F(2,75) = 7.98, p < .001; depression, F(2, 75) = 23.86, p < .000; SWL, F(2,75) = 23.66, p < .000; and spirituality, F(2, 75) = 71.62, p < .000. Chi square test found no significant associations between the two resilience patterns of gender (X2(2, N = 78) = 1.997, p = 0.368), and marital status (X2( 8, N = 78) = 8.287, p = 0.406). Race results were significant (X2(4, N = 78) = 9.559, p = 0.049), but race was unable to be used due to the majority of participants being Caucasians. DISCUSSION: The current study suggested that there are three resilience patterns recognized in this sample of people with SCI. The hierarchical cluster analysis clustered participants into three clusters: Spontaneous Resilience (SR), Evolving Resilience (ER) and Rebounding Resilience (RR), three of which reflect the levels of resilience change over time and differences in depression, SWL and spirituality. Rehabilitation professionals could apply the present findings on understanding the status of patients’ resilience and design according adjustment psycho-educational therapy for growing patients’ optimal resilience.Item A Sense of Humor: Theories, Benefits, & Therapeutic Applications(2016-08-25) Solowiej, Kathryn Lee; Casenave, Gerald W.; Davis, Carlos; Vreeland, AllanThis paper aims to synthesize the literature on humor theory and its therapeutic application as is related to mental health. Though humor is a universally experienced phenomenon and it widely accepted that humor is a positive adaptive response to life's difficult moments, it is seldom formally taught in psychology programs today. Benefits of humor in therapy have been widely reported; whether clients benefit is a subject of ongoing debate. The paper attempts to define humor, present a discussion of the existing theories on humor, and then analyze the research findings regarding its effect on mental health and the therapeutic use of humor. It remains a largely unexplored psychotherapeutic technique and a potentially untapped resource.Item State Vocational Rehabilitation Services and Employment for Individuals with Cardiac and Other Types of Circulatory System Conditions(2015-12-03) Camacho, Juan Jose; Casenave, Gerald W.; Chiu, Chung-Yi; Rose, LindseyBACKGROUND: Obtaining and maintain employment can be a significant challenge for individuals with disabilities, including cardiac and other conditions of the circulatory system. Although federal vocational rehabilitation laws allow for each state to provide various services, it is not well understood which services make a difference in employment rates, or how receipt of cash and medical benefits affect the rate of employment as well. SUBJECTS: Data points regarding 4,475 state vocational rehabilitation consumers were extracted from an archival database controlled by US Department of Education containing demographic covariates, specific vocational rehabilitation services used, and final employment outcome. METHOD: A hierarchical logistic regression analysis was utilized using vocational rehabilitation services as predictors to predicting employment for consumers with a cardiac and/or circulatory system disability. RESULTS: A total of 2,616 out of 4,475 cardiac consumers (58.5%) were competitively employed after receiving vocational rehabilitation services. Logistic regression analysis results indicated that cash benefits (OR = 0.34; 95% CI: 0.3-0.4) were negatively associated with employment, whereas on-the-job supports (OR = 4.25; 95% CI: 3.51-5.16), diagnosis and treatment (OR = 1.69; 95% CI: 1.45-1.96), on-the-job training (OR = 1.91; 95% CI: 1.2-3.04), job placement assistance (OR = 1.7; 95% CI: 1.43-2.03), and maintenance (OR = 1.95; 95% CI: 1.58-2.39), and the other services category (OR = 1.3; 95% CI: 1.1-1.54) were significant predictors of positive employment outcomes. DISCUSSION: Vocational services offered by state vocational agencies have been found to positively benefit individuals with a cardiac or other circulatory condition disability by assisting with obtaining or maintaining employment.Item University of Texas Southwestern Medical Center Group Therapy Outcomes: Social Skills Training for Adults with Mental Illness(2012-12-06) Russo, Amanda; Chiu, Chung-Yi; Casenave, Gerald W.; Rose, LindseyBACKGROUND: Group therapy is an effective method of treating people with various mental illnesses. Social skills training is often used in a group therapy setting to improve the social functioning of people with mental illness, many of whom have social skills deficits. Currently, there is very little literature on how social skills training reduces symptomology, most of which is limited to children or adolescents and people with autism spectrum disorders. The current study looks to determine what, if any, effect social skills training has on alleviating depression and anxiety symptoms in a mixed mental illness sample. SUBJECTS: 23 subjects were recruited from the University Rehabilitative Services to take part in the study. There were 11 males and 12 females divided into two treatment groups named Connections (CG) and Personal and Social Adjustment Treatment (PSATG). METHOD: A one-way paired samples t-test was used to determine improvement between pre and post BDI-II and BAI scores. RESULTS: BDI-II scores were significantly lowered, indicating improvement in depression symptoms. BAI scores were not statistically significant. DISCUSSION: Social skills training does alleviate depression symptoms in an adult mixed mental illness sample. Future studies need to focus on improving anxiety symptoms as well.