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Predictors of Inpatient Violence
PI: Evan Waldheter, David Penn, Ph.D.
Funded by: None

For his master’s thesis, Evan studied social cognitive and other predictors of inpatient violence among individuals with a severe mental illness at John Umstead Hospital in Butner, NC.

See related publication: Waldheter, E.J., Jones, N.T., Johnson, E.R., & Penn, D.L. (2005). Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness. The Journal of Nervous and Mental Disease, 193, 609-618.

Prospective contact and persons with severe mental illness: A stigma-reduction strategy
PI: Shannon Couture, David Penn, Ph.D.
Funded by: None 

See related publications: Couture, S.M. & Penn, D.L. (2006).  The effects of prospective naturalistic contact on the stigma of mental illnessJournal of Community Psychology, 34(5), 635-645.

Couture, S.M. & Penn, D.L. (2003).  Interpersonal contact and the stigma of mental illness. Journal of Mental Heath, 12, 291-305.

Pathways to Care in First Episode Psychosis
PI: Abigail Judge, B.A.; Co-I: Diana Perkins, M.D., David Penn, Ph.D. Sue Estroff, Ph.D.
Funded by: UNC Psychiatry

Abigail’s master’s thesis was entitled “Recognizing and Responding to Early Psychosis: A Qualitative Analysis of Individual Narratives.” Early intervention in schizophrenia depends on a clearer understanding of how individuals recognize emerging psychosis and seek help, processes which remain poorly understood. This project utilized a qualitative, narrative method to explore when and how individuals recognize changes in themselves, as well as what circumstances give rise to help-seeking behaviors. Findings suggest important differences in how individuals and clinicians perceive emerging psychosis with implications for future quantitative investigations and psychosocial programming.

See related publications: Judge, A., Perkins, D. O., Nieri, J., & Penn, D. L. (2005).  Pathways to care in first episode psychosis: A pilot study on help-seeking precipitants and barriers to care. Journal of Mental Health14, 465-469.

Judge, A.M., Estroff, S.E., Perkins, D.O. & Penn, D.L. (2008). Recognizing and responding to early psychosis: A qualitative analysis of individual narratives. Psychiatric Services, 59(1), 96-99.

The Effects of Effort, Interest, and Non-Specific Social Factors on Wisconsin Card Sorting Performance in Schizophrenia
PI: Dave Roberts, M. A., David Penn, Ph.D.
Funded by: None

This thesis is examining the influence of non-specific factors and motivation on performance on the WCST in individuals with chronic schizophrenia.

See related publication: Roberts, D. & Penn, D. L. (in press). The effects of task engagement and interpersonal rapport on WCST performance in schizophreniaAmerican Journal of Psychiatric Rehabilitation.

Predictors of Group Alliance
PI: David Johnson, David Penn, Ph.D.
Funded by: Stanley Foundation

For his master’s thesis, Dave studied client characteristics that predicted the strength of the group alliance in the context of a group treatment outcome study comparing CBT to Supportive Therapy for individuals with treatment resistant auditory hallucinations.

See related publication: Johnson, D. P., Penn, D. L., Bauer D. J., Meyer, P., & Evans, E. (2008). Predictors of the therapeutic alliance in group therapy for individuals with treatment-resistant auditory hallucinationsBritish Journal of Clinical Psychology, 47, 171-183.

A Preliminary Trial of Adherence-Coping-Education (ACE) Therapy for First-Episode Schizophrenia 
PI: Sarah Uzenoff, David Penn, Ph.D.
Funded by: Stanley Foundation

Sarah ’s master’s thesis evaluates the efficacy of Adherence-Coping-Education (ACE) therapy, a cognitively-oriented therapy for individuals with first-episode psychosis that was developed and piloted at UNC. As non-adherence to medication and relapse are significant problems for individuals recovering from a first episode of psychosis, this therapy was designed specifically to target patients’ medication adherence and attitudes towards medication. It also focuses on promoting healthy coping skills and rebuilding social, family, and work relationships that may have been disrupted by the individual’s illness. Sarah’s thesis analyzes data from a randomized, single-blind, controlled clinical trial.

See related publication: Uzenoff, S. R., Perkins, D. O., Hamer, R. M., Wiesen, C. A., & Penn, D. L. (2008). A preliminary trial of Adherence-Coping-Education (ACE) therapy for early psychosisJournal of Nervous and Mental Disease, 196, 572-575.

Social Cognition Interaction Training (SCIT) for Autism
PI: Tim Perry, David Penn, Ph.D.
Funded by: Autism Speaks

Tim ’s master’s thesis involves adapting the Social Cognition Interaction Training (SCIT) intervention for use with adults and adolescents with high-functioning autism.  Additionally, Tim’s thesis will examine the relationship between social impairment and psychological distress (depression, anxiety) in this population before and after intervention.

See related publication: Turner-Brown, L.M., Perry, T.D., Dichter, G.S., Bodfish, J.W., & Penn, D.L. (2008). Brief report: feasibility of social cognition and interaction training for adults with high functioning autismJournal of Autism and Developmental Disorders, 38, 1777-1784.

Social Skill Deficits in Adolescents at Genetic High Risk for Psychosis 
PI: Clare Marks, David Penn, Ph.D., Asyenil Belger, PhD
Funded by: NIMH

Clare’s thesis is part of a longitudinal study at UNC’s Conte Center entitled “Prospective Studies of the Pathogenesis of Schizophrenia.” Clare’s research looks at social skill and social cognition in adolescents at genetic high risk for psychosis (GHR). To assess social skill, participants completed a short behavioral performance task. Their performance was evaluated with a theoretically-derived rating manual developed by Clare and David Penn. Social cognition, specifically Theory of Mind, was measured with the Eyes Test. Clare plans to compare the GHR group with a healthy control group. This area of research is critical because it raises the possibility that poor social behavior could be a marker of disease vulnerability and target those who would benefit from early disease intervention and prevention.

See related publication: Marks-Gibson, C., Penn, D. L., Prinstein, M. J., Perkins, D. O., & Belger, A. (2011). Social skill and social cognition in adolescents at genetic risk for psychosis. Schizophrenia Research, 122, 179-184.

Development of the Conversational Assessment of Social Skills (CASS) 
PI: Allison Bassett, David Penn, Ph.D.
Funded by: Autism Speaks

This project developed a peer-based role play measure of social skills for adolescents and young adults with high-functioning autism and Asperger’s syndrome. Participants’ verbal and nonverbal behaviors are coded during two separate role plays: one in which a confederate displays interest in the participant, and another in which a confederate displays disinterest/boredom with the participant. The CASS is currently in use as an outcome measure for social skills trials at Virginia Tech, UCLA, Eastern Virginia Medical School, University of Northern Colorado.

See Related publication: Ratto, A.B., Turner-Brown, L., Rupp, B.M., Mesibov, G.B., & Penn, D.L. (2011). Development of the Contextual Assessment of Social Skills (CASS): A role play measure of social skill for individuals with high-functioning autism. Journal of Autism and Developmental Disorders, 41(9), 1277-1286.

Influence of therapist characteristics on alliance in group therapy for individuals with treatment resistant auditory hallucinations
PI: Katy Harper Romeo, David Penn. Ph.D.

Coded tapes of previous RCT for group CBT vs. supportive therapy for treatment refractory auditory hallucinations using the Vanderbilt Psychotherapy Process Scale in a study of the relationship between therapist characteristics, alliance and outcome for Masters thesis project

See Related publication: Harper Romeo, K., Meyer, P., Johnson, D. & Penn, D. (2013). Therapeutic Alliance in group therapy for treatment resistant auditory hallucinations. Journal of Mental Health. (Accepted).

The Narrative of Emotions Task: A psychometric study of social cognition and social functioning in individuals with schizophrenia
PI: Benjamin Buck, David Penn. Ph.D.

Extant measures of social cognition have been criticized for being impersonal, detached, and lacking in ecological validity. Ben’s master’s thesis sought to create and validate a measure which assesses social cognition in a way that addresses some of these limitations. The Narrative of Emotions Task is a standardized interview and coding system adapted from prior research on emotional narrative in both schizophrenia (Gruber & Kring, 2008) and autism (Losh & Capps, 2006). It allows participants to demonstrate social cognition by sharing and explaining emotional narratives in a complex and coherent manner. Findings suggest that the measure shows strong relationships with existing measures of theory of mind and emotion perception as well as social skills role play, even after controlling for brief verbal IQ.

Buck, B., Ludwig, K., Meyer, P. S., & Penn, D. L. (2014). The use of narrative sampling in the assessment of social cognition: The Narrative of Emotions Task (NET). Psychiatry Research, 217(3), 233-239.

Observable Social Cognition: A Rating Scale: An Interview-Based Assessment for Schizophrenia 
PI: Kristin Healey, David Penn. Ph.D.

Individuals with schizophrenia consistently show impairments in social cognition (SC). SC has become a potential treatment target due to its association with functional outcomes. However, current SC measures are hampered by methodological issues that limit use of SC as a viable treatment target, such as poor psychometric properties. An alternative method of assessment is to administer an observer-based scale incorporating an informant’s “first hand” impressions in ratings. Kristin’s master’s thesis used the Observable Social Cognition: A Rating Scale (OSCARS) to assess performance in the following domains: emotion perception, theory of mind, attributional style, jumping to conclusions, and cognitive rigidity. Findings indicate good reliability, construct validity, and criterion validity. Little evidence was found for convergent and discriminant validity. Further research will explore these issues.

 Healey, K. M., Combs, D. R., Gibson, C. M., Keefe, R. S., Roberts, D. L., & Penn, D. L. (2015). Observable Social Cognition – A Rating Scale: an interview-based assessment for schizophrenia. Cognitive Neuropsychiatry, 20(3), 198-221.

Performance of Empathic Expression Rating Scale
PI: Emily Gagen, David Penn. Ph.D.

Social cognitive deficits are well documented in people with schizophrenia; this includes deficits in empathy, or the ability to both understand and share the emotions of another person.  However, current measures of empathy were developed for use on other populations, only measure individual constructs that comprise empathy, or utilize self-report methods. Emily’s master’s thesis evaluated the psychometric properties of a role-play measure of empathy called the Performance of Empathic Expression Rating Scale (PEERS). The role-play ratings assess a person’s ability to interact empathically with a confederate in an emotionally charged situation. Findings indicate acceptable discriminant validity and some construct and convergent validity. Future research will further investigate the relationship between an individual’s social skill ability and ability to demonstrate empathy.

Gagen, E. C., Gibson, C. M., Elliott, T. L., Smedley, K. L., Jarskog, L. F., Pedersen, C. A., & Penn, D. L. (2017). Are Social Skill and Empathy Separable Constructs? A Psychometric Evaluation of a New Role-play Assessment of Empathy for Individuals with Schizophrenia. Journal of Experimental Psychopathology, 8(2), 175-191.

Walking Around Chapel Hill (WACH): A Pilot Exercise Program for Individuals with Serious Mental Illness
PI: Julia Browne, David Penn. Ph.D.

For her master’s thesis, Julia conducted a qualitative and quantitative study aimed at developing and evaluating an exercise program for individuals with serious mental illness. In Phase 1, she conducted focus groups with clients and clinicians to better understand the barriers to exercise in this population. In Phase 2, she developed and evaluated a pilot walking program for individuals with schizophrenia spectrum disorders in an open trial.

Browne, J., Penn, D.L., Battaglini, C., & Ludwig, K. (2016). Work out by walking (WOW): A pilot exercise  program for individuals with schizophrenia spectrum disorders. Journal of Nervous and Mental Disease, 204(9), 651-657.

Browne, J., Mihas, P., & Penn, D.L. (2015). Focus on exercise: Client and clinician perspectives on exercise in individuals with serious mental illness. Community Mental Health Journal, 52, 4, 387-394.

Social Cognition and African Americans: The Roles of Perceived Discrimination, Experimenter Race, and Racial Identity on Task Performance

PI: Arundati Nagendra, David Penn, Ph.D.

For her master’s thesis, Arun examined whether race-related variables affect social cognition in a sample of 51 healthy Black American men. She used tasks from the Social Cognition Psychometric Evaluation (SCOPE) study, which will soon be the gold standard battery used to assess social cognition in schizophrenia. Results indicated that participants performed better on a skills-based task factor (comprised of measures that are associated with neurocognition) when their experimenter was also Black. Additionally, greater perceived racism was associated with more perceived hostility in interpersonal situations. Taken together, the findings indicate that race-related variables may impact the measurement of social cognition in African Americans.


Social Cognition Psychometric Evaluation (SCOPE) Study in Early Psychosis

PI: Kelsey Ludwig, David Penn, Ph.D.

Kelsey’s thesis entails an assessment of the psychometric properties of the Social Cognition Psychometric Evaluation (SCOPE) battery for use with first episode psychosis patients. In addition to examining the suitability of the SCOPE battery for use with first episode, Kelsey’s thesis incorporates a direct comparison of social cognitive abilities between first episode psychosis and chronic schizophrenia outpatients recruited during the first phase of the SCOPE study.

Ludwig, K. A., Pinkham, A. E., Harvey, P. D., Kelsven, S., & Penn, D. L. (2017). Social cognition psychometric evaluation (SCOPE) in people with early psychosis: A preliminary study. Schizophrenia Research.

Diagnostic Accuracy of the 7-Up 7-Down Scale: Differentiating Unipolar and Bipolar Depression in an Outpatient Setting

PI: Tate Halverson

Tate’s thesis examined the diagnostic and clinical utility of a new 14-item scale, the 7-Up 7-Down (7U7D), to differentiate bipolar diagnoses in an outpatient setting. Youths (N = 1737) and caregivers completed the 7U7D as well as semi-structured diagnostic interviews. Caregiver and youth-reported 7U7D scores significantly identified youth bipolar diagnoses from other diagnoses. Additionally, the 7U7D showed strong incremental validity even after controlling for demographic and clinical characteristics. Altogether, the 7U7D is a brief but effective instrument to identify youth bipolar disorders.

The Therapeutic Alliance in Integrated Coping Awareness Therapy

PI: Maku Orleans-Pobee, David Penn, Ph.D.

The therapeutic alliance (TA) is a crucial component of psychotherapy, but few studies have examined TA in specialized interventions for first-episode psychosis (FEP). Maku’s thesis examined the role of TA (rated by clients, therapists, and independent observers) in the context of a novel FEP intervention. Demographic and clinical variables were examined as potential predictors of TA, and the relationship between TA and treatment outcomes was examined. Client-rated TA was higher than therapist-rated TA, and TA did not differ between treatment conditions. Younger age and lower baseline symptom severity predicted stronger client-rated TA. Lastly, stronger client-rated TA predicted lower post-treatment symptom severity. Results suggest that client-rated TA predicts treatment outcomes in this population more than therapist- or observer-rated TA, and that client-rated TA may also be more sensitive to demographic and clinical predictors.

Horyzons USA: Pilot Trial Findings and the Effect of the Alliance on Outcomes and Platform Usage
PI: Bryan Stiles, David Penn, Ph.D.

Bryan’s thesis had two primary areas of investigation. First, it evaluated the acceptability and feasibility of a contemporary version of the Horyzons platform among young adults with early psychosis in North Carolina. Second, it investigated the effect of the therapeutic alliance on change in social recovery outcomes and on platform usage using an alliance measure adapted for guided digital interventions. Results indicated that users found the intervention acceptable and feasible. Further, a high-quality overall alliance at mid-treatment predicted decreases in loneliness and social anxiety over time and was further associated with higher completion of therapy activities and authoring of comments and reactions. A strong bond with an online therapist supported reductions in loneliness, improvements in perceived social support, and reductions in social anxiety over time, as well as a higher number of reactions made by clients on the platform’s social network. Greater alliance with the platform’s tasks and goals facilitated reductions in social anxiety and was further associated with higher completion of therapy activities and reactions in the social network.

Stiles, B., Halverson, T. F., Stone, A., Still, C., Gleeson, J., Alvarez-Jimenez, M., Perkins, D., & Penn, D. (2023). The effect of the alliance on social recovery outcomes and usage in moderated online social therapy for first episode psychosis. Manuscript submitted for publication.

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