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Schizophrenia: From the Inside Looking Out: An Educational Intervention based on the Dynamic Interactive Cognitive and Affective Model (DICAM) for Cognitive Restructuring and Attitude Change

Myers, Kerris (1998) Schizophrenia: From the Inside Looking Out: An Educational Intervention based on the Dynamic Interactive Cognitive and Affective Model (DICAM) for Cognitive Restructuring and Attitude Change. PhD thesis, Murdoch University.

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      Abstract

      Despite public education campaigns and academic training, the public in general and mental health professionals in particular continue to embrace beliefs and attitudes towards schizophrenia, which adversely affect people with schizophrenia and their families. This dissertation reports both a personal and an academic journey which led to the development and trial of an educational intervention, a 60 minute documentary/drama, designed to reduce the stigma associated with schizophrenia by generating accurate schizophrenia schemata and equitable attitudes towards people with schizophrenia and their families.

      The conceptual model underlying the intervention was initially developed from a synthesis of schema theory and social cognitive theory. The final model, the Dynamic Interactive Cognitive and Affective Model for cognitive restructuring and attitude change (DICAM) was developed and refined during the period of the research. The DICAM proposes an integration of theories of learning, persuasion and attitude change, with recent psychobiological and neurological research findings. Consistent with neuroscientific and biological evidence the DICAM views emotion and emotional information as playing a critical role in the process of rational thought and thus in the formation and change of schemata and attitudes. It proposes that emotional responses are stronger and more memorable than cognitive responses and that they serve as a 'trigger' for more detailed and accurate cognitive responses in both 'on line' and 'memory based' schema and attitude change.

      The DICAM also proposes that rapid 'on line' cognitive restructuring and attitude change can be achieved through the technique of 'chaining'.
      This technique involves:

      a) creating a zone of potential change (ZPC) through cognitive and/or emotional arousal;

      b) providing textured repetition of cognitive and emotional data through direct information and simulated experience; and

      c) validating that data through further cognitive information and emotional experience.

      In addition it is suggested that the dynamic interaction of emotion and cognition produces an effect that is greater than the sum of the effects of either emotional or cognitive strategies when introduced independently.

      'Schizophrenia: From the Inside Looking Out', the 60 minute documentary/drama aimed at changing participants' mental representations of schizophrenia (schemata) and their attitudes of social distance, fear, culpability and justice towards people with schizophrenia and their families is an integral part of this dissertation. It is grounded in the theoretical underpinnings of the DICAM, integrating the techniques of screen drama (the emotional component) with the techniques of screen documentary (the cognitive component) in order to provide a dynamic spiral of cognitive conflict and emotional experience which is continually textured, repeated and validated.

      This 'integrated' film is designed to present a seamless and persistent, graphic enactment of the equilibration process as it takes place and thus it purports to mirror the actual activity of the human brain as it reacts to incoming sensory data. The 'marriage' of screen genres which it contains is unique, as the 'documentary' source, an academic and clinical psychiatrist chosen for his credibility, also plays the part of the fictional psychiatrist within the dramatic narrative.

      The efficacy of the 'integrated' film based on the DICAM was examined in an empirical study, with a sample of 304 student health professionals. The study used an extended Solomon IV group design, with provision fox a delayed post-test after a period of nine months. The effects of the 'integrated' film were compared with those of three other interventions: a) a documentary film about schizophrenia based on a cognitive model; b) a drama about schizophrenia based on an affective model; and c) an unrelated documentary which acted as a placebo. These four treatment groups were also compared to a 'no treatment' group.

      The effects of these interventions were assessed on both a Knowledge of Schizophrenia Inventory (KOSI) and an Attitudes Towards Schizophrenia Inventory (ATSI), (measuring attitudes of social distance and fear, rights and blame and family culpability). These instruments were specifically developed for use in this study using the principles of Rasch measurement.

      Only the 'integrated' film was found to have both an immediate effect and an enduring effect (at the nine-month follow up), on both knowledge of schizophrenia and attitudes towards people with schizophrenia and their families.

      The Dynamic Interactive Cognitive and Affective Model for cognitive restructuring and attitude change (DICAM), complements and extends the two current dominant models of attitude change, the Elaboration Likelihood Model (ELM) and the Heuristic Systematic Model (HSM). By acknowledging the central role of emotion in the process of schema and attitude change, the DICAM provides a more comprehensive basis for the development of educational resources designed to combat prejudice and to promote healthy attitudes.

      It is suggested that the DICAM may be used to generate effective educational interventions in areas such as moral education, drug abuse, cancer screening, sexual abuse of children, racial prejudice and attention deficit disorders. It is also suggested that the DICAM may be used not only as a model for attitude change but as a model for education in its broadest sense.

      Publication Type: Thesis (PhD)
      Murdoch Affiliation: School of Education
      Supervisor: Volet, Simone
      URI: http://researchrepository.murdoch.edu.au/id/eprint/10745
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