fabian aguirre austin psychology therapist university of texas

CALIFORNIA STATE UNIVERSITY, NORTHRIDGE

COPING STRATEGIES IN PERSONS WITH SCHIZOTYPY

A thesis submitted in partial fulfillment of the requirements

For the Master of Arts degree in Psychology, Clinical Psychology

By

Fabian Aguirre

June 2006

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The thesis of Fabian Aguirre is approved:

________________________________________ ____________________

Mr. Andrew Ainsworth Date

________________________________________ ____________________

Dr. Dee Shepherd-Look Date

________________________________________ ____________________

Dr. Mark Sergi, Chair Date

California State University, Northridge

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Acknowledgements

I would like to acknowledge all the faculty and staff in the psychology department

at California State University, Northridge. The faculty members have played an integral

role in my professional development. I acknowledge Dr. Mark Sergi for all his help and

support. As my thesis adviser, Dr. Sergi has guided my growth from a student writing a

report to a scholar writing an academic thesis. Not only is he a mentor, Dr. Sergi is truly

an aspiration in the research development of persons with schizotypy. His expertise in

this area led me to be more interested in psychosis prevention.

I would also like to acknowledge Dr. Dee Shepherd-Look. Her kindness and good

heartedness aided my development not only as a professional but also as a person.

Through her practicum, I received a genuine feel and understanding of the challenges

faced by parents with special need children. This experience also enabled me to see the

impact we, as professionals in psychology, have on people’s lives.

I would further like to acknowledge, Professor Andrew Ainsworth. He introduced

me to the world of statistics. His energy and enthusiasm for such a dry topic was so

infectious and enjoyable that I actually took an additional course that did not count

towards my course requirements. I admire Mr. Ainsworth as a professor and consider him

a friend.

Additionally, I would like to acknowledge all the other professors within their

specialties; Dr. Donald Butler, Dr. Ronald Doctor, Dr. Jean Elbert, and Dr. Luciana

Laganá. They have all been instrumental to my education. Lastly, but not least, I would

like to acknowledge all the research assistants in Dr. Sergi’s lab. It was through their hard

work and dedication that this thesis project was made possible.

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Table of Contents

Signature Page ii

Acknowledgements iii

Abstract vi

Chapter 1: Introduction 1

a. Schizotypy 1

b. Coping & Stress 2

c. Assessing Coping Strategies 4

d. Research in Coping on the Schizophrenia Spectrum 5

e. Neurocognition and the effects on coping 6

f. Hypotheses 8

Chapter 2: Methods 9

a. Participants 9

b. Design Procedures 9

c. Apparatus 9

d. Data Analysis 12

Chapter 3: Results 14

a. Demographics 14

b. Coping styles and schizotypy status 14

c. Cognitive appraisal and coping styles 16

d. Neurocognitive factors with schizotypy status and coping styles 16

Chapter 4: Discussion 18

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References 21

Appendix 26

A. Schizotypal Personality Questionnaire-Brief (SPQ-B) 26

B. Revised Social Anhedonia Scale (R-SAS) 28

C. Coping Response Inventory (CRI) 30

D. Cognitive Appraisal of Life Events Scale (CALES) 37

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ABSTRACT

COPING STRAGIETS IN PERSONS WITH SCHIZOTYPY

By

Fabian Aguirre

Master of Arts degree in Psychology, Clinical Psychology

Ample studies have shown that persons with schizotypy are very similar to individuals

with schizophrenia. However, little is known about the way persons with schizotypy use

coping strategies. This study compares 71 college students, identified as either high or

low in schizotypy with the use of the Schizotypal Personality Questionnaire-Brief (SPQ-

B), on coping strategies while controlling for cognitive appraisal and neurocognition. We

found that, when controlling for cognitive appraisal, persons high in schizotypy were

significantly more likely to use avoidance coping than persons low in schizotypy.

However, persons high and low in schizotypy show little to no difference in approach

coping. We also found that neurocognition does not correlate with coping strategies.

Therefore, college students high in schizotypy may be using less effective coping, as

patients diagnosed with schizophrenia do.

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Chapter 1

Introduction

Schizotypy

What is Schizotypy? The personality organization schizotypy was originally

described by Meehl (1962) as a person who has pleasure deficits, cognitive slippage,

ambivalence, and interpersonal aversiveness. These individuals may experience ideas of

reference, magical thinking, unusual perceptual experiences, eccentric behavior or

appearance, suspiciousness/paranoia, disorganized/odd speech, constricted affect,

excessive social anxiety, and a dearth of social relationships (Meehl, 1990). This

schizotypic behavior may be observed within the normal population and, by itself, does not

necessarily cause dysfunction. Thus, schizotypy is a dimensional clinical construct, not a

categorical psychiatric diagnosis.

Schizotypy on the schizophrenia spectrum. In the field of research, schizotypy is

conceptualized as involving mild symptoms of Schizotypal Personality Disorder (SPD) and

schizophrenia. Hence, schizotypic behavior may represent the prodromal manifestations of

schizophrenia or the less impairing SPD (Claridge, 1994; Claridge & Beech, 1995).

Persons with schizotypy may be assigned the diagnosis of SPD if their schizotypic

behaviors cause sufficient social dysfunction. In order to be diagnosed with SPD, at least

five of the following criteria must be present: ideas of reference, odd beliefs of magical

thinking which influence behavior, unusual perceptual experiences, odd thinking and

speech, suspiciousness, inappropriate affect, odd behavior or appearance, lack of close

friends, and excessive social anxiety (American Psychiatric Association, 1994). While

2

SPD affects approximately three percent of the U.S. population, it is estimated that at least

five to ten percent of the population possess traits of schizotypy.

Furthermore, persons with schizotypy may reflect the initial stages of schizophrenia

(Horan et al., 2004; Meehl, 1990) and are considered to fall within the schizophrenia

spectrum. Research has shown that persons with schizotypy present the same positive

symptoms, negative symptoms, and cognitive deficits of patients with schizophrenia,

except, with a lesser severity (Matsui et. al., 2004). For instance, patients with

schizophrenia will experience positive symptoms, such as hallucinations and delusions,

and negative symptoms, such as flat affect, which disrupt their everyday living ability.

Schizotypy individuals, however, may believe that people can read his or her mind, but this

thought does not impede upon their daily functioning. These schizotypy individuals do not

become consumed by this belief to the point of wearing a hat made to foil to keep people

from reading his thoughts. For this reason, persons with schizotypy are considered to

belong within the schizophrenia spectrum. Thus, due to the dearth of research on

schizotypy subjects in respect to coping and stress, studies on patients with schizophrenia

will drive expected similar findings with schizotypy individuals.

Coping & Stress

The relationship between coping styles and mental/physical health has grown as

an area of investigation over the past 20 years (Somerfield & McCrae, 2000). It has been

accepted that coping and stress are strongly related. People become more stressed when

their efforts (cognitive and behavioral) are not able to manage the external or internal

demand (Lazarus & Folkman, 1984). For example, John is uninsured and drives his car

into a rail. In this case, John needs money to repair the damage to his car (external

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demand). If John has the necessary financial resources (efforts) to meet the external

demand, then this event will not be stressful. However, if John does not have the financial

resources, then John will experience a great deal of stress because his efforts did not meet

the external demand.

Aldwin (1994) stated two purposes of coping research: 1) to understand why

people differ so greatly in how they cope with stress and 2) to understand how different

responses relate to well-being. These two purposes have lead researchers to investigate

the importance of coping and the impact of stress on individuals with mental disorders.

Various studies have looked at particular mental illnesses to assess the role of coping and

stress.

Ventura & Liberman (2000) state that all biomedical disorders are stress-related

biological illnesses. They reason that stressors impinge on the individual, triggering

episodes of symptom exacerbation, dysfunction, and hospitalization. Take bacterial

infections for instance. Campisi et al. (2003) showed that stress-induced rats were more

susceptible and took longer to recover from the bacteria injected into their bodies.

Although this cannot be tested on humans, for ethical reasons, theories have also

supported the idea that stress can exacerbate symptoms. For example, it has been

accepted for many years that stress influences the onset and course of schizophrenia

(Ventura & Liberman, 2000). This vulnerability-stress model asserts that schizophrenia is

not purely genetic. Zubin and Spring (1977) theorized that some individuals have a

predisposition (genetic vulnerability) to schizophrenia that is triggered by an

environmental stressor.

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To illustrate, suppose Matthew has a genetic vulnerability of schizophrenia since

his grandfather (who he never met) was diagnosed with this disorder. Matthew led a

normal life until the age of 18, when he started college. In college, Matthew became

overwhelmed and stressed with the adjustment to college life. These environmental

stressors triggered Matthew’s delusions of aliens stealing his ideas. This sparks two

important questions: (a) would Matthew have developed delusions if he knew how to

properly cope with his environmental stressors, and (b) how do we identify these

individual prior to the onset of psychotic symptoms?

Assessing Coping Strategies

Since stressful events can exacerbate symptoms, successful coping strategies

seem to be a protective factor (Ventura et al., 2002). Before any coping intervention can

be used on this population, we have to assess coping styles in this population. There are

various ways to assess coping. One theory distinguishes problem-focused coping from

emotion-based coping. Problem-focused coping focuses on the evaluation of the situation

and the creation of possible solutions that actively reduce the level of stress. In contrast,

emotion-based coping centers on how the individual changes his or her feelings about the

stressful situation (Carver et al., 1989).

Moos and Schaefer (1993) developed an alternative model that distinguishes

between approach-coping and avoidance-coping. In approach-coping, the individual uses

cognitive and/or behavioral attempts to resolve the conflict situation. In contrast,

avoidance coping involves minimizing the importance of the stressful event or distracting

oneself from the stressful event. Moos (2002) found that using approach-coping strategies

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contributes to favorable outcomes and avoidance-coping strategies generally indicate

worse outcomes.

Research in Coping on the Schizophrenia Spectrum

Due to the scarce amount of research on schizotypy and coping strategies, a

review of studies of coping in schizophrenia may improve our ability to anticipate the

forms and effectiveness of coping in individuals with schizotypy. As mentioned earlier,

the vulnerability-stress model asserts that a predisposition to schizophrenia and

environmental stressors trigger the illness. Although one study found that the relationship

between the amount of stress and relapse to be relatively weak (Hirsch et. al, 1996),

recent studies have shown that stressful events indeed increase the risk of psychosis and

exacerbate psychotic symptoms (Ventura et al., 2002). Therefore, when assessing coping

styles in a sample, the experimenter must control for the amount of stress that is reported

by the experimental and comparison groups.

In addition, research has established that patients with schizophrenia fail to use

appropriate coping strategies in response to stressful events. For instance, Horan et al.

(2003) found that maladaptive coping approaches associated with emotional responses to

psychosocial stressors are one of the dividing factors among patients with schizophrenia

and the general population. Hence, patients with schizophrenia are less able to cope with

stressful situations. This lack in coping ability has been linked to an increase in their

psychotic symptoms. Because of these findings, researchers’ efforts have been spent on

reducing stressful events to decrease psychotic symptoms. However, most of their efforts

are geared toward establishing effective coping mechanisms in response to stressful

situations, since such situations are unavoidable. Various studies indicate that coping

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interventions reduce stress (Ponizovsky et al., 2004), as well as symptoms and the

likelihood of rehospitalization (Norman et al., 2002). In the Norman et al. (2002) study,

they found that training in stress management provided the patient with additional

strategies for coping, which in turn reduced the possibility of subsequent symptom

exacerbations and reduced the risk of rehospitalization. The limited studies of coping in

schizophrenia have examined approach- and avoidance-coping. These studies have found

that patients with schizophrenia frequently utilize more avoidance-coping and less

approach-coping (Hultman et al., 1997; Jansen et al., 1999; van den Bosch et al., 1992;

Ventura et al., 2004). Furthermore, Ventura et al. (2004) revealed that normal controls

used significantly more approach coping strategies than patients with schizophrenia.

These findings suggest that approach-coping is successful coping, while

avoidance-coping may increase psychotic symptoms and rehospitalization. However,

there is a scarcity of research on the evaluation of coping skills among the less

symptomatic and more functional schizotypy population. One study found that patients

diagnosed with Paranoid Personality Disorder (PD), Schizoid PD, or Schizotypal PD,

seek less social support and utilize more avoidance coping strategies (Bijttebier et al.,

1999). This intriguing finding points to the need for further study of coping in schizotypy.

By examining the coping of persons with schizotypy we will determine whether they

“overuse” avoidance-coping strategies and “under use” approach-coping strategies as

persons with schizophrenia reportedly do.

Neurocognition and the effects on coping

Coping may be influenced by neurocognitive abilities. Many domains of

neurocognition are impaired in schizophrenia, and these deficits result in impaired social

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functioning (Green, 1996; Green et al., 2000). For instance, Green (1996) concluded that

secondary verbal memory and sustained attention (vigilance) were significant predictors

of social problem solving. This leads us to expect that neurocognitive factors might

contribute to the use of distinctive coping strategies. Recent studies identify a strong

correlation between neurocognition and approach coping, but not for avoidance coping.

Ventura et al. (2004) found that low self-efficacy (low appraisal of ability to handle

adversity and low self-esteem) was associated with the lower frequency of approach

coping strategies. Furthermore, they found that greater cognitive capacity (e.g. executive

functioning assessed with the WCST, secondary verbal memory assessed with the CVLT)

was associated with higher rates of approach problem solving.

Schizotypy and Neurocognition. Research indicates that persons with schizotypy

experience cognitive deficits similar to those experienced by persons with schizophrenia.

Matsui et al. (2004) demonstrated that verbal memory and visual-motor abilities are

lacking in both groups. However, schizotypy individuals did not show executive

functioning difficulties, as did patients with schizophrenia. In fact, schizotypy individuals

perform as well as the “normal” controls in executive functioning. Therefore, “cognitive

deficits in patients with schizotypal features were qualitatively similar to, but

quantitatively milder than, patients with schizophrenia” (Matsui et. al., 2004). These

qualitative deficits have also been identified in neuro-imaging findings. One study found

that those with SPD are similar to “normal” controls in most lateral frontal regions.

However, they exhibited intermediate values, which fell between “normal” controls and

schizophrenic subjects in the lateral temporal regions (Buchsbaum et al., 2002). These

studies suggest that persons with schizotypy are in the schizophrenia-spectrum, which

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encourages research of parallel dysfunctions, such as coping skills, within these

populations.

Hypotheses

The theoretical and observed links between schizophrenia and schizotypy allow

one to extrapolate schizophrenia findings into predictions for studies of persons with

schizotypy. In this case, coping has been more studied in schizophrenia; thus, the

hypotheses of the present study are guided by the coping literature in schizophrenia. The

aims of this study are to explore coping styles in persons high in schizotypy and compare

them to persons low in schizotypy, while controlling for appraisal and neurocognitive

ability. The primary hypothesis is that persons high in schizotypy will engage in more

avoidance coping and less approach coping than persons low in schizotypy (i.e., healthy

persons). A secondary hypothesis is that persons high in schizotypy will perceive more

stress than those low in schizotypy. It is also hypothesized that persons high in

schizotypy will be impaired in neurocognition (secondary verbal memory and executive

functioning) relative to persons low in schizotypy. However, neurocognitive functioning

is not expected to effect the type of coping behaviors used by persons high or low in

schizotypy. Thus, persons with better cognition will not necessarily use proportionally

more approach coping and persons with more impaired cognition will not necessarily use

proportionally more avoidance coping.

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Chapter 2

Methods

Participants

Approximately 1000 undergraduate psychology students attending California

State University, Northridge received the 22-item Schizoptypal Personality

Questionnaire-Brief Version (SPQ-B) as part of the Department of Psychology’s pre-

testing. In this pre-screening, students were divided into two groups: persons high in

schizotypy were identified by total SPQ-B scores that fell between 15 and 22 and persons

low in schizotypy were identified by total SPQ-B scores that fell between 0 and 2. From

this pool, seventy-one undergraduate students (36 persons high in schizotypy and 35

persons low in schizotypy) participated in this study after providing their written

informed consent. All participants received credit in their lower division psychology

course for participating in this study.

Design Procedures

In this double-blind experiment, participants completed a two-hour battery

involving measures of coping, neurocognition, stress and appraisal, and functional status.

The battery was administrated individually in quiet cubicles by undergraduate research

assistants. The four research assistants were trained on the all measures by the thesis

advisor and required to demonstrate correct administration of the measures.

Apparatus

Schizotypy. Raine and Benishay (1995) created the Schizotypal Personality

Questionnaire-Brief (SPQ-B) as a short version of the Schizotypal Personality

Questionnaire (SPQ). The SPQ-B consists of 22 yes/no items, each valued with 1 or 0.

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The SPQ-B contains three subscales: Cognitive-Perceptual, Interpersonal, and

Disorganized. In a sample of 220 undergraduate students, Raine and Benishay reported

internal reliabilities ranging from .72 to .80, mean of .76. The test-retest, two-month time

lapse, reliabilities range from .86 to .95, mean of .90. Inter-correlations between SPQ-B

factors and SPQ factors range from .89 to .94 (mean=.91). Criterion validity was

established through correlations between SPQ-B subscales and clinical interviews of

individuals with Schizotypal Personality Disorder. They reported high correlations for

the total scale (.66), as well as the cognitive-perceptual (.73) and interpersonal (.63)

subscales. However, correlations were lower for the disorganized subscale (.36). A

second psychometrics study of the SPQ-B yielded similar findings (Axelrod et al., 2001).

Negative schizotypy. The Revised Social Anhedonia Scale (R-SAS; Eckblad et al.,

1982), is a 40-item true or false test, which measures social withdrawal and a lack of

interest in pleasure from social relationships. This self-report test includes statements that

are characteristic of negative symptoms, such as “Having close friends is not as important

as many people say,” and “I prefer watching television to going out with other people.”

The R-SAS will be administered as part of the test battery. The purpose of this measure is

to identify the negative schizotypy among the persons high in schizotypy and compare

them to the reminding persons high in schizotypy on coping styles and neurocognition.

The negative schizotypy will be grouped by R-SAS scores 16 or greater for females and

20 or greater for males, due to cutoff scored based on standardization by Eckblad et al.

(1982). The estimated administration time of the R-SAS is ten minutes.

Secondary verbal memory. The California Verbal Learning Test (CVLT; Delis et

al., 1983) assesses secondary verbal memory by asking participants to recall 16 items

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from four taxonomic categories presented over a series of five trials. Each word list is

read aloud by the administrator. Additional elements of the measure assess short delay

free recall, short delay cued recall (“Name as many items as you can that are Fruits?”),

long delay free recall, long delay cued recall, and recognition. The estimated

administration time of the CVLT is 15 minutes.

Executive functioning. The Wisconsin Card Sorting Test (WCST-64; Heaton et al.,

1993) is a measure of frontal executive functioning and problem-solving skills. The

subject is presented with four keycards. Each card has different shapes, numbers of

shapes, and colors. The subject is required to individually match the presented stimulus

cards to one of four keycards. Each card presented can be matched according to the shape,

number, or color of the symbols of the existing four cards. The computerized version of

the WCST will be administered. The WCST requires about 20 minutes to administer.

Coping. The Coping Responses Inventory (CRI; Moos & Schaefer, 1993)

involves 48 items, which are rated along a 4-point Likert-type scale: “0 = not at all” to “4

= yes, fairly often.” The interview is based on one open-ended question: In the past 12

months, have you had any situations that you thought were stressful or difficult? The

subject then narrows down the situations to deem one the most stressful, which is used in

answering the 48 items. The CRI is a revised version from the original 72-item version.

Moos and colleagues established strong reliability through Cronbach’s alpha and derived

eight dimensions of coping under two broad headings: Approach Coping Responses: (a)

Logical Analysis, (b) Positive Reappraisal, (c) Seeking Guidance and Support, and (d)

Problem Solving; Avoidance Coping Responses: (e) Cognitive Avoidance, (f)

Acceptance or Resignation, (g) Seeking Alternative Rewards, and (h) Emotional

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Discharge. The Approach Coping Responses cluster consists of items such as, “Did you

try to step back from the situation and be more objective” and “Did you tell yourself

things to make yourself feel better?” The Avoidance Coping Responses cluster consists

of items such as “Did you try to help others deal with a similar problem?” and “Did you

take it out on other people when you felt angry or depressed?” For these dimensions,

Cronbach’s alpha ranged in a sample of males (n = 1194) from 0.61 to 0.74 and in

females (n = 722) from 0.58 to 0.71. The correlations among the four approach-coping

strategies are higher in men (r = 0.29) and women (r = 0.42) than the correlations among

the four avoidance strategies for men (r = 0.29) and for women (r = 0.24). The estimated

administration time of the CRI is 20 minutes.

Stress and appraisal. The Cognitive Appraisal of Life Events Scale (CALES;

Ventura & Nuechterlein, 1994) will be used to assess stress level and appraisal style. This

is a self-administered scale that is used to measures the subject’s perception of the

stressful event. The CALES investigates eight dimensions related to the stressful quality

of the event: desirability, familiarity, controllability, predictability, preoccupation,

required readjustment, coping effectiveness, and upset. The measure’s nine questions are

rated from 1 to 9, with the following anchors 1 = “not at all,” 3 = “somewhat,” 5 =

“moderately,” 7 = “highly,” and 9 = “extremely.” The estimated time to complete this

questionnaire is 5 minutes.

Data Analysis

In this cross-sectional study of pre-existing groups, a MANOVA was used to

compare the two levels of schizotypy status on the 12 dependent variables (Approach-

Coping, Avoidance Coping, CVLT total, WCST-64 total, and all eight domains of the

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CALES) to control for an inflation of alpha. The analysis was followed up by ANOVAs

to compare each dependent variable between persons high and low in schizotypy.

Correlational analyses, Pearson product correlation coefficients were used to examine

whether neurocognitive ability was related to schizotypy status and coping. Last,

ANCOVAs were used to determine if schizotypy status affects coping response when

controlling for cognitive appraisal.

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Chapter 3

Results

Demographics

Both groups shared relatively equal proportions in gender, ethnicity, age, and

education. (See Table 1).

Table 1. Sociodemographic and Clinical Characteristics of Subjects

Schizotypy Group

Characteristic

Low Schizotypy

(n=35)

High Schizotypy

(n=36)

N % N %

Female 29 82.9 24 66.7

Ethnicity

African American 4 11.4 10 27.8

Armenian 1 2.9 2 5.6

Asian American 4 11.4 1 2.8

Hispanic 15 42.9 8 22.2

Caucasian 11 31.4 15 41.7

Mean SD Mean SD

Age (years) 20.3 4.1 19.8 4.2

Education (years) 13.0 1.0 12.5 0.9

SPQ-B1 1.3 0.9 16.9 1.7

R-SAS2

3.9 3.2 12.0 7.5 1Schizotypal Personality Questionnaire-Brief total to 22. “0-2” (symptoms are not observed) and “15-22”

(symptoms are observed). 2Revised Social Anhedonia Scale items total of “0-15 for females” and “0-19 for males” (symptoms are not

observed) and scores “ 16-40 for females” and “20-40 for males” (symptoms are observed).

In Table 1 females are largely represented in both groups. This was anticipated

since females represent the majority of students in the CSUN psychology department.

Although there were no correlations between the sociodemographic factors, there were

expected correlations among the demographic factors, such as age and education.

Coping styles and schizotypy status

The coping usage of persons high and low in schizotypy is displayed in Table 2.

With the use of Wilks’ criterion, the combined 12 dependent variables were

15

Table 2. Statistics of High vs. Low Schizotypy on Coping Measures, Cognitive

Appraisal, and Neurocognitive Measure

1Partial Eta Squared = .129.



Low

Schizotypy

n =35

Mean (SD)

High

Schizotypy

n = 36

Mean (SD)

Schizotypy Group

Main Effects

F df p

Coping Measures

Approach Response Coping 66.3 (11.8) 66.2 (12.7) 0.00 1,69 NS

--Logical analysis 16.4 (3.1) 17.4 (3.5) 1.56 1,69 NS

--Positive reappraisal 17.2 (3.9) 16.9 (4.8) 0.11 1,69 NS

--Seeking guidance/support 15.4 (3.7) 14.5 (4.5) 0.80 1,69 NS

--Problem solving 17.3 (4.0) 17.4 (3.5) 0.02 1,69 NS

Avoidance Response Coping1

51.1 (12.3) 60.2 (11.7) 10.20 1,69 .002

--Cognitive avoidance 14.2 (4.7) 17.1 (4.6) 6.96 1,69 .01

--Acceptance or resignation 13.1 (4.0) 15.0 (4.3) 3.88 1,69 NS

--Seeking Alternative Rewards 13.1 (3.7) 14.4 (4.2) 1.78 1,69 NS

--Emotional Discharge 10.7 (2.8) 13.7 (3.9) 13.88 1,69 .000

Cognitive Appraisal

Desirability -1.9 (2.8) -2.3 (2.6) 0.32 1,69 NS

Frequency of Event2 3.5 (2.8) 5.5 (3.3) 7.14 1,69 .009

Controllability 4.0 (2.5) 4.0 (2.5) 0.01 1,69 NS

Predictability 4.1 (2.5) 3.7 (2.7) 0.40 1,69 NS

Preoccupation 5.9 (2.1) 6.5 (2.5) 0.92 1,69 NS

Required Readjustment 4.8 (2.6) 5.8 (2.6) 2.40 1,69 NS

Coping Effectiveness 0.9 (2.1) 0.5 (2.3) 0.40 1,69 NS

Upsetting or Uplifting3 -1.5 (2.5) -2.7 (2.1) 4.71 1,69 .034

Neurocognitive Measures

WCST

--Total Correct 49.1 (5.0) 48.0 (8.6) 0.44 1,68 NS

-- Perseverative Errors 7.3 (3.4) 7.4 (4.0) 0.04 1,68 NS

--Categories Completed 3.5 (1.2) 3.5 (1.4) 0.00 1,68 NS

CVLT

--Total Correct (Trials 1 – 5) 57.3 (8.1) 54.7 (9.4) 1.60 1,69 NS

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significantly related to schizotypy status, F(12, 57) = 1.93, p = .049, There was a modest

association between the dependent variables and schizotypy status, with partial η2 = .29.

This was followed up by individual ANOVAs. Persons high in schizotypy reported using

more avoidance coping than persons low in schizotypy, F(1,69) = 10.20, p = .002.

However, persons high and low in schizotypy did not differ in their use of approach

coping.

To further investigate this significant difference between schizotypy status and

avoidance coping response, we divided this general category to four specific components:

cognitive avoidance, acceptance or resignation, seeking alternative rewards, and

emotional discharge. Persons high in schizotypy were more likely to use Cognitive

Avoidance F(1,69) = 6.96, p = .01, and Emotional Discharge F(1,69) = 13.88, p < .001

then persons low in schizotypy, when faced with a stressful situation.

Cognitive appraisal and coping styles

Persons high in schizotypy perceived that their stressful life events occurred more

frequently F(1,69) = 7.14, p = .009 and causes them greater emotional upset F(1,69) =

4.70, p = .034 (See Table 2). Through an ANCOVA, holding the two CALES factors as

covariates, we found that the persons high in schizotypy remained significantly more

likely to use avoidance coping responses than persons low in schizotypy F(1,69) = 6.04,

p = .017. Hence, even with frequency and emotional upset of the stressful event held

constant, persons high in schizotypy still reported more avoidance coping.

Neurocognitive factors with schizotypy status and coping styles

Persons high and low in schizotypy did not differ in executive functioning or

secondary verbal memory (See Table 2). As predicted, executive functioning and

17

secondary verbal memory were not associated with avoidance or approach coping in

either the persons high in schizotypy or the persons low in schizotypy (See Table 3).

Table 3. Pearson Correlations between Coping Response and Neurocognitive

Measures

Neurocognitive

Measures

Coping Response Styles

Approach Coping Avoidance Coping

CVLT

Total Correct

r = .04, p = .78

r = -.09, p = .46

WCST

Total Correct

Perseverative Errors

Categories Completed

r = -.16, p = .18

r = .22, p = .07

r = -.18, p = .13

r = -.05, p = .66

r = -.01, p = .96

r = .06, p = .62

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Chapter 4

Discussion

Undergraduates identified as high in schizotypy used more avoidance coping than

those identified as low in schizotypy, even when appraisals of stressor frequency and

upset were statistically controlled. In contrast, persons high and low in schizotypy did not

differ in approach coping. The cognitive appraisals of persons high in schizotypy differed

from those low in schizotypy in that persons high in schizotypy perceived that stressful

events occurred with greater frequency and reported more upset about stressful events.

The finding that persons high in schizotypy use more avoidance coping is

consistent with earlier studies. Bijttebier et al. (1999) found that individuals with

personality disorders (i.e., Paranoid Personality Disorder (PD), Schizoid PD, and

Schizotypal PD) utilized more avoidance coping strategies than persons without

personality disorders. Research on patients with schizophrenia, on the other hand,

suggests that these persons use more avoidance coping and less approach coping than

unaffected persons (Hultman et al., 1997; Jansen et al., 1999; van den Bosch et al., 1992;

Ventura et. al, 2004).

We also found that neurocognitive factors (executive functioning and secondary

verbal memory) did not correlate with coping styles, and that there was no significant

difference on neurocognitive factors between persons high and low in schizotypy. The

latter finding is inconsistent with earlier research. Some studies have found a significant

difference in both executive functioning and secondary verbal memory when comparing

persons high in schizotypy to “normals.” In executive functioning, studies have reported

an increase in perseverative errors in the high schizotypy group (Gooding et al., 1999,

19

2001; Lenzenweger & Korfine, 1994). In secondary verbal memory, Voglmaier et al.

(1993) found significant decrements in the CVLT in subjects with nonfamilial

schizotypal personality disorder. We reasoned that since both our samples were

composed of college students, both groups have average cognitive ability. In addition, the

importance of neurocognitive measures for the purpose of this study was to assure that

neurocognition did not correlate with coping styles.

The current study’s limitations must be mentioned. First, the sample was

composed of only CSUN college students. This limits our ability to generalize beyond

college students. The high educational attainment of the sample likely affected the null

findings regarding approach coping, executive functioning, and secondary verbal

memory. Future studies should examine coping and neurocognition in community

samples of schizotypes. A second limitation is that subjects were only tested at one time

point. Although, the research indicates that coping styles are stable over time, this is not

necessarily true in persons with schizotypy. Therefore, longitudinal studies of coping in

schizotypy are needed.

Despite these limitations, this study provides useful information about persons

high in schizotypy and has implications for treatment and future research. In recent years,

researchers have attempted to identify prodromal symptoms of psychosis and, using

various types of interventions, decrease symptoms and/or the rate of persons who will

convert to schizophrenia. For instance, Liberman and Robertson (2005) used the full

version of the SPQ to identify high school students that are high in schizotypy as “high-

risk” individuals for schizophrenia-spectrum disorders. They used an eight-week social

skills training program on these students high in schizotypy and found a significant

20

reduction (at post-test) in schizotypal traits, as well as an improvement in social skills and

self- esteem. O’Brien et al. (2006) recently found that an early intervention with youths at

risk for schizophrenia reduced psychotic features.

Training in effective coping strategies has not been studied in persons at risk for

schizophrenia. Evidence shows that the positive symptoms in schizophrenia are

exacerbated by stressful situations. It follows that teaching coping techniques may help

persons with schizophrenia prevent or lessen the effects of future psychotic episodes.

Future research should implement a coping strategies intervention with persons high in

schizotypy to determine whether earlier detection of schizotypy features will reduce

frequency in stressful events and pathogenic impact of those events.

21

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26

Appendix A

Schizotypal Personality Questionnaire-Brief (SPQ-B)

Please answer each item by circling Y (Yes) or N (No). Answer all items even if unsure

of your answer. When you have finished, check over each one to make sure you have

answered them all.

Y N 1. People sometimes find me aloof and distant.

Y N 2. Have you ever had the sense that some person or force is around you,

even though you cannot see anyone?

Y N 3. People sometimes comment on my unusual mannerisms and habits.

Y N 4. Are you sometimes sure that other people can tell what you are

thinking?

Y N 5. Have you ever noticed a common event or object that seemed to be a

special sign for you?

Y N 6. Some people think that I am a very bizarre person.

Y N 7. I feel I have to be on my guard even with friends.

Y N 8. Some people find me a bit vague and elusive during a conversation.

Y N 9. Do you often pick up hidden threats or put-downs from what people

say or do?

Y N 10. When shopping do you get the feeling that other people are taking

notice of you?

Y N 11. I feel very uncomfortable in social situations involving unfamiliar

people.

Y N 12. Have you had experiences with astrology, seeing the future, UFOs,

ESP or a sixth sense?

Y N 13. I sometimes use words in unusual ways.

Y N 14. Have you found that it is best not to let other people know too much

about you?

Y N 15. I tend to keep in the background on social occasions.

Y N 16. Do you ever suddenly feel distracted by distant sounds that you are not

normally aware of?

27

Y N 17. Do you often have to keep an eye out to stop people from taking

advantage of you?

Y N 18. Do you feel that you are unable to get “close” to people?

Y N 19. I am an odd, unusual person.

Y N 20. I find it hard to communicate clearly what I want to say to people.

Y N 21. I feel very uneasy talking to people I do not know well.

Y N 22. I tend to keep my feelings to myself.

28

Appendix B

Revised Social Anhedonia Scale (R-SAS)

Please read each of the statements below and circle True (T) or False (F)

T F 1. Having close friend is not as important as many people say.

T F 2. I attach very little importance to having close friends.

T F 3. I prefer watching television to going out with other people.

T F 4. A car ride is much more enjoyable if someone is with me.

T F 5. I like to make long distance phone calls to friends and relatives.

T F 6. Playing with children is a real chore.

T F 7. I have always enjoyed looking at photographs of friends.

T F 8. Although there are things that I enjoy doing by myself, I usually seem

to have more fun when I do things with other people.

T F 9. I sometimes become deeply attached to people I spend a lot of time

with.

T F 10. People sometimes think that I am shy when I really just want to be

left alone.

T F 11. When things are going really good for my close friends, it makes me

fell good too.

T F 12. When someone close to me is depressed, it brings me down also.

T F 13. My emotional responses seem very different from those of other

people.

T F 14. When I am alone, I often resent people telephoning me or knocking on

my door.

T F 15. Just being with friends can make me feel really good.

T F 16. When things are bothering me, I like to talk to other people about it.

T F 17. I prefer hobbies and leisure activities that do not involve other people.

T F 18. It’s fun to sing with other people.

T F 19. Knowing that I have friends who care about me gives me a sense of

security.

T F 20. When I move to a new city, I feel a strong need to make new friends.

29

T F 21. People are usually better off if they stay aloof from emotional

involvements with most others.

T F 22. Although I know I should have affection for certain people, I don’t

really feel it.

T F 23. People often expect me to spend more time talking with them than I

would like.

T F 24. I feel pleased and gratified as I learn more and more about the

emotional life of my friends.

T F 25. When others try to tell me about their problems and hang-ups, I

usually listen with interest and attention.

T F 26. I never had really close friend in high school.

T F 27. I am usually content to just sit alone, thinking and daydreaming.

T F 28. I’m much too independent to really get involved with other people.

T F 29. There are few things more tiring than to have a long, personal

discussion with someone.

T F 30. It made me sad to see all my high school friends go their separate ways

when high school was over.

T F 31. I have often found it hard to resist talking to a good friend, even when

I have other things to do.

T F 32. Making new friends isn’t worth the energy it takes.

T F 33. There are things that are more important to me than privacy.

T F 34. People who try to get to know me better usually give up after awhile.

T F 35. I could be happy living all alone in a cabin in the woods or mountains.

T F 36. If given the choice, I would much rather be with others than be alone.

T F 37. I find that people too often assume that their daily activities and

opinions will be interesting to me.

T F 38. I don’t really feel very close to my friends.

T F 39. My relationships with other people never get very intense.

T F 40. In many ways, I prefer the company of pets to the company of people.

30

Appendix C

Coping Response Inventory (CRI)

Subject ID: ____________________

Date: _________________________

Interviewer: ____________________

Date of Life Event: ______________

Part I:

Please think about the most important problem or stressful situations you have

experienced DURING THE LAST 12 MONTHS (for example, having troubles with

friends or significant others, having academic problems, having financial or work

problems). Describe the problems. If you have not experienced a major problem, then list

a minor problem that you have had to deal with.

DESCRIBE THE PROBLEM OR SITUATION:

1) _____________________________________________________________________

2) _____________________________________________________________________

3) _____________________________________________________________________

4) _____________________________________________________________________

5) _____________________________________________________________________

WHICH OF THESE CAUSED THE MOST STRESS: _______

CONTENT: _____

(1 = School, 2 = Work, 3 = Relationship, 4 = Transportation, 5 = Family, 6 = Residence,

7 = Crime and legal matters, 8 = Finance, 9 = Social Activities, 10 = Health,

11 = Earthquake, 12 = Middle East War, 13 = Misc. Crisis or Traumatic event,

16 = Malibu fires, 17 = Training Program, 18 = September 11th

, 19 = Iraq War,

20 = Other)

INDEPENDENCE: _____

(1 = Independent, 2 = Possible independent, 3 = Dependent, subject could influence it,

4 = Dependent, due to current symptomatology, 5 = Dependent, possibly due to current

symptomatology, 6 = Dependent, due to past symptomatology)

INTERPERSONAL: _____

(0 = No, 1 = Yes)

31

DEALING WITH A PROBLEM OR SITUATION

PART II:

Please answer the following questions about the problem you have listed. Place an “X” in

the appropriate box:

Definitely Mainly Mainly Definitely

No No _ Yes Yes__

1. Have you ever faced a problem

like this before?..……………………

2. Did you know this problem was

going to occur?...................................

3. Did you have enough time to get

ready to handle this problem?............

4. When this problem occurred, did

you think of it as a threat?..................

5. When this problem occurred, did

you think of it as a challenge?...........

6. Was this problem caused by

something you did?...........................

7. Was this problem cause by

something someone else did?.............

8. Did anything good come out of

dealing with this problem?.................

9. Has this problem or situation

been resolved?....................................

10. If the problem has been worked out,

did it turn out all right for you?..........

32

PART III:

Please think again about the problem you described on PART I; indicate which of the

following you did in connection with that situation.

YES, YES, YES,

once or some- fairly

No twice _times_ often__

DID YOU:

1. Think of different ways to deal

with the problem……………………

2. Tell yourself things to make

yourself feel better?............................

3. Talk with your spouse or other

relative about the problem?...............

4. Make a plan of action and follow it?.

5. Try to forget the whole thing?..........

6. Feel that time would make a differance

--the only thing to do was wait? ..............

7. Try to help others deal with a

similar problem?.................................

8. Take it out on other people when

you felt angry or depressed?...............

9. Try to step back from the situation

and be more objective?......................

10. Remind yourself how much worse

things could be?.................................

11. Talk with a friend about the

problem?............................................

12. Know what had to be done and try

hard to make things work?..................

13. Try not to think about the problem?..

14. Realize that you had no control

over the problem?..............................

33

Questions about how you handled the problem you listed on PART I (continued)

YES, YES, YES,



DID YOU:

15. Get involved in new activites?...........

16. Take a chance and do something

risky?..................................................

17. Go over in your mind what you

would say or do?................................

18. Try to see the good side of the

situation?............................................

19. Talk with a professional person

(e.g., doctor, lawyer, clergy)?.............

20. Decide what you wanted and try

hard to get it?.....................................

21. Daydream or imagine a better time

or place than the one you were in?......

22. Think that the outcome would be

decided by fate?.................................

23. Try to make new friends?..................

24. Keep away from people in general? ..

25. Try to anticipate how things

would turn out?..................................

26. Think about how you were much

better off than other people with

similar problems?...............................

27. Seek help from persons or groups

with the same type of problems?........

28. Try at least two different ways to

solve the problem?.............................

34


YES, YES, YES,



DID YOU:

29. Try to put off thinking about the

situation, even though you knew

you would have to at some point?......

30. Accept it; nothing could be done?........

31. Read more often as a source of

enjoyment?.........................................

32. Yell or shout to let off steam?............

33. Try to find some personal

meaning in the situation?...................

34. Try to tell yourself that things would

get better?..........................................

35. Try to find out more about the

situation?.............................................

36. Try to learn to do more things on

your own?...........................................

37. Wish the problem would go away

or somehow be over with?.................

38. Expect the worst possible outcome?..

39. Spend more time in recreational

activities?...........................................

40. Cry to let your feelings out?...............

41. Try to anticipate the new demands

that would be placed on you?............

42. Think about how this event could

change your life in a positive way ?....

35


YES, YES, YES,



DID YOU:

43. Pray for guidance and/or strength?....

44. Take things a day at a time, one step

at a time?............................................

45. Try to deny how serious the problem

really was?.........................................

46. Lose hope that things would ever be

the same?...........................................

47. Turn to work or other activities to

help you manage things?....................

48. Do something that you didn’t think

would work, but at least you were

doing something?...............................

49. Turn to drugs, alcohol, or food to

help you deal with the problem?........

50. Not know what to do, so you did

nothing?..............................................

51. Try the same solution over and over

even though it didn’t work the first

time?...................................................

52. Not even know there was a problem

until it was too late?...........................

53. Hope that someone else would fix

the problem for you?..........................

54. Sleep more than usual after

encountering the problem?.................

55. Use any form of humor (e.g. make

joke) to deal with the problem?..........

36


DID YOU:

56. Did you use any coping methods that were not listed? Yes______ No______

If yes, please list them.

57. __________________________________________________________________

58. __________________________________________________________________

59. __________________________________________________________________

60. __________________________________________________________________

61. Were your coping efforts successful? Yes______ No______

If yes, please list which coping methods were most helpful for you?

62. __________________________________________________________________

63. __________________________________________________________________

64. __________________________________________________________________

37

Appendix D

Cognitive Appraisal of Life Events Scale (CALES)

Subject ID: ____________________

Date: _________________________

Interviewer: ____________________

Date of Life Event: ______________

Instructions: Please answer each question by circling the point on the scale which most

closely describes the way you felt about the event.

1. Has this event ever happened to you before?

1 2 3 4 5 6 7 8 9

Not at all Somewhat Moderately Highly Extremely

familiar familiar familiar familiar familiar

2. How much control did you have over whether this event happened?

1 2 3 4 5 6 7 8 9

No control Some degree Moderate High degree Extreme

at all of control degree of of control degree of

control control

3. Did you have any advance notice about the event?

1 2 3 4 5 6 7 8 9

No advance Some degree Moderate High degree Extreme

notice at all of advance degree of of advance degree of

notice advance notice advance

notice notice

4. How much of the time has the event been on your mind?

1 2 3 4 5 6 7 8 9

Not at all On my mind On my mind On my mind On my mind

on my mind some of the much of the most of the all of the

time time time time

5. How much of a change in your daily routine has the event caused?

1 2 3 4 5 6 7 8 9

No change Some degree Moderate High degree Extreme

at all of change degree of of change degree of

change change

38

6. How desirable was this event?

-4 -3 -2 -1 0 1 2 3 4 Extremely Highly Moderately Somewhat Neither Somewhat Moderately Highly Extremely

undesirable undesirable undesirable undesirable desirable desirable desirable desirable desirable

nor

undesirable

7. Were you successful at handling the event?


unsuccessful unsuccessful unsuccessful unsuccessful successful successful successful successful successful

nor

unsuccessful

8. How upsetting or uplifting was this event for you?


upsetting upsetting upsetting upsetting upsetting uplifting uplifting uplifting uplifting

nor

uplifting

9. How upsetting or uplifting has this past month been for you?


upsetting upsetting upsetting upsetting upsetting uplifting uplifting uplifting uplifting

nor

uplifting

fabian aguirre austin psychology therapist university of texas

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