Tammy Oladapo

IR 1/ 10 CC/ 2
12/2/19
Interview 1: Dr. David Roberts

Dr. David Roberts, University of Texas Health San Antonio, Doctor, December 2, 2019

*connection issues omitted, replaced with ...

D: Hello, this is Dave Roberts
T: Hi Dr. Roberts this is Tammy, how are you?
D: I’m good Tammy, I’m glad we’re connecting
T: Me too
...
D: So, how can I be helpful?
T: I just have a few questions I’d like to ask you regarding my research and my topic. Do you
mind if I record you?
D: No, it’s oka​y
T: Alright, Thank you. So, first of all, although I’ve researched it I would like a concrete answer
from your perspective. What specific goals does CBT attempt to address and how do they overall
impact psychotic symptoms.
D: Okay, so the goal of CBT is trying to address somebody who has the common symptoms
is to reduce the stress associated with psychotic symptoms. That’s probably the main goal.
And then to help the person move towards goals that they… or a boyfriend or living
independently. And then the third goal would be… to decrease the psychotic symptoms.
But CBTcan't make the voices go away, you know like the auditory hallucinations, CBT
can’t make that go away. But sometimes CBT can reduce delusions a little bit. Do you
know what I mean when I say delusions?
T: Yes
D: Okay. Sometimes CBT can reduce delusions, but more often it reduces the stress that’s
associated with delusions and hallucinations rather than reducing the symptoms itself.
T: Alright, that’s good. So I know you’ve done some research possibly with Dr. David Penn
regarding social cognition, so how can social cognition be utilized to treat psychosis especially
focusing on youth and young adults?
D: So, If you ask people with psychosis what they want help with, where their greatest area
of treatment need is, they won’t say 'I don't want to have delusions' or 'I don’t want to
have hallucinations' or 'I want my symptoms to go away.' What they would say is 'I want
to have friends' 'I want to have a boyfriend or girlfriend’ ‘I want to get married someday’,
‘I want to have social relationships with people’ ‘I want people to care about me’. If you
look at the treatments currently available for psychosis, none of those treatments, with
medication or even really CBT, none of those were designed to improve people’s social
relationships. They were designed to help cope with symptoms or in some cases to help
functioning. And so social cognition treatment is valuable because it helps target the one
area that people with psychosis most strongly want help with. And to help with young
adults, it’s a particularly difficult time. Even if your not psychotic, young adulthood is a
really difficult social time where you’re kind of discovering who you are and feeling self
conscious, so addressing social cognition may be particularly important ion that time
because that’s also the time in your life where you establish relationships that are most
likely to be the essential one for the remainder of your life.
T: So, is psychosis common with young adults or is it mostly with older people
D: Well, It’s an interesting thing. I like that you’re using the word psychosis instead of
schizophrenia, it’s a broader term than schizophrenia. Most of the people who have
psychosis do have schizophrenia and about 1% of the adult population have schizophrenia.
So 1 in 100 people have it. But it starts between the age of (well, children don’t usually have
it) it starts between the age of 16 and 30. It starts a little bit younger for men than for
women. For men it starts on average maybe a little bit under the age of 22, and for women
might be closer to 28 or something. So younger adults are likely to have the experience of
psychosis just emerging, but the thing is, once it starts, it usually stays for the rest of your
life. It will just be emerging in your twenties or teens and then by the time you’re 40 or 50,
you’ll get used to it. You would’ve had it for 20 or 30 years.
T: So, they get used to it and learn how to live with it and cope with it?
D:That’s right.
T: Alright, thank you! As for the specific treatment Social Cognition Interactive Training, SCIT,
Is it being used anywhere or is it still in the developmental phase?
D: It’s being used fairly widely outside of the United States, so it's used a lot on places like
Finland, Portugal, Spain, Japan, Australia, China, Hong Kong, Germany, used in most
places, but it is used in the United States in some places. We’re not using it right now in
San Antonio though.
T: Is there a specific reason for this or is it just circumstance?
D: Yeah there is a reason. It’s because, two things. One, public healthcare funding in Texas
is pretty poor. There’s not a lot of money set aside to pay for mental health treatments for
people with schizophrenia. People with schizophrenia generally don’t have jobs; they
usually have medicaid or medicare. Couple of things so there’s not a lot of money to pay for
these treatments. If you go to the Public Mental Health CLinic in San Antonio, they don’t
have enough funds to pay for therapists to provide these treatments. Another reason is
because San Antonio is such a spread out city, with not a very strong public transportation
system. People with Schizophrenia (in my clinic we were offering SCIT) if you lived on the
south side you’d have to take three buses to get to the clinic. And it’s just too much to ask
for so people with schizophrenia choose not to do it. They’ll come do a Doctor’s
appointment for medication once a month, but they won’t come in for a weekly
psychotherapy.
T: That’s Interesting
D: Yeah, it is.
T: So how do you think psychosis is impacting today’s youth, and is there anything we can do to
help prevent it?
D: That’s very interesting. Well, I would say the way it’s affecting today’s youth is similar
to the way it was affecting youth over the generation in the past. It always makes people
feel paranoid and makes people feel worried about their social standing. So I imagine this
is interacting to some degree with the new social media that exists and a lot of young people
who are developing psychosis have a lot of delusions related to social media, I think that is
definitely happening. In terms of prevention, there is very interesting work being done,
where they take a public health approach and they do information campaigns just like the
public health approach to have advertisements and billboards and social media posts to
help people make the choice not to smoke cigarettes. They’ll do this thing, they’ve done
studies where they say try to identify the very early symptoms of you or someone you know
having psychosis and if they are, send them to this specialized treatment center and we'll
start treating them with counseling or maybe a little bit of medication. There’s some
evidence that you can actually prevent people from developing schizophrenia if you give
them some early on treatment when they first start developing schizophrenia symptoms.
The problem is identifying those people early.
T: Oh yeah. So, a while back I read one article about how they use artificial intelligence to
determine which teens go on to develop psychosis based on the patterns in the words that you
used and if the words you use have similar meanings. Do you have any knowledge on that?
D: No I do not. Let me understand a little bit better. Are you saying that they used
Artificial Intelligence kind of like a computer would have a conversation with them?
T: It was more of a writing type thing where they wrote something out and the computer would
assess their writing based on certain indicators that are related to psychosis.
D: Are you saying that the computer analysis of the writing would help them identify
people who are early on in developing psychosis or they would use them to develop a
treatment for psychosis.
T: Yes, it helps them to identify who will develop psychosis with about 93% accuracy. Sorry I
just had to pull it up. I haven’t looked at it in a while.
D: That’s very fascinating.
T: Yeah. So the mechanisms would be based on the semantic density of the writing, meaning the
more vague it is as well as people who use more sound related words or words with similar
meanings.
D: That’s amazing. Things like that are needed to help identify early on who will develop
psychosis. It’s easy to see how that could be utilized through an internet based platform.
It’s fascinating
T: Very Interesting. Now finally, this is more of a personal question. So as a highschool student
who doesn’t have credibility or access to people with schizophrenia, how do you think I can best
make an impact on the treatment of psychosis and on the lives of these people
D: Oh, that’s very interesting. Well, one of the main things is what we call stigma busting.
Do you know what I mean when I say stigma?
T: Yes.
D: So we’ve come a long way, but there’s still a lot of societal stigma against psychosis. For
example, if you are in a conversation with someone on the street and you say “I was talking
to somebody who was psychotic” they might think you were talking to someone who was a
murderer or who’s violent. But in fact if you’re psychotic you’re not likely to be violent at
all. So one of the things you could really do is help by stigma busting through informational
approaches or public awareness approaches to help people understand that people with
psychosis are not dangerous and to help increase acceptance.
T: Yeah, that’s good. Alright, that’s about it. Thank you!
D: Wow. Those were really good questions and that was a very interesting artificial
intelligence article that you brought up.
T: Thank you!
D: ​So listen, I’d be happy if there’s any more information you need in the future or if you
need me to do anything else to support this process, just let me know. I’m happy to help
and I admire what you’re working on!
T: Alright, thank you. Thank you so much. Have a nice day.
D: You too! Bye.

Reflection
I believe the interview was successful, as I gained a wealth of information regarding my topic
along with a deeper perspective into the desires of psychotic people. Speaking with Doctor
Roberts helped me to better understand what both CBT and SCIT aim to achieve. The social
aspect in treating schizophrenia is much more important than one would imagine, as the
symptoms can be gotten used to but the loneliness and social isolation cannot. Hearing this from
a professional in my field helped me to understand the topic much better than any article could. I
am also more greatly considering going the route of stigma busting, as the negative stigma
attached to psychosis is a major factor in the social life of schizophrenics. For the next interview,
I will try to have more specific, research focused questions, along with planning it better and
more efficiently. Setting up the interview was very stressful, as it was difficult to find a time
where both I and my advisor would be available. The interview was rescheduled 3 times before it
finally took place, encountering issues with conflicting times, time zone discrepancies, and more.
It also took a long time to think of questions that were probing and would directly help my
research. For the next interview, I will try to plan as far ahead as possible so that any issues with
time can be resolved before the due date and I’ll have more time to formulate questions.
 Tammy Oladapo
IR 1, 10 CC, Pd. 2
1/9/2020
Interview 2: Shannon Couture O’Flinn, Private Psychologist/Therapist, Ph.D., January 9, 2020
1. In your experience, how has the negative stigma associated with psychosis impacted
patients’ social lives?
a. People would not want to be friends/communicate with people that have
schizophrenia, often having negative attitudes; thinking that they’re unpredictable
and dangerous. The patient internalizes this stigma, thinking they’re incapable of
making friends.
i. “From that perspective of the patient, sometimes they have internalized
stigma themselves that they’re not capable of having friends or people
don’t want to be friends with them because they have a mental illness, so
they might actually avoid trying to make friends.”
2. How can social cognition be utilized to treat psychosis?
a. If people can understand the rules of social engagement, they may be more
successful in being employed, maintaining jobs, and having friends. Treatments
vary, with some being focused on one domain of social cognition like emotional
recognition, while others are more broad-based, trying to apply it directly to
people's lives. It doesn’t treat the symptoms of schizophrenia, but it aims to
improve people’s social lives, reducing the negative impacts on the patients
functioning from social cognitive deficits.
3. How can stigma best be reduced in psychosis?
a. It’s very difficult to change people’s attitudes, however many things people try
are based on the Contact Hypothesis. Increasing social interactions between
people with psychosis and the public can disprove negative attitudes or beliefs
about them.
i. “Negative attitudes are based on not having experience with people who
have a mental illness, and therefore you make all these assumptions about
 them, and if you bring people together, they can see that they’re not
always correct”
b. However, this went wrong in a study, as the clinicians had negative experiences
with patients, with some being hospitalized or doing something weird/strange.
Although they had more empathy for the patients, they would not want to be
friends with them or have their children in a relationship with them.
c. Another issue is media portrayal, where mass shootings happen so frequently and
the perpetrator is always assumed to have a mental illness. This increases the
stigma that people with mental illnesses are dangerous and not safe. If we do a
better job of educating the media they might listen and try not to portray things
that way, it can have a positive societal impact.
4. Do you think social cognition or cognitive therapy can be utilized to reduce stigma?
a. Social Cognition treatment wouldn’t reduce the stigma that you would receive
from other people, but it can help people with schizophrenia learn coping skills
and reduces internalized stigma. It helps shift the patient's own views about what
they think their mental illness means in terms of what they can or cannot do.
5. I’ve learned that Theory of Mind is one domain of social cognition, but how does it
specifically impact the social lives of patients?
a. The idea that you know other people have a different perspective than you.
Schizophrenics tend to understand that other people have different beliefs. The
issue is with more nuance stuff, for example, they may take a sarcastic comment
literally because they don’t understand that they're joking. This causes an
awkward social interaction, making it more difficult to form relationships and
maintain jobs.
6. Do you believe that the stereotypes associated with psychosis/schizophrenia are on the
decline right now? What can be done to help?
a. I don’t think it’s decreasing. If anything, these experiences of violence like these
mass shootings where people are trying to be tried as not guilty by mentally
illness, making people more afraid. Fear is the biggest problem because if you’re
 afraid of someone you’d want them to be as far away from you as possible, which
only increases stigma.
b. We need to keep trying to research new ways of reducing stigma. Times have
changed since this research was first conducted, with new factors such as social
media to be utilized. For example, it’s becoming more likely to see influencers
talking about their depression and anxiety, making it more acceptable. If there
were more people in such a social status who talked about hearing voices, that
sort of thing could help.

Reflection
I will likely research more on the contact theory, as I have alluded to it in my research but
I didn’t have a concrete foundation to prove it. I will continue to focus on how social cognition
helps decrease internalized stigma and increase social interactions. A point of further research
would be the effect of social media and media representation on the stigma of mental illnesses.
The interview generally went well. It took place as planned, although an earlier date wasn’t
possible. I was able to gain a plethora of information about both social cognition and stigma
reduction. The interview also confirmed many of my research points, making me more confident
in my outline. For future interviews, I would likely try to conduct it at a less busy time in life, as
I had a lot going on that week and the stress and fatigue could be heard through my tone. I will
also try to use less verbal hesitation such as so, um, and like. I will also keep my phone off of my
laptop so that my typing isn’t heard through the call. It was difficult trying to schedule the
interview on time, as many of the people who are most relevant to my research didn’t respond
and those who did respond weren’t available until almost a month later. The questions weren’t
too difficult to write and the actual interview wasn’t a pain, but the overall stress during the time
period had a strong negative impact on the interview.