Ph.D candidate, Psychology
STEPS in the Right Direction
by Sharday Mosurinjohn
To Katherine Holshausen, a career in research means having the power to answer your own questions—not by plugging them into a search engine, but by creating your own knowledge. By mid–Bachelor’s degree she realized what a charge this ability held for her, having sped past the assigned chapter of her abnormal psychology text to exhaust the contents of the entire book. This was at McMaster University in Hamilton, ON, in Psychology, Neuroscience, and Behaviour. Wanting to prioritize research along with clinical training, which McMaster’s graduate studies didn’t offer, Holshausen interviewed at a number of schools, ultimately joining Dr. Christopher Bowie’s Cognitive and Psychotic Disorders Lab at Queen’s. On the basis of her pioneering Master’s work on psychotic disorders and social relationships, Holshausen was awarded the prestigious Vanier Scholarship to continue researching with her mentor in the doctoral stream of the clinical programme.
The topics of Holshausen’s Master’s and doctoral theses will be distinct, but they are linked by the development of an expertise in the study of schizophrenia. “Most people see schizophrenia as a chronic debilitating disorder that’s almost like a death sentence,” reflects Holshausen, “but that’s not necessarily the case.” With treatment, “many individuals function in the community and meet personal goals in ways that people who don’t understand psychosis might not expect.”
In picking this research field Holshausen knew she wanted to work inside a system where she could study mental illness and “find a way to help people improve their quality of life.”
Over the two years of Holshausen’s Master’s degree, she and Dr. Bowie developed and evaluated a treatment for thought disorder called STEPS—structured therapy for the enhancement of purposeful speech. (She credits a labmate, Michael Grossman, with the snappy acronym).
“Disordered communication is a proxy for disordered thinking,” elaborates Holshausen, “because if you have disorganized thoughts, then you have difficulty staying on track, having conversations, and communicating your needs to others.” Not only do these difficulties take a serious toll on the relationships that make up people’s personal and professional worlds, but of course the long–term outcomes of various psychosis treatments are also contingent on whether or not a client is capable of having a conversation with their therapist.
There is no real treatment for disorganized thought disorder at present, says Holshausen. But by using the principles of behavioural therapy, like positive reinforcement and giving real time feedback throughout a client–therapist interaction, she and Dr. Bowie ran a treatment study that successfully shaped the way that people with schizophrenia communicated. The result—STEPS—is one of only a handful of treatments, and the only one in the last few decades, to remediate thought disorder or to enhance purposeful speech.
Holshausen’s supervisor, who she praises for his “unparalleled ability to push you to your limits,” was instrumental in establishing an international collaboration to take their work with STEPS further. Dr. Bowie introduced Holshausen to colleagues at Columbia University through a conference where she was presenting a poster on the protocol. Intrigued, Dr. Jimmy Choi of Columbia University invited Holshausen to give a talk at the Columbia Department of Psychology and Psychiatry, where she would also run a two–day workshop on how to use STEPS.
After spending six weeks in New York on a visiting scholar internship last summer, Holshausen is now collaborating on a randomized controlled trial study with Columbia researchers. Its aim is to evaluate changes in linguistic areas of the brain after targeting participants’ speech with behavioural cues. “The way it works,” Holshausen explains, “is that you see a comic and you’re told the beginning of a story. Then you’re asked to build on that story. When you’re on topic a green light is shown, but when you go off topic—such as by introducing a new character without telling listener who that is, or by totally switching topics—then the therapist changes the light to red. The red light indicates a misunderstanding has occurred from the listener’s perspective. The therapist then explains what happened, and reminds the participant what they had been talking about before getting off track.” The research team is now in the midst of collecting data in order to publish their findings.
Going forward, Holshausen will investigate three overlapping but somewhat distinct areas related to social cognition in people with psychosis. (“Social cognition” describes the kinds of thinking skills we use in interactions, like perceiving others’ emotions [“theory of mind”] and understanding why things in your environment happen [“attributional bias”]).
The common thread among these areas, she describes, is context processing. This term is basically shorthand for referring to how we apply the right steps to the right context, adjusting our beliefs and behaviours when circumstances change. According to Holshausen, context processing is not often done in the social cognition field, or else it’s defined otherwise, such as ‘social knowledge.’
The analytical advantage of her approach is to foreground the question of how people shift during a situation based on contextual pieces of information. “I’m looking to study context processing in a performance-based way where I can observe people socially and ask questions about why they’re doing what they’re doing in that way.”
Holshausen is thankful for the Vanier program’s support of this project in a time when adequate funding for graduate research is far from assured. Likewise, she is grateful for Dr. Bowie’s “refusal to shy away from answering important research questions just because finding a way to answer the question isn’t immediately apparent.”
In the future, Holshausen’s ideal job is in a research hospital or a university—but before then, she will have had to complete courses, comprehensive exams, six 120–hour practicum placements, a thesis, and a year–long internship. A large portion of the work she envisions would be research based, but would also allow Holshausen to keep her finger on the pulse of clinical work, and to teach. “I love that people are strange and interesting,” smiles Holshausen, “I couldn’t have chosen a more aptly suited career path.”