Impact of acceptance and commitment therapy versus education on stigma toward people with psychological disorders

Acceptance and commitment therapy (ACT) has previously been shown to alter stigmatizing attitudes and to be relatively useful for psychologically inflexible participants. The present study is the first to bring those two findings together by comparing ACT to an education intervention for reducing stigma toward people with psychological disorders, and examining whether results differ for psychologically inflexible versus flexible individuals. A sample of college students (N =95) was randomly assigned to a 2(1)2h ACT or educational workshop. Measures were taken before and after the workshop and at a 1-month follow-up. ACT reduced mental health stigma significantly regardless of participants' pre-treatment levels of psychological flexibility, but education reduced stigma only among participants who were relatively flexible and non-avoidant to begin with. Acceptance could be an important avenue of exploration for stigma researchers.     

The stigma of mental illness: Explanatory models and methods for change

For people with mental illness, diminished quality of life and loss of personal goals does not result solely from the symptoms, distress, and disabilities caused by their psychiatric disorder. Quality of life and personal goals are also hindered by people who embrace the stigma that accompanies mental illness and mental health care. This paper reviews evidence of the impact of mental illness stigma and strategies for seeking to ease its impact. To achieve these goals, we (a) describe the ways in which stigma harm people with mental illness, (b) summarize models that explain the development and maintenance of these stigmatizing effects, and (c) review strategies that have been shown to decrease the impact of stigma. Concerns about stigma are on the political agendas of many mental health advocacy groups. It has recently also become the focus of extensive research. Our goal in this paper is to balance the practical concerns raised by mental health advocates against data that support or contradicts specific assertions.     

Cognitive behaviour therapy for common mental disorders in people with Multiple Sclerosis: A bench marking study

Background

Mental health problems such as depression and anxiety are common in Multiple Sclerosis (MS) and are often under treated.

Aims

This paper reports on the clinical effectiveness of a cognitive behaviour therapy service for common mental disorders in people with MS and compares it to previous randomised controlled trials (RCTs) of cognitive behaviour therapy (CBT) in this population.

Methods

49 patients were deemed appropriate for CBT and 29 accepted treatment. Assessments were completed at baseline and end of treatment and included the Hospital Anxiety & Depression Scale. Results in the form of a standardized effect of treatment were compared with five previous RCTs.

Results

The results from this clinical service indicated statistically significant outcomes with reductions in depression and anxiety. The uncontrolled effect size was large but inferior to those found in published RCTs.

Conclusions

Cognitive behaviour therapy is effective for people with MS in routine clinical practice. Possible limits on effectiveness include more liberal patient selection, lack of specificity in rating scales and heterogeneity of target problems. Given the high rates of distress in this population, routine psychological interventions within neurology services are justifiable. Future research should aim to maximise CBT in such settings.     

Most people with mental disorders are happy: A 3-year follow-up in the Dutch general population

The nature of the associations between life satisfaction, anxiety, and depression remains elusive. Using questionnaire data from a large population-based sample (N = 6326) of young adult Norwegian twins (aged 18–31 years) we explored the extent to which latent genetic and environmental factors are (1) common or distinct, and (2) sex-specific. Phenotypic correlations ranged between 0.44 and 0.70 in females, and between 0.41 and 0.69 in males. Environmental influences accounted for 75% of these correlations in females, and less than 50% in males. Genetic and environmental sources of life satisfaction, symptoms of anxiety, and symptoms of depression were shared mostly, but the magnitude of the effects was different in males and females. In both sexes, however, aetiological factors enhancing life satisfaction were simultaneously protecting against feelings of sadness and displeasure, but contributed less to countervailing anxiety and tension.     

Just world beliefs, causal beliefs, and acquaintance: Associations with stigma toward eating disorders and obesity

The current study investigated the relationship between just world beliefs and stigmatizing attitudes toward eating disorders and obesity. Further, the associations between stigma and causal beliefs, and between stigma and acquaintance with these conditions, were examined. Participants (n = 447) read four vignettes describing an individual with anorexia nervosa, bulimia nervosa, binge eating disorder, or obesity. After each vignette, participants completed questionnaires assessing stigmatizing attitudes, just world beliefs, causal beliefs, and acquaintance with the condition depicted in the vignette. Stronger just world beliefs were associated with greater stigma toward all three eating disorders, as well as obesity (rs ranging from −.11 to −.18). More stigmatizing attitudes were associated with greater attribution of individual responsibility for the development of the disorder. However, participants with personal experience or who knew someone with the depicted problem did not have lower stigma scores than those who did not. The current study suggests that justification ideologies such as just world beliefs and controllability beliefs may underlie the stigmatization of eating disorders and obesity. These findings provide support for stigma reduction efforts aimed at targeting justification ideologies and altering causal beliefs.     

Drawn towards what others seem to like: Implicit preference for objects and people looked at with a duchenne smile

People tend to like objects that are looked at by others, especially if the person looking at the object expresses a positive emotion. But not all positive emotions are equal. We investigated the effect of third party gazing while expressing subtle positive emotions on perceivers’ subsequent preferences and evaluations of objects and people. In two studies participants saw faces looking at target objects and people either with a Duchenne, a non-Duchenne smile, or a neural expression. Participants first indicated gaze direction and later reported intuitive target preference and evaluated the targets. Results show a preference for target stimuli that were smiled at with a Duchenne smile as opposed to when they were looked at with a non-Duchenne smile or a neutral expression. More explicit evaluations of the target stimuli were not affected by the type of facial expression.     

Effects of biological determinist and interactionist causal explanations on undergraduate students' stigma of children with attention deficits hyperactivity disorders: An experimental investigation

This experimental study examined the effects of biological explanations on individuals' stigma against children with ADHD. We randomly assigned 174 undergraduate students to read one of the three fictitious articles: the first article focused on the determining role of biology in affecting children's ADHD symptoms (biological determinist), the second article highlighted the interplay between biological and environmental factors (interactionist), and the third article was unrelated to ADHD (control). Analyses of variance showed that participants who read the biological determinist message, relative to the control group, were (a) less likely to blame the children for their problems, but (b) more likely to endorse fixed beliefs about the nature of ADHD (entity beliefs). Thus, the overall direct effect of biological determinist message on desire for social distance was not significant. By contrast, participants who read the interactionist message showed (a) less blame attribution and (b) lower levels of entity beliefs, which contributed to less desire for social distance. These findings suggest that (a) presenting biological information regarding ADHD in a deterministic way may not be an effective way to reduce stigma, whereas (b) providing an interactionist account of ADHD may undermine the potential negative effect of an exclusively biological explanation.     

T-PALS framework to assess children who stutter with coexisting disorders: A tutorial

The purpose of this paper is to present a tutorial on a diagnostic framework developed to assess children who stutter and exhibit co-existing disorders. While we have guidelines for treating these children, there are no specific guidelines for assessing them. We provide a rationale for the development of T-PALS with support from the literature. The T-PALS framework assesses 5 foundational key elements for the child: Temperament (T), Pragmatics (P), Articulation/phonology (A), Language (L), and Stuttering (S). Both qualitative and quantitative measures are used within each dimension. This framework is discussed with reference to using two clinical case examples. T-PALS observation data are presented as well as treatment suggestions for each case. We conclude that T-PALS may be a useful framework for both clinicians and researchers, working with children who present with stuttering and comorbid conditions. Clinicians are encouraged to reach beyond the traditional focus on solely assessing the stuttering behavior, even when that is the main concern for referral, and to consider a broader view of the child. It is hoped that this more integrative approach to assessment may yield a more holistic diagnostic picture of a dual diagnosis child from which treatment goals can be derived.     

Predicting bullying and victimization among early adolescents: Associations with disruptive behavior disorders

Bullying is a common problem faced by children and adolescents in schools. One hypothesis that needs to be examined regarding the causation of this problem is whether being a bully or a victim may stem from disparate underlying patterns of psychopathology. Results are particularly scarce regarding the association between bully‐victim problems and disruptive behavior disorders. The present study sought to investigate the association between DSM‐IV symptoms of Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and bully‐victim problems in a sample of 202 adolescents, aged 12–15, attending two junior high schools in Cyprus, to determine whether these symptoms differentiate between bullies and victims and provide a new approach to the understanding of bully‐victim problems. Students completed measures of bullying, victimization, disruptive behavior disorder symptoms, and self‐esteem, along with demographic questions. On the basis of their responses, teenagers were classified as bullies, victims, or both bullies and victims. Those who were bully/victims reported greater CD symptomatology. CD and low self‐esteem were predictive of bullying, whereas ODD and low self‐esteem were predictive of victimization. Aggr. Behav. 30:520–533, 2004. © 2004 Wiley‐Liss, Inc.     

Risk behaviour and mental workload: Multimodal assessment techniques applied to motorbike riding simulation

We present data from an ongoing research project on the cognitive, emotional and neuropsychological basis of risk behaviour. The main aim of the project is to build a model of risk behaviour so that if we know certain cognitive, behavioural and emotional variables, we will be able to predict decisions made in the face of uncertainty and risk, with the final goal of designing programs for evaluating, preventing and controlling risk behaviour. The objective of the present study was to look for individual differences in hazard perception during a static riding simulation and their relationship with mental workload. We used a multidimensional methodology, including behavioural, subjective and physiological data. The behavioural measures were obtained in a static riding simulation during eight hazard situations. We evaluated whether eye activity measures correlated with cognitive workload and different types of risky behaviours. Eye movement parameters were measured using a video-based eye tracking system. We found that risk-prone individuals showed specific patterns of risky behaviours and that peak of saccadic velocity and subjective mental workload indexes were both reliable indicators of risk proneness. Mental workload was higher for participants showing attitudes to risk behaviours probably because of a lack of conscious awareness of specific cues indicating dangerous scenarios.     

Gait variability in people with neurological disorders: A systematic review and meta-analysis

There has been growing evidence showing gait variability provides unique information about gait characteristics in neurological disorders. This study systemically reviewed and quantitatively synthesized (via meta-analysis) existing evidence on gait variability in various neurological diseases, including Alzheimer’s disease (AD), amyotrophic lateral sclerosis (ALS), cerebellar ataxia (CA), Huntington’s disease (HD), multiple sclerosis (MS), and Parkinson’s disease (PD). Keyword search were conducted in PubMed, Web of science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Meta-analysis was performed to estimate the pooled effect size for gait variability for each neurological group. Meta-regression was performed to compare gait variability across multiple groups with neurological diseases. Gait variability of 777 patients with AD, ALS, CA, HD, MS, or PD participating in 25 studies was included in meta-analysis. All pathological groups had increased amount of gait variability and loss of fractal structure of gait dynamics compared to healthy controls, and gait variability differentiated distinctive neurological conditions. The HD groups had the highest alterations in gait variability among all pathological groups, whereas the PD, AD and MS groups had the lowest. Interventions that aim to improve gait function in patients with neurological disorders should consider the heterogeneous relationship between gait variability and neurological conditions.     

Housing design and people with severe mental illness: An observational approach to the investigation of supported housing facilities

An observational approach was employed to investigate the role played by architectural characteristics of supported housing facilities (SHF) in sustaining interactional behavior among people with severe mental illness (SMI) (N = 29) and staff (N = 27). The observations were carried out in dining areas, corridors and outdoor environments of SHF (N = 4). In order to test differences in the observed behaviors two SHFs with high physical‐environment quality (HQ) and two with low physical‐environment quality (LQ) according to the perception of people with SMI were chosen. Results showed that the dining areas of HQ better support social interactions between SHF users. No differences between the housing facilities were found concerning corridors areas, while housing facilities that provided proximity and accessibility to outdoor environments, such as those with HQ, were significantly more supportive for social interactional behavior than LQ housing. These results corroborate previous findings from this project and suggest that the characteristics of the housing design have a significant impact on the use of the environment and on the behavior patterns in the setting.     

How parents introduce new words to young children: The influence of development and developmental disorders

This study documents how parents weave new words into on-going interactions with children who are just beginning to speak. Dyads with typically developing toddlers and with young children with autism spectrum disorder and Down syndrome (n = 56, 23, and 29) were observed using a Communication Play Protocol during which parents could use novel words to refer to novel objects. Parents readily introduced both labels and sound words even when their child did not respond expressively or produce the words. Results highlight both how parents act in ways that may facilitate their child's appreciation of the relation between a new word and its referent and how they subtly adjust their actions to suit their child's level of word learning and specific learning challenges.     

Legal issues in maximum security institutions for people with mental illness: liberty,security, and administrative discretion

This article explores four legal issues relevant to the provision of care in secure hospitals. These include the current status of right to treatment litigation; the potential impact of the Americans with Disabilities Act; new developments in laws governing restraint and seclusion; and the need for uniform institutional policies on risk assessment. These issues illustrate the potential conflicts between individual autonomy and institutional control that have been at the heart of mental health law for three decades. The article suggests that because of the diminishing oversight provided by the federal judiciary, institutional custodians have a particular obligation to ensure that individual rights are not overwhelmed by concerns with security.     

Familiarity with and social distance from people with mental illness: Testing the mediating effects of prejudiced attitudes

The purpose of this study was to examine prejudiced attitudes as a factor associated with social distance from people with mental illness. A total of 289 university students from Greece completed written measures assessing social distance from, prejudiced attitudes about, and familiarity with mental illness. A structural equation model with manifest variables was tested. Participants who reported to be more familiar with mental illness held stronger social care and weaker prejudiced beliefs, and consequently expressed a less strong desire for social distance. Implications of the results and suggestions for future research are outlined. Copyright © 2011 John Wiley & Sons, Ltd.     

Family involvement and empowerment in mental health service provision for children with emotional and behavioral disorders

Involvement of families is a critical component in effective systems of care for children with disabilities and their families. We investigated the sociodemographic correlates of family involvement in mental health services for children who have emotional and behavioral disorders. Further, we investigated the relationship between family involvement and family empowerment. The Family Involvement Scale-Family Version was used to measure involvement of families in the provision of mental services for their children and the Family Empowerment Scale was used to measure pempowerment in families with children who have emotional and behavioral disorders. In additions, demographic data concerming family composition, race, education, incone, membership in a parent support group, and the mental health status of the children were also collected. The results showed that mothers, as well as respondents with less formal education, reported greater involvement in services for their children than fathers and those who were more educated. Further, the knowledge subscale of empowerment was significantly correlated with all, subscales of family involvement and personal empowerment was significantly correlated with the treatment subscale of family involvement.     

The family roles of siblings of people diagnosed with a mental disorder: Heroes and lost children

In order to cope with the diagnosis of mental illness in a family member, siblings may be forced to adjust their roles in the family. Taking into account the crucial role that some siblings play in caregiving for the mentally ill especially when the parents are no longer available, it is imperative to develop awareness of their unique needs and address them. Thirty‐three adult siblings of people diagnosed with a mental disorder completed the Role Behaviour Inventory (RBI) and a general questionnaire including open‐ended questions regarding the roles they played in their families of origin. Findings from the inventory and general questionnaire suggest that the well siblings score higher on two roles, the Hero and Lost Child, and lower on the Mascot and Scapegoat roles relative to a comparison group (N = 33). Being a sibling caregiver emerged as a risk factor to assume certain dysfunctional roles in the family. Implications for future research and therapy are discussed.     

The interface between physical and mental disorders: The need to dismantle the biopsychosocialneuroimmunological model of disease

This article argues for the necessity of cognitive-behavioral assessment for a thorough understanding of how psychological factors mediate disease process across a wide range of diseases including coronary artery disease, breast cancer, and human immunodeficiency disease. Based on empirical data presented as part of the APA Presidential miniconvention, “To Your Health: Psychology through the Life Span,” the conclusion is that psychological treatment can help extend life. Stress management programs can positively influence adherence to treatment regimens and positively influence the human immune system response during the course of treatment and recovery from illness. Even in the face of life-threatening circumstances such as liver transplantation, Stage II and III breast cancer, and after HIV infection has been diagnosed, the quality of life can be remarkably improved. Physicians and psychologists must work together to produce the beneficial effects of the synergy between mind-body processes.     

Walking in sacred spaces in the therapeutic bond: therapists' experiences of compassion satisfaction coupled with the potential for vicarious traumatization

The therapeutic bond is at the heart of effective therapy, yet few studies have examined therapists' experience of this bond. Using a qualitative study design, this exploratory study examines the experiences of couple and family therapists in relation to their perceptions of the satisfactions and risks involved in the therapeutic bond. The research was conducted using grounded theory methodology and eight in-depth interviews were conducted with therapists working in five counseling agencies in Sydney, Australia. Therapists described the importance of the 3 component parts of the therapeutic bond: the empathic connection between therapist and client; the role investment of the client; and the mutual affirmation experienced by both therapist and client in the therapeutic process. Walking in sacred spaces with the client was seen as both enriching and challenging for the therapist. The therapeutic bond gave therapists intense satisfaction and posed risks for them, especially when working with traumatic client experiences. However, the findings suggest that the experience of compassion satisfaction and the development of vicarious resilience counter-balanced the intense difficulty of bearing witness to clients' traumatic experiences and the potential for vicarious traumatization. The implications for sustaining couple and family therapists in their work are discussed.