Factors contributing to the survival of self-help groups

Despite the growing utilization of self-help groups, there have been only a handful of studies that have examined the factors that contribute to their survival. The purpose of this study was to explore the factors that contribute to self-help group survival by examining their relationship with external sources (i.e., national and local self-help organizations, professionals) and group organizational characteristics (i.e., leadership diversification, recruitment, attendance at group meetings). Representatives from 245 active and 94 recently disbanded self-help groups were included in the analysis. Results indicated that the primary factors that discriminated between active and disbanded groups were the number of new people to attend a meeting, average group meeting attendance, length of existence, leadership diversification, outreach to potential group members, and support from national and local organizations. Results are discussed in terms of what national self-help organizations, self-help clearinghouses, and others who interact with self-help groups can do to empower and support them.     

Medical help-seeking by different types of chronic pain patients

Abstract

This paper reports on a study of the use of health services by different types of patients with chronic benign pain. The purpose of the study was to identify differences in medical consumption between different types of pain patients. In the course of one year 586 patients were selected by 45 general practitioners: they included patients who had had almost daily chronic pain symptoms for at least six months, without a medical diagnosis (such as cancer or arthritis) to explain the pain. Patients were categorized according to the Multidimensional Pain Inventory which distinguishes four categories: the dysfunctional, who perceive severe pain and gain social support; the interpersonally distressed, who combine pain with affective and relational distress; adaptive copers, who cope with their pain in a number of ways; the average type, with characteristics of all three other types. It was hypothesised that adaptive copers would make less use of health services and would be more involved in self-help activities than dysfunctional or interpersonally distressed patients. Frequent use of psychological services by the interpersonally distressed group was expected. It was predicted that difference in health services use would continue during the subsequent year.

No differences were found between the four groups in location, temporal characteristics, or possible medical causes of the pain symptoms. Dysfunctional patients used more services than the others. Adaptive copers used the least. The four groups did not differ in self-care activities. Group-membership as well as pain severity are related to the use of health services. None of the groups showed a significant decline in the use of health services during the year. It is concluded that chronic pain is invalidating, but that not all patients are equally excessive in their use of medical services.     

Self-help conferences for people who stutter: a qualitative investigation

Self-help activities for people who stutter (PWS) have been gaining in popularity; however, there is a scarcity of evidence to support their utility in stuttering management. The purpose of this investigation was to understand the lived experience of individuals who attended a self-help conference(s) for PWS from the perspective of a PWS to learn its potential utility in stuttering management. The investigator used Interpretive Phenomenological Analysis (IPA) to systematically collect authentic data of this social phenomenon. Twelve participants were recruited from a self-help conference and the self-help community of PWS. Semi-structured interviews were conducted 4–18 months after each participant's last conference. Interviews were transcribed and analyzed. Themes were explained in investigator narratives and illustrated through participants’ quotes. Interpreted themes of the experience of having attended a self-help conference(s) for PWS included: socializing opportunities with other PWS, affiliation, redefining oneself and post-conference disclosures. A conclusion of the study was that the experience of having attended a self-help conference(s) for PWS helped to minimize negative impact that stuttering can have on daily functioning. It appears that self-help conferences were perceived as a safer or “stutter-friendly” environment and promoted social interaction, relationship building, and community building through planned and unplanned activities. Another conclusion was that the experience of having attended self-help conferences for PWS helped participants to communicate more easily. Reported increases in social activity and an “openness” about stuttering, suggest self-help conferences’ utility in stuttering management. These findings are supported by other studies about successful stuttering management and self-help activities for PWS. They have helped attendees who stutter to communicate more easily and suggest a reduction in the negative impact that stuttering has on their lives.Educational objectives: The reader will be able to: (1) describe recurring themes associated with the lived experience having attended a self-help conference(s) for people who stutter (PWS) from the perspective of a group of adults who stutter, and (2) describe the potential benefits of attending self-help conferences for PWS in order to make appropriate evidence-based referrals to self-help conferences for PWS.     

Healing Men and Community: Predictors of Outcome in a Men’s Initiatory and Support Organization

Men have poorer health and declining social outcomes when compared to women, and research suggests that behaviors related to restrictive and traditional male gender roles contribute to this disparity. This study is an examination of The ManKind Project International (MKPI), a community-based organization that provides alternative male gender norms and a community support system to help reinforce them. The MKPI runs an intensive, experiential “Training Adventure Weekend” (TAW), followed by voluntary, on-going peer-led support and integration groups (I-Groups). One hundred men completed a pre-TAW questionnaire, an interview, and a long-term follow-up (>18 mo.) questionnaire. The study examined if there was change on the primary study variables at follow-up, and the relationship of background characteristics (age, self-help group experience) and factors related to participation (MKPI beliefs, social support, I-Group participation) to the criterion variables (depression symptoms, gender role conflict, and life satisfaction) at follow-up. Results indicated significant change in the expected directions on the primary study variables, suggesting that for these men, participation has a positive impact. Most importantly, changes in MKPI-related beliefs and social support significantly predicted positive outcomes. Also, more positive outcomes were found among men 30–44 years of age, but not among those with more prior self-help experience or I-Group participation. Possible explanations for these findings and directions for further research are discussed.     

Group climate in an open-ended cancer support group

A number of well-described, controlled studies assessing cancer support group intervention support their effectiveness. All of these experimental groups have been close-ended and typically involve six to eight weekly sessions. Because many cancer patients are unable or unwilling to participate in closed, extended-session groups, there is particular need for analysis of the effectiveness of short-term, open-ended groups. Additionally, objective measures are needed to delineate the factors contributing to a successful outcome in cancer support groups. We used the Short Form of the Group Climate Questionnaire (GCQ-S) to characterize 23 sessions in an open-ended, short-term, Veterans Hospital based cancer support group. The cancer group scored significantly lower on the Avoiding and Conflict dimensions (p<.001) compared to a normative psychotherapy group sample. There was no difference on the Engaged dimension. This pilot study suggests that a cancer support group in this setting can create an environment where members are cohesive and take responsibility for their own change process, while keeping interpersonal conflict to a minimum. Based on these preliminary findings, we encourage controlled clinical trials examining the efficacy of open-ended cancer support groups.At the time of this study, Dr. Daroff was a resident in Psychiatry, University of California, San Francisco.     

Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.     

Support groups for parents with an adult child suffering from bipolar disorder

Confronted with the disconcerting behaviour exhibited by their children, parents of bipolar patients are in severe distress. Research focuses on the study of the ‘burden’ that the pathology puts on caregivers, owing to their experience of depression, sometimes combined with the presence of hostile attitudes and negative affects. In France, parents of adult patients encounter an initial specific difficulty: they are not systematically included in the care management system. Thanks to the initiative of an association of psychiatrists and psychoanalysts, the authors set up a psychoanalytic support group for the parents of ‘bipolar’ adults. The diagnosis of a bipolar disorder is established by a psychiatrist within a medical structure. Support groups for parents do exist in France, but their experiences have not led to scientific publications on this specific topic. Existing publications focus on other types of pathology and other therapeutic approaches. In this article, we will highlight how this type of psychoanalytic support group, with operating rules based on the theoretical work of Anzieu, can help parents of patients with bipolar disorders. Group participants accepted the principle of a research study that maintained their anonymity. We collected and analysed qualitative data from the first year of the group, so we highlight the specific difficulties of these parents, faced with chronic disease. The relevance of our qualitative study also resides in the data collected over a period of time, enabling us to see the progress made, and encouraging us to reflect on the place of psychoanalytic groups for parents, as well as on the care management of this pathology.     

The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain

Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.     

Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review

The number of acceptance- and mindfulness-based interventions for chronic pain, such as acceptance and commitment therapy (ACT), mindfulness-based stress reduction (MBSR), and mindfulness-based cognitive therapy (MBCT), increased in recent years. Therefore an update is warranted of our former systematic review and meta-analysis of studies that reported effects on the mental and physical health of chronic pain patients. Pubmed, EMBASE, PsycInfo and Cochrane were searched for eligible studies. Current meta-analysis only included randomized controlled trials (RCTs). Studies were rated for quality. Mean quality did not improve in recent years. Pooled standardized mean differences using the random-effect model were calculated to represent the average intervention effect and, to perform subgroup analyses. Outcome measures were pain intensity, depression, anxiety, pain interference, disability and quality of life. Included were twenty-five RCTs totaling 1285 patients with chronic pain, in which we compared acceptance- and mindfulness-based interventions to the waitlist, (medical) treatment-as-usual, and education or support control groups. Effect sizes ranged from small (on all outcome measures except anxiety and pain interference) to moderate (on anxiety and pain interference) at post-treatment and from small (on pain intensity and disability) to large (on pain interference) at follow-up. ACT showed significantly higher effects on depression and anxiety than MBSR and MBCT. Studies’ quality, attrition rate, type of pain and control group, did not moderate the effects of acceptance- and mindfulness-based interventions. Current acceptance- and mindfulness-based interventions, while not superior to traditional cognitive behavioral treatments, can be good alternatives.     

The Pain of Endo Existence: Toward a Feminist Disability Studies Reading of Endometriosis

Disability scholars have critiqued medical models that pathologize disability as an individual flaw that needs treatment, rehabilitation, and cure, favoring instead a social‐constructionist approach that likens disability to other identity categories such as gender, race, class, and sexuality. However, the emphasis on social constructionism has left chronic illness and pain largely untheorized. This article argues that feminist disability studies (FDS) must attend to the common, chronic gynecological condition endometriosis (endo) when theorizing pain. Endo is particularly important for FDS analysis because the highly feminized and sexualized nature of endo pain is a major source of disability. Because medical treatments of endo enhance fertility rather than provide pain relief, those with endo must not only have access to medical services to manage their pain, but also demand better medical management of their pain as well as disability accommodations for their pain. Thus, I propose a pain‐centric model of disability that politicizes pain through social‐constructionist and medical models of disability by attending to the lived experiences of pain.     

Self-conscious emotions in patients suffering from chronic musculoskeletal pain: A brief report

Objective: The role of self-conscious emotions (SCEs) including shame, guilt, humiliation and embarrassment are of increasing interest within health. Yet, little is known about SCEs in the experience of chronic pain. This study explored prevalence and experience of SCEs in chronic pain patients compared to controls and assessed the relationship between SCEs and disability in pain patients.

Design and measures: Questionnaire assessment comparing musculoskeletal pain patients (n = 64) and pain-free control participants (n = 63). Pain was assessed using the McGill Pain Questionnaire; disability, using the Roland–Morris Disability Questionnaire; and six SCEs derived from three measures (i) Test of Self-Conscious Affect-3 yielding subscales of shame, guilt, externalisation and detachment (ii) The Brief Fear of Negative Evaluation Scale and (iii) The Pain Self-Perception Scale assessing mental defeat.

Results: Significantly greater levels of shame, guilt, fear of negative evaluation and mental defeat were observed in chronic pain patients compared to controls. In the pain group, SCE variables significantly predicted affective pain intensity; only mental defeat was significantly related to disability.

Conclusion: Findings highlight the prevalence of negative SCEs and their importance in assessment and management of chronic pain. The role of mood in this relationship is yet to be explored.     

Social support,organizational characteristics,psychological well-being,and group appraisal in three self-help group populations

This study examined the relationship of three social support and three organizational variables to two well-being and two group appraisal variables among 144 members of Compassionate Friends, Multiple Sclerosis, and Overeaters Anonymous self-help groups. An anonymous questionnaire was the major research instrument. Receiving social support was not significantly related to depression or anxiety but was positively related to perceived group benefits and group satisfaction. Providing social support and friendship were each positively related to one well-being and one group appraisal variable. Bidirectional supporters (i.e., individuals high on both receiving and providing support) reported more favorable well-being and group appraisal than Receivers, Providers, and Low Supporters. At the group level of analysis (n = 15 groups), groups with higher levels of role differentiation, greater order and organization, and in which leaders were perceived as more capable contained members who reported more positive well-being and group appraisal. The implications for future research and professional consultation to self-help groups are discussed.     

Bereavement support groups: Who joins; who does not; and why

Compared widowed spouses who joined (n = 40) bereavement support groups (BSGs) during the first 13 months of bereavement with those who declined to join (n = 96). Controlling for gender, age, and socioeconomic status, no differences were found for perceived levels of social support, but joiners, compared with nonjoiners, reported experiencing more stressful events and scored significantly higher on measures of depression, anger, anxiety, and subjective stress. Nonjoiners and, to a lesser extent, joiners viewed those attending groups as less self-sufficient (e.g., need help, lonely), suggesting a mildly stigmatizing image of BSGs. A dialectical model is proposed in which BSG utilization rates are seen as the product of an avoidance-avoidance conflict involving the choice between suffering emotional distress on one's own or the perceived stigma of joining a BSG. Implications for future research on participation in self-help and mutual support groups are discussed.     

Leader Positive Mood and Group Performance: The Case of Customer Service

It was hypothesized that leader positive mood would be positively associated with group performance in a service setting. Additionally, it was expected that while leader positive mood would be positively associated with both the leader's level of job satisfaction and job involvement, leader positive mood would be positively associated with group performance, controlling for both leader job satisfaction and job involvement. Leader positive mood also was expected to be positively associated with group performance controlling for group positive affective tone. Two potential antecedents of leader positive mood, the leader's level of positive affectivity and the extent to which the leader's own manager engaged in contingent reward behavior, were hypothesized to be positively associated with leader positive mood at work. These hypotheses were tested among a sample of 53 sales managers who led groups ranging in size from 4 to 9 members. All of the hypotheses were supported. Implications of these results and directions for future research are discussed.     

Adversarial Growth in Patients with Multiple Sclerosis and their Partners: Relationships with Illness Perceptions,Disability and Distress

The purpose of this study was to investigate whether patients with multiple sclerosis (MS) and their partners show adversarial growth and to examine which psychological and disability variables contribute to this in patients and their partners. The study also investigated the relationship between growth and distress. Seventy-two patients with MS and their partners provided demographic information and completed measures of posttraumatic growth, illness perceptions, depression, cognitive function and disability. Both patients and partners showed adversarial growth, with patients reporting significantly higher growth than partners. The only significant predictor for patient growth was partner growth, and vice versa. Dissimilarity in illness representations between patients and their partners on the consequences of MS dimension, patient mood and patient growth accounted for significant variance in partner growth. The findings support the idea of a ‘communal search for meaning’ where patients and their partners experience the trauma of having a chronic illness and subsequently find positive aspects together.     

A randomised controlled trial to assess the effectiveness of providing self-help information to people with symptoms of acute stress disorder following a traumatic injury

BACKGROUND: Patients attending accident and emergency (A&E) may develop long-term psychological difficulties. Psycho-education has been suggested to reduce the risk of post-injury disorders. AIMS: We tested the efficacy of providing self-help information to a high-risk sample. METHODS: A&E attenders were screened for acute stress disorder and randomised to two groups: patients (n=116) receiving a self-help booklet and those who did not (n=111). A sample of 'low' scorers was also included (n=120); they did not receive a booklet. Psychological assessments were completed at baseline (within 1 month post-injury) and 3 and 6 months post-injury. RESULTS: Post-traumatic stress disorder (PTSD), anxiety and depression decreased (p<0.001) across time but there were no group differences in these measures or quality of life. However, subjective ratings of the usefulness of the self-help booklet were very high. CONCLUSIONS: This trial failed to support the efficacy of providing self-help information, as a preventative strategy to ameliorate PTSD.     

Understanding the attitudes and intentions of future professionals toward self-help

Examined the attitudes, beliefs, and intentions toward self-help groups of 168 graduate students in clinical psychology and social work from five universities using the theory of reasoned action as a model (Fishbein, 1979). Participants held positive attitudes and beliefs regarding self-help and intended to collaborate. Participants who were members of self-help groups had significantly greater intentions to collaborate and had more positive beliefs vs. nonmembers. There were no differences between social work and psychology students. Path analysis showed that students who held positive attitudes and beliefs and perceived that their faculty were positive regarding self-help had intentions to collaborate with self-help groups. Involving self-help groups as partners in professional training was considered empowering and a wise use of the expert resources that groups can provide.     

Culture,psychology and ecology: An interview with Theodore Roszak

Objectives: This study investigates the efficacy of a standard cognitive behavioral group-program for chronic pain, in comparison with the same group program that integrates an existential perspective at treatment conclusion, 3-month, and 6-month follow-up. Design: This study is a quasi-experimental clinical trial with two treatment groups. Methods: We included 113 patients suffering from chronic pain who had been accepted for treatment at an interdisciplinary pain center. In addition to the specific therapy program, the patients received intense interdisciplinary treatment. Outcome measures include both pain-related disability and pain severity. Repeated-measures analyses of variance (ANOVAs) were used to test statistical significance, followed by tests of simple contrasts with pre-treatment as a reference-point. Results: Results indicated that the integration of an existential perspective leads to significantly lowered pain-related disability than the classic cognitive behavioral group-program. Additionally, existential aspects seem to be particularly important for patients with a spiritual orientation. The findings from this study support the importance of considering specific existential aspects in the cognitive-behavioral approach in treating chronic illness.     

A stress management programme for Crohn's disease

The present study was designed to assess the effectiveness of techniques of behavioural assessment and treatment of Crohn's disease (CD). On the assumption that stress events have a pronounced influence on the life of Crohn's patients, we proposed stress management treatment. This is intended to control stress and improve patients' personal and social competence. Forty-five patients with Crohn's disease were randomly assigned to one of three treatment groups, two experimental groups: stress management and self-directed stress management, and a control group: conventional medical treatment. The subjects underwent eight individual sessions which were specific to each condition. All subjects completed symptom monitoring diaries. The subjects who received training in stress management experienced a significant post-treatment reduction of tiredness (P < 0.1), constipation (P < 0.1), abdominal pain (P < 0.5) and distended abdomen (P < 0.5). The subjects who received training in self-directed stress management experienced a significant reduction in tiredness (P < 0.1) and abdominal pain (P < 0.5). No significant changes were observed in symptomatology in the conventional medical treatment group. Similar results were obtained in the 12 month follow-up.