PSYC 3690 Chapter Notes -Cognitive Therapy

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Published on 15 Apr 2013
School
University of Guelph
Department
Psychology
Course
PSYC 3690
Page:
of 4
Article #: 30
Title: Recovery and Stigma in People with Psychiatric Disabilities
Introduction
- the ideas of recovery and stigma have mutual effects on each other
- recovery has reintroduced goal directness, hope, and self-determination into
comprehensive discussions about mental health and its service system
- stigma is a major hurdle to recovery
- people with serious mental illness are sometimes unable to achieve important life
goals when the public endorses stereotypes about their disorders and discriminates
against them as a result
- just as stigma impedes recovery, so recovery challenges stigma
- stigma is being squelched, as all stakeholders come to understand and adopt the
principles of recovery
Historical and Theoretical Overview of Recovery
- recovery has been described in 2 ways: (1) recovery is understood in terms of
outcomes - overcome and live with symptoms and dysfunctions, able to achieve goals
such as employment (2) recovery is seen as a process - recovery has reintroduced
such important processes as hope and well-being into rehabilitation
Recovery as Process
- one of the purposes of recovery as a movement was to reject pessimism and re-inject
hope into their lives
- recovery from this perspective is less concerned about outcomes (whether the person
achieves some kind of symptom and disability free endpoint) and more about
processes
- recovery is more about how a person with mental illness would pursue a meaningful
life
- an essential element of recovery as a process is empowerment, people must have the
power to act on decisions that produce an optimistic future which reflects their
personal goals
What Are the Harmful Effects of Stigma?
- many people who might benefit from services fail to complete the recovery process,
either by not obtaining needed services or not fully adhering to treatment regimens
Cognitive Behavioural Model of Stigma
- stigma associated with mental illness is multidimensional and based on a complex
process
- this complexity can be best described using a cognitive behavioural model that has 3
components: cognition, affect, and behaviour
1. Stereotypes (cognitive component) - knowledge structure that the public has learned
about a marked social group
- e.g. stereotypes that people with mental illness are violent or incompetent
2. Prejudice (affect component) - affective reaction regarding a particular group based
on endorsing stereotypes about that groups e.g. dangerousness is strongly
associated with fear and can be exacerbated by beliefs that people with mental
illness are unpredictable
3. Discriminatory Behaviour (behaviour component) - manifests itself in negative actions
against the outgroup or exclusively - avoidance e.g. not associating with people with
mental illness
Types of Stigma
- 4 types of stigma is relevant to health conditions and especially mental illness:
1. Public Stigma - occurs when members of the general population endorse prejudice
and act in a discriminating manner
2. Self-Stigma - occurs when people internalize the prejudice and discriminate against
themselves, has been divided into progressive stages known as the “threes As”:
aware, agree and apply
- applying or internalizing stereotypes has two harmful effects, cognitively and
emotionally, internalizing stigma can hurt self-esteem, and lessens self-efficacy
- behaviorally, the three As lead to the “why try” effect
3. Label Avoidance - blocks service use for people in need of psychiatric care - one
way people are publicly labeled is by associating with a mental health program, to
avoid labeling some people refrain form seeking services
4. Structural Stigma - the absence of appropriate services for people with mental
illness, manifests itself in 2 ways: (1) policies of private and governmental institutions
that intentionally restrict opportunities, and (2) polices of institutions that yield
unintended consequences which hinder the options of people with mental illness
- intentional institutional discrimination manifests itself as rules, policies and procedures
of private and public entities in positions of power that consciously and purposefully
restrict the rights and opportunities of minority groups
What Is There To Do About Recovery
Evidence-Based Practices
- assumes that consumers will be involved only in services that have been shown to be
effective
- help all stakeholders choose which practice will be more effective
- disadvantages: (1) the criteria for classifying a service as effective (empirical evidence
base) reflect the priorities of the research community, but not necessarily of the
community of consumers, survivors and ex-patients, (2) do not easily crosswalk with
more ethereal constructs such as spirituality, and (3) puts several possible intervention
programs for people with mental illness into limbo, because definitive research has yet
to be concluded
Moment-to-Moment Skill Sets
Fundamental Two - reflective listening and support, these are the epitomes of person-
centered psychotherapies
- they rest on 3 principles: (a) genuineness - counsellor must remain true to their beliefs
and not attempt to frame interaction in any other light, (b) empathy - people benefit
immensely form the counselor who understand and then reflect back their gut-level
emotions and belief, and (c) unconditional positive regard - despite whatever the
person might have said or done, he or she is respected as a person
Two Fundamental Skills
- (1) important to reflective listening skills is providing a quiet place and time for the
person to tell his or her story of the moment
- counselor should avoid barriers to communication such as asking too many questions
- counselor listens for the processes that underlie the message
- (2) support - with support comes commitment: recognition that ample time and
perhaps a quiet place are needed for these kinds of exchange
- there are two types of support: (a) Interpersonal - people are fundamentally social
beings with a need for social exchange and (b) Instrumental - goal-directed to help
the person accomplish daily goals in real-life settings
An Additional Set of Tools
- there are 4 other tool sets that are frequently basic to ERPʼs:
1. Motivational Interviewing - helping the person understand the costs and benefits of
a specific decision
2. Shared Decision Making - includes 3 parts: (a) influence decision-making by helping
the person examine the costs and benefits of specific health decisions or behaviour,
(b) facilitated by providing information so that the person better understand the
disease process and treatment, and (c) fundamentally social intercourse
3. Problem Solving - two kinds: (a) personal - tools to help the person overcome
difficulties that are largely his or her alone and (b) interpersonal - problems are
meaningfully shared among 2 or more people
- commitment is a key ingredient to addressing interpersonal problems, the people
involved need to determine whether it is worth the effort to work together to resolve the
problem
- problem solving of bot kinds involves 5 steps: (1) identify the problem - specify who,
what, when, and where of a problem, (2) brainstorm solutions - do not censor
solutions, (3) evaluate individual solutions, (4) pick one or a small mix of solutions and
plan it out, (5) evaluate the solution
Relapse Prevention and Advanced Directives
- relapse is very common in people with psychiatric disabilities
- relapse prevention seeks to teach people ways to cope with relapses during periods
when the person is thinking clearly and is not overwhelmed emotionally
- people learn how to recognize environmental triggers and early-warning signs of
relapse
Confronting the Stigma of Mental Illness
- various approaches to changing public stigma into 3 groups: protest, educator and
contact
- protest is a strategy that highlights the moral injustices of stigma, chastising offenders
for their believing and acting in a socially iniquitous way

Document Summary

Title: recovery and stigma in people with psychiatric disabilities. The ideas of recovery and stigma have mutual effects on each other. Recovery has reintroduced goal directness, hope, and self-determination into comprehensive discussions about mental health and its service system. Stigma is a major hurdle to recovery. People with serious mental illness are sometimes unable to achieve important life goals when the public endorses stereotypes about their disorders and discriminates against them as a result. Just as stigma impedes recovery, so recovery challenges stigma. Stigma is being squelched, as all stakeholders come to understand and adopt the principles of recovery. One of the purposes of recovery as a movement was to reject pessimism and re-inject hope into their lives. Recovery from this perspective is less concerned about outcomes (whether the person achieves some kind of symptom and disability free endpoint) and more about processes. Recovery is more about how a person with mental illness would pursue a meaningful life.