THE IMPACT OF ILLNESS IDENTITY ON RECOVERY FROM.pptx
Transcript of THE IMPACT OF ILLNESS IDENTITY ON RECOVERY FROM.pptx
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THE IMPACT OF ILLNESS
IDENTITY ON RECOVERY
FROM SEVERE MENTAL
ILLNESSSupervisor : dr Sabar P Siregar, Sp KJ
American Journal of Psychiatric Rehabilitation, 13: 7393, 2010Copyright # Taylor & Francis Group, LLCISSN: 1548-7768 print=1548-7776 onlineDOI: 10.1080/15487761003756860
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INTRODUCTION
The impact of the experience and diagnosis of
mental illness on ones identity has long been
recognized; however, little is known about the
impact of illness identity. The present article proposes a theoretically
driven model of the impact of illness identity on
the course and recovery from severe mental
illness and reviews relevant research.
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DEFINITION
the set of roles and
attitudes that peoplehave developed aboutthemselves in relationto their understandingof mental illness.
IllnessIdentity
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THE MODEL
No comprehensive theoretical model currently
exists of how illness identity impacts important
aspects of recovery.
The purpose of the present paper is to propose atheoretically driven model of the impact of
illness identity on the course of and recovery
from severe mental illness and to review the
existing empirical research that supports it.
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HYPOTHESIS
Illness identity may play a major role in the course of
severe mental illness, affecting both subjective and
objective outcomes related to recovery.
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Cont(1)
the impact of any awareness of having apsychiatric problem is moderated by the
meanings that the person attaches to that
problem (that is, how the illness is
conceptualized and what that means about theperson experiencing it).
once a person has decided to characterize
unusual experiences at least partly as being the
result of mental illness, what that illness means
about him or her becomes a key issue.
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Cont(2)
Illness identity affects hope and self-esteem.
Self-esteem refers to the evaluative aspects of
the self, or self-regard (Baker & Gallant, 1984).
some persons may identify with having a mentalillness and ascribe widely-held stigmatizing views
to this status, while others may make a similar
identification but take on a positive identity by
way of identification with peers
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Key of ideas: Cont(3)
First key:
persons diagnosed with
severe mental illness donot merely experiencesymptoms but they alsointerpret their experienceof having an illness and
assign meanings to it which
in turn qualify and affecthope and self-esteem.
Second key:
Internalization of these
meanings and, in particular,stigma, can infect personalconstructions of illness,damaging hope and self-esteem
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Cont(4)
Hopefullnessand selfesteem
lack of hope and lowself-esteem may
increase depressionand create a risk for
suicide
influence socialinteraction
the individual to usemore avoidant
strategies such asremoval from anxiety-provoking situationsor to use alcohol or
drugs to numbunpleasant emotional
states.
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Cont(5)
the types of coping strategies used can directly affect
vocational outcomes, symptom severity, as well as social
interaction.
the types of coping strategies used, social interactions, and
vocational functioning all affect the severity of psychoticsymptoms.
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Review of Evidence for the Model
General Evidence for Relationship
Between Illness Identity and Recovery
Relationship Between Illness Identity andHope/Self-Esteem
Impact of Hope and Self-Esteem onSuicide Risk,Coping, and Social Isolation
Impact of Hope, Self-Esteem, and Copingon Vocational Outcomes
Impact of Coping, Vocational Outcomes,
and Social Isolation on Symptoms.
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General Evidence for Relationship Between
Illness Identity and Recovery
In a series of qualitative studies, described how
the process of constructing a new sense of self
is an important part of the process of recovery
from mental illness.
A longitudinal qualitative study, assessing theprocess of recovery from severe mental illness
has supported this conclusion, finding that
individuals who improved functioning over a 1-
year period showed a progression from theidentity of patient to person in their
narratives, suggesting that maintaining a patient
identity can be detrimental to recovery.
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Cont(2)
Multiple, quantitative, longitudinal single-case
studies have also suggested that as persons
progress toward recovery, one of the first steps
tends to be the reclamation of a sense of oneselfas active agent
These studies and those described above
suggest that an essential part of the recovery
process involves transforming undervaluedidentities associated with internalized stigma
and replacing them with more individualized
empowered identities.
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Relationship Between Illness Identity and
Hope/Self-Esteem
Cross sectional studies have found thatgreater insight is associated with higher
levels of dysphoria, lowered self-esteem,
and decreased well-being and quality of
life.
Several studies have also established that
there is a relationship between
internalized stigma and diminished self-esteem and hope.
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Impact of Hope and Self-Esteem on Suicide
Risk,Coping, and Social Isolation
There is good support for the relationshipbetween hopelessness and suicide risk among
persons with severe mental illness.
In the recent review of the predictors of suicidal
behavior among people diagnosed with
schizophrenia, the researchers identified eight
studies finding support for a relationship
between hopelessness and suicide risk/behavior
among people with schizophrenia.
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Cont(2)
Collectively, these findings suggest that
diminished hope and self-esteem impact suicidal
ideation among people with severe mental
illness, and that diminished hope and self-esteem are likely impacted by illness identity
factors.
A few cross-sectional studies have examined the
link between hope/self-esteem and socialisolation among persons with severe mental
illness.
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Cont(3)
In a sample of individuals with recent onset
schizophrenia, hopelessness was related to
greater social isolation.
Self-esteem was positively related to size of thesocial network and frequency of social
interaction.
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Impact of Hope, Self-Esteem, and Coping on
Vocational Outcomes
There is limited evidence for this relationship, asfew studies have addressed the relationship
between psychological variables and vocational
outcomes.
More specifically with regard to hope, theresearcher found that different dimensions of
hopelessness were related to different aspects of
subsequent work performance.
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Cont(2)
Specifically, loss of motivation was related to
poorer social skills and work cooperation,
suggesting that individuals who have given up on
working as a possibility do not invest the effort inbehavior necessary for good job success.
The relationship between coping and vocational
outcomes has been relatively unstudied
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Cont(3)
One prospective study (Yau, Chan,Chan, & Chui, 2005),
however, found that avoidant coping (depressive
resignation) was related to impaired work skills among
Clubhouse (Model of Psychosocial Rehabilitation)
participants with severe mental illness, and thatreductions in avoidant coping over time predicted
improvements in work skills.
While this study does not necessarily support a
relationship between coping and competitiveemployment, it indicates that coping affects skills related
to employment success.
I f C i V i l O d
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Impact of Coping, Vocational Outcomes, and
Social Isolation on Symptoms.
There is evidence supporting all three of these
hypothesized
relationships.
There is cross-sectional evidence that the types
of coping strategies typically used by personswith severe mental illness are related to
symptom severity
The changes in coping strategies were associated
with changes in symptom severity over time.
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Cont(2)
However, one prospective study, found support
that coping may influence symptoms;
specifically, the preferences for adaptive coping
at baseline predicted fewer psychotic symptomsat follow-up.
Strong evidence from studies employing the
Experience Sampling Method has found that
social interactions with acquaintancesand familymembers are associated with reductions in the
experience of delusions
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Cont(3)
Similar findings were not observed for
hallucinations,however, suggesting that social
interaction might reduce the intensity of some
types of symptoms but not others.
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Integrative StudiesOne recent study
(Yanos, Roe, Markus,& Lysaker, 2008) has
attempted toconduct an
integrated study of
some of therelationships
discussed above.
A path analysis supported
the hypothesis thatinternalized stigma
affected avoidant coping,active social avoidance,depressive symptoms,
and that these
relationships weremediated by hope and
self-esteem.
There was also evidence
that internalized stigmaaffects positive symptom
severity by way of itsimpact on socialavoidance, but a
predicted relationship
between avoidant copingand symptom severity
was not supported.
Li it ti f th i ti id &
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Limitations of the existing evidence &
recommendations for future research
More prospectiveresearch is needed
to address manyof the areas that
have beendiscussed
There is a need forresearch to test multiplefacets of the model in an
integrated fashion
In some areas, suchas hope/self-esteem
and employment,research has been
mainly eitherexploratory or cross-
sectional.
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DISCUSSION Evidence in support of the proposed
model suggests that ignoring theimportance of illness identity may lead to
difficult roadblocks in treatment and
rehabilitation for many persons withsevere mental illness.
The proposed model demonstrates how
illness identity appears to be a crucial andcentral intersection influencing various
domains of recovery directly, as well as
indirectly, through mediating processes.
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If illness identity has such important effects, the
question is raised: how can the illness identity of
people with severe mental illness be
transformed to facilitate recovery?
Cont(2)
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Cont(3)
The researchers believe that treatment
specifically focused on illness identity can have a
positive effect on outcomes in this area and can
allow persons with severe mental illness tobenefit from other high-quality services.
Specifically,the cognitive-behavioral therapy
(CBT) approaches focused on addressing
attitudes related to illness identity can have afavorable impact in this regard.
Cont(4)
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Helping individuals recovertheir identity would address
self-stigmatizing views ascognitive distortions ordysfunctional attitudes.
Experiencing and perceivingoneself differently in relation
to stressors and the sense ofthreat or suffering they
generate.
CBT techniques such aspsychoeducation,teachingskills to conduct cognitive, and
exposure may all be used toaddress internalized stigma.
Coping techniques may alsobe helpful in facilitating a
process of constructing andnegotiating meanings
Cognitive-Behavioral
Therapy (CBT)
Cont(4)
Cont(5)
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Narrative enhancementHelping those with
severe mental illnessto accept themselvesas sufficiently
privileged to construct
and develop ameaningful story of
ones self
The goal of such a
process would be tohelp clients tell morecoherent stories about
their lives in which
their role as aprotagonist is
developed
Cont(5)
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Summary The researchers have offered a model of how a
collection of social, psychological, and clinicalforces may interact to create substantial barriers
to recovery.
They also suggested that to begin with a
definition of oneself as mentally ill and to
assume that mental illness means incompetence
and inadequacy, places people at risk of ceasing
to try to work and fit into their communities.
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Cont(2)
We have suggested that when stigma leads to an
impoverished sense of self, low self-esteem andsuicide risk follow.
This model can not only be tested empirically
but it may expose a chain of thoughts andbehaviors that could be individually targeted for
intervention.
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CRITICALAPPRAISAL
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ournal identity The study come from :
Psychology Department, John Jay College of Criminal Justice,
City University of New York, New York, USA
Authors:
Philip T. Yanos
David Roe
Paul H. Lysaker
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Cont(2)
Published by:
American Journal of Psychiatric Rehabilitation, 13: 73
93, 2010
Copyright # Taylor & Francis Group, LLC
ISSN: 1548-7768 print=1548-7776 online
DOI: 10.1080/15487761003756860
Available at:
http://dx.doi.org/10.1080/15487761003756860
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Cont(3)
Titles:
The Impact of Illness Identity on Recovery from Severe
Mental Illness
Positive:
Clearly shows that variables that were investigated
Bold written There is no abbreviation
Less than 12 words (11 words)
Negative:
No location
No time
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bstractConsist only 3 sections
Aim Keywords
Conclusion
< 250 words (113 words)
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The Model Positive:
The diagram of the model is clear.
The examples is clear and easy to be
understood.
Negative: The outcomes are not clear
The explanation is not clear and always
being explained superficially
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Review of Evidence forthe Model
Positive
There is explanation for every reviews
The authors compared every hypothesis with the
other journals or articles with reliable refrences.
The usage of examples from authors is suitable with
the context of reviews
- Negative: The explanation has been discussed briefly.
There is no further explanation for the context of
reviews.
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Discussion
Positive The authors matched the solutions
according to the previous research.
The examples is suitable with the context
and easily be understood by the readers.
- Negative:
The authors discussed only for few
suggestions or solutions.
The authors held on too much
assumptions.
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Conclusion
The authors tried to discuss an interestingtitle,but not successfully to elaborate the
contents same with the readers expectations.
They came up with easy examples but there is no
further explanation for the content that beendiscussed.
There is no new findings in their journal as they
chose to compare their hypothesis with the
previous journals.
Overall,the journal is good to get the additional
informations about illness identity.
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