An Integrative Cognitive Model of Internalized Stigma in Psychosis

Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory. Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice. Conclusion: An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level

Acute Inpatients’ Experiences of Stigma From Psychosis: A Qualitative Exploration.

Stigma is a common difficulty for those who experience psychosis as they are viewed as most dangerous, unpredictable, and least likely to recover. In particular, experiences of stigma are yet to be explored with inpatients admitted to psychiatric hospital. The aim of this study was to examine subjective experiences of stigma with acute psychiatric inpatients who experience psychosis. Twenty-five psychiatric inpatients with experiences of psychosis were interviewed using a semistructured interview measure to examine their subjective experiences of stigma. The interview schedule enquired about their experiences of stigma and discrimination and the personal impacts this has had. Thematic analysis was employed to analyze the qualitative data. The analysis identified 3 superordinate themes: ‘stigmatizing social environment and networks,’ ‘stigmatized person with psychosis,’ and ‘stigma interactions.’ These themes reflected experiences of stigma during the inpatient stay as well as in the community. A graphical representation of these themes and their interaction was developed. Stigma is a concern for acute psychiatric inpatients with psychosis. This concern should be explored in future research, and where appropriate addressed during admission to an acute psychiatric inpatient hospital

Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis

It is acknowledged that people with a schizophrenia-spectrum diagnosis experience higher levels of stigma compared to any other mental health diagnosis. As a consequence, their experience of internalised stigma is likely to be the most detrimental and pervasive. Internalised stigma interventions have shown some benefits in those who experience serious mental illness including those with a schizophrenia-spectrum diagnosis. A systematic narrative review and meta-analysis were conducted examining the efficacy of internalised stigma interventions for people with a schizophrenia-spectrum diagnosis. Randomised Controlled Trials, controlled trials, and cohort studies were included and assessed against quality criteria. The search identified 12 studies; 7 randomised controlled trials, 3 cohort studies and 2 controlled trials. A variety of psychosocial interventions were utilised with the majority employing Cognitive Behaviour Therapy (CBT), psychoeducation and social skills training. The core outcomes used to examine the efficacy of the intervention were internalised stigma, self-esteem, empowerment, and functioning. The meta-analysis revealed an improvement in internalised stigma favouring the internalised stigma intervention but was not significant (5 RCTs, n = 200). Self-efficacy and insight were significantly improved favouring the internalised stigma intervention. Internalised stigma interventions show promise in those with schizophrenia-spectrum diagnoses. Existing interventions have demonstrated small effects and employed small samples. Large scale RCTs are required to further develop the evidence base of more targeted interventions

Participant views on involvement in a trial of social recovery cognitive behaviour therapy

Background The PRODIGY trial (Prevention of long term social disability amongst young people with emerging psychological difficulties, ISRCTN47998710) is a pilot trial of social recovery cognitive behaviour therapy (SRCBT). Aims The PRODIGY qualitative substudy aimed to (a) explore individual experiences of participating in the pilot randomised, controlled trial (recruitment, randomisation, assessment) andinitial views of therapy, and (b) to explore perceived benefits of taking part in research v. ethical concerns and potential risks. Method Qualitative investigation using semi-structured interviews with thematic analysis. Results Analysis revealed participant experiences around the key themes of acceptability, disclosure, practicalities, altruism and engagement. Conclusions Participants in both trial arms perceived themselves as gaining benefits from being involved in the study, above and beyond the intervention. This has implications for the design of future research and services for this client group, highlighting the importance of being flexible and an individualised approach as key engagement tools

Semi-structured Interview Measure of Stigma (SIMS) in psychosis: Assessment of psychometric properties

Stigma is a significant difficulty for people who experience psychosis. To date, there have been no outcome measures developed to examine stigma exclusively in people with psychosis. The aim of this study was develop and validate a semi-structured interview measure of stigma (SIMS) in psychosis. The SIMS is an eleven item measure of stigma developed in consultation with service users who have experienced psychosis. 79 participants with experience of psychosis were recruited for the purposes of this study. They were administered the SIMS alongside a battery of other relevant outcome measures to examine reliability and validity. A one-factor solution was identified for the SIMS which encompassed all ten rateable items. The measure met all reliability and validity criteria and illustrated good internal consistency, inter-rater reliability, test retest reliability, criterion validity, construct validity, sensitivity to change and had no floor or ceiling effects. The SIMS is a reliable and valid measure of stigma in psychosis. It may be more engaging and acceptable than other stigma measures due to its semi-structured interview format

Observations on metamorphosing tadpoles of Hyalinobatrachium orientale (Anura: Centrolenidae)

Observações sobre girinos de Hyalinobatrachium orientale (Anura: Centrolenidae) em metamorfose. A metamorfose, processo em que os anfíbios anuros reabsorvem suas caudas e remodelam suas partes bucais e órgãos internos, é um estágio vulnerável de sua história de vida. Durante a transformação de larvas em adultos, os girinos não estão bem adaptados à vida aquática nem à vida terrestre ativa. Estudos anteriores examinaram a duração da metamorfose em diversas espécies com relação ao tamanho do girino, habitat e outros fatores; entretanto, a duração da metamorfose em relação ao local onde esta ocorre não foi relatada pantrolenídeos. Em Hyalinobatrachium orientale, a metamorfose ocorre nas superfícies superiores das folhas das plantas de sub-bosque baixo e dura de 3,5 a 4,0 dias, um pouco mais do que o esperado para um girino desse tamanho de corpo. Os indivíduos recém-metamorfoseados parecem mudar seus poleiros de folha para folha aleatoriamente. Não há diferenças significativas na temperatura ou umidade relativa das superfícies superior e inferior das folhas no sub-bosque da floresta; assim, o uso das superfícies superiores das folhas pode fornecer-lhes umidade da vegetação do estrato superior após as chuvas e protegê-los de predadores terrestres.Observations on metamorphosing tadpoles of Hyalinobatrachium orientale (Anura: Centrolenidae). Metamorphosis, when anuran amphibians resorb their tails and remodel their mouthparts and internal organs, is a vulnerable stage in the frog’s life history. As larvae metamorphose from tadpoles to adult frogs, they are neither suited to aquatic life nor ready for active terrestrial life. Previous studies have examined the duration of metamorphosis in a range of species, with respect to tadpole size, habitat, and other factors; however, the duration of metamorphosis relative to where it takes place has not been reported in centrolenids. In Hyalinobatrachium orientale, metamorphosis takes place on the upper surfaces of the leaves of low understory plants and lasts 3.5–4.0 days, a little longer than expected for the tadpole of this body size. Metamorphs seem to shift their perches from leaf to leaf randomly. There are no significant differences in the temperature or relative humidity of the upper and lower surfaces of leaves in the forest understory; thus, the presence of the metamorphs on the upper surfaces of leaves may provide moisture from the upper story vegetation after rain and protect them from terrestrial predators

Exploring the Use of Immersive Technologies to Enhance the Student Experience

This paper reports on the initial phase of a National Forum funded Learning Enhancement Project (LEP), under the Strategic Alignment of Teaching and Learning Enhancement (SATLE) funding stream. The purpose of the LEP is to explore the use of immersive technologies such as Augmented Reality, Virtual Reality and 360o Learning in three key domain areas within one higher education institution in Ireland. While significant research has been conducted into the use of these technologies in training and business contexts, the application and use in higher education is still scarce. Radianti et al. (2020) suggest that while the use of virtual reality in higher education is promising, it is still quite experimental and focuses more on performance and usability than learning-oriented applications. Augmented Reality has been used in areas such as teacher education (Sáez-López, 2020) and EFL (Arkhipova, 2022) but is also largely experimental. Together with Mixed Reality and 360-degree Learning, these technologies have the potential to offer students a more immersive learning experience. Three domain areas are involved in this project: Online Learning; the university library; and the academic discipline of Business Tourism. It is envisaged that based on their expertise and experience team members will trial at least two of the immersive technologies with their students during the academic year 2023-2024. Engaging the students in the research will foster a partnership approach and provide an understanding of how this new approach to learning benefits the students but will also reveal the challenges associated with introducing new technologies

Assessing social recovery of vulnerable youth in global mental health settings: a pilot study of clinical research tools in Malaysia

Background A social recovery approach to youth mental health focuses on increasing the time spent in valuable and meaningful structured activities, with a view to preventing enduring mental health problems and social disability. In Malaysia, access to mental health care is particularly limited and little research has focused on identifying young people at risk of serious socially disabling mental health problems such as psychosis. We provide preliminary evidence for the feasibility and acceptability of core social recovery assessment tools in a Malaysian context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample. Methods Nine vulnerable young people from low-income backgrounds were recruited from a non-government social enterprise and partner organisations in Peninsular Malaysia. Participants completed a battery of social recovery assessment tools (including time use, unusual experiences, self-schematic beliefs and values). Time for completion and completion rates were used as indices of feasibility. Acceptability was examined using qualitative interviews in which participants were asked to reflect on the experience of completing the assessment tools. Following a deductive approach, the themes were examined for fit with previous UK qualitative accounts of social recovery assessments. Results Feasibility was indicated by relatively efficient completion time and high completion rates. Qualitative interviews highlighted the perceived benefits of social recovery assessments, such as providing psychoeducation, aiding in self-reflection and stimulating goal setting, in line with findings from UK youth samples. Conclusions We provide preliminary evidence for the feasibility and acceptability of social recovery assessment tools in a low-resource context, comparing the experiential process of engaging young Malaysian participants in social recovery assessments with prior accounts from a UK sample. We also suggest that respondents may derive some personal and psychoeducational benefits from participating in assessments (e.g. of their time use and mental health) within a social recovery framework

Behaviour change techniques and intervention characteristics in digital cardiac rehabilitation: a systematic review and meta-analysis of randomised controlled trials

Evidence suggests that digitally delivered cardiac rehabilitation (CR) is likely to be an effective alternative to centre-based CR. However, there is limited understanding of the behaviour change techniques (BCTs) and intervention characteristics included in digital CR programmes. This systematic review aimed to identify the BCTs and intervention characteristics that have been used in digital CR programmes, and to study those associated with effective programmes. Twenty-five randomised controlled trials were included in the review. Digital CR was associated with significant improvements in daily steps, light physical activity, medication adherence, functional capacity, and low-density lipoprotein-cholesterol when compared to usual care, and produced effects on these outcomes comparable to centre-based CR. The evidence for improved quality of life was mixed. Interventions that were effective at improving behavioural outcomes frequently employed BCTs relating to feedback and monitoring, goals and planning, natural consequences, and social support. Completeness of reporting on the TIDieR checklist across studies ranged from 42% to 92%, with intervention material descriptions being the most poorly reported item. Digital CR appears effective at improving outcomes for patients with cardiovascular disease. The integration of certain BCTs and intervention characteristics may lead to more effective interventions, however better intervention reporting is required