THE IMPACT OF ILLNESS IDENTITY ON RECOVERY FROM.pptx

8/14/2019 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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THE IMPACT OF ILLNESS IDENTITY ON RECOVERY FROM.pptx