Psychological Inflexibility in People with Chronic Psychosis: The Mediating Role of Self-Stigma and Social Functioning.

Ana González-Menéndez,Mercedes Paino,David González-Pando,Nuria Ordoñez-Camblor,Elena García-Vega,Tatiana Arboleya Faedo

doi:10.3390/ijerph182312376

Abstract

Psychosis is associated with self-stigmatization and loss of social functioning that increase the severity of the disorder. Psychological inflexibility (PI)—an individual’s tendency to suppress undesirable private events—plays a fundamental role in the emergence and worst prognosis of psychosis. The main objective of this study was to analyze whether self-stigma and social functioning mediate the association of PI with the severity of psychosis in adults with chronic schizophrenia. The study was carried out with a sample of 103 outpatients. The Acceptance and Action Questionnaire, the Internalized Stigma of Mental Illness Scale, and the Social Functioning Scale were used for clinical assessments. Data analyses were performed by using the PROCESS macro for SPSS. Results showed that the link between PI and the severity of psychosis is not direct, but is better explained by mediation of the self-stigma and social functioning of those assessed. PI also predicts worse social functioning without the need to take self-stigma into account. Moreover, self-stigma alone does not predict the severity of psychotic symptoms; this relationship has to be mediated by social functioning. These findings suggest that interventions designed to increase psychological flexibility, such as Acceptance and Commitment Therapy (ACT), may offer an alternative to attenuate the negative impact of self-stigma and to improve the social functioning.

Highlights

Mental illness stigma, which includes negative attitudes, beliefs, and actions directed towards persons with severe mental illness, has been implicated in a host of negative consequences
The results showed that only the stereotype endorsement and stigma resistan mensions of Internalized Stigma of Mental Illness Scale (ISMI) were significant for predicting social functioning
This study demonstrated that that psychological inflexibility predicts decreased social functioning without the need to people with an inflexible psychological style avoid and struggle to rid themselves of their negative self-evaluations, and that this struggle diminishes take self-stigma into account

Summary

Introduction

Mental illness stigma, which includes negative attitudes, beliefs, and actions directed towards persons with severe mental illness, has been implicated in a host of negative consequences. The stigma affects symptom management, understanding and awareness (insight) of the disorder, and the commencement of and adherence to available treatments [4]. It is usually described as prejudice and discrimination caused by negative stereotypes of those who are associated with the diagnostic label (e.g., people who are dangerous, unpredictable, incompetent) [5,6]. Those who are identified as part of a stigmatized group endorse such stereotypes, anticipating social rejection and incorporating such viewpoints into their own systems of values [7] (i.e., self-stigma or internalized stigma). Self-stigma is a prominent feature of people living with psychotic symptoms (i.e., people with psychosis) and their families [8], and can become a barrier to recovery and the pursuit of personally valuable and important goals [9]

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