Management of the self:An interdisciplinary approach to self-management in psychiatry and psychosomatic medicine Stefan Van Geelen (bio) and Gaston Franssen (bio) In recent years, there has been a rapidly increasing interest in self-management strategies in psychiatry and psychosomatic medicine (Siantz & Aranda, 2014; Crawford et al., 2014; Kemp, 2011). Among the conditions in which self-management is currently investigated in these contexts are bipolar disorder (Jones et al., 2011; Depp et al., 2009), depression (Van Grieken et al., 2015; Houle et al., 2013), post-traumatic stress disorder (Engel et al., 2015; Possemato et al., 2015), schizophrenia (Saito et al., 2013; Cimo et al., 2012), attention deficit hyperactivity disorder (Bussing et al., 2016; Christiansen et al., 2014), irritable bowel syndrome (Eugenio et al., 2012), chronic fatigue syndrome (Meng, Friedberg, & Castora-Binkley, 2014, Friedberg et al., 2013), and fibromyalgia (Bourgault et al., 2015; Hamnes et al., 2012). These approaches aim to stimulate patients to be more actively engaged in their own care, and they intend to shift the burden of the responsibility for treatment success away from psychiatrists, doctors, nurses and other healthcare professionals (Lawn et al., 2007; Davidson, 2005). Thus, acquiring the mastery of self-management is a critical component for patients in dealing with their conditions, and within mental healthcare it is commonly regarded as an innovative person-centered approach to provide individuals with the necessary skills to deal with the unique challenges they face in everyday life (Janney, Bauer, & Kilbourne, 2014; Stanghellini, Bolton, & Fulford, 2013). At present, approaches within mental healthcare settings that try to actively involve the patients in their own care comprise a wide range of strategies and interventions, which have also been described in terms of self-help (Lewis, Pearce, & Bisson, 2012; Moritz et al., 2011), self-care (Holmberg & Kane, 1999), and self-treatment (Charlton, 2009). As for the literature on self-management [End Page 109] in particular, psychiatric and psychosomatic research encompasses a similarly broad terminological variety, among which chronic disease self-management (Lorig et al., 2014), self-management support (Houle et al., 2013), comprehensive self-management (Eugenio et al., 2012), activity pacing self-management (Kos et al., 2015), and illness self-management (Saito et al., 2013). No less diverse and seemingly eclectic are the commonly used modes of delivery, ranging from straightforward patient education and medical information brochures, workbooks and manuals, mobile technologies and internet-based modalities, all the way to peer-led interventions, nurse assisted training, graded exercise programs, and cognitive behavioral therapies (e.g. Engel et al., 2015; Janney, Bauer, & Kilbourne, 2014; Crawford et al., 2014). A proliferation of different methods, frameworks, targets and resources, then, appears to be intrinsic to self-management strategies over different healthcare settings. Initially, the interest in self-management interventions arose within the context of chronic somatic disease (Newman, Steed, & Mulligan, 2004; Lorig & Holman, 2003). Here, self-management is often defined as: "the individual's ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition" (Barlow et al., 2002, p. 178). Consequently, the traditional goals of self-management are the promotion of self-efficacy in dealing with the corollaries of long-lasting illness, teaching condition-specific skills, encouraging adequate behavior in regard to disease, implementing problem-based coping strategies, increasing patients' medical knowledge, and raising their treatment motivation and compliance (Newman, Steed, & Mulligan, 2004; Lorig & Holman, 2003; Barlow et al., 2002). Along the same lines, in mental health settings the targets are often defined as improving symptomatology, preventing relapse, increasing performance in daily life activities, aiding in recovery, obtaining positive attitudes towards medication use, and the initiation of self-management of drug intake (Kos et al., 2015; Houle et al., 2013; Saito et al., 2013; Jones et al., 2011). Overall, within mental healthcare, it is commonly assumed that self-management "encourages consumers to take responsibility for their own illness, and to fully participate in decisions about their illness" (Kemp, 2011, p. 147). Thus, it would seem that self-management strategies across medical disciplines are appealing, as they promise 1) to increase the autonomy and well-being of patients, 2) to stimulate shared decision-making and joint crisis planning, and, consequently, 3) to make healthcare...
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Jun 26, 2021
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