Ilanit Hasson-Ohayon

Women with advanced breast cancer and their spouses: diversity of support and psychological distress.

Objective: The current study examines the effect of perceived support from different agents (spouse, family, friends, religion—spirituality) on psychological distress experienced by women with advanced breast cancer and their male spouses.

Internalized stigma and quality of life among persons with severe mental illness: The mediating roles of self-esteem and hope

Research has revealed the negative consequences of internalized stigma among people with serious mental illness (SMI), including reductions in self-esteem and hope. The purpose of the present study was to investigate the relation between internalized stigma and subjective quality of life (QoL) by examining the mediating role of self-esteem and hope. Measures of internalized stigma, self-esteem, QoL, and hope were administrated to 179 people who had a SMI. Linear regression analysis and structural equation modeling (SEM) were used to analyze the cross-sectional data. Self-esteem mediated the relation between internalized stigma and hope. In addition, hope partially mediated the relationship between self-esteem and QoL. The findings suggest that the effect of internalized stigma upon hope and QoL may be closely related to levels of self-esteem. This may point to the need for the development of interventions that target internalized stigma as well as self-esteem.

Meaning in life, insight and self-stigma among people with severe mental illness

Recapturing meaning in life has been described as an essential element in the process of recovery from severe mental illness (SMI), but limited quantitative research still restricts our understanding of this phenomenon. The purpose of the current study was to explore the meaning in life among people with SMI and variables that may influence it such as internalized stigma and insight into the mental illness. We expected a significant negative correlation between internalized stigma and meaning in life, and that internalized stigma would moderate the relationship between insight and meaning in life. To explore these assumptions, 60 persons with SMI completed questionnaires that assessed their meaning in life, insight into their mental illness and internalized stigma, after which the data were analyzed using correlation and cluster analysis. Both hypotheses were confirmed. The mechanism behind the relationship between self-stigma and meaning in life and the theoretical and clinical implications of the moderation model are discussed.

Narrative Enhancement and Cognitive Therapy (NECT) Effectiveness: A Quasi-Experimental Study

OBJECTIVE Accumulated evidence suggests that approximately one third of people with a serious mental illness (SMI) experience elevated self-stigma. Narrative enhancement and cognitive therapy (NECT) is a structured group-based intervention aimed to reduce self-stigma. The current study aims to examine the effectiveness of NECT. A quasi-experimental design. DESIGN Baseline and follow-up data were collected and outcomes were compared between 63 persons with SMI who participated in NECT and 56 persons who received treatment as usual. RESULTS The NECT treatment group showed significant (p < .05) reductions in self-stigma and increases in self-esteem, quality of life, and Hope-Agency scores between pre- and posttreatment assessments, compared with the control group. CONCLUSIONS The current results provide preliminary support for the use of NECT as an effective treatment to reduce self-stigma and its implications for treatment and practice are discussed.

Individual psychotherapy for schizophrenia: trends and developments in the wake of the recovery movement.

Although the role and relative prominence of psychotherapy in the treatment of schizophrenia has fluctuated over time, an analysis of the history of psychotherapy for schizophrenia, focusing on findings from the recovery movement, reveals recent trends including the emergence of the development of integrative psychotherapy approaches. The authors suggest that the recovery movement has revealed limitations in traditional approaches to psychotherapy, and has provided opportunities for integrative approaches to emerge as a mechanism for promoting recovery in persons with schizophrenia. Five approaches to integrative psychotherapy for persons with schizophrenia are presented, and a shared conceptual framework that allows these five approaches to be compatible with one another is proposed. The conceptual framework is consistent with theories of recovery and emphasizes interpersonal attachment, personal narrative, and metacognitive processes. Implications for future research on integrative psychotherapy are considered.

The psychometric properties of the Illness Management and Recovery scale: client and clinician versions.

The present study examined the psychometric properties of the clinician and client versions of the Illness Management and Recovery (IMR) scale. Using a 5-point behaviorally anchored response format, these scales were designed to tap the critical illness management and recovery domains targeted by the IMR program. This program is a curriculum-based approach to helping persons with a serious mental illness (SMI) acquire the knowledge and skills they need to manage their illness effectively and to achieve personal recovery goals. Two hundred and ten persons with a diagnosis of a SMI and their 13 clinicians filled-out the client and clinician versions of the IMR questionnaire. The clients also responded to measures of coping efficacy and social support. While indicating limitations of the IMR scales and pointing to how they could be improved, this study provided some support for the construct and concurrent validity of the client and clinician versions of the IMR questionnaire. Moderate reliabilities were uncovered for these parallel versions of the questionnaire. Client responses to the client IMR scale and clinician responses to the clinician IMR scale were shown to be characterized by similar major components of the IMR intervention.

Depression and insight in schizophrenia: Comparisons of levels of deficits in social cognition and metacognition and internalized stigma across three profiles

While research has paradoxically linked insight to greater emotional distress and depression in schizophrenia, little is known why and for whom insight can result in depression. One possibility is that internalized stigma and deficits in social cognition and metacognition are risk factors for insight to convert to depression. To explore this possibility we assessed insight, depression, internalized stigma, social cognition and metacognition for sixty five persons with schizophrenia spectrum disorders. We then performed a cluster analysis based on insight and depression scores. Three groups were produced by the cluster analysis: Good insight/Mild depression (n=22); Fair insight/Moderate depression (n=26) and Poor insight/Minimal depression (n=17). As predicted, ANOVA comparing groups revealed the three groups differed in social cognition, and the metacognitive mastery aspect of metacognition. Those with fair insight and moderate depression reported more internalized stigma than those with poor insight and minimal depression. Persons with good insight and mild depression had higher levels of social cognition and metacognitive mastery than the other two groups. These differences persisted when controlling for neurocognition and symptom severity. These findings point to the possibility that future research should examine whether bolstering metacognitive and social cognitive capacities may have a protective effect as persons are assisted to achieve insight.

Insight into mental illness and self-stigma: The mediating role of shame proneness

Insight into mental illness and self-stigma among persons with serious mental illness (SMI) have been found to be related, but the process behind this relation is still unclear. The current study examined whether shame and guilt proneness mediates or moderates the relation between insight into mental illness and self-stigma among persons with SMI. Sixty persons with SMI completed questionnaires that assessed their insight, shame, guilt proneness, and self-stigma. Results reveal that shame proneness but not guilt proneness mediates the relation between insight and self-stigma. The theoretical and clinical implications of the differences between shame and guilt and their relation to the development of self-stigma are discussed.

Stereotype endorsement, metacognitive capacity, and self-esteem as predictors of stigma resistance in persons with schizophrenia.

OBJECTIVE While research continues to document the impact of internalized stigma among persons with schizophrenia, little is known about the factors which promote stigma resistance or the ability to recognize and reject stigma. This study aimed to replicate previous findings linking stigma resistance with lesser levels of depression and higher levels of self-esteem while also examining the extent to which other factors, including metacognitive capacity and positive and negative symptoms, are linked to the ability to resist stigma. METHOD Participants were 62 adults with schizophrenia-spectrum disorders who completed self-reports of stigma resistance, internalized stigma, self-esteem, and rater assessments of positive, negative, disorganization, and emotional discomfort symptoms, and metacognitive capacity. RESULTS Stigma resistance was significantly correlated with lower levels of acceptance of stereotypes of mental illness, negative symptoms, and higher levels of metacognitive capacity, and self-esteem. A stepwise multiple regression revealed that acceptance of stereotypes of mental illness, metacognitive capacity, and self-esteem all uniquely contributed to greater levels of stigma resistance, accounting for 39% of the variance. CONCLUSION Stigma resistance is related to, but not synonymous with, internalized stigma. Greater metacognitive capacity, better self-esteem, and fewer negative symptoms may be factors which facilitate stigma resistance.

Call It a Monster for Lack of Anything Else: Narrative Insight in Psychosis

Individuals diagnosed with schizophrenia often appear to be unaware of having an illness or actively reject their diagnostic label. It is unclear, however, how this lack of awareness relates to important outcomes. Broadening the definition of awareness to include “narrative insight” may clarify this issue. The objective of this study was to identify profiles of narrative insight and test how these relate to standardized measure of insight. Sixty-five individuals with schizophrenia spectrum disorders participated in an assessment that included the Scale of Unawareness of Mental Disorder (SUMD) and an in-depth semi-structured interview. Qualitative analysis revealed 5 central themes related to insight on the basis of which each interview was then rated. Cluster analysis of these ratings resulted in 4 profiles of narrative insight: (1) accepts illness/rejects label, (2) rejects illness/searches for a name (3) passive insight of illness and label, and (4) integrative insight. The SUMD differentiated between individuals assigned to profile 2 who showed low insight to their illness and those assigned to the other profiles of narrative insight, but could not differentiae between them. Results support the claim that illness narratives are multifaceted and that traditional measures of insight may not be sensitive to different ways in which people understand their illness.