Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training

Associations of continuum beliefs with personality disorder stigma: correlational and experimental evidence

PURPOSE

A pervasive and deeply entrenched stigma of personality disorders exists. For other mental disorders, a large body of research suggests that continuum beliefs (i.e., the endorsement of continuum perspectives on mental health and psychopathology) stimulate more favorable attitudes toward affected persons. Additionally, mental disorder classification systems increasingly incorporate continuous personality disorder models. Yet, it is unclear how continuum beliefs are related to personality disorder stigma. This study evaluated the link of continuum beliefs with personality disorder stigma based on correlational and experimental data.

METHODS

A large general population sample (N = 848) completed self-report measures of continuum beliefs regarding personality disorders, desired social distance, and prejudice toward persons with personality disorders. Additionally, participants were randomly presented with information supporting a continuous or a dichotomous view of personality disorders.

RESULTS

Continuum beliefs were associated with lower desired social distance (r = - 0.19) and prejudice (r = - 0.22). Additionally, the brief continuum intervention was associated with increased continuum beliefs (d = 0.99) and decreased desired social distance (d = - 0.14) and prejudice (d = - 0.17). Finally, the intervention effects on desired social distance and prejudice were mediated by continuum beliefs.

CONCLUSION

This study suggests that highlighting continuum views on personality disorders in public communication and interventions might reduce personality disorder stigma.

The effectiveness of mental health disorder stigma-reducing interventions in the healthcare setting: An integrative review

Individuals with mental health disorders frequently seek medical treatment in health care settings other than a mental health facility. However, mental health disorder stigmatization is prevalent in the healthcare setting across the globe. Stigmatizing attitudes remain widespread among healthcare professionals who are responsible for delivering patient-centered, quality care. Stigma in the healthcare setting can undermine effective diagnosis, therapy, and optimum health outcomes. Addressing stigma is critical to delivering quality health care in both developed and developing countries. Therefore, it is important to deliver successful anti-stigma education, along with practical strategies, to reduce the stigma of mental health disorders among healthcare professionals. An integrative review was conducted to identify the effectiveness of various interventions used in 10 different countries globally to reduce the stigma of mental health disorders in the healthcare setting.

Acceptance and commitment therapy (ACT) for professional staff burnout: a systematic review and narrative synthesis of controlled trials

BACKGROUND

Staff working in people-oriented professions are vulnerable to burnout which is negatively associated with professional well-being and service-user care.

AIM

To investigate if interventions based on Acceptance and Commitment Therapy (ACT) are effective in reducing staff burnout.

METHOD

Systematic database and reference list searches were conducted resulting in the inclusion of 14 quantitative papers. A narrative synthesis, including extraction of individual effect sizes, was performed.

RESULTS

All studies were controlled trials. The settings for ACT delivery were varied across health, social care, and public services. The ACT interventions demonstrated statistically significant effects in favour of ACT on the outcome measure subscales across the majority of studies (n = 9). Thirteen studies demonstrated an effect in favour of ACT in at least one outcome measure subscale. Positive aspects of work engagement varied according to a professional role.

CONCLUSIONS

The findings suggest that ACT-based interventions using a wide range of formats may have the potential to decrease burnout across a range of professional groups. However, samples were small in the studies reviewed and the interventions were not always defined. Further research would benefit from larger studies, incorporating process measures, with explicit protocols.

Group-based acceptance and commitment therapy interventions for improving general distress and work-related distress in healthcare professionals: A systematic review and meta-analysis

BACKGROUND

A large proportion of the healthcare workforce reports significant distress and burnout, which can lead to poor patient care. Several psychological interventions, such as Acceptance and Commitment Therapy (ACT), have been applied to improve general distress and work-related distress in healthcare professionals (HCPs). However, the overall efficacy of ACT in this context is unknown. This review and meta-analysis aimed to: 1) test the pooled efficacy of ACT trials for improving general distress and reducing work-related distress in HCPs; 2) evaluate the overall study quality and risk of bias; and 3) investigate potential moderators of intervention effectiveness.

METHOD

Four databases (Ovid MEDLINE, EMBASE, PsycINFO, CINHAL) were searched, with 22 pre-post design and randomised controlled trial (RCTs) studies meeting the inclusion criteria. 10 RCTs studies were included in the meta-analysis.

RESULTS

Two random effects meta-analyses on general distress and work-related distress found that ACT outperformed pooled control conditions with a small effect size for general distress at post-intervention (g = 0.394, CIs [.040; .748]) and for work-related distress (g = 0.301, CIs [.122; .480]) at follow-up. However, ACT was more effective than controls. The number of treatment sessions was a moderator of intervention efficacy for general distress. ACT process measures (psychological flexibility) did not show significantly greater improvements in those who received the intervention.

LIMITATIONS

The methodological quality of studies was poor and needs to be improved.

CONCLUSIONS

Overall, ACT interventions are effective in improving general distress and work-related distress in HCPs. These findings have implications for policymakers, healthcare organisations and clinicians.

Improving Attitudes Towards Personality Disorder: Is Training for Health and Social Care Professionals Effective?

Health and social care professionals are more likely to hold negative attitudes towards people with a diagnosis of personality disorder than toward people with other mental health diagnoses. Negative attitudes have also been found to adversely impact care and service provision. This review sought to systemically evaluate training aimed at improving professional attitudes towards people with a diagnosis of personality disorder. Electronic databases PsychINFO, PubMed, Embase, Web of Science, and ProQuest were searched, and 19 articles were identified. Results show that training is effective and that improvements tend to be maintained. The results suggest that (1) co-production with people with personal experience of a personality disorder diagnosis, (2) communicating a psychological model to participants, and (3) teaching participants clinical skills for use in their work improve effectiveness. Further research in the form of randomized controlled trials that use validated measures and follow-up participants for at least 6 months is needed.

Attitudes of Mental Health Staff Toward Patients With Borderline Personality Disorder: An Italian Cross-Sectional Multisite Study

Negative attitudes toward borderline personality disorder (BPD) can present a barrier to those seeking care. We explored caring attitudes toward BPD among 860 mental health professionals, including psychiatrists, psychologists, social health educators, nurses, and social workers. The results showed that social workers and nurses scored significantly lower on caring attitudes than psychiatrists, social health educators, and psychologists. Our analysis showed that the more BPD patients treated in the past year, more years of experience in mental health, and having prior BPD training were positively associated with caring attitudes scores. For all professional subgroups, except for social health educators, the caring attitudes score is higher in those who have had prior BPD training, and for professionals with low and medium level of experience in mental health. This result shows that training on BPD should target less experienced clinicians and those professional groups who had less opportunity to receive such education.

Rebuttal of Atkins et al. (2017) critique of the Öst (2014) meta-analysis of ACT

Atkins et al. strongly criticize my (Öst, 2014) systematic review and meta-analysis of ACT. The bulk of their re-examination of my article is divided into four parts: a) Selection of studies, b) Ratings of methodological quality, c) Meta-analysis, and d) Judgments of quality of evidence. It is evident from my paper that I have refuted their claims regarding each of these parts. Regarding a) Selection of studies I showed that only four studies had a cell size of less than 10 and their inclusion did not change the mean effect size or increased variability. Concerning b) Ratings of methodological quality I have showed that my ratings were reliable and had accuracy. As for c) Meta-analysis, I have demonstrated that I got very similar results to those of A-Tjak et al. (2015) that Atkins et al. describes as a much better meta-analysis. Regarding d) Judgments of quality of evidence, Atkins et al. brought up 23 studies for which they argued that I have done an incorrect evaluation but for every single study I have disproved their arguments and maintain my 2014 evaluation of the evidence base of ACT. Thus, there is no reason to follow Atkins et al. suggestion that my review "should now be set aside in making decisions regarding the treatment efficacy of ACT."

Stigma in health facilities: why it matters and how we can change it

Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge-both approaches and methods-regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development's Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described.The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.

Effects of dialectical behavior therapy skills training on outcomes for mental health staff in a child and adolescent residential setting

Training in Dialectical Behavior Therapy (DBT) skills coaching is desirable for staff in psychiatric settings, due to the efficacy of DBT in treating difficult patient populations. In such settings, training resources are typically limited, and staff turnover is high, necessitating brief training. This study evaluated the effects of a brief training in DBT skills coaching for nursing staff working in a child and adolescent psychiatric residential program. Nursing staff (n = 22) completed assessments of DBT skill knowledge, burnout, and stigma towards patients with borderline personality disorder (BPD) before and after a six-week DBT skills coaching training. Repeated measure ANOVAs were conducted to examine changes on all measures from pre- to post- treatment and hierarchical linear regressions to examine relationships between pre- training DBT knowledge, burnout, and BPD stigma and these same measures post-training. The brief DBT skill coaching training significantly increased DBT knowledge (p = .007) and decreased staff personal (p = .02) and work (p = .03) burnout and stigma towards BPD patients (p = .02). Burnout indices and BPD stigma were highly correlated at both time points (p < .001); however, while pre-training BPD stigma significantly predicted post-training client burnout (p = .04), pre-training burnout did not predict post-training BPD stigma. These findings suggest that brief training of psychiatric nursing staff in DBT skills and coaching techniques can result in significant benefits, including reduced staff burnout and stigma toward patients with BPD-related problems, and that reducing BPD stigma may particularly promote lower burnout.

The Stigma of Personality Disorders

This article reviews the recent literature on the stigma of personality disorders, including an overview of general mental illness stigma and an examination of the personality-specific stigma. Overall, public knowledge of personality disorders is low, and people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness. Health provider stigma seems particularly pernicious for those with borderline personality disorder. Most stigma research on personality disorders has been completed outside the USA, and few stigma-change interventions specific to personality disorder have been scientifically tested. Limited evidence suggests that health provider training can improve stigmatizing attitudes and that interventions combining positive messages of recovery potential with biological etiology will be most impactful to reduce stigma. Anti-stigma interventions designed specifically for health providers, family members, criminal justice personnel, and law enforcement seem particularly beneficial, given these sources of stigma.