Personal and interpersonal perceived control and the quality of life of persons with severe mental illness

The interaction between sense of mastery, social support, and parental distress among mothers with and without serious mental illness

BACKGROUND

Social support and sense of mastery are considered important resources in coping both with serious mental illness (SMI) and with motherhood-related challenges. However, their interactive effects on the parental stress of mothers with SMI are not clear.

METHODS

Scales assessing parental distress, social support, and sense of mastery were administered to 60 mothers with SMI and 60 mothers without SMI.

RESULTS

A main effect of sense of mastery and a lack of main effect of social support were found in both groups. An interaction effect of social support with mastery was found among mothers with SMI revealing that for mothers who had a high sense of mastery, social support was beneficial, whereas for mothers who had a low sense of mastery, social support was harmful.

CONCLUSIONS

In practice, attention should be given to the sensitive provision of support, balancing between what is needed and what is requested, with the aim of not harming an individual's sense of mastery.

Perceived Control among People with Severe Mental Illness: A Comparative Study

BACKGROUND

Given the importance of perceived control to mental health and recovery, research is needed to determine strategies to increase perceived control for people with a mental illness.

AIM

Investigate the implications of a therapeutic recreation program on the perceived control of people with a mental illness.

METHOD

Participants of an intervention group (n=27) and comparison group (n=18) completed the Perceived Control Across Domains Scale at three time intervals. Subscale and total scores were analysed.

RESULTS AND DISCUSSION

Significant variation occurred in the perceived control areas of substance use, personal cognition and personal empowerment.

IMPLICATIONS

A unique nurse led therapeutic recreation initiative, such as Recovery Camp, can improve and maintain facets of perceived control among people with mental illness.

Information-enhancement and goal setting techniques for increasing adaptive motivation and decreasing urges to drink alcohol

OBJECTIVE

The aim of the study was to determine whether experimental manipulation of sense of control would change moderate drinkers' (N=106) task-specific motivational structure and explicit and implicit determinants of their urge to drink alcohol.

METHOD

The effects of various levels of information-enhancement and goal-setting on participants' performance on experimental tasks were assessed. Participants were randomly assigned to a high-sense-of-control, low-sense-of-control, or no-intervention group. Dependent measures were indices derived from a task-specific version of the Personal Concerns Inventory and the Shapiro Control Inventory, Alcohol Urge Questionnaire, and alcohol Stroop test.

RESULTS

At baseline, there were no differences among the groups on any of the measures; however, post-experimentally, induced sense of control had led to increases in adaptive motivation and decreases in explicit and implicit measures of the urge to drink.

CONCLUSIONS

The results show that sense of control can be experimentally induced. This finding has important clinical implications.

Poor savouring and low self-efficacy are predictors of anhedonia in patients with schizophrenia spectrum disorders

Previous research suggests that negative schizotypes may be impaired in their ability to savour pleasant events (Applegate et al., 2009) and that schizophrenia patients believe that everyday tasks are excessively difficult to complete so that they attempt these tasks less frequently (MacCarthy et al., 1986; Bentall et al., 2010). It is possible that these beliefs and behaviours underpin negative symptoms such as anhedonia, avolition, apathy and associality. In the present study, 50 schizophrenia patients and 100 matched controls (half employed and half unemployed) completed self-report measures of self-efficacy and savouring. Patients reported savouring past, present and future events less than employed and unemployed groups, irrespective of mood state and I.Q. Patients also rated everyday tasks as more difficult to master. Inpatients compared to outpatients rated tasks more difficult but less important although they did not differ on the savouring measure. Abnormal judgements of difficulty and the reduced propensity to mentally rehearse past or future positive experiences to up-regulate mood could explain negative symptom patients' lack of engagement in everyday activities and eventual social withdrawal. These findings suggest the need to develop cognitive-behavioural savouring and self-efficacy interventions for patients experiencing the negative symptoms of schizophrenia.

Nature adventure rehabilitation for combat-related posttraumatic chronic stress disorder: a randomized control trial

Chronic combat-related posttraumatic stress disorder (CR-PTSD) is a condition with many treatment barriers. Nature Adventure Rehabilitation (NAR) as a second line or as a supplemental intervention has the potential to overcome some of these barriers and incorporate aspects of successful treatment modalities for PTSD within an experiential learning paradigm. In a pre-post controlled trial, CR-PTSD veterans (n=22) underwent a 1-year NAR intervention compared to a waiting list (WL) control group (n=20). Posttraumatic symptoms (PTS), depression, functional problems, quality of life, perceived control over illness (PCI) and hope were measured by self report measures. PTS, emotional and social quality of life, PCI, hope and functioning improved significantly. Change in PTS was contingent upon change in PCI. The current study is the first to present NAR as a promising supplemental intervention for chronic CR-PTSD. NAR seems to work through a process of behavioral activation, desensitization, gradual exposure to anxiety evoking situations and gaining control over symptomatology.

Issues and developments on the consumer recovery construct

The consumer recovery model has had increasing influence on mental health practices in the United States, Western Europe, and several other countries. However, adoption of the model has reflected political decisions rather than empirical evidence of the validity of the model or its value for treatment services. The recovery construct is poorly defined, and until recently there has been no reliable and valid measure with which to base a research program. We have developed an empirical measure that is well-suited for both research and clinical applications: the Maryland Assessment of Recovery in Serious Mental Ill-ness (MARS). We briefly describe the MARS and present preliminary data demonstrating that recovery is not a simple by-product of traditional outcome do-mains, but seems to be a distinct construct that may have important implications for understanding consumers with serious mental illness and for evaluating the outcome of treatment programs.

Recovery components as determinants of the health-related quality of life among patients with schizophrenia: structural equation modelling analysis

OBJECTIVE

The Substance Abuse and Mental Health Services Administration (SAMHSA) National Consensus Statement on Mental Health Recovery proposed 10 recovery components as guiding principles for fostering recovery among people with severe mental illness. Although researchers have recognized a close association between patient-oriented recovery and health-related quality of life (HRQOL), the relation between the recovery components and patients' self-reported HRQOL is still unknown. The purpose of the present study was therefore to use structural equation modelling to predict HRQOL of schizophrenia outpatients from the recovery components proposed by SAMHSA.

METHODS

The recovery status of 201 outpatients with schizophrenia, schizophreniform, or schizoaffective disorder was measured using 12 variables that indicate the outcome of 10 recovery components. Canonical correlation analysis was applied to screen variables that are highly correlated with HRQOL. Valid variables were then used to build a structural model that predicted individuals' HRQOL as indicated by the World Health Organization Quality of Life Measure Abbreviated (WHOQOL-BREF (HK)).

RESULTS

The bestfit model was able to explain 80.7% of the variance in WHOQOL-BREF outcome. The model demonstrated significant direct and indirect effects of five recovery components on HRQOL. The effect of psychosocial symptoms on HRQOL was highest (total beta = -0.64), followed by sense of personal agency (total beta = 0.58), sense of optimism (total beta = 0.54), perceived support (total beta = 0.47), and internal stigma (total beta = -0.42).

CONCLUSION

The recovery components proposed by the SAMHSA consensus statement provided a useful framework to explain HRQOL of outpatients with schizophrenia. The present model indicated a moderate to large effect of five major recovery components on HRQOL. It showed that patients' perceptions of support, optimism, and personal agency were influenced by psychosocial symptoms and internal stigma. This empirical study supported the use of recovery principles, such as resilience building or mastery-based intervention to improve the QOL of community dwellers with schizophrenia.

Scrupulosity disorder: an overview and introductory analysis

Scrupulosity is a psychological disorder primarily characterized by pathological guilt or obsession associated with moral or religious issues that is often accompanied by compulsive moral or religious observance and is highly distressing and maladaptive. This paper provides a comprehensive overview of scrupulosity and an original conceptualization of the disorder based on an exhaustive literature review to increase awareness of the disorder among practicing clinicians and stimulate further research. It explores the clinical features of scrupulosity, classified as cognitive, behavioral, affective, and social features, as well as the epidemiology, etiology, and treatment of the disorder. Additionally, it is suggested that scrupulosity, despite its similarity to OCD, may merit a distinctive diagnosis, particularly considering its unique constellation and severity of symptoms and its treatment refractoriness, as supported by statistical analysis.