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

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.

Experiences of Self-Stigma in People with Chronic Psychosis: A Qualitative Study

“…Self-criticism and selfdeprecation often result in the abandonment of work, treatment and help-seeking as well as the loss of opportunities for independent living. In this sense, as has been suggested in the previous literature, people with psychosis may benefit from intervention programmes that include strategies related to self-compassion, acceptance and cognitive defusion [25,34]. Lien et al [35] found that guiding patients with a diagnosis of schizophrenia to perceive themselves more positively can effectively reduce their SS.…”

“…Lien et al [35] found that guiding patients with a diagnosis of schizophrenia to perceive themselves more positively can effectively reduce their SS. Indeed, the tendency to avoid and try to get rid of negative self-evaluations has a negative impact on the social functioning of people with psychosis [25], it undermines their independence and feeds the experience of SS over and over again.…”

“…The research was conducted with a sample of outpatients from a Mental Health Public Service in Asturias (Spain) that provides mental health care to a population of 50,000 people in the context of a city of 250,000 inhabitants. The sample was based on a previous study [25] in which 103 patients were assessed using the Internalized Stigma of Mental Illness Scale (ISMI) [26]. To be included in this study, participants were required to comply a number of inclusion criteria such as: being over 18 years of age; being able to express themselves verbally; meeting diagnostic criteria for the International Classification of Diseases Tenth Edition (ICD-10) codes F20-F29 for schizophrenia, schizotypal disorders and delusional disorders [27] for at least two years and presenting with elevated levels of SS (scores ≥2.5 in subscales of alienation and approval of stereotypes of ISMI).…”

Environmental and psychopathological predictors of clinical high‐risk of psychosis in adolescence

“…A longitudinal study to assess the evolution of adolescents with CHRp would help specify the relationship between variables. Fourth, the predictive model presented should be interpreted with caution, given the lack of consideration of other possible moderating or mediating variables and contextual factors, such as social isolation, stigma, family relationships, and attachment styles, that also influence the progression of the pathology (González‐Menéndez et al, 2021). Nevertheless, a large percentage of the psychopathology encountered is likely due to ER factors, in which case these nonspecific symptoms and psychological processes may act as mediators of ER risk.…”