Self-help groups for mental health
Encyclopedia
Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness
or otherwise increase their level of cognitive or emotional wellbeing. There are several international mental health self-help organizations including Emotions Anonymous
, the Depression and Bipolar Support Alliance
(DBSA), GROW
, and Recovery International. Mental Health America (MHA) and the National Alliance on Mental Illness
(NAMI) are also large organizations based in the United States. Both MHA and NAMI have networks of state and/or local organizations that sponsor support groups and various public advocacy forums. Recovery International uses a cognitive training
approach similar to cognitive-behavioral therapy, Emotions Anonymous uses a twelve-step
approach, whereas GROW incorporates a combination of cognitive training and twelve-step methods. DBSA affiliates sponsor support groups using a variety of techniques Despite the different approaches, many of the psychosocial processes in the groups are the same and they share similar relationships with mental health professionals. The terms 'self-help', 'mutual-help' and 'mutual-aid' are used interchangeably in this context.
. Mutual support is a process by which people voluntarily come together to help each other address common problems. Peer support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health
conditions where there is some mutual agreement on what is helpful.
The definitions of mutual support and peer support include many other mental health consumer
non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. In the former set members seek to improve themselves, wheres the latter set encompasses advocacy organizations such as Mental Health America, NAMI www.nami.org and USPRA
. Self-help groups include Family-to-Family education and support groups, a program of NAMI. The effectiveness of this program has been confirmed in a recent controlled study. In recent years, culturally adapted versions of the Family to Family program have begun to spread to lower income countries, for example, in El Salvador (www.ACISAM.org, in collaboration with the U.S. based Center for Health and Human Development), Mexico, and Malaysia.
Self-help
groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots
level. Self-help Organizations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favor of those affected.
and TOPS
) and Stress Coping groups (such as mental health support groups, cancer patient support groups
, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.
Significant differences exist between Behavioral Control groups and Stress Coping groups. Meetings of Behavior Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behavior Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months), and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behavior Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.
. Conversely, if particular groups are affiliated with a national organization professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group's effectiveness.
and other mental illnesses. EA is the largest of three organizations that have adapted AA's Twelve Steps to create a program for people suffering from mental or emotional illness, replacing the word "alcohol" with "our emotions" in the First Step. Smaller organizations include Neurotics Anonymous (N/A or NAIL) and Emotional Health Anonymous (EHA). EA is a successor organization of Neurotics Anonymous.
EA and NAIL are open to anyone who desires to become emotionally well, EHA additionally requires that members are not suffering from problems that are specifically addressed by other twelve-step groups (e.g. substance abuse
, eating disorder
s, sexual addiction
, compulsive gambling, etc.). According to the Twelve Traditions
, EA, NAIL, and EHA groups cannot accept outside contributions.
, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organization now known as Recovery International) and integrated its processes into their program. GROW's original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA's Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.
using principles in contrast to those popularized by psychoanalysis
. During the organization's annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as "nervous" (a compromise between the loaded term neurotic
and the colloquial phrase "nervous breakdown"); strictly encourages members to follow their physician's, social worker's, psychologist's or psychiatrist's orders; and does not operate with funding restrictions.
Fundamentally, Low believes "Adult life is not driven by instincts but guided by Will
," using a definition of will opposite of Arthur Schopenhauer's
. Low's program is based on increasing determination to act, self-control
and self-confidence
. Edward Sagarin
compared it to a modern, reasonable, and rational implementation of Émile Coué's
psychotherapy. Recovery International is "twelve-step friendly." Members of any twelve-step group are encourage to attend Recovery International meetings in addition to their twelve-step group participation.
Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing, is also deemphasized. Reality testing relies on consensual validation
, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.
and simplicity
. Elegant theoretical formulations, systematic behavioral techniques, and complicated cognitive-restructuring
methods are not necessary.
Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited too: acceptance
, behavioral rehearsal
, changing member's perspectives
of themselves, changing member's perspectives of the world, catharsis
, extinction
, role model
ing, learning new coping strategies
, mutual affirmation, personal goal setting, instilling hope
, justification
, normalization
, positive reinforcement
, reducing social isolation
, reducing stigma, self-disclosure
, sharing (or "opening up"), and showing empathy
.
Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.
A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one's life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behavior. The former category includes strategies such as acceptance and balancing
activities. The latter includes positive thinking
, increasing one's own personal agency/control
and activism within the mental health system
.
s in the United States found they had a relatively favorable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.
A survey of psychotherapists in Germany
found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.
Surveys of self-help groups has shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is "Doctors know better than we do how a sickness can be treated. We know better than doctors how sick people can be treated as humans."
, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programs, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalization and shorter durations of hospitalization indicate that self-help groups result in financial savings for the health care system, as hospitalization is one of the most expensive mental health services. Similarly, reduced utilization of other mental health services may translate into additional savings for the system.
While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation
, improve decision-making
, decrease tendency to decompensate
under stress
, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community
, education
and personal empowerment
.
Members of self-help groups for mental health rated their perception of the group's effectiveness on average at 4.3 on a 5-point Likert scale
.
, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticized self-help group structure as being too rigid.
is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous
found expert power to be more influential in measurements of perceived group helpfulness.
—that the group's processes can remedy any problem.
Mental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
or otherwise increase their level of cognitive or emotional wellbeing. There are several international mental health self-help organizations including Emotions Anonymous
Emotions Anonymous
Emotions Anonymous is a twelve-step program for recovery from mental and emotional illness. there were approximately 1,100 EA groups active in the United States. EA is the largest of three organizations that have adapted the Twelve Steps of Alcoholics Anonymous to create a program for people...
, the Depression and Bipolar Support Alliance
Depression and Bipolar Support Alliance
The Depression and Bipolar Support Alliance is a non-profit organization providing support groups for people with depression or bipolar disorder as well as their friends and family. DBSA's scope, also includes outreach, education and advocacy regarding depression and bipolar disorder...
(DBSA), GROW
GROW
GROW is a peer support and mutual-aid organization for recovery from, and prevention of, serious mental illness. GROW was founded in Sydney, Australia in 1957 by Father Cornelius B. "Con" Keogh, a Roman Catholic priest, and psychiatric patients who sought help with their mental illness in...
, and Recovery International. Mental Health America (MHA) and the National Alliance on Mental Illness
National Alliance on Mental Illness
The National Alliance on Mental Illness was founded in 1979 as the National Alliance for the Mentally Ill. NAMI is a nation-wide American advocacy group, representing families and people affected by mental illness as a non-profit grass roots organization and has affiliates in every American state...
(NAMI) are also large organizations based in the United States. Both MHA and NAMI have networks of state and/or local organizations that sponsor support groups and various public advocacy forums. Recovery International uses a cognitive training
Cognitive therapy
Cognitive behavioral therapy is a psychotherapeutic approach: a talking therapy. CBT aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic procedure in the present...
approach similar to cognitive-behavioral therapy, Emotions Anonymous uses a twelve-step
Twelve-step program
A Twelve-Step Program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems...
approach, whereas GROW incorporates a combination of cognitive training and twelve-step methods. DBSA affiliates sponsor support groups using a variety of techniques Despite the different approaches, many of the psychosocial processes in the groups are the same and they share similar relationships with mental health professionals. The terms 'self-help', 'mutual-help' and 'mutual-aid' are used interchangeably in this context.
Classification
Self-help groups for mental health provide mutual support and peer supportPeer support
Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, listening, or counseling...
. Mutual support is a process by which people voluntarily come together to help each other address common problems. Peer support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
conditions where there is some mutual agreement on what is helpful.
The definitions of mutual support and peer support include many other mental health consumer
Mental health consumer
A mental health consumer is a person who is under treatment for a psychiatric illness or disorder. The term was coined by people who use mental health services in an attempt to empower those with mental health issues, usually considered a marginalized segment of society...
non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. In the former set members seek to improve themselves, wheres the latter set encompasses advocacy organizations such as Mental Health America, NAMI www.nami.org and USPRA
United States Psychiatric Rehabilitation Association
The United States Psychiatric Rehabilitation Association , formerly known as the International Association of Psychosocial Rehabilitation Services is the professional association for practitioners of the field of psychiatric rehabilitation and persons and families living with psychiatric...
. Self-help groups include Family-to-Family education and support groups, a program of NAMI. The effectiveness of this program has been confirmed in a recent controlled study. In recent years, culturally adapted versions of the Family to Family program have begun to spread to lower income countries, for example, in El Salvador (www.ACISAM.org, in collaboration with the U.S. based Center for Health and Human Development), Mexico, and Malaysia.
Self-help
Self-help
Self-help, or self-improvement, is a self-guided improvement—economically, intellectually, or emotionally—often with a substantial psychological basis. There are many different self-help movements and each has its own focus, techniques, associated beliefs, proponents and in some cases, leaders...
groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots
Grassroots
A grassroots movement is one driven by the politics of a community. The term implies that the creation of the movement and the group supporting it are natural and spontaneous, highlighting the differences between this and a movement that is orchestrated by traditional power structures...
level. Self-help Organizations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favor of those affected.
Behavior Control and Stress Coping groups
Of Individual Therapy groups, researchers distinguish between Behavior Control groups (such as Alcoholics AnonymousAlcoholics Anonymous
Alcoholics Anonymous is an international mutual aid movement which says its "primary purpose is to stay sober and help other alcoholics achieve sobriety." Now claiming more than 2 million members, AA was founded in 1935 by Bill Wilson and Dr. Bob Smith in Akron, Ohio...
and TOPS
TOPS Club, Inc.
TOPS Club, Inc. is a non-profit charitable corporation based in Milwaukee, Wisconsin, USA, having members in chapters located worldwide, the majority of them in the United States and Canada. Its twofold objective is to sponsor research and foster support groups in human body weight control...
) and Stress Coping groups (such as mental health support groups, cancer patient support groups
Cancer support group
Cancer support groups provide a setting in which cancer patients can talk about living with cancer with others who may be having similar experiences...
, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.
Significant differences exist between Behavioral Control groups and Stress Coping groups. Meetings of Behavior Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behavior Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months), and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behavior Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.
Talking Groups
In Germany a specific subset of Conversation Circles are categorized as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.Affiliation and lifespan
If self-help groups are not affiliated with a national organization, professional involvement increases their life expectancyLife expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
. Conversely, if particular groups are affiliated with a national organization professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group's effectiveness.
Emotions Anonymous
Emotions Anonymous (EA) is a twelve-step program similar to Alcoholics Anonymous (AA), but for the purpose of helping its members recover from depressionClinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
and other mental illnesses. EA is the largest of three organizations that have adapted AA's Twelve Steps to create a program for people suffering from mental or emotional illness, replacing the word "alcohol" with "our emotions" in the First Step. Smaller organizations include Neurotics Anonymous (N/A or NAIL) and Emotional Health Anonymous (EHA). EA is a successor organization of Neurotics Anonymous.
EA and NAIL are open to anyone who desires to become emotionally well, EHA additionally requires that members are not suffering from problems that are specifically addressed by other twelve-step groups (e.g. substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
, eating disorder
Eating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
s, sexual addiction
Sexual addiction
Sexual addiction is a popular model to explain hypersexuality—sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control...
, compulsive gambling, etc.). According to the Twelve Traditions
Twelve Traditions
The Twelve Traditions of twelve-step programs provide guidelines for relationships between the twelve-step groups, members, other groups, the global fellowship, and society at large. Questions of finance, public relations, donations, and purpose are addressed in the Traditions...
, EA, NAIL, and EHA groups cannot accept outside contributions.
GROW
GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priestPriest
A priest is a person authorized to perform the sacred rites of a religion, especially as a mediatory agent between humans and deities. They also have the authority or power to administer religious rites; in particular, rites of sacrifice to, and propitiation of, a deity or deities...
, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organization now known as Recovery International) and integrated its processes into their program. GROW's original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA's Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.
Recovery International
Recovery, Inc. was founded in Chicago, Illinois in 1937 by psychiatrist Abraham LowAbraham Low
Abraham Low , was a Jewish-American neuropsychiatrist noted for his work establishing self-help programs for the mentally ill, and criticism of Freudian psychoanalysis. He was born February 28, 1891 in Baranów Sandomierski, Poland....
using principles in contrast to those popularized by psychoanalysis
Psychoanalysis
Psychoanalysis is a psychological theory developed in the late 19th and early 20th centuries by Austrian neurologist Sigmund Freud. Psychoanalysis has expanded, been criticized and developed in different directions, mostly by some of Freud's former students, such as Alfred Adler and Carl Gustav...
. During the organization's annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as "nervous" (a compromise between the loaded term neurotic
Neurosis
Neurosis is a class of functional mental disorders involving distress but neither delusions nor hallucinations, whereby behavior is not outside socially acceptable norms. It is also known as psychoneurosis or neurotic disorder, and thus those suffering from it are said to be neurotic...
and the colloquial phrase "nervous breakdown"); strictly encourages members to follow their physician's, social worker's, psychologist's or psychiatrist's orders; and does not operate with funding restrictions.
Fundamentally, Low believes "Adult life is not driven by instincts but guided by Will
Will (philosophy)
Will, in philosophical discussions, consonant with a common English usage, refers to a property of the mind, and an attribute of acts intentionally performed. Actions made according to a person's will are called "willing" or "voluntary" and sometimes pejoratively "willful"...
," using a definition of will opposite of Arthur Schopenhauer's
Arthur Schopenhauer
Arthur Schopenhauer was a German philosopher known for his pessimism and philosophical clarity. At age 25, he published his doctoral dissertation, On the Fourfold Root of the Principle of Sufficient Reason, which examined the four separate manifestations of reason in the phenomenal...
. Low's program is based on increasing determination to act, self-control
Self control
Self control is the ability to control one's emotions, behavior and desires in order to obtain some reward later. In psychology it is sometimes called self-regulation...
and self-confidence
Self-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...
. Edward Sagarin
Edward Sagarin
Edward Sagarin , also known by his pen name Donald Webster Cory, was an American professor of sociology and criminology at the City University of New York, and a writer...
compared it to a modern, reasonable, and rational implementation of Émile Coué's
Émile Coué
Émile Coué de la Châtaigneraie was a French psychologist and pharmacist who introduced a method of psychotherapy and self-improvement based on optimistic autosuggestion....
psychotherapy. Recovery International is "twelve-step friendly." Members of any twelve-step group are encourage to attend Recovery International meetings in addition to their twelve-step group participation.
Professionally led group psychotherapy
Self-help groups are not intended to provide "deep" psychotherapy. Nevertheless, their emphasis on psychosocial processes, and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing, is also deemphasized. Reality testing relies on consensual validation
Compliance (psychology)
Compliance refers to a response — specifically, a submission — made in reaction to a request. The request may be explicit or implicit . The target may or may not recognize that he or she is being urged to act in a particular way.Social psychology is centered on the idea of social influence...
, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.
Group processes
No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safetySafety
Safety is the state of being "safe" , the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types or consequences of failure, damage, error, accidents, harm or any other event which could be...
and simplicity
Simplicity
Simplicity is the state or quality of being simple. It usually relates to the burden which a thing puts on someone trying to explain or understand it. Something which is easy to understand or explain is simple, in contrast to something complicated...
. Elegant theoretical formulations, systematic behavioral techniques, and complicated cognitive-restructuring
Cognitive restructuring
Cognitive restructuring, sometimes used synonymously with Debating, is the process of learning to identify irrational or maladaptive thoughts and challenge their veracity using strategies such as logical disputation....
methods are not necessary.
Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited too: acceptance
Acceptance
Acceptance is a person's agreement to experience a situation, to follow a process or condition without attempting to change it, protest, or exit....
, behavioral rehearsal
Practice (learning method)
Practice is the act of rehearsing a behavior over and over, or engaging in an activity again and again, for the purpose of improving or mastering it, as in the phrase "practice makes perfect". Sports teams practice to prepare for actual games. Playing a musical instrument well takes a lot of...
, changing member's perspectives
Perspective (cognitive)
Perspective in theory of cognition is the choice of a context or a reference from which to sense, categorize, measure or codify experience, cohesively forming a coherent belief, typically for comparing with another...
of themselves, changing member's perspectives of the world, catharsis
Catharsis
Catharsis or katharsis is a Greek word meaning "cleansing" or "purging". It is derived from the verb καθαίρειν, kathairein, "to purify, purge," and it is related to the adjective καθαρός, katharos, "pure or clean."-Dramatic uses:...
, extinction
Extinction (psychology)
Extinction is the conditioning phenomenon in which a previously learned response to a cue is reduced when the cue is presented in the absence of the previously paired aversive or appetitive stimulus.-Fear conditioning:...
, role model
Role model
The term role model generally means any "person who serves as an example, whose behaviour is emulated by others".The term first appeared in Robert K. Merton's socialization research of medical students...
ing, learning new coping strategies
Coping Strategies
Coping Strategies is treatment designed for posttraumatic stress disorder within United States Armed Forces personnel and their families by the charitable organization Patriot Outreach...
, mutual affirmation, personal goal setting, instilling hope
Hope
Hope is the emotional state which promotes the belief in a positive outcome related to events and circumstances in one's life. It is the "feeling that what is wanted can be had or that events will turn out for the best" or the act of "look[ing] forward to with desire and reasonable confidence" or...
, justification
Theory of justification
Theory of justification is a part of epistemology that attempts to understand the justification of propositions and beliefs. Epistemologists are concerned with various epistemic features of belief, which include the ideas of justification, warrant, rationality, and probability...
, normalization
Normalization (sociology)
Normalization refers to social processes through which ideas and actions come to be seen as "normal" and become taken-for-granted or 'natural' in everyday life. In sociological theory normalization appears in two forms....
, positive reinforcement
Reinforcement
Reinforcement is a term in operant conditioning and behavior analysis for the process of increasing the rate or probability of a behavior in the form of a "response" by the delivery or emergence of a stimulus Reinforcement is a term in operant conditioning and behavior analysis for the process of...
, reducing social isolation
Social isolation
Social isolation refers to a lack of contact with society for members of social species. There may be many causes and individuals in numerous generally social species are isolated at times, it need not be a pathological condition. In human society, in those cases where it is viewed as a pathology,...
, reducing stigma, self-disclosure
Self-disclosure
Self-disclosure is both the conscious and subconscious act of revealing more about oneself to others. This may include, but is not limited to, thoughts, feelings, aspirations, goals, failures, successes, fears, dreams as well as one's likes, dislikes, and favorites.Typically, a self-disclosure...
, sharing (or "opening up"), and showing empathy
Empathy
Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...
.
Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.
- Social supportSocial supportSocial support can be defined and measured in many ways. It can loosely be defined as feeling that one is cared for by and has assistance available from other people and that one is part of a supportive social network...
: Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease. - Experiential knowledgeExperiential knowledgeExperiential knowledge is knowledge gained through experience as opposed to a priori knowledge. In the philosophy of mind, the phrase often refers to knowledge that can only be acquired through experience, such as, for example, the knowledge of what it is like to see colours, which could not be...
: Members obtain specialized information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increase their confidence. - Social learning theorySocial learning theory-Theory:Social learning theory is derived from the work of Albert Bandura which proposed that social learning occurred through four main stages of imitation:* close contact* imitation of superiors* understanding of concepts* role model behavior...
: Members with experience become creditable role models. - Social comparison theorySocial comparison theorySocial comparison theory is a theory initially proposed by social psychologist Leon Festinger in 1954. It explains how individuals evaluate their own opinions and desires by comparing themselves to others.- Basic framework :...
: Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be). - Helper theoryHelper theoryHelper theory or the helper therapy principle is a model, first described in 1965 by Frank Riessman, attempting to explain the therapeutic effect for both people in a "helper" and "helpee" relationship within self-help/mutual-aid support groups...
: Those helping each other feel greater interpersonal competence from changing other's lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive "personalized learning" from working with helpees. The helpers' self-esteem improves with the social approval received from those they have helped, putting them an a more advantageous position to help others.
A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one's life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behavior. The former category includes strategies such as acceptance and balancing
Balance (metaphysics)
In the metaphysical or conceptual sense, balance is used to mean a point between two opposite forces that is desirable over purely one state or the other, such as a balance between the metaphysical Law and Chaos — law by itself being overly controlling, chaos being overly unmanageable,...
activities. The latter includes positive thinking
Positive Mental Attitude
The concept of a "Positive Mental Attitude" was first introduced by Napoleon Hill in his book, "Think and Grow Rich" in 1937. He later went on to write several other books including "Success Through a Positive Mental Attitude"....
, increasing one's own personal agency/control
Control theory (sociology)
Control Theory in sociology can either be classified as centralized or decentralized or neither. Decentralized control is considered market control. Centralized control is considered bureaucratic control...
and activism within the mental health system
Psychiatric survivors movement
The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...
.
Relationship with mental health professionals
A 1978 survey of mental health professionalMental health professional
A mental health professional is a health care practitioner who offers services for the purpose of improving an individual's mental health or to treat mental illness. This broad category includes psychiatrists, clinical psychologists, clinical social workers, psychiatric nurses, mental health...
s in the United States found they had a relatively favorable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.
A survey of psychotherapists in Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.
Surveys of self-help groups has shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is "Doctors know better than we do how a sickness can be treated. We know better than doctors how sick people can be treated as humans."
Referrals
Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about the their group from friends and relatives, and relatively few learned about them from professional referrals.Effectiveness
Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Effects of 12-step programs exceed those of congnitive-behavioral inpatient programs. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalizations, and shorter hospitalizations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worryWorry
Worry is thoughts, images and emotions of a negative nature in whichmental attempts are made to avoid anticipated potential threats. As an emotion it is experienced as anxiety or concern about a real or imagined issue, usually personal issues such as health or finances or broader ones such as...
, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programs, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalization and shorter durations of hospitalization indicate that self-help groups result in financial savings for the health care system, as hospitalization is one of the most expensive mental health services. Similarly, reduced utilization of other mental health services may translate into additional savings for the system.
While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation
Psychiatric rehabilitation
Psychiatric rehabilitation, also known as psychosocial rehabilitation, and usually simplified to psych rehab, is the process of restoration of community functioning and well-being of an individual who has a psychiatric disability...
, improve decision-making
Decision making
Decision making can be regarded as the mental processes resulting in the selection of a course of action among several alternative scenarios. Every decision making process produces a final choice. The output can be an action or an opinion of choice.- Overview :Human performance in decision terms...
, decrease tendency to decompensate
Decompensation
In medicine, decompensation is the functional deterioration of a previously working structure or system. Decompensation may occur due to fatigue, stress, illness, or old age. When a system is "compensated," it is able to function despite stressors or defects. Decompensation describes an inability...
under stress
Stress (medicine)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community
Sense of community
Sense of community is a concept in community psychology and social psychology, as well as in several other research disciplines, such as urban sociology, which focuses on the experience of community rather than its structure, formation, setting, or other features...
, education
Education
Education in its broadest, general sense is the means through which the aims and habits of a group of people lives on from one generation to the next. Generally, it occurs through any experience that has a formative effect on the way one thinks, feels, or acts...
and personal empowerment
Empowerment
Empowerment refers to increasing the spiritual, political, social, racial, educational, gender or economic strength of individuals and communities...
.
Members of self-help groups for mental health rated their perception of the group's effectiveness on average at 4.3 on a 5-point Likert scale
Likert scale
A Likert scale is a psychometric scale commonly involved in research that employs questionnaires. It is the most widely used approach to scaling responses in survey research, such that the term is often used interchangeably with rating scale, or more accurately the Likert-type scale, even though...
.
Criticism
There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow-up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognize a "newcomer" presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups' formulaic approach, attrition rates, over-generalization, and "panacea complex".Formulaic approach
Researchers have questioned whether formulaic approaches to self-help group therapyGroup therapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticized self-help group structure as being too rigid.
High attrition rates
There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.Overgeneralization
Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent powerReferent power
Referent power is individual power of a Leader over the Team or Followers, based on a high level of identification with, admiration of, or respect for the powerholder/ leader....
is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous
Schizophrenics Anonymous
Schizophrenics Anonymous is a self-help group to help people who are affected by schizophrenia to cope with the disease.-History:The program was established in the Detroit area in 1985. The founder was Joanne Verbanic,and the co-founder was Dr. David R. Hawkins, M.D, PhD. who had been diagnosed...
found expert power to be more influential in measurements of perceived group helpfulness.
Panacea complex
There is a risk that self-help group members may come to believe that group participation is a panaceaPanacea (medicine)
The panacea , named after the Greek goddess of healing, Panacea, also known as panchrest, was supposed to be a remedy that would cure all diseases and prolong life indefinitely...
—that the group's processes can remedy any problem.