How a person values and describes themselves.
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376 to 400 of 1,216Corrigan PW, Rao D (2012)reviewMEDLINE-indexed journal, not yet read by usCanadian journal of psychiatry. Revue canadienne de psychiatrie552 citations On the self-stigma of mental illness: stages, disclosure, and strategies for change.
People with mental illness have long experienced prejudice and discrimination. Researchers have been able to study this phenomenon as stigma and have begun to examine ways of reducing this stigma. Public stigma is the most prominent form observed and studied, as it represents the prejudice and discrimination directed at a group by the larger population. Self-stigma occurs when people internalize these public attitudes and suffer numerous negative consequences as a result. In our article, we more fully define the concept of self-stigma and describe the negative consequences of self-stigma for people with mental illness. We also examine the advantages and disadvantages of disclosure in reducing the impact of stigma. In addition, we argue that a key to challenging self-stigma is to promote personal empowerment. Lastly, we discuss individual- and societal-level methods for reducing self-stig…
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Medial prefrontal cortex and the self in major depression.
Self-focus (i.e. the process by which one engages oneself in self-referential processing) is a core issue in the psychopathology of major depression. The cortical midline structures, including the medial prefrontal cortex (MPFC), play a key role in self-referential processing in healthy subjects. Four functional magnetic resonance imaging studies recently found either an increased or a decreased MPFC activation during self-referential processing in depressed patients compared to healthy controls. Building on critical differences in experimental settings, we argue that these conflicting results are indeed consistent with two modes of elevated MPFC activation in major depression. An elevated tonic ventral MPFC activation, as uncovered by an event-related design, may embody automatic aspects of depressive self-focus, such as attracting attention to self-relevant incoming information. An ele…
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Self-development: integrating cognitive, socioemotional, and neuroimaging perspectives.
This review integrates cognitive, socioemotional, and neuroimaging perspectives on self-development. Neural correlates of key processes implicated in personal and social identity are reported from studies of children, adolescents, and adults, including autobiographical memory, direct and reflected self-appraisals, and social exclusion. While cortical midline structures of medial prefrontal cortex and medial posterior parietal cortex are consistently identified in neuroimaging studies considering personal identity from a primarily cognitive perspective ("who am I?"), additional regions are implicated by studies considering personal and social identity from a more socioemotional perspective ("what do others think about me, where do I fit in?"), especially in child or adolescent samples. The involvement of these additional regions (including tempo-parietal junction and posterior superior te…
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Psychological pathways linking social support to health outcomes: a visit with the "ghosts" of research past, present, and future.
Contemporary models postulate the importance of psychological mechanisms linking perceived and received social support to physical health outcomes. In this review, we examine studies that directly tested the potential psychological mechanisms responsible for links between social support and health-relevant physiological processes (1980s-2010). Inconsistent with existing theoretical models, no evidence was found that psychological mechanisms such as depression, perceived stress, and other affective processes are directly responsible for links between support and health. We discuss the importance of considering statistical/design issues, emerging conceptual perspectives, and limitations of our existing models for future research aimed at elucidating the psychological mechanisms responsible for links between social support and physical health outcomes.
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Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation.
This paper reviews the conceptual foundation of mindfulness-based eating awareness training (MB-EAT). It provides an overview of key therapeutic components as well as a brief review of current research. MB-EAT is a group intervention that was developed for treatment of binge eating disorder (BED) and related issues. BED is marked by emotional, behavioral and physiological disregulation in relation to food intake and self-identity. MB-EAT involves training in mindfulness meditation and guided mindfulness practices that are designed to address the core issues of BED: controlling responses to varying emotional states; making conscious food choices; developing an awareness of hunger and satiety cues; and cultivating self-acceptance. Evidence to date supports the value of MB-EAT in decreasing binge episodes, improving one's sense of self-control with regard to eating, and diminishing depressi…
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Conceptualizing mindfulness and acceptance as components of psychological resilience to trauma.
Mindfulness- and acceptance-based conceptualizations of PTSD implicate experiential avoidance and non-mindful behavior in the etiology and maintenance of the disorder. If experiential avoidance is associated with vulnerability to PTSD, then a mindful and accepting orientation toward experience may confer psychological resilience following exposure to trauma. This article examines how mindfulness- and acceptance-based theories of psychopathology relate to risk of and resilience to PTSD. Research is reviewed dealing with the impact of experiential avoidance, avoidant coping, dissociation, acceptance, and mindfulness on PTSD symptom severity and posttraumatic functioning. This review suggests that trait mindfulness and acceptance are associated with greater psychological adjustment following exposure to trauma, while experiential avoidance, persistent dissociation, and coping strategies inv…
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How is our self related to midline regions and the default-mode network?
The problem of the self has been of increasing interest in recent neuroscience. Brain imaging studies have raised the question of whether neural activity in cortical midline regions is self-specific and whether self-specific activity is related to resting state activity (RSA). A quantitative meta-analysis that included 87 studies, representing 1433 participants, was conducted to discuss these questions. First, the specificity of the self (e.g. hearing one's own name, seeing one's own face) was tested and compared across familiar (using stimuli from personally known people) and other (non-self-non-familiar, i.e. strangers and widely-known figures) conditions. Second, the relationship between the self and resting state activity, as reflected by the default-mode network (DMN), was tested. The results indicated that the perigenual anterior cingulate cortex (PACC) is specifically involved in …
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Self-help parenting interventions for childhood behaviour disorders: a review of the evidence.
The use of self-help interventions for parents of children with behaviour problems is becoming more prevalent. This review critically evaluated the evidence supporting the efficacy of such programmes for children with behaviour problems. Using a systematic literature search, two modes of delivery were evaluated, namely bibliotherapy and multimedia. Programmes that included minimal therapist support were also included. Overall, there is good evidence supporting the efficacy of self-help programmes in improving child behaviour, over the short and longer term. Self-help programmes led to outcomes similar to those achieved with more intensive therapist input. Including minimal levels of therapist support in addition to self-help materials enhances child and parent outcomes. Parents view self-help favourably but significantly less so than programmes including some form of therapist input. The…
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Whether, how, and when social anxiety shapes positive experiences and events: a self-regulatory framework and treatment implications.
Although neglected in diagnostic criteria lists, theoretical models, and treatment approaches, attenuated positive emotions and cognitions distinguish social anxiety and social anxiety disorder from other anxiety conditions (and cannot be accounted for by comorbidity with depression). We present a self-control resource depletion model to explain how the intense self-regulatory efforts of high socially anxious individuals dampen positive experiences and events. We review existing research on individuals with social anxiety difficulties, focusing on impoverished positive experiences and quality of life, atypical reactions to overtly positive social outcomes, the absence of a normative bias toward the positive in social situations, and a meaningful subset of individuals who show signs of impulsive, short-lived positive events. We also discuss findings from the social psychology literature f…
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Physical activity and obesity in children.
Globally, obesity is affecting an increasing proportion of children. Physical activity plays an important role in the prevention of becoming overweight and obese in childhood and adolescence, and reducing the risk of obesity in adulthood. Puberty and the following adolescent period are acknowledged as particularly vulnerable times for the development of obesity due to sexual maturation and, in many individuals, a concomitant reduction in physical activity. In many Western settings, a large proportion of children and adolescents do not meet recommended physical activity guidelines and, typically, those who are more physically active have lower levels of body fat than those who are less active. Active behaviours have been displaced by more sedentary pursuits which have contributed to reductions in physical activity energy expenditure. Without appropriate activity engagement there is an inc…
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A theoretical and empirical review of the death-thought accessibility concept in terror management research.
Terror management theory (TMT) highlights the motivational impact of thoughts of death in various aspects of everyday life. Since its inception in 1986, research on TMT has undergone a slight but significant shift from an almost exclusive focus on the manipulation of thoughts of death to a marked increase in studies that measure the accessibility of death-related cognition. Indeed, the number of death-thought accessibility (DTA) studies in the published literature has grown substantially in recent years. In light of this increasing reliance on the DTA concept, the present article is meant to provide a comprehensive theoretical and empirical review of the literature employing this concept. After discussing the roots of DTA, the authors outline the theoretical refinements to TMT that have accompanied significant research findings associated with the DTA concept. Four distinct categories (m…
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DSM-V and the stigma of mental illness.
Stigma associated with mental illness has been shown to have devastating effects on the lives of people with psychiatric disorders, their families, and those who care for them. In the current article, the relationship between diagnostic labels and stigma is examined in the context of the forthcoming DSM-V. Three types of negative outcomes are reviewed in detail - public stigma, self-stigma, and label avoidance. The article illustrates how a clinical diagnosis may exacerbate these forms of stigma through socio-cognitive processes of groupness, homogeneity, and stability. Initial draft revisions recently proposed by the DSM-V work groups are presented, and their possible future implications for stigma associated with mental illness are discussed.
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Garcia C (2010)reviewMEDLINE-indexed journal, not yet read by usJournal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing54 citations Conceptualization and measurement of coping during adolescence: a review of the literature.
Purpose: The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research.
Design: A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological.
Methods: A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample…
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Cognitive behavioral therapy for eating disorders.
Cognitive behavioral therapy (CBT) is the leading evidence-based treatment for bulimia nervosa. A new "enhanced" version of the treatment appears to be more potent and has the added advantage of being suitable for all eating disorders, including anorexia nervosa and eating disorder not otherwise specified. This article reviews the evidence supporting CBT in the treatment of eating disorders and provides an account of the "transdiagnostic" theory that underpins the enhanced form of the treatment. It ends with an outline of the treatment's main strategies and procedures.
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Stigma in mental health: clients and professionals.
Stigmatising attitudes are not uncommon among mental health professionals who may be less than optimistic about outcomes for people with long-term mental health problems. These perceptions are probably related to the professionals' experiences, such as those working in the public sector dealing with clients in the most disturbed phases of mental illness. We provide an overview of stigma and some contemporary stigma conceptualisations and then explore some stigma-reducing strategies for mental health professionals. The way that mental health professionals work with patients can have an important effect on their recovery.
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The insula and drug addiction: an interoceptive view of pleasure, urges, and decision-making.
We have recently shown that damage to the insula leads to a profound disruption of addiction to cigarette smoking (Naqvi et al., Science 315:531-534, 2007). Yet, there is little understanding of why the insula should play such an important role in an addictive behavior. A broad literature (much of it reviewed in this issue) has addressed the role of the insula in processes related to conscious interoception, emotional experience, and decision-making. Here, we review evidence for the role of the insula in drug addiction, and propose a novel theoretical framework for addiction in which the insula represents the interoceptive effects of drug taking, making this information available to conscious awareness, memory and executive functions. A central theme of this framework is that a primary goal for the addicted individual is to obtain the effects of the drug use ritual upon the body, and rep…
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Interoception in anxiety and depression.
We review the literature on interoception as it relates to depression and anxiety, with a focus on belief, and alliesthesia. The connection between increased but noisy afferent interoceptive input, self-referential and belief-based states, and top-down modulation of poorly predictive signals is integrated into a neuroanatomical and processing model for depression and anxiety. The advantage of this conceptualization is the ability to specifically examine the interface between basic interoception, self-referential belief-based states, and enhanced top-down modulation to attenuate poor predictability. We conclude that depression and anxiety are not simply interoceptive disorders but are altered interoceptive states as a consequence of noisily amplified self-referential interoceptive predictive belief states.
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Experiences of mental illness stigma, prejudice and discrimination: a review of measures.
Background: There has been a substantial increase in research on mental illness related stigma over the past 10 years, with many measures in use. This study aims to review current practice in the survey measurement of mental illness stigma, prejudice and discrimination experienced by people who have personal experience of mental illness. We will identify measures used, their characteristics and psychometric properties.
Method: A narrative literature review of survey measures of mental illness stigma was conducted. The databases Medline, PsychInfo and the British Nursing Index were searched for the period 1990-2009.
Results: 57 studies were included in the review. 14 survey measures of mental illness stigma were identified. Seven of the located measures addressed aspects of perceived stigma, 10 aspects of experienced stigma and 5 aspects of self-stigma. Of the identified studies, 79% used…
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An eating disorder-specific model of interpersonal psychotherapy (IPT-ED): causal pathways and treatment implications.
Several studies support the efficacy of interpersonal psychotherapy (IPT) in the treatment of eating disorders. Treatment outcomes are likely to be augmented through a greater understanding, and hence treatment targeting, of the mechanisms whereby IPT induces therapeutic gains. To this end, the present paper seeks to develop a theoretical model of IPT in the context of eating disorders (IPT-ED). After providing a brief description of IPT, the IPT-ED model is presented and research supporting its theorized mechanisms is summarized. This model proposes that negative social evaluation plays a pivotal role as both a cause (via its detrimental impact on self evaluation and associated affect) and consequence of eating disorder symptoms. In the final section, key eating disorder constructs (namely, the developmental period of adolescence, clinical perfectionism, cognitive dysfunction, and affec…
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The stigma of childhood mental disorders: a conceptual framework.
Objective: To describe the state of the literature on stigma associated with children's mental disorders and highlight gaps in empirical work.
Method: We reviewed child mental illness stigma articles in (English only) peer-reviewed journals available through Medline and PsychInfo. We augmented these with adult-oriented stigma articles that focus on theory and measurement. A total of 145 articles in PsychInfo and 77 articles in MEDLINE met search criteria. The review process involved identifying and appraising literature convergence on the definition of critical dimensions of stigma, antecedents, and outcomes reported in empirical studies.
Results: We found concurrence on three dimensions of stigma (negative stereotypes, devaluation, and discrimination), two contexts of stigma (self, general public), and two targets of stigma (self/individual, family). Theory and empirics on institutional…
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The body in the brain revisited.
Corporeal awareness is a difficult concept which refers to perception, knowledge and evaluation of one's own body as well as of other bodies. We discuss here some controversies regarding the significance of the concepts of body schema and body image, as variously entertained by different authors, for the understanding of corporeal awareness, and consider some newly proposed alternatives. We describe some recent discoveries of cortical areas specialized for the processing of bodily forms and bodily actions, as revealed by neuroimaging, neurophysiological, and lesion studies. We further describe new empirical and theoretical evidence for the importance of interoception, in addition to exteroception and proprioception, for corporeal awareness, and discuss how itch, a typical interoceptive input, has been wrongly excluded from the classic concept of the proprioceptive-tactile body schema. Fi…
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Personality development: continuity and change over the life course.
The development of personality across the human life course may be observed from three different standpoints: the person as actor (behaving), agent (striving), and author (narrating). Evident even in infancy, broad differences in social action patterns foreshadow the long-term developmental elaboration of early temperament into adult dispositional traits. Research on personal strivings and other motivational constructs provides a second perspective on personality, one that becomes psychologically salient in childhood with the consolidation of an agentic self and the articulation of more-or-less stable goals. Layered over traits and goals, internalized life stories begin to emerge in adolescence and young adulthood, as the person authors a narrative identity to make meaning out of life. The review traces the development of traits, goals, and life stories from infancy through late adulthoo…
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Developmental origins of cognitive vulnerabilities to depression: review of processes contributing to stability and change across time.
Cognitive theories of depression have been shown to be potent predictors of future increases in depressive symptoms and disorder in children, adolescents, and adults. This article focuses on potential developmental origins of the main cognitive vulnerabilities, including dysfunctional attitudes, negative cognitive style, and rumination. We selectively review processes and factors that have been hypothesized to contribute to the emergence and stabilization of these cognitive risk factors. This review focuses on genetic factors, temperament, parents and peers as salient interpersonal influences, and stressful life events. We end with suggestions for future theory development and research. In particular, we emphasize the need for additional conceptual and empirical work integrating these disparate processes together into a coherent, developmental psychopathological model, and we highlight t…
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A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder.
The precise nature and etiopathogenesis of borderline personality disorder (BPD) continues to elude researchers and clinicians. Yet, increasing evidence from various strands of research converges to suggest that affect dysregulation, impulsivity, and unstable relationships constitute the core features of BPD. Over the last two decades, the mentalization-based approach to BPD has attempted to provide a theoretically consistent way of conceptualizing the interrelationship between these core features of BPD, with the aim of providing clinicians with a conceptually sound and empirically supported approach to BPD and its treatment. This paper presents an extended version of this approach to BPD based on recently accumulated data. In particular, we suggest that the core features of BPD reflect impairments in different facets of mentalization, each related to impairments in relatively distinct …
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Predictors and parameters of resilience to loss: toward an individual differences model.
Although there is marked variation in how people cope with interpersonal loss, there is growing recognition that most people manage this extremely stressful experience with minimal to no impact on their daily functioning (G. A. Bonanno, 2004). What gives rise to this resilient capacity? In this paper, we provide an operational definition of resilience as a specific trajectory of psychological outcome and describe how the resilient trajectory differs from other trajectories of response to loss. We review recent data on individual differences in resilience to loss, including self-enhancing biases, repressive coping, a priori beliefs, identity continuity and complexity, dismissive attachment, positive emotions, and comfort from positive memories. We integrate these individual differences in a hypothesized model of resilience, focusing on their role in appraisal processes and the use of soci…
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