THE EFFECT OF ASSERTIVENESS SKILLS TRAINING ON SELF-ESTEEM AND INTERNALIZED STIGMATIZATION OF CHRONIC PSYCHIATRIC PATIENTS

Year 2021, Volume: 24 Issue: 2, 167 - 174, 25.06.2021

Burcu Ceylan , Nesibe Günay Molu , Fatma Yener Özcan , Ayşe Özcan Akif Usta

https://doi.org/10.17049/ataunihem.630219

Cited By: 1

Abstract

Aim: This study was planned to evaluate the effect of assertiveness skill training on chronic psychiatric patients on self-esteem and internalized stigmatization levels of patients.

Methods: This study is intervention study consisting of a single group of repeated measures. The research will be conducted in the Community Mental Health Center (CMHC) of a hospital affiliated to the Ministry of Health in Konya. All patients will be included in the study except for those patients with acute symptoms and mental retardation who are consulted from the CMHC team. The data was collected through face-to-face interviews. The data will be collected using the Information form, the Rosenberg Self-Esteem Scale, and the Internalized Stigmatization Scale for Mental Illness. The analysis of the data was obtained by using descriptive statistics (frequencies, percentages, means, standard deviations) and analysis of variance in repeated measurements. A probability value of p<0.05 was considered statistically significant.

Results: Although assertiveness skills training applied to chronic psychiatric patients decreased the mean self-esteem of the patients, it was found to be not significant (p=0.542). Education on internalized stigmatization is found to be effective (p=0.002).

Conclusion: Assertiveness skills training is thought to be effective methods to increase the low self-esteem of patients and to combat internalized stigmatization.

Keywords

Assertiveness skills training, self-esteem, internalized stigmatization, chronic psychiatric patient

KRONİK PSİKİYATRİ HASTALARINA UYGULANAN ATILGANLIK BECERİLERİ EĞİTİMİNİN HASTALARIN BENLİK SAYGISI VE İÇSELLEŞTİRİLMİŞ DAMGALAMA DÜZEYLERİNE ETKİSİ

Abstract

Amaç: Bu araştırma, kronik psikiyatri hastalarına uygulanan atılganlık beceri eğitiminin hastaların benlik saygısı ve içselleştirilmiş damgalama düzeylerine etkisini değerlendirmek amacıyla yapılmıştır.

Yöntem: Bu çalışma tek gruplu tekrarlanan ölçümlerden oluşan yarı deneysel bir çalışma olarak planlanmıştır. Araştırma, Konya ilinde Sağlık Bakanlığına bağlı bir hastanenin Toplum Ruh Sağlığı Merkezi (TRSM)’nde yapılmıştır. TRSM ekibinden görüş alınıp, akut belirtileri ve zeka geriliği bulunan hastalar hariç tüm hastalar çalışmaya dahil edilmiştir. Verilerin toplanmasında Bilgi formu, Rosenberg Benlik Saygısı Ölçeği ve Ruhsal Hastalıklarda İçselleştirilmiş Damgalama Ölçeği kullanılmıştır. Veriler yüz yüze görüşme yöntemi kullanılarak toplanmıştır. Veriler sayı, yüzde, ortalama, standart sapma ve tekrarlayan ölçümlerde varyans analizi kullanılmıştır. İstatistik olarak p<0.05 değerler anlamlı kabul edilmiştir.

Bulgular: Kronik psikiyatri hastalarına uygulanan atılganlık beceri eğitiminin hastaların benlik saygısı ortalamalarını düşürmesine rağmen sonucun anlamlı olmadığı bulunmuştur (p=0.542). İçselleştirilmiş damgalama üzerine ise eğitimin etkili olduğu bulunmuştur (p=0.002).

Sonuç: Atılganlık beceri eğitiminin hastaların düşük benlik saygısını artırmak ve içselleştirilmiş damgalama ile mücadele etmede etkili yöntemler olduğu düşünülmektedir.

Keywords

atılganlık beceri eğitimi, benlik saygısı, içselleştirilmiş damgalama, kronik psikiyatri hastası

References

• 1. Öztürk MO, Uluşahin NA. Şizofreni. Ruh Sağlığı ve Bozuklukları. 15. Baskı. Ankara: Sözkesen Matbaacılık;2018. p.189-248.
• 2. Goldman HH, Gattozzi AA, Taube CA. Defining and Counting the Chronically Mentally III.Hospital and Community Psychiatry 1981;132(1):21-7.
• 3. Taşkın EO. Ruhsal Hastalıklarda Damgalama ve Ayrımcılık. Stigma Ruhsal Hastalıklara Yönelik Tutumlar ve Damgalama. 1. Baskı. İzmir: Meta Basım ve Matbaacılık; 2007. p. 17-30.
• 4. Szeto AC, Luong D, Dobson KS. Does Labeling Matter? An Examination of Attitudes and Perceptions of Labels For Mental Disorders. Social Psychiatry and Psychiatric Epidemiology 2013; 48:659-71.
• 5. Thornicroft G. Toplumun Reddettiği Ruhsal Hastalığı Olan İnsanlara Karşı Ayrımcılık. Soygür H, Editör. 1. Baskı. Ankara: Şizofreni Dernekleri Federasyonu. 2014.
• 6. Avcil C, Bulut H, Hızlı-Sayar G. Psikiyatrik Hastalıklar ve Damgalama. Üsküdar Üniversitesi Sosyal Bilimler Dergisi 2016;2(2):175-202.
• 7. Batastini AB, Lester ME, Thompson RA. Mental İllness İn The Eyes of The Law: Examining Perceptions of Stigma Among Judge Sandattorneys. Psychology, Crime & Law 2018; 24(7):673-86.
• 8. Oban G, Küçük L. Lise Öğrencilerinde Şizofreniye Yönelik Bilgilendirme Eğitiminin Sosyal Mesafe Tutuma Etkisi. Hemşirelikte Eğitim ve Araştırma Dergisi 2012; 9(2):35-41.
• 9. Aina OF, Oshodi OY, Erinfolami AR, Adeyemi JD, Suleiman TF. Non-Mental Health Workers’ Attitudes and Social Distance Towards People With Mental İllness in A Nigerian Teaching Hospital. South Sudan Medical Journal 2015; 8(3):57-9.
• 10. Afe TO, Ogunsemi O. Social Distancing Attitudes Toward the Mentally Ill And Victims of Sexual Violence Among College Students İn Southwest Nigeria. Indian Journal of Social Psychiatry 2016;32:320-4.
• 11. Adeosun II, Fatiregun O, Adeyemo S. Social Distance Towards People With HIV-AIDS Versus Mental Illness in A Sample of Adolescent Secondary Students in Lagos Nigeria. Journal of Education, Society and Behavioural Science 2017; 22(3): 1-7.
• 12. Martensen LK, Hahn E, Cao TC, Schomerus G, Nguyen MH, Böge K, et al. Mpact of Perceived Course Of İllness On The Desire For Social Distance Towards People With Symptoms of Schizophrenia in Hanoi, Vietnam. Psychiatry Research 2018;268:206-10.
• 13. Kleim B, Vauth R, Adam G, Stieglitz R, Hayward P, Corrigan P. Perceived Stigma Predicts Low Self-Efficacy and Poor Coping İn Schizophrenia. Journal of Mental Health 2008;17(5):482-91.
• 14. Lundberg B, Hansson L, Wentz E, Björkman T. Stigma, Discrimination, Empowerment and Social Networks: A Preliminary Investigation of Their İnfluence on Subjective Quality of Life İn A Swedish Sample. International Journal of Social Psychiatry 2008; 5:47-55.
• 15. Marcussen K, Ritter C, Munetz MR. The Effect of Services and Stigma on Quality of Life For Persons With Serious Mental İllnesses. Psychiatric Services 2010;61:489-94.
• 16. Egbe OC, Brooke-Sumner C, Kathree T, Selohilwe O, Thornicroft G, Petersen. Psychiatric Stigma and Discrimination in South Africa: Perspectives From Key Stakeholders. BMC Psychiatry 2014;14(191):1-14.
• 17. Fung KM, Tsang HW, Corrigan PW. Self Stigma of People with Schizophrenia Aspredictor of Their Adherence to Psychosocial Treatment. Psychiatric Rehabilitation Journal 2008;32(2):95–104.
• 18. Tsang HWH, Fung KMT, Chung RCK. Self-Stigma and Stages of Change as Predictors of Treatment Adherence of Individuals with Schizophrenia. Psychiatry Research 2010; 180(1): 10-5.
• 19. Yanos PT, Roe D, West ML, Smith SM, Lysaker PH. Group-Based Treatment for Internalized Stigma Among Persons with Severe Mental İllness: Findings From A Randomized Controlled Trial. Psychological Services 2012a; 9(3):248-58.
• 20. Yanos PT, West M, Gonzales L, Smith S, Roe D, Lysaker P. Change in Internalized Stigma and Social Functioning Among Persons Diagnosed With Severe Mental İllness. Psychiatry Research 2012b; 200 (2-3):1032-4.
• 21. Baysal GÖD. Damgalanma ve Ruh Sağlığı. Arşiv Kaynak Tarama Dergisi 2013; 22(2):239-51.
• 22. Boyd-Ritsher J, Phelan JC. Internalized Stigma Predicts Erosion of Morale Among Psychiatric Outpatients. Psychiatry Research 2004;129:257-65.
• 23. West ML, Yanos PT, Smith SM, Roe D, Lysaker PH. Prevalence of Internalized Stigma Among Persons with Severe Mental Illness. Stigma Research and Action 2011; 1:3-10.
• 24. Brohan E, Elgie R, Sartorius N, Thornicroft G. GAMIAN-Europe Study Group. Self-Stigma, Empowerment and Perceived Discrimination Among People with Schizophrenia in 14 European Countries. Schizophrenia Research 2010;122: 232-8.
• 25. Üstündağ MF, Kesebir S. İki Uçlu Bozuklukta İçselleştirilmiş Damgalanma: Klinik Özellikler, Yaşam Kalitesi ve Tedaviye Uyum ile İlişkisi. Türk Psikiyatri Dergisi 2013; 24(4): 231-39.
• 26. Beyazyüz M, Beyazyüz E, Albayrak Y, Baykal S, Göka E. Bir Eğitim Araştırma Hastanesi Psikiyatri Polikliniğine Başvuran Hastalarda İçselleştirilmiş Damgalanma Düzeylerinin Bazı Tanı Grupları, Sosyodemografik Özellikler ve Benlik Saygısı ile İlişkisi. Yeni Symposium 2015;53(2):2-13.
• 27. Tel H, Ertekin-Pınar Ş. Ayaktan İzlenen Psikiyatri Hastalarında İçselleştirilmiş Damgalanma ve Benlik Saygısı. Journal of Psychiatric Nursing 2012;3:61-6.
• 28. Kök H, Demir S. Şizofreni Ve Bipolar Bozukluğu Olan Hastalarda İçselleştirilmiş Damgalama, Benlik Saygısı ve Algılanan Sosyal Destek. Cukurova Medical Journal 2018; 43(1):114-22.
• 29. Bukhari SR, Imtiaz A, Akbar N, Malik UA, Gilani A. Internalized Stigma, Quality of Life And Self Esteem in Chronic Schizophrenic Patients. Pakistan Journal of Medical Research 2019;58(1): 13-6.
• 30. Morgades-Bamba CI, Fuster-Ruizdeapodaca MJ, Molero F. The İmpact of İnternalized Stigma on The Well-Being of People with Schizophrenia. Psychiatry Research 2019; 271:621-7.
• 31. Boyd JE, Adler EP, Otilingam PG, Peters T. Internalized Stigma of Mental Illness (ISMI) Scale: A Multinational Review. Comprehensive Psychiatry 2014;55(1):221-31.
• 32. Razali SM, Hussein S, Ismail TAT. Perceived Stigma and Self-Esteem Among Patients with Schizophrenia. International Medical Journal 2010;17:255-60.
• 33. Dinçer U, Öztunç D. Hemşirelik ve Ebelik Öğrencilerinin Benlik Saygısı ve Atılganlık Düzeyleri. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi 2009; 16(2): 22-33.
• 34. Üstüner Top F, Kaya B. Sağlık Bilimleri Fakültesi Öğrencilerinin Benlik Saygıları ve Atılganlık Düzeylerinin Sosyodemografik Özellikleri Açısından İncelenmesi. New Symposium, A Journal of Psychiatry, Neurology and Behavioral Sciences 2009; 47(4): 194-202.
• 35. Mohamed SM, Abdelaziz EM. Effect of Assertive Training Program on Social İnteraction Anxiety and Self-Esteem of Institutionalized Patients with Chronic Schizophrenia. IOSR Journal of Nursing And Health Science 2016;5(5):36-44.
• 36. Ritsher JB, Otilingam PG, Grajales M. (2003). Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research, 121, 31-49.
• 37. Ersoy MA, Varan A. Reliability and Validity of The Turkish Version of the İnternalized Stigma of Mental İllness Scale. Türk Psikiyatri Dergisi 2007;18(2):163-71.
• 38. Rosenberg M. Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Pres; 1965.
• 39. Çuhadaroğlu F. Adölesanlarda Benlik Saygısı, Hacettepe Üniversitesi Tıp Fakültesi Çocuk Ve Ergen Ruh Sağlığı Ve Hastalıkları Anabilim Dalı, Yayımlanmamış Uzmanlık Tezi, Ankara: Hacettepe Üniversitesi.1986.
• 40. Bellak AS, Mueser KT, Gingerich S, Agresta J. Şizofreni İçin Sosyal Beceri Eğitimi. Akı E (Çev. Ed.). 2. Baskı. Hiper Tıp Yayınevi; 2015.
• 41. Yıldız M. Şizofreni Hastaları için Ruhsal Toplumsal Beceri Eğitimi. Ankara: Türkiye Sosyal Psikiyatri Derneği Yayınları; 2011.
• 42. Thalheimer W, Cook S. How To Calculate Effect Sizes From Published Research Articles: A Simplified Methodology. 2002. http://Education.Gsu.Edu/Coshima/EPRS8530/Effect_Sizes_Pdf4.Pdf Erişim Tarihi Şubat 03, 2019.
• 43. AO, Owoeye AO, Erinfolami AO, Ola BA. Correlates of Self stigma Among Outpatients with Mental Illness in Lagos, Nigeria. International Journal of Social Psychiatry 2011;57:418-27.
• 44. Barke A, Nyarko S, Klecha D. The Stigma of mental İllness İn Southern Ghana: Attitudes of The Urban Population and Patients' views. Social Psychiatry and Psychiatric Epidemiology 2011;46(11): 1191-202.
• 45. Assefa D, Shibre T, Asher L, Fekadu A. Internalized Stigma Among Patients with Schizophrenia in Ethiopia: Across-Sectional Facility-Based Study. Biomedcentral Psychiatry 2012: 12; 239-45.
• 46. Yıldız M, Özten E, Işık S, Özyıldırım İ, Karayün D, Cerit C, et al. Şizofreni Hastaları, Hasta Yakınları Ve Majör Depresif Bozukluk Hastalarında Kendini Damgalama. Anadolu Psikiyatri Dergisi 2012; 13(1): 1-7.
• 47. Lv Y, Wolf A, Wang X. Experienced Stigma and Self Stigma İn Chinese Patients with Schizophrenia. General Hospital Psychiatry 2012; 35: 83-8.
• 48. Mosanya TJ, Adelufosi AO, Adebowale OT, Ogunwale A, Adebayo OK. Self Stigma, Quality of Life and Schizophrenia: An Outpatient Clinic Survey İn Nigeria. International Journal of Social Psychiatry 2014;60(4):377-86.
• 49. Caqueo Urízar A, Boyer L, Urzúa A, Williams DR. Self-Stigma İn Patients with Schizophrenia: A Multicentric Study from Three Latin-America Countries. Social Psychiatry and Psychiatric Epidemiology 2019;54(8):905-9.
• 50. Macinnes DL, Lewis M. The Evaluation of A Short Group Programme to Reduce Self-Stigma İn People With Serious And Enduring Mental Health Problems. Journal of Psychiatric and Mental Health Nursing 2008;15:59-65.
• 51. Uchino T, Maeda M, Uchimura N. Psychoeducation May Reduce Self-Stigma of People with Schizophrenia and Schizoaffective Disorder. Kurume Medical Journal 2012; 59:25-31.
• 52. Kim NR, Jang MH. Effects Of Self-Assertive Training Applying Reality Therapy Techniques on Self-Esteem and Internalized Stigma İn Schizophrenia Patients. The Journal of Korean Academy of Psychiatric and Mental Health Nursing 2019; 28(1):37-49.
• 53. Rizwan M, Ahmad R. Self-Esteem Deficits Among Psychiatric Patients. SAGE Open April-June 2015: 1-6.
• 54. Fung KMT, Tsang HWH, Cheung W. Randomized Controlled Trial of The Self-Stigma Reduction Program Among İndividuals With Schizophrenia. Psychiatry Research 2011;189:208-14.
• 55. Tsang HWH, Ching SC, Tang KH, Lam HT, Law PYY, Wan CN. Therapeutic İntervention For İnternalized Stigma of Severe mental Illness: A Systematic Review and Meta-Analysis. Schizophrenia Research 2016; 173: 45–53.
• 56. Speed BC, Goldstein BL, Goldfried MR. Assertiveness Training: A Forgotten Evidence-Based Treatment. Clinical Psychology: Science and Practice 2018;25:1-20.