ACT for Stigma Against Mental Health Patients
April 24, 2006 - 4:14am — Steven Hayes
Aki Masuda tested ACT versus education for reducing stigma against mental health patients in an RCT. The interventions were both very short (2.5 hours) and the sample was one of convenience (Intro Psych students). Both conditions reduced stigmatizing attitudes signficantly and gains were maintained at a 2 month follow up but there was no difference between them.
The study was Aki's dissertation at UNR. You should be able to get it at Dissertation Abstracts International late in 2006.
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Comments
a few thoughts
This sounds like a really interesting result. A few thoughts spring to mind with this and I think there is likely to be merit in digging around a bit more in this area of stigmatising attitudes and ACT.
I'm wondering what the methods of measurement were. Explicit 'pen-paper' questionnaires are, unfortunately from a research perspective notoriously easy to fake. The expected answer is in the questions. This could be one for an IRAP study, looking at implicit and explicit measures. Dermot Barnes-Holmes has already looked at this with one of his students regarding attitudes towards autism, and I am looking at attitudes towards sex offenders in forensic and non forensic staff. It might be found that explicitly attitudes are better, but participants may still find it easier to respond to mental health patients negatively on the IRAP (implicit test). This is more or less what was found in the autism study and what I seem to be finding with the sex offender study.
From an IRAP perspective if both groups were able to respond faster and easier to stimulus that broadly equated to mental health patient = 'bad stuff', then this is where the differences between the education and ACT group may begin to emerge. For the education group, in their 'heads' they may 'know' certain things about the client group in question, but some how they are still find it hard to respond to that group in a positive manner. If they were staff working with that group then this may lead them into a whole host of unhelpful fusion activity. The ACT group on the other hand, may be better equipped to have and deal with (or not deal with!) such negative thoughts or judgements.
I can’t think of any reasons why the ACT group might respond differently on the IRAP (maybe Dermot can), but this may not be where the effect might lie. The difference between the two groups may lie in the responses to the responses so to speak. The ACT group may be better able to have transient negative thoughts about the client group without getting fused with them.
Another thing that strikes me about the results is that even though the ACT group did not outperform the education group at follow-up, this is not necessarily a failure for ACT. I don't know too much about the education intervention group, but is sounds like it was akin to cognitive restructuring, in terms of "you might think X about mental health, but it is really Y". What these results seem to show is that, this may not be necessary and that good results can be achieved without "restructuring" someone’s attitudes or beliefs.
So if both interventions produced similar significant results, what benefits might there be for ACT in this area. I'm thinking that some of the benefits may lie in the participant’s experience of the intervention itself. One group may be sent the message "it’s wrong to think the way you do, think this instead". I imagine that such a verbal statement or rule, could act as a Crel or Sd for some pretty heavy fusion behaviour ("I'm stupid, I’m broken, I'm bad, What sort of person am I to have thought..X?). So I’m thinking that the education group may have had a different experience of the process than the ACT group did. The ACT group may have felt more supported, valued and understood. There may also be some generalised effect of the ACT condition regarding wider defusion and acceptance beyond the issue of mental health patients.
This sounds like a really good study that has potentially has some really useful data hiding in there and some really good signposts for future research. I hope it gets published.