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Ameliorating Patient Stigma Amongst Staff Working With Personality Disorder: Randomized Controlled Trial of Self-Management Versus Skills Training

Published online by Cambridge University Press:  11 November 2014

Sue Clarke ,
Georgina Taylor ,
Helen Bolderston ,
Joanna Lancaster  and
Bob Remington
Sue Clarke*
Affiliation:
Bournemouth University, UK
Georgina Taylor
Affiliation:
University of Southampton, UK
Helen Bolderston
Affiliation:
University of Southampton, UK
Joanna Lancaster
Affiliation:
St Ann's Hospital, Poole, UK
Bob Remington
Affiliation:
University of Southampton, UK
*
Reprint requests to Sue Clarke, University Department of Mental Health, St Ann's Hospital, 69 Haven Road, Poole BH13 7LN, UK. E-mail: susan.clarke@dhuft.nhs.uk
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Abstract

Background: Patients diagnosed with a personality disorder (PD) are often stigmatized by the healthcare staff who treat them. Aims: This study aimed to compare the impact on front-line staff of a self-management Acceptance and Commitment Therapy-based training intervention (ACTr) with a knowledge- and skills-based Dialectical Behaviour Training intervention (DBTr). Method: A service-based randomized controlled trial was conducted comparing the effects of 2-day ACTr (N = 53) and DBTr (N = 47) staff workshops over 6 months. Primary outcome measures were staff attitudes towards patients and staff-patient relationships. Results: For both interventions, staff attitudes, therapeutic relationship, and social distancing all improved pre- to postintervention, and these changes were maintained at 6-month follow-up. Conclusions: Although offering different resources to staff, both ACTr and DBTr were associated with an improved disposition towards PD patients. Future research could evaluate a combined approach, both for staff working with PD patients and those working with other stigmatized groups.

Keywords

Personality disorderstigmaAcceptance and Commitment Therapy (ACT)Dialectical Behaviour Therapy (DBT)trainingacceptance
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 43 , Issue 6 , November 2015 , pp. 692 - 704
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

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References

Aviram, R. B., Brodsky, B. S. and Stanley, B. (2006). Borderline personality disorder, stigma, and treatment implications. Harvard Review of Psychiatry, 14, 249–256. doi:10.1080/10673220600975121Google Scholar
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: a revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688. doi:10.1016/j.beth.2011.03.007Google Scholar
Bowers, L. and Allan, T. (2006). The Attitude to Personality Disorder Questionnaire: psychometric properties and results. Journal of Personality Disorders, 20, 281–293. doi:10.1521/pedi.2006.20.3.281Google Scholar
Cook, J. A., Jonikas, M. J. A. and Razzano, L. (1995). A randomized evaluation of consumer versus nonconsumer training of state mental health service providers. Community Mental Health Journal, 31, 229–238.Google Scholar
Corker, E., Hamilton, S., Henderson, C., Weeks, C., Pinfold, V., Rose, D., et al. (2013). Experiences of discrimination among people using mental health services in England 2008–2011. The British Journal of Psychiatry, 202 (s55), s58–s63. doi:10.1192/bjp.bp.112.112912Google Scholar
Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59, 614. doi:10.1037/0003–066X.59.7.614Google Scholar
Corrigan, P. W. and Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9, 35–53. doi:10.1093/clipsy.9.1.35Google Scholar
Devilly, G. J. and Borkovec, T. D. (2000). Psychometric properties of the credibility/expectancy questionnaire.Journal of Behavior Therapy and Experimental Psychiatry, 31, 73–86. doi:10.1016/S0005-7916(00)00012-4Google Scholar
Flaxman, P. E. and Bond, F. W. (2006). Acceptance and Commitment Therapy in the workplace. In Baer, R. A. (Ed.), Mindfulness-Based Treatment Approaches (pp. 377–399). London: Elsevier.Google Scholar
Foertsch, C., Manning, S. Y. and Dimeff, L. (2003). Difficult-to-treat patients: the approach from Dialectical Behavior Therapy. In Leahy, R. L. (Ed.), Roadblocks in Cognitive-Behavioral Therapy: transforming challenges into opportunities for change (pp.255–273). New York: Guilford Press.Google Scholar
Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive Summary. The Mid Staffordshire NHS Foundation Trust Public Inquiry. Retrieved from http://www.midstaffspublicinquiry.com/sitesdefault/files/report/Executive%20summary.pdfGoogle Scholar
Friedrich, B., Evans-Lacko, S., London, J., Rhydderch, D., Henderson, C. and Thornicroft, G. (2013). Anti-stigma training for medical students: the Education Not Discrimination project. The British Journal of Psychiatry, 202 (s55), s89–s94. doi:10.1192/bjp.bp.112.114017Google Scholar
Goldberg, D. P. and Hillier, V. F. (1979). A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139–145. doi: 10.1017/S0033291700021644Google Scholar
Hayes, S.C., Bissett, R., Roget, N., Padilla, M., Kohlenberg, B.S., Fisher, G., et al. (2004). The impact of Acceptance and Commitment Training and Multicultural Training on the stigmatizing attitudes and professional burnout of substance abuse counselors. Behaviour Therapy, 35, 821–835.Google Scholar
Hayes, S.C., Strosahl, K. and Wilson, K.G. (1999 ). Acceptance and Commitment Therapy: an experiential approach to behavior change. New York: Guilford Press.Google Scholar
Hazelton, M., Rossiter, R. and Milner, J. (2006). Managing the “unmanageable”: training staff in the use of dialectical behaviour therapy for borderline personality disorder. Contemporary Nurse, 21, 120–130.Google Scholar
Hinshelwood, R. D. (1999). The difficult patient. British Journal of Psychiatry, 174, 187–190. Retrieved from http://rdhinshelwood.net/PDFPapers/DiffPt.docGoogle Scholar
Joffe, H. and Yardley, L. (2004). Content and thematic analysis. In Mark, D. and Yardley, L. (Eds.), Research Methods for Clinical and Health Psychology (pp. 56–68). London: Sage Publications.Google Scholar
Koekkoek, B., van Meijel, B. and Hutschemaekers, G. (2006). Difficult patients in mental health care: a review. Psychiatric Services, 57, 795–802. doi: 10.1176/appi.ps.57.6.795Google Scholar
Lakasing, E. (2007). How to define and manage difficult patients. Practice Nursing, 18, 15–20.Google Scholar
Laskowski, C. (2001). The mental health clinical nurse specialist and the “difficult” patient: evolving meaning. Issues in Mental Health Nursing, 22, 5–22.Google Scholar
Lillis, J. and Hayes, S. C. (2007). Applying acceptance, mindfulness, and values to the reduction of prejudice: a pilot study. Behavior Modification, 31, 389–411. doi: 10.1177/0145445506298413Google Scholar
Linehan, M. M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.Google Scholar
Link, B. G., Cullen, F. T., Frank, J. and Wozniak, J. F. (1987). The social rejection of former mental patients: understanding why labels matter. American Journal of Sociology, 92, 1461–1500.Google Scholar
Luborsky, L., Barber, J., Siqueland, L. J. S., Najavits, L., Frank, A. and Daley, D. (1996). The Revised Helping Alliance Questionnaire–II (HAq–II): psychometric properties. Journal of Psychotherapy Research and Practice, 6, 260–271.Google Scholar
Maslach, C., Jackson, S. E. and Leiter, M.P. (1996). Maslach Burnout Inventory Manual (3rd ed.). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., et al. (2007). Impact of acceptance and commitment therapy versus education on stigma toward people with psychological disorders. Behaviour Research and Therapy, 45, 2764–2772. doi:10.1016/j.brat.2007.05.008Google Scholar
Miller, S. A. and Davenport, N. C. (1996). Increasing staff knowledge of and improving attitudes toward patients. Psychiatric Services, 47, 533–535.Google Scholar
National Institute for Mental Health in England (2003). Personality Disorder: no longer a diagnosis of exclusion - policy implementation guidance for the development of services for people with personality disorder. London: Department of Health. Retrieved from http://www.personalitydisorder.org.uk/assets/resources/56.pdfGoogle Scholar
Newton-Howes, G., Weaver, T. and Tyrer, P. (2008). Attitudes of staff towards patients with personality disorder in community mental health teams. Australasian Psychiatry, 42, 572–577. doi:10.1080/00048670802119739Google Scholar
Perseius, K. I., Öjehagen, A., Ekdahl, S., Åsberg, M. and Samuelsson, M. (2003). Treatment of suicidal and deliberate self-harming patients with borderline personality disorder using dialectical behavioral therapy: the patients’ and the therapists’ perceptions. Archives of Psychiatric Nursing, 17, 218–227.Google Scholar
Scally, G., Chalmers, J., Fallon-Williams, R. and Sly, P. (2012). Report of the NHS Review of Commissioning of Care and Treatment at Winterbourne View. NHS South of England. Retrieved from http://www.southofengland.nhs.uk/wp-content/uploads/2012/03/Final-Report-for-publication-Report-of-the-NHS-Review-of-Commissioning-of-Care-and-Treatment-at-Winterbourne-View-30-July-2012.pdfGoogle Scholar
Sterling, M. (2011). General Health Questionnaire–28 (GHQ-28). Journal of Physiotherapy, 57, 259. Retrieved from http://svc019.wic048p.server-web.com/ajp/vol_57/4/Clin.pdfGoogle Scholar
Taylor, G. (2011). Understanding and Ameliorating Stigma towards Clients with a Personality Disorder: an acceptance and commitment therapy-based approach. Doctoral dissertation, University of Southampton.Google Scholar
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