Reducing stigma and increasing competence working with mental illness: Adaptation of a contact-based program for osteopathic medical students to a virtual, active learning format.

PURPOSE: Contact-based education, offering meaningful contact with individuals living in recovery with mental illness, reduces stigma. This study evaluated the effectiveness of the National Alliance on Mental Illness Provider Education Program (NAMI PEP) when implemented as a curricular requirement across two cohorts of third-year osteopathic medical students, comparing traditional, passive learning and active, online delivery formats. MATERIALS AND METHODS: Participants were two cohorts of third-year medical students (Cohort 1 n = 186; Cohort 2 n = 139; overall N = 325) who completed questionnaires measuring affect, beliefs, and behaviors toward patients with mental illness at pre-program, 1-week follow-up, and 6-month follow-up. For Cohort 1, the existing community-based NAMI PEP was implemented. For Cohort 2, the program was adapted to an online, active learning format tailored to medical students, and an additional 3-month follow-up assessment was added to better identify intermediate-term effects. RESULTS: The NAMI PEP was associated with longitudinal improvements in target outcomes, with enhanced effects with the adapted curriculum in Cohort 2. At 6-month follow-up, students reported less stigma, fewer stereotyping negative attitudes, and lower anxiety treating patients with mental illness. They also reported increased confidence integrating psychiatry into routine care and increased competence in principles of collaborative mental health treatment. CONCLUSIONS: This study demonstrates the longitudinal effectiveness of the NAMI PEP across two cohorts of medical students, with strengthened effects observed when the program is tailored to contemporary medical education.

Medical student coping and performance in simulated disasters.

OBJECTIVES: Coping with the stress of real and simulated disasters is thought to be integral to the performance of emergency medicine providers. Yet, little is known about which coping strategies are employed in these scenarios and whether differential use of strategies predicts actual clinical and interpersonal performance. METHODS: Thirty-four medical students were evaluated by trained simulated patients and physician observers across 111 clinical encounters during a simulated disaster. Linear Mixed Effects Modelling was used to test study hypotheses while accounting for demographic variables, psychological factors, and the dependency of multiple encounters for each participant. RESULTS: Results indicated that multilevel modeling was necessary. Positive thinking positively predicted observed clinical performance whereas avoidant coping was a negative predictor. Anticipatory anxiety and positive affect, but not reported coping, positively predicted student interpersonal performance. CONCLUSIONS: The present study indicates that the way medical students report managing the stress of disaster scenarios has clear links to their observed clinical performance above and beyond demographic and psychological factors. It further demonstrates the feasibility of empirically identifying specific coping strategies that may be important targets for disaster response training.

Effect of Contact-Based Education on Medical Student Barriers to Treating Severe Mental Illness: a Non-randomized, Controlled Trial.

OBJECTIVE: Emerging evidence suggests that contact-based education-learning via structured social interactions designed around intergroup contact theory-could be an important educational adjunct in improving attitudes, beliefs, and behaviors of medical students toward patients with severe mental illness (SMI). However, existing literature in the area lacks structured curriculum, control group designs, or longitudinal analyses. The authors conducted a longitudinal, non-randomized, controlled trial of the National Alliance on Mental Illness (NAMI) Provider Education Program-a 15-h contact-based adjunctive curriculum-on the attitudes, beliefs, and behavior of third-year medical students (MS3) at a single institution. METHODS: Two-hundred and thirty-one students were invited to participate. Forty-one students elected to complete the curriculum and eighty served as the control group (response rate = 52%). Participants in both conditions completed questionnaires assessing aspects of caring for patients with SMI at pre-test, 1-week post-curriculum, and at 3-month follow-up. RESULTS: Results indicated that participants in the curriculum reported improved attitudes, beliefs, and behavior in working with SMI as compared with their cohort-matched peers. The majority of these outcomes were maintained at 3-months post-intervention, with effect sizes in the medium to large range. The largest improvement was in behavioral responses to a vignette describing an acute psychiatric emergency. CONCLUSIONS: The present study provides evidence that a contact-based curriculum leads to improvements in the attitudes, beliefs, and behaviors of MS3 students when offered as an adjunctive program following their first year of clinical rotations.

Modeling cohesion change in group counseling: The role of client characteristics, group variables, and leader behaviors.

Despite continued empirical support for a relationship between group cohesion and therapeutic gain, few studies have attempted to examine predictors of cohesion during the life of counseling groups. The present investigation explored the impact of client variables, group characteristics, and first-session leader behaviors on changes in cohesion across time. Participants were 128 volunteer clients and 14 group therapists participating in 23 separate 8-week-long counseling groups. Results of latent growth curve (LGC) analysis indicated that a piecewise, linear-quadratic model best fit the data at the individual level, while a simplified linear model best fit the data at the group level. Overall, individual differences accounted for 80-97% of the total variance in cohesion intercept and slope terms, with the included covariates explaining 9-39% of this variation. Significant individual-level covariates were gender and anxious and avoidant attachment. The only significant group-level predictor was an interaction effect between leadership behaviors in the first session. Specifically, when leaders performed a high number of structuring behaviors in the absence of facilitating emotional sharing, cohesion was lower at the end of the first session. Limitations, areas of future research, and implications for the theory and practice of brief group counseling are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How Medical Students' Compassionate Values Influence Help-Seeking Barriers.

THEORY: Despite high rates of psychiatric illnesses, medical students and medical professionals often avoid psychological help. Stigma may prevent medical students from seeking psychological help when experiencing distress, which may hinder their job performance and mental health. Compassionate values-preferred principles that guide attitudes and behaviors to focus on the wellness of others-may be a relevant predictor of medical students' perceptions of psychological help. The present study examined the association between medical students' compassionate values, help-seeking stigma, and help-seeking attitudes in a convenience sample of medical students. HYPOTHESES: Rating compassionate values as more important than self-interested values will be associated with less stigma, which in turn will be associated with more positive help-seeking attitudes. METHOD: There were 220 medical students in their 2nd year of medical training who were recruited in-class and through e-mail between January and March of 2017 at Des Moines University. Students were provided an anonymous online link to a survey composed of validated measures assessing values, psychological distress, and stigma and attitudes related to psychological help. RESULTS: The survey response rate was 41%, leaving a final sample of 91. For every 1 SD increase in the relative importance of compassionate values over self-interested values, help-seeking stigma decreased 0.40 SDs, and help-seeking attitudes increased 0.23 SDs. CONCLUSIONS: Prioritizing compassionate values more strongly than self-interested values is associated with medical students' perceiving psychological help-seeking more positively.

Promoting forgiveness: Characteristics of the treatment, the clients, and their interaction.

Forgiveness-based group treatments to address interpersonal hurts have been shown to be efficacious across a range of therapy models (Wade, Hoyt, Kidwell, & Worthington, 2014). However, little is known about how treatment and individual characteristics may interact in predicting outcomes. The present study examined a sample of 162 community adults randomly assigned to three treatment conditions; an 8-week REACH Forgiveness intervention (Worthington, 2006), an 8-week process group, and a waitlist control. Hierarchical linear modeling (HLM) indicated that the forgiveness-based treatment was more effective than the waitlist control across a range of forgiveness-related constructs but no more effective than the process condition. Furthermore, attachment avoidance and anxiety interacted with treatment type to predict certain outcomes, indicating that the REACH Forgiveness model may be more helpful for promoting forgiveness with insecurely attached individuals. (PsycINFO Database Record

Disentangling self-stigma: are mental illness and help-seeking self-stigmas different?

Two established but disparate lines of research exist: studies examining the self-stigma associated with mental illness and studies examining the self-stigma associated with seeking psychological help. Whereas some researchers have implicitly treated these 2 constructs as synonymous, others have made the argument that they are theoretically and empirically distinct. To help clarify this debate, we examined in the present investigation the overlap and uniqueness of the self-stigmas associated with mental illness and with seeking psychological help. Data were collected from a sample of college undergraduates experiencing clinical levels of psychological distress (N = 217) and a second sample of community members with a self-reported history of mental illness (N = 324). Confirmatory factor analyses provide strong evidence for the factorial independence of the 2 types of self-stigma. Additionally, results of regression analyses in both samples suggest that the 2 self-stigmas uniquely predict variations in stigma-related constructs (i.e., shame, self-blame, and social inadequacy) and attitudes and intentions to seek help. Implications for researchers and clinicians interested in understanding stigma and enhancing mental health service utilization are discussed.

Predictors of the change in self-stigma following a single session of group counseling.

One of the major obstacles to seeking psychological help is the stigma associated with counseling and therapy. Self-stigma, the fear of losing self-respect or self-esteem as a result of seeking help, is an important factor in the help-seeking process. In the present study, college students meeting a clinical cutoff for psychological symptoms participated in 1 session of group counseling that either contained therapist self-disclosure or did not. In general, participants reported significantly less self-stigma following the session. Working alliance-bond and session depth significantly predicted the change in self-stigma. Furthermore, self-stigma (as well as bond, depth, psychological symptoms, and being female) predicted the intention to seek help following the session. Self-stigma and session depth also predicted interest in continuing with counseling. The therapist self-disclosure condition, however, had no effect on the change in self-stigma, intentions to seek help, or interest in continuing with group counseling.