Journal List > J Korean Acad Psychiatr Ment Health Nurs > v.28(1) > 1119803

Kim and Jang: Effects of Self-Assertive Training Applying Reality Therapy Techniques on Self-esteem and Internalized Stigma in Schizophrenia Patients

Abstract

Purpose

The aim of this study was to examine the effect of self-assertive training applying the reality therapy techniques (SATART) on self-esteem and internalized stigma of schizophrenia patients.

Methods

This study was a non-equivalent control group pretest-posttest design and enrolled 55 people with schizophrenia (experimental group=27, control group=28) from two community mental health centers. The SATART was offered twice a week for 6 weeks in a total 12 sessions. Data were collected from February to April, 2017, using the Korean version of the Internalized Stigma of Mental Illness Scale and Rosenberg Self-Esteem Scale. The collected data was analyzed using χ2 test, independent t-test, one-way ANCOVA, and repeated measures ANOVA with using the SPSS/WIN 22.0 program.

Results

The experimental group showed significant improvements in self-esteem and recudction of internalized stigma compared to the control group. However, there was no significant improvement on stigma resistance measurement among the subscales of internalized stigma between two groups.

Conclusion

The findings indicate that the SATART program is effective and could be recommended as a psychosocial intervention for self-esteem enhancement and internalized stigma reduction of people with schizophrenia.

Figures and Tables

Figure 1

Flow diagram of the study participants.

jkapmhn-28-37-g001
Table 1

Contents of Self-assertive Training based on Reality Therapy Techniques

jkapmhn-28-37-i001

WDEP=want-doing-evaluation-plan.

Table 2

Homogeneity of Demographic Characteristics (N=55)

jkapmhn-28-37-i002

Exp.=experimental group; Cont.=control group; Fisher's exact test.

Table 3

Homogeneity of Dependent Variables (N=55)

jkapmhn-28-37-i003

Exp.=experimental group; Cont.=control group; Mann Whitney U-test.

Table 4

Effects of Intervention on Dependent Variables (N=55)

jkapmhn-28-37-i004

Exp.=experimental group (n=27); Cont.=control group (n=28); ANCOVA used after calibration correction value 6th week.

Notes

This article is a revision of the first author's master's thesis from Kyung Hee University.

CONFLICTS OF INTEREST The authors declared no conflict of interest.

References

1. Hong JP, Lee DW, Ham BJ, Lee SH, Sung SJ, Yoon T, et al. 2016 survey of mental disorders in Korea. Seoul: Ministry of Health and Welfare (Korea);2017. 04. Report No. 11-1352000-000564-13.
2. Chang SM, Cho S-J, Jeon HJ, Hahm BJ, Lee HJ, Park JI, et al. Economic burden of schizophrenia in South Korea. Journal of Korean Medical Science. 2008; 23(2):167–175. DOI: 10.3346/jkms.2008.23.2.167.
crossref pmid pmc
3. Jin H, Mosweu I. The societal cost of schizophrenia: a systematic review. Pharmacoeconomics. 2017; 35(1):25–42. DOI: 10.1007/s40273-016-0444-6.
crossref pmid
4. Kunikata H, Mino Y, Nakajima K. Factors affecting WHOQOL-26 in community-dwelling patients with schizophrenia. Japanese Journal of Public Health. 2006; 53(4):301–309.
pmid
5. Abiri S, Oakley LD, Hitchcock ME, Hall A. Stigma related avoidance in people lining with severe mental illness (SMI): findings of an integrative review. Community Mental Health Journal. 2016; 52(3):251–261. DOI: 10.1007/s10597-015-9957-2.
crossref pmid
6. Kim MY, Jeon SS. Development and effects of a cognitive-behavioral therapy based program in reducing internalized stigma in patients with schizophrenia. Journal of Korean Academy of Nursing. 2016; 46(3):349–363. DOI: 10.4040/jkan.2016.46.3.349.
crossref pmid
7. Lee HJ. The changing discourse of depression and its cultural implications in South Korea: an analysis of newspaper coverage between 1991 and 2010. Journal of Korean Cultural Anthropology. 2012; 45(1):43–88.
8. Link BG, Cullen FT, Struening E, Shrout PE, Dohrenwend BP. A modified labeling theory approach to mental disorders: an empirical assessment. American Sociological Review. 1989; 54(3):400–423. DOI: 10.2307/2095613.
crossref
9. Mittal D, Sullivan G, Chekuri L, Allee E, Corrigan PW. Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatric Services. 2012; 63(10):974–981. DOI: 10.1176/appi.ps.201100459.
crossref pmid
10. Segalovich J, Doron A, Behrbalk P, Kurs R, Romem P. Internalization of stigma and self-esteem as it affects the capacity for intimacy among patients with schizophrenia. Archives of Psychiatric Nursing. 2013; 27(5):231–234. DOI: 10.1016/j.apnu.2013.05.002.
crossref pmid
11. Tsang HWH, Ching SC, Tang KH, Lam HT, Law PYY, Wan CN. Therapeutic intervention for internalized stigma of severe mental illness: a systematic review and meta-analysis. Schizophrenia Research. 2016; 173(1-2):45–53. DOI: 10.1016/j.schres.2016.02.013.
crossref pmid
12. Lee TY, Chang SC, Chu H, Yang CY, Ou KL, Chung MH, et al. The effects of assertiveness training in patients with schizophrenia: a randomized, single-blind, controlled study. Journal of Advanced Nursing. 2013; 69(11):2549–2559. DOI: 10.1111/jan.12142.
crossref pmid
13. Speed BC, Goldstein BL, Goldfried MR. Assertiveness training: a forgotten evidence-based treatment. Clinical Psychology: Science and Practice. 2018; 25(1):1–20. DOI: 10.1111/cpsp.12216.
crossref
14. Yıldırım A, Aşılar RH, Camcıoğlu TH, Erdiman S, Karaağaç E. Effect of psychosocial skills training on disease symptoms, insight, internalized stigmatization, and social functioning in patients with schizophrenia. Rehabilitation Nursing. 2015; 40(6):341–348. DOI: 10.1002/rnj.195.
crossref pmid
15. Fung KMT, Tsang HWH, Cheung W. Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia. Psychiatry Research. 2011; 189(2):208–214. DOI: 10.1016/j.psychres.2011.02.013.
crossref pmid
16. Ko KH, Yang SH, Kim YA, Kwon MS, Bang SH, Lee JM, et al. The effects of an empowerment program for chronic schizophrenic patients on their empowerment and internalized stigma. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2008; 17(4):491–499.
17. Lee WK, Hwang TY. Efficacy of a group treatment, self-stigma overcome programs for inpatients with schizophrenia. Journal of Korean Neuropsychiatric Association. 2010; 49(5):444–452.
18. Corey G. Theory and practice of counseling and psychotherapy. 10th ed. Hague JD: Cengage Learning;2017. p. 540.
19. Kim JS. Effectiveness of reality therapy for schizophrenic patients. Journal of Korean Academy of Nursing. 2005; 35(8):1485–1492.
pmid
20. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press;1965. p. 347.
21. Jeon BJ. Self-esteem: a test of it's measurability. Yonsei Nonchong. 1974; 11:107–130.
22. Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research. 2003; 121(1):31–49. DOI: 10.1016/j.psychres.2003.08.008.
crossref pmid
23. Hwang TY, Lee WK, Han ES, Kwon EJ. A study on the reliability and validity of the Korean version of internalized stigma of mental illness scale (K-ISMI). Journal of Korean Neuropsychiatric Association. 2006; 45(5):418–426.
24. Lee J, Nam S, Lee MK, Lee JH, Lee SM. Rosenberg's self-esteem scale: analysis of item-level validity. The Korean Journal of Counseling and Psychotherapy. 2009; 21(1):173–189.
25. Kunikata H, Yoshinaga N, Shiraishi Y, Okada Y. Nurse-led cognitive-behavioral group therapy for recovery of self-esteem in patients with mental disorders: a pilot study. Japan Journal of Nursing Science. 2016; 13(3):355–364. DOI: 10.1111/jjns.12114.
crossref pmid
26. Chien WT, Leung SF, Yeung FKK, Wong WK. Current approaches to treatments for schizophrenia spectrum disorders, part II: psychosocial interventions and patient-focused perspectives in psychiatric care. Neuropsychiatric Disease and Treatment. 2013; 9:1311–1332. DOI: 10.2147/NDT.S49263.
crossref pmid pmc
27. Knight MT, Wykes T, Hayward P. Group treatment of perceived stigma and self-esteem in schizophrenia: a waiting list trial of efficacy. Behavioral and Cognitive Psychotherapy. 2006; 34(3):305–318. DOI: 10.1017/S1352465805002705.
crossref
28. Yanos PT, Roe D, West ML, Smith SM, Lysaker PH. Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial. Psychological Services. 2012; 9(3):248–258. DOI: 10.1037/a0028048.
crossref pmid pmc
29. Kim MY, Jun SS. Factors affecting internalized stigma of patient with schizophrenia. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2012; 21(2):108–117.
crossref
30. Kim WJ, Song YJ, Ryu HS, Ryu V, Kim JM, Ha RY, et al. Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness. Psychiatry Research. 2015; 225(3):433–439. DOI: 10.1016/j.psychres.2014.11.071.
crossref
TOOLS
ORCID iDs

Na-Ra Kim
https://orcid.org/0000-0002-7082-9063

Mi Heui Jang
https://orcid.org/0000-0002-5645-4816

Similar articles