Abstract
Objectives
The present study examined the longitudinal impact of self-compassion and psychological flexibility on clinical recovery and personal recovery among people with mental illness and explored the potential mechanisms underlying this impact. We hypothesized that self-compassion and psychological flexibility would be longitudinally associated with higher levels of clinical recovery and personal recovery and these longitudinal associations would be mediated by lower levels of self-stigma and disengagement from mental health services.
Method
On three occasions (i.e., T1, T2, and T3) across 2 years, 202 people with mental illness provided questionnaire data on self-compassion, psychological flexibility, self-stigma, service disengagement, clinical recovery, and personal recovery.
Results
Path analyses showed that self-compassion and psychological flexibility at T1 had significant direct effects on self-stigma and service disengagement at T2, which, in turn, had significant direct effects on clinical recovery and personal recovery at T3. Bootstrap analyses further showed that self-compassion and psychological flexibility at T1 had significant indirect effects on clinical recovery and personal recovery at T3 through self-stigma and service disengagement at T2.
Conclusions
Our findings reveal how self-compassion and psychological flexibility may enable people with mental illness to reduce self-stigma and service disengagement, which can, in turn, facilitate symptomatic remission and promote psychological wellness. These findings point to the potential utility of cultivating self-compassion and psychological flexibility in enabling people with mental illness to recover from mental health problems and live hopeful and satisfying lives.
Preregistration
This study is not preregistered.
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Data Availability
Data used in this study are available at the Open Science Framework (https://osf.io/d9r6y/).
References
Angermeyer, M. C., & Dietrich, S. (2006). Public beliefs about and attitudes towards people with mental illness: A review of population studies. Acta Psychiatrica Scandinavica, 113(3), 163–179. https://doi.org/10.1111/j.1600-0447.2005.00699.x
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688. https://doi.org/10.1016/j.beth.2011.03.007
Chan, K. K. S., & Fung, W. T. W. (2019). The impact of experienced discrimination and self-stigma on sleep and health-related quality of life among individuals with mental disorders in Hong Kong. Quality of Life Research, 28(8), 2171–2182. https://doi.org/10.1007/s11136-019-02181-1
Chan, K. K. S., Fung, W. T. W., Leung, D. C. K., & Tsui, J. K. C. (2022). The impact of perceived and internalised stigma on clinical and functional recovery among people with mental illness. Health and Social Care in the Community, 30(6), e6102–e6111. https://doi.org/10.1111/hsc.14047
Chan, K. K. S., & Lam, C. B. (2018). The impact of familial expressed emotion on clinical and personal recovery among patients with psychiatric disorders: The mediating roles of self-stigma content and process. American Journal of Orthopsychiatry, 88(6), 626–635. https://doi.org/10.1037/ort0000327
Chan, K. K. S., Lee, C. W. L., & Mak, W. W. S. (2018). Mindfulness model of stigma resistance among individuals with psychiatric disorders. Mindfulness, 9(5), 1433–1442. https://doi.org/10.1007/s12671-018-0887-2
Chan, K. K. S., & Mak, W. W. S. (2014). The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community. Quality of Life Research, 23(9), 2559–2568. https://doi.org/10.1007/s11136-014-0695-7
Chan, K. K. S., & Mak, W. W. S. (2017). The content and process of self-stigma in people with mental illness. American Journal of Orthopsychiatry, 87(1), 34–43. https://doi.org/10.1037/ort0000127
Chan, K. K. S., & Tsui, J. K. C. (2023). Longitudinal impact of experienced discrimination on mental health among people with mental disorders. Psychiatry Research, 322, 115099. https://doi.org/10.1016/j.psychres.2023.115099
Chan, K. K. S., & Tsui, J. K. C. (in press). Perceived stigma from mental health service providers and its adverse impact on service engagement and recovery among people with mental illness. American Journal of Orthopsychiatry.
Chan, K. K. S., Yip, C. C. H., & Tsui, J. K. C. (2023). Self-compassion mediates the impact of family support on clinical and personal recovery among people with mental illness. Mindfulness, 14(3), 720–731. https://doi.org/10.1007/s12671-023-02088-6
Cherry, K. M., Hoeven, E. V., Patterson, T. S., & Lumley, M. N. (2021). Defining and measuring “psychological flexibility”: A narrative scoping review of diverse flexibility and rigidity constructs and perspectives. Clinical Psychology Review, 84, 101973. https://doi.org/10.1016/j.cpr.2021.101973
Chio, F. H. N., Mak, W. W. S., & Yu, B. C. L. (2021). Meta-analytic review on the differential effects of self-compassion components on well-being and psychological distress: The moderating role of dialecticism on self-compassion. Clinical Psychology Review, 85, 101986. https://doi.org/10.1016/j.cpr.2021.101986
Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. S. L., & Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. https://doi.org/10.1017/S0033291714000129
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Routledge. https://doi.org/10.4324/9780203771587
Conrad, K. J., Yagelka, J. R., Matters, M. D., Rich, A. R., Williams, V., & Buchanan, M. (2001). Reliability and validity of a Modified Colorado Symptom Index in a national homeless sample. Mental Health Services Research, 3(3), 141–153. https://doi.org/10.1023/A:1011571531303
Corrigan, P. W., Bink, A. B., Schmidt, A., Jones, N., & Rüsch, N. (2016). What is the impact of self-stigma? Loss of self-respect and the “why try” effect. Journal of Mental Health, 25(1), 10–15. https://doi.org/10.3109/09638237.2015.1021902
Corrigan, P. W., Larson, J. E., & Rüsch, N. (2009). Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75–81. https://doi.org/10.1002/j.2051-5545.2009.tb00218.x
Corrigan, P. W., Rafacz, J., & Rüsch, N. (2011). Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Research, 189(3), 339–343. https://doi.org/10.1016/j.psychres.2011.05.024
Corrigan, P. W., Salzer, M., Ralph, R. O., Sangster, Y., & Keck, L. (2004). Examining the factor structure of the Recovery Assessment Scale. Schizophrenia Bulletin, 30(4), 1035–1041. https://doi.org/10.1093/oxfordjournals.schbul.a007118
Dubreucq, J., Plasse, J., & Franck, N. (2021). Self-stigma in serious mental illness: A systematic review of frequency, correlates, and consequences. Schizophrenia Bulletin, 47(5), 1261–1287. https://doi.org/10.1093/schbul/sbaa181
González-Menéndez, A., Faedo, T. A., González-Pando, D., Ordoñez-Camblor, N., García-Vega, E., & Paino, M. (2021). Psychological inflexibility in people with chronic psychosis: The mediating role of self-stigma and social functioning. International Journal of Environmental Research and Public Health, 18(23), 12376. https://doi.org/10.3390/ijerph182312376
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.
Kenny, D. A. (2021). Mediation. Retrieved from http://davidakenny.net/cm/mediate.htm
Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science and Medicine, 71(12), 2150–2161. https://doi.org/10.1016/j.socscimed.2010.09.030
Luoma, J. B., & Platt, M. G. (2015). Shame, self-criticism, self-stigma, and compassion in Acceptance and Commitment Therapy. Current Opinion in Psychology, 2, 97–101. https://doi.org/10.1016/j.copsyc.2014.12.016
Mak, W. W. S., Chan, R. C. H., Wong, S. Y. S., Lau, J. T. F., Tang, W. K., Tang, A. K. L., Chiang, T. P., Cheng, S. K. W., Chan, F., Cheung, F. M., Woo, J., & Lee, D. T. F. (2017). A cross-diagnostic investigation of the differential impact of discrimination on clinical and personal recovery. Psychiatric Service, 68(2), 159–166. https://doi.org/10.1176/appi.ps.201500339
Mak, W. W. S., Chio, F. H. N., Chong, K. S. C., & Law, R. W. (2021). From mindfulness to personal recovery: The mediating roles of self-warmth, psychological flexibility, and valued living. Mindfulness, 12(4), 994–1001. https://doi.org/10.1007/s12671-020-01568-3
Mills, H., Mulfinger, N., Raeder, S., Rüsch, N., Clements, H., & Scior, K. (2020). Self-help interventions to reduce self-stigma in people with mental health problems: A systematic literature review. Psychiatry Research, 284, 112702. https://doi.org/10.1016/j.psychres.2019.112702
Moitra, E., & Gaudiano, B. A. (2016). A psychological flexibility model of medication adherence in psychotic-spectrum disorders. Journal of Contextual Behavioral Science, 5(4), 252–257. https://doi.org/10.1016/j.jcbs.2016.10.003
Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027
Parcesepe, A. M., & Cabassa, L. J. (2013). Public stigma of mental illness in the United States: A systematic literature review. Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 384–399. https://doi.org/10.1007/s10488-012-0430-z
Podsakoff, P. M., MacKenzie, S. B., & Podsakoff, N. P. (2012). Sources of method bias in social science research and recommendations on how to control it. Annual Review of Psychology, 63, 539–569. https://doi.org/10.1146/annurev-psych-120710-100452
Quinn, D. M., Williams, M. K., & Weisz, B. M. (2015). From discrimination to internalized mental illness stigma: The mediating roles of anticipated discrimination and anticipated stigma. Psychiatric Rehabilitation Journal, 38(2), 103–108. https://doi.org/10.1037/prj0000136
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology and Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702
Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: Psychometric properties of a new measure. Psychiatry Research, 121(1), 31–49. https://doi.org/10.1016/j.psychres.2003.08.008
Stynes, G., Leão, C. S., & McHugh, L. (2022). Exploring the effectiveness of mindfulness-based and third wave interventions in addressing self-stigma, shame and their impacts on psychosocial functioning: A systematic review. Journal of Contextual Behavioral Science, 23, 174–189. https://doi.org/10.1016/j.jcbs.2022.01.006
Tait, L., Birchwood, M., & Trower, P. (2002). A new scale (SES) to measure engagement with community mental health services. Journal of Mental Health, 11(2), 191–198. https://doi.org/10.1080/09638230020023570-2
Thornicroft, G., Brohan, E., Rose, D., Sartorius, N., Leese, M., The INDIGO Study Group. (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: A cross-sectional survey. The Lancet, 373(9661), 408–415. https://doi.org/10.1016/S0140-6736(08)61817-6
Tsang, H. W. H., Ching, S. C., Tang, K. H., Lam, H. T., Law, P. Y. Y., & Wan, C. N. (2016). Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophrenia Research, 173(1–2), 45–53. https://doi.org/10.1016/j.schres.2016.02.013
Wakelin, K. E., Perman, G., & Simonds, L. M. (2022). Effectiveness of self-compassion-related interventions for reducing self-criticism: A systematic review and meta-analysis. Clinical Psychology and Psychotherapy, 29(1), 1–25. https://doi.org/10.1002/cpp.2586
Wang, Z., Yip, C. C. H., Leung, D. C. K., & Chan, K. K. S. (2023). The impact of mindfulness on stigma stress and well-being among individuals with mental disorders. Mindfulness, 14(4), 808–817. https://doi.org/10.1007/s12671-023-02111-w
Wong, C. C. Y., Knee, C. R., Neighbors, C., & Zvolensky, M. J. (2019). Hacking stigma by loving yourself: A mediated-moderation model of self-compassion and stigma. Mindfulness, 10(3), 415–433. https://doi.org/10.1007/s12671-018-0984-2
Yang, X., & Mak, W. W. S. (2017). The differential moderating roles of self-compassion and mindfulness in self-stigma and well-being among people living with mental illness or HIV. Mindfulness, 8(3), 595–602. https://doi.org/10.1007/s12671-016-0635-4
Yanos, P. T., Roe, D., Markus, K., & Lysaker, P. H. (2008). Pathways between internalized stigma and outcomes related to recovery in schizophrenia spectrum disorders. Psychiatric Services, 59(12), 1437–1442. https://doi.org/10.1176/ps.2008.59.12.1437
Yip, C. C. H., Fung, W. T. W., Leung, D. C. K., & Chan, K. K. S. (2023). The impact of stigma on engaged living and life satisfaction among people with mental illness in Hong Kong. Quality of Life Research, 32(1), 161–170. https://doi.org/10.1007/s11136-022-03218-8
Yu, B. C. L., Chio, F. H. N., Mak, W. W. S., Corrigan, P. W., & Chan, K. K. Y. (2021). Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clinical Psychology Review, 87, 102029. https://doi.org/10.1016/j.cpr.2021.102029
Acknowledgements
We would like to express our sincere gratitude to the following non-governmental organizations (in alphabetical order) for facilitating us in recruiting eligible participants from their service users: Baptist Oi Kwan Social Service; Christian Oi Hip Fellowship Limited; New Life Psychiatric Rehabilitation Association; The Mental Health Association of Hong Kong; and The Society of Rehabilitation and Crime Prevention.
Funding
This study was funded by the Early Career Scheme of the Research Grants Council of Hong Kong (Project Number: 28611515).
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Kevin Ka Shing Chan: conceptualization, methodology, formal analysis, investigation, resources, data curation, writing—original draft, writing—review and editing, supervision, funding acquisition. Jack Ka Chun Tsui: conceptualization, writing—review and editing, project administration. Alan Tsz Yin Tang: conceptualization, writing—review and editing, project administration.
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This study was approved by the Human Research Ethics Committee of The Education University of Hong Kong.
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Chan, K.K.S., Tsui, J.K.C. & Tang, A.T.Y. Longitudinal Impact of Self-Compassion and Psychological Flexibility on Mental Illness Recovery: The Mediating Roles of Self-Stigma and Mental Health Service Engagement. Mindfulness 14, 1125–1134 (2023). https://doi.org/10.1007/s12671-023-02127-2
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DOI: https://doi.org/10.1007/s12671-023-02127-2