Tag: Support

An Overview of Services for Mental Disorders

Published on by Andrew MarshallLeave a comment

Introduction

Services for mental health disorders provide treatment, support, or advocacy to people who have psychiatric illnesses. These may include medical, behavioural, social, and legal services.

Medical services are usually provided by mental health experts like psychiatrists, psychologists, and behavioural health counsellors in a hospital or outpatient clinic. Behavioural services go hand-in-hand with medical services, referring specifically to pharmacological and cognitive therapy. Social services are usually provided by the government or non-profit organisations. They arrange housing options, job training, or other community resources overseen by experienced professionals to ensure overall productivity and well-being of individuals with mental illnesses. Legal services ensure that people with mental health disorders are not discriminated against in society and advocate for their basic human rights. In addition, legal services make sure that those individuals who might be a danger to themselves or others are diverted away from the judicial system to receive adequate treatment for underlying mental health issues.

The information provided below is primarily regarding services offered within the US, unless otherwise specified.

Medical Services

There are several types of medical service settings that can serve to deliver mental health care or services. These include, but are not limited to family practice, psychiatric hospitals or clinics, general hospitals, and community mental or behavioural health centres. One medical service that is not used as much is the self-help plan. The self-help plan is where a person with mental illness addresses their condition then find strategies to get better. This may include addressing any triggers, recovery options or warning signs. Different services endorse different payment models. Some may be more government-based or patient-based, while others may endorse mixed-models payment systems. Not all service types or institutions are accessible by all patients. A considerable barrier surrounds the difficulty in finding in-network mental health care providers, given the backdrop of our current and critical nationwide shortage of mental health professionals.

Family practice or general practice centres in communities are often the first line for assessment of mental health conditions. The basic services provided may include prescribing psychiatric drugs and sometimes providing basic counselling or therapy for “common mental disorders.” Secondary medical services may include psychiatric hospitals, or clinics. However, given the trend towards the deinstitutionalisation of mental health hospitals – the movement of mental health patients out of the “asylum-based” mental health care system towards community-oriented care – psychiatric hospitals have been going out of favour, with services being directed to wards within general hospitals as well as more locally based community mental health services.

Mental health services may be provided either on an inpatient or, more commonly, an outpatient basis. A wide range of treatments may be provided to patients, with a mainstay of treatment being centred on psychiatric drugs. However, medication does not cure any mental illness but it does help manage symptoms. Various mental health professionals may be involved including psychiatrists, psychiatric and mental health nurses and, less commonly, non-medical professionals such as clinical psychologists, social workers, and various kinds of therapists or counsellors. Usually headed by psychiatrists and therefore based on a medical model, multidisciplinary teams may be involved in assertive community treatment and early intervention and may be coordinated via a case management system (sometimes referred to as “service coordination”).

Behavioural Therapy Services

Numerous services exist exclusively for the therapy of mental disorders and distress. Since symptoms vary across individuals, therapy is usually individualised for patients. All behaviours can be learned and also can be changed. Behavioural therapy is a method of therapy that is used to help identify unhealthy behaviours and to help change such behaviours. Methods exist that target numerous areas at once, such as integrative psychotherapy (an eclectic tailored mix of approaches). Integrative psychotherapists consider many factors when treating a patient, such as preferences, physical capabilities, or family support. In contrast to integrative psychotherapy, many approaches focus on particular areas. Cognitive behavioural therapy, psychodynamic therapy, interpersonal therapy, and dialectical behavioural therapy are all examples of approaches that have primary focuses when attempting to treat a patient. Conditions that can be treated by these therapies include anxiety, eating disorders, substance use disorders, obsessive compulsive disorders, and insomnia. The chosen therapy depends on several factors, with patient preference being a significant one.

Each type of therapy has its own strengths and weaknesses. Cognitive behavioural therapy is an attempt to allow patients to realise any inaccurate thoughts they may have and to allow them to perceive situations differently. Roughly about 75% of people who have used the cognitive behaviour therapy have experience a great outcome, which shows how effective this type of therapy is. There is also another type of cognitive therapy which is called cognitive behavioural play therapy. This therapy is particularly used for children. It is done by the therapist watching the child play then determining what the child is uncomfortable expressing. Psychodynamic therapy differs from cognitive behavioural therapy in that it is a longer-term therapy that usually requires more sessions for its effectiveness. Psychodynamic therapy is less structured and relies heavily on the relationship between the therapist and the patient. Although cognitive behavioural therapy has become the more favoured form of therapy, psychodynamic therapy continues to be viewed as the more effective treatment. When medication and psychodynamic are being used together it gives a higher chance of recovery. An integrative approach would allow one therapist to implement both cognitive behavioural therapy and psychodynamic therapy while treating the same patient. Interpersonal therapy is highly structured and is usually targeted at depression. There is evidence that suggests interpersonal therapy provides a benefit that is equal to pharmacologic therapy for depression. Dialectical behavioural therapy is an evidence-based psychotherapy that is usually used to treat suicidal behaviours. Each form of behavioural therapy uses different strategies to reach the goal of improving the quality of life for patients.

Social Services

Community-based social services often include supportive housing, clubhouses, and national hotlines. These resources may be provided by people who are successfully living with psychiatric disorders. Peer-led support encourage those individuals struggling with mental health disorders to seek self-help strategies and belong to social support network.

Supportive Housing

Supportive housing is an innovative solution that aims to provide permanent, accessible, and affordable housing options for individuals with mental health disorders. Additional help is often available to manage one’s finances, daily activities, and healthcare needs. Rent is usually less than 30% of one’s income and is further made affordable through rental assistance programmes offered by the government. It, also, provides access to public transportation as well as healthcare providers and other community resources. In supervised or partially-supervised supportive housing, trained staff may be present to help with medication management, paying bills, cleaning, cooking, and other day-to-day tasks. These environments are usually group home settings, where individuals have their own bedroom and bathroom but share common areas with other residents. Alternatively, individuals may also choose to live in independent supportive housing if they do not require frequent supervision regarding their activities of daily living. It is important to note that tenants have the freedom to choose which services they would like to utilise based on their degree of independence and unmet needs.

One of the limitations that prevent the widespread availability of supportive housing is the cost associated with hiring trained staff and maintaining the building as well as surrounding premises, while still keeping the rent affordable. However, studies have shown that the integrated services offered by supportive housing helps to decrease homelessness, incarceration rates, emergency room visits, and the number of days patients stay in a hospital. Such widespread effects can promote the lowering of costs associated with services in the above-mentioned areas and these funds can be diverted to sustain supportive housing projects.

Clubhouse Model

Clubhouses are community centres that are usually run by individuals who have a current or previous history of mental illness. The main purpose of these establishments is to promote rehabilitation and self-sufficiency of individuals by offering them employment opportunities. This includes access to community workshops, job training programmes, and educational opportunities. Additionally, clubhouse staff may maintain partnerships with local employers to provide full-time or part-time employment opportunities. Members, also, have access to social events and team-based activities, which helps them to develop a social support network.

Phone-Based Services

A mental health hotline is a free, confidential, and convenient way to receive information regarding various mental health services that are available in the community. The hotline is operated by trained employees and volunteers who can connect callers with the appropriate medical, legal, or social resources. There are no restrictions regarding how many times an individual may utilise a particular hotline. Some services may be available 24 hours a day, 7 days a week and via text messaging applications.

A few phone-based services exclusively deal with mental health emergencies or crisis situations, such as suicide and substance abuse. Suicide prevention lifelines are operated by mental health counsellors or community volunteers. They are trained to identify suicide risk, de-escalate an emergent crisis, and provide emotional support for those in distress. Substance abuse and relapse helplines provide behavioural support to those struggling with addiction as well as connect them with rehabilitation centres for treatment.

Phone-based services also allow for providers to remove language barriers. This is due to the fact that there are several online translation services in order to record and relay information in real time, across several different languages. By eliminating language barriers, providers are also able to prevent patients from experiencing social prejudice. Patients can now reach out to a wider variety of providers and are no longer bound to their local community practitioners, where there could be added stigma.

Telehealth Services

The use of Telehealth, health related services distributed electronically, has exploded in popularity across the world of medicine following the 2019-2020 COVID-19 pandemic. Remote health services have opened up a new dimension for healthcare providers to provide care to patients with efficiency and a wider range of accessibility. The inclusion of mental health services in this expansion has helped dispel the belief that mental health is not capable of being done electronically and has opened up new possibilities in the field of mental health services, and service provision. There are still limits restricting Telehealth including the fact that many people still do not have access to technology such as phones and computers, and that it cannot replace more intensive treatment settings.

Apps Providing Psychological Services

Mental health apps are an increasingly popular means of providing mental health services. They are cost effective, easy to access at almost any location, affordable, anonymous, can provide around the clock support, can reach a greater number of people, and are capable of providing a supporting role to other services for mental disorders. Even though apps have great potential to accomplish new and innovative goals in the field of mental health, they do still have some limitations. Not everyone has access to technology through which the apps can be run, there are elements of data collection which may make some users uncomfortable, there is not much regulation of these mental health services, and the apps may turn people away from using harder to access but more provenly effective services that they could benefit from.

Legal Services

Legal services supervise the involuntary commitment or outpatient commitment of those judged to have mental disorders and to be a danger to themselves or others. Some legal organisations provide specialised services for those diagnosed with mental disorders who may be challenging discrimination or involuntary commitment.

Mental health courts are specialised court dockets that provide community treatment and supervision in lieu of incarceration for criminal offenders with mental illness. A judge assesses the defendant’s background as well as the influence of his or her mental disorder on the committed crime. A team of mental health professionals and legal advisors ensures that a particular mental health treatment programme provides appropriate opportunities for rehabilitation and prevent future criminal behaviour. The defendant is given the choice to decide if they want to participate in the treatment, unless they are unable to provide informed consent. In such cases, a conservator could make treatment decisions on behalf of the defendant and may give permission to use medications, if appropriate. Successful completion of the programme may result in reduced sentences or all charges against the defendant to be dropped.

Global Situation

Statistics

In 2017, more than 970 million or 1-in-7 individuals were purported to have one or more mental or substance use disorder(s). Anxiety and depressive disorders were, by far, the most attributed. Moreover, around 5%, and up to 12%, of global disease burden was attributable to mental or substance use disorders. Countries that have the greatest disease burden from mental or substance use disorders include Kuwait, Qatar, Australia, among others.

A Global Mental Health Group in coordination with the World Health Organisation has called for an urgent scaling up of the funding, staffing and coverage of services for mental disorders in all countries, especially in low-income and middle-income countries.

According to the Recovery model, services must always support an individual’s personal journey of recovery and independence, and a person may or may not need services at any particular time, or at all. The UK is moving towards paying mental health providers by the outcome results that their services achieve.

Traditional and Alternative Services

Traditional healing centres are popular worldwide and provide accessible mental health services for the native population. This community-based practice is led by folk healers, who use herbal remedies, spiritual rituals, and indigenous perspectives to provide comfort for individuals. These services are highly culture-specific and, therefore, its structure varies across the globe. Traditional healing approaches are sometimes used alongside conventional or western medicine.

In addition, each country has its own view on mental health disorders. While many nations share advocacy for mental health, there are still several countries that stigmatize medical or behavioural treatment for these disease states. Examples of these are Canada and China, such that both have high mental health illness rates but low utilisation rates of mental health services. While the cause of this is unknown, it is believed to be due to general stigma in those communities towards seeking help for mental health.

Problems with Mental Health Services

Expanding Increase in Demand

As awareness of mental health increases more and more people require mental health services. According to studies in 2023 over half of adults (54.7%) suffering from a mental illness are not receiving treatment, and almost a 3rd (28.2%) of adults with mental illness cannot get the treatment they need. There is increasing demand for new paths to provide mental services such as telehealth to make the distribution of services more streamlined along with need for more service providers to account for growing demand for treatment.

Struggle to Provide Services for Underserved Communities

Service providers for mental health have long struggled to provide adequate care for underserved communities such as minorities, the homeless, and incarcerated populations. These groups generally are in need of greater amounts of care in part due to the adversities that have both created and perpetuated their situations like systemic racism, troubled backgrounds, access to housing, and poverty. There are barriers to access for mental health services that continue to make them inaccessible such as high cost, language barriers, and access to providers in many communities.

Systemic Barriers

Many governments across the globe continue to neglect the importance of mental health services. The United States for example continues to not provide healthcare accommodation for mental health services and struggles to fulfil policies like The Mental Health and Addiction Parity Act of 2008 that are intended to make mental health services more accessible. Many governments continue to fail to recognise mental health services as important facets of healthcare and properly provide for them. Many countries still consider mental health a problem of which only high earning countries face and fail to recognize mental health as a developing struggle that affects people of all backgrounds.

Push Toward Change

There is an increasing push for new innovative ways to provide mental health services. Telehealth has been a massively eye opening success following its widespread usage during the 2019-2020 COVID-19 Pandemic and has changed the belief that mental health services cannot be useful when provided electronically. Suggestions such as governmental change and the creation of workers who bring mental health services to hard to reach communities and individuals have been theorised to be possible solutions. Apps for psychological services are also looked at as a promising new development that could greatly expand people’s access to psychological services in the future due to their numerous benefits such as convenience, anonymity, and outreach.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Services_for_mental_disorders >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Twelve-Step Programme?

Published on by Andrew MarshallLeave a comment

Introduction

Twelve-step programmes are international mutual aid programs supporting recovery from substance addictions, behavioural addictions and compulsions. Developed in the 1930s, the first twelve-step programme, Alcoholics Anonymous (AA), founded by Bill Wilson and Bob Smith, aided its membership to overcome alcoholism. Since that time dozens of other organisations have been derived from AA’s approach to address problems as varied as drug addiction, compulsive gambling, sex, and overeating. All twelve-step programmes utilise a version of AA’s suggested twelve steps first published in the 1939 book Alcoholics Anonymous: The Story of How More Than One Hundred Men Have Recovered from Alcoholism.

As summarised by the American Psychological Association (APA), the process involves the following:

  • Admitting that one cannot control one’s alcoholism, addiction, or compulsion;
  • Coming to believe in a Higher Power that can give strength;
  • Examining past errors with the help of a sponsor (experienced member);
  • Making amends for these errors;
  • Learning to live a new life with a new code of behaviour; and
  • Helping others who suffer from the same alcoholism, addictions, or compulsions.

Overview

Twelve-step methods have been adapted to address a wide range of alcoholism, substance abuse, and dependency problems. Over 200 mutual aid organisations – often known as fellowships—with a worldwide membership of millions have adopted and adapted AA’s 12 Steps and 12 Traditions for recovery. Narcotics Anonymous was formed by addicts who did not relate to the specifics of alcohol dependency.

Demographic preferences related to the addicts’ drug of choice has led to the creation of Cocaine Anonymous, Crystal Meth Anonymous and Marijuana Anonymous. Behavioural issues such as compulsion for or addiction to gambling, crime, food, sex, hoarding, getting into debt and work are addressed in fellowships such as Gamblers Anonymous, Overeaters Anonymous, Sexaholics Anonymous and Debtors Anonymous.

Auxiliary groups such as Al-Anon and Nar-Anon, for friends and family members of alcoholics and addicts, respectively, are part of a response to treating addiction as a disease that is enabled by family systems. Adult Children of Alcoholics (ACA or ACOA) addresses the effects of growing up in an alcoholic or otherwise dysfunctional family. Co-Dependents Anonymous (CoDA) addresses compulsions related to relationships, referred to as co-dependency.

Brief History

Alcoholics Anonymous (AA), the first twelve-step fellowship, was founded in 1935 by Bill Wilson and Dr. Robert Holbrook Smith, known to AA members as “Bill W.” and “Dr. Bob”, in Akron, Ohio. In 1946 they formally established the twelve traditions to help deal with the issues of how various groups could relate and function as membership grew. The practice of remaining anonymous (using only one’s first names) when interacting with the general public was published in the first edition of the AA Big Book.

As AA chapters were increasing in number during the 1930s and 1940s, the guiding principles were gradually defined as the Twelve Traditions. A singleness of purpose emerged as Tradition Five: “Each group has but one primary purpose—to carry its message to the alcoholic who still suffers”. Consequently, drug addicts who do not suffer from the specifics of alcoholism involved in AA hoping for recovery technically are not welcome in “closed” meetings unless they have a desire to stop drinking alcohol.

The principles of AA have been used to form numerous other fellowships specifically designed for those recovering from various pathologies; each emphasizes recovery from the specific malady which brought the sufferer into the fellowship.

The Twelve Steps

The following are the original twelve steps as published by Alcoholics Anonymous:[11]

  1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
  2. Came to believe that a power greater than ourselves could restore us to sanity.
  3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
  4. Made a searching and fearless moral inventory of ourselves.
  5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
  6. Were entirely ready to have God remove all these defects of character.
  7. Humbly asked Him to remove our shortcomings.
  8. Made a list of all persons we had harmed, and became willing to make amends to them all.
  9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
  10. Continued to take personal inventory, and when we were wrong, promptly admitted it.
  11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
  12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.

Where other twelve-step groups have adapted the AA steps as guiding principles, step one is generally updated to reflect the focus of recovery. For example, in Overeaters Anonymous, the first step reads, “We admitted we were powerless over compulsive overeating—that our lives had become unmanageable.” The third step is also sometimes altered to remove gender-specific pronouns.

The Twelve Traditions

The Twelve Traditions accompany the Twelve Steps. The Traditions provide guidelines for group governance. They were developed in AA in order to help resolve conflicts in the areas of publicity, politics, religion, and finances. Alcoholics Anonymous’ Twelve Traditions are:

  1. Our common welfare should come first; personal recovery depends upon AA unity.
  2. For our group purpose there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
  3. The only requirement for AA membership is a desire to stop drinking.
  4. Each group should be autonomous except in matters affecting other groups or AA as a whole.
  5. Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.
  6. An AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
  7. Every AA group ought to be fully self-supporting, declining outside contributions.
  8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
  9. AA, as such, ought never be organised; but we may create service boards or committees directly responsible to those they serve.
  10. Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.
  11. Our public relations policy is based on attraction rather than promotion; we need always to maintain personal anonymity at the level of press, radio, and films.
  12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.

The Process

In the twelve-step programme, the human structure is symbolically represented in three dimensions: physical, mental, and spiritual. The problems the groups deal with are understood to manifest themselves in each dimension. For addicts and alcoholics, the physical dimension is best described by the allergy-like bodily reaction resulting in the compulsion to continue using substances even when it’s harmful or wanting to quit. The statement in the First Step that the individual is “powerless” over the substance-abuse related behaviour at issue refers to the lack of control over this compulsion, which persists despite any negative consequences that may be endured as a result.

The mental obsession is described as the cognitive processes that cause the individual to repeat the compulsive behaviour after some period of abstinence, either knowing that the result will be an inability to stop or operating under the delusion that the result will be different. The description in the First Step of the life of the alcoholic or addict as “unmanageable” refers to the lack of choice that the mind of the addict or alcoholic affords concerning whether to drink or use again. The illness of the spiritual dimension, or “spiritual malady,” is considered in all twelve-step groups to be self-centeredness. The process of working the steps is intended to replace self-centeredness with a growing moral consciousness and a willingness for self-sacrifice and unselfish constructive action. In twelve-step groups, this is known as a “spiritual awakening.” This should not be confused with abreaction, which produces dramatic, but temporary, changes. As a rule, in twelve-step fellowships, spiritual awakening occurs slowly over a period of time, although there are exceptions where members experience a sudden spiritual awakening.

In accordance with the First Step, twelve-step groups emphasize self-admission by members of the problem they are recovering from. It is in this spirit that members often identify themselves along with an admission of their problem, often as “Hi, I’m [first name only], and I’m an alcoholic”.

Sponsorship

A sponsor is a more experienced person in recovery who guides the less-experienced aspirant (“sponsee”) through the program’s twelve steps. New members in twelve-step programmes are encouraged to secure a relationship with at least one sponsor who both has a sponsor and has taken the twelve steps themselves. Publications from twelve-step fellowships emphasize that sponsorship is a “one on one” non-hierarchical relationship of shared experiences focused on working the Twelve Steps. According to Narcotics Anonymous:

Sponsors share their experience, strength, and hope with their sponsees… A sponsor’s role is not that of a legal adviser, a banker, a parent, a marriage counsellor, or a social worker. Nor is a sponsor a therapist offering some sort of professional advice. A sponsor is simply another addict in recovery who is willing to share his or her journey through the Twelve Steps.

Sponsors and sponsees participate in activities that lead to spiritual growth. Experiences in the programme are often shared by outgoing members with incoming members. This rotation of experience is often considered to have a great spiritual reward. These may include practices such as literature discussion and study, meditation, and writing. Completing the programme usually implies competency to guide newcomers which is often encouraged. Sponsees typically do their Fifth Step, review their moral inventory written as part of the Fourth Step, with their sponsor. The Fifth Step, as well as the Ninth Step, have been compared to confession and penitence. Michel Foucault, a French philosopher, noted such practices produce intrinsic modifications in the person—exonerating, redeeming and purifying them; relieves them of their burden of wrong, liberating them and promising salvation.

The personal nature of the behavioural issues that lead to seeking help in twelve-step fellowships results in a strong relationship between sponsee and sponsor. As the relationship is based on spiritual principles, it is unique and not generally characterised as “friendship”. Fundamentally, the sponsor has the single purpose of helping the sponsee recover from the behavioural problem that brought the sufferer into twelve-step work, which reflexively helps the sponsor recover.

A study of sponsorship as practiced in Alcoholics Anonymous and Narcotics Anonymous found that providing direction and support to other alcoholics and addicts is associated with sustained abstinence for the sponsor, but suggested that there were few short-term benefits for the sponsee’s one-year sustained abstinence rate.

Effectiveness

Alcoholics Anonymous is the largest of all of the twelve-step programmes (from which all other twelve-step programmes are derived), followed by Narcotics Anonymous; the majority of twelve-step members are recovering from addiction to alcohol or other drugs. The majority of twelve-step programmes, however, address illnesses other than substance addiction. For example, the third-largest twelve-step programme, Al-Anon, assists family members and friends of people who have alcoholism and other addictions. About twenty percent of twelve-step programmes are for substance addiction recovery, the other eighty percent address a variety of problems from debt to depression. It would be an error to assume the effectiveness of twelve-step methods at treating problems in one domain translates to all or to another domain.

A 2020 Cochrane review of Alcoholics Anonymous showed that participation in AA resulted in more alcoholics being abstinent from alcohol and for longer periods of time than cognitive behavioural therapy and motivational enhancement therapy, and as effective as these in other measures. The 2020 review did not compare twelve step programmes to the use of disulfiram or naltrexone, though some patients did receive these medications. These medications are considered the standard of care in alcohol use disorder treatment among medical experts and have demonstrated efficacy in randomised controlled trials in promoting alcohol abstinence. A systematic review published in 2017 found that twelve-step programmes for reducing illicit drug use are neither better nor worse than other interventions.

Criticism

In the past, some medical professionals have criticised 12-step programmes as “a cult that relies on God as the mechanism of action” and as lacking any experimental evidence in favour of its efficacy. Ethical and operational issues had prevented robust randomised controlled trials from being conducted comparing 12-step programmes directly to other approaches. More recent studies employing non-randomised and quasi-experimental studies have shown 12-step programmes provide similar benefit compared to motivational enhancement therapy (MET) and cognitive behavioural therapy (CBT), and were more effective in producing continuous abstinence and remission compared to these approaches.

Confidentiality

The Twelve Traditions encourage members to practice the spiritual principle of anonymity in the public media and members are also asked to respect each other’s confidentiality. This is a group norm, however, and not legally mandated; there are no legal consequences to discourage those attending twelve-step groups from revealing information disclosed during meetings. Statutes on group therapy do not encompass those associations that lack a professional therapist or clergyman to whom confidentiality and privilege might apply. Professionals and paraprofessionals who refer patients to these groups, to avoid both civil liability and licensure problems, have been advised that they should alert their patients that, at any time, their statements made in meetings may be disclosed.

Cultural Identity

One review warned of detrimental iatrogenic effects of twelve-step philosophy and labelled the organisations as cults, while another review asserts that these programs bore little semblance to religious cults and that the techniques used appeared beneficial to some. Another study found that a twelve-step program’s focus on self-admission of having a problem increases deviant stigma and strips members of their previous cultural identity, replacing it with the deviant identity. Another study asserts that the prior cultural identity may not be replaced entirely, but rather members found adapted a bicultural identity.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Twelve-step_program >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Empathy-Altruism?

Published on by Andrew MarshallLeave a comment

Introduction

Empathy-altruism is a form of altruism based on moral emotions or feelings for others.

Social exchange theory holds that in seemingly altruistic behaviour benefits to the altruist outweigh the costs the altruist bears and thus such behaviour is self-interested. In contrast, C. Daniel Batson holds that people help others in need out of genuine concern for the well-being of the other person. The key ingredient to such helping is “empathic concern”. According to Batson’s “empathy-altruism hypothesis”, if someone feels empathy towards another person, they will help them, regardless of what they can gain from it. An alternative hypothesis is “empathy-joy”, which states a person helps because they find pleasure at seeing another person experience relief. When a person does not feel empathy, the standards of social exchange theory apply.

Evidence

Debate over whether other-helping behaviour is motivated by self- or other-interest has raged between (approximately) 2000 and 2022. The prime actors in this debate included Daniel Batson, arguing for empathy-altruism, and Robert Cialdini, arguing for self-interest.

Batson recognises that people sometimes help for selfish reasons. He and his team were interested in finding ways to distinguish between motives. In one experiment, students were asked to listen to tapes from a radio programme. One of the interviews was with a woman named Carol, who talked about her bad car accident in which both of her legs were broken, her struggles and how behind she was becoming in class. Students who were listening to this particular interview were given a letter asking the student to share lecture notes and meet with her. The experimenters changed the level of empathy by telling one group to try to focus on how she was feeling (high empathy level) and the other group not to be concerned with that (low empathy level). The experimenters also varied the cost of not helping: the high cost group was told that Carol would be in their psychology class after returning to school and the low cost group believed she would finish the class at home. The results confirmed the empathy-altruism hypothesis: those in the high empathy group were almost equally likely to help her in either circumstance, while the low empathy group helped out of self-interest (seeing her in class every day made them feel guilty if they did not help).

Countering Hypotheses

Batson and colleagues set out to show that empathy motivates other-regarding helping behaviour not out of self-interest but out of true interest in the well-being of others. They addressed two hypotheses that counter the empathy-altruism hypothesis:

  • Empathy Specific Reward: Empathy triggers the need for social reward which can be gained by helping.
  • Empathy Specific Punishment: Empathy triggers the fear of social punishment which can be avoided by helping.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Empathy-altruism >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

An Overview of Self-Help Groups for Mental Health

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Introduction

Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing.

Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.

Types

Mutual Support and Self-Help

Mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. Mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.

Mutual support may include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. The former is where members seek to improve themselves, where as the latter set encompasses advocacy organisations such as the National Alliance on Mental Illness and Psychiatric Rehabilitation Association.

Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help organisations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favour of those affected.

Behaviour Control or Stress Coping Groups

Of individual therapy groups, researchers distinguish between Behaviour Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.

Significant differences exist between Behavioural Control groups and Stress Coping groups. Meetings of Behaviour Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behaviour Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behaviour Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.

Member vs Professional Leadership

Member leadership. In Germany, a specific subset of Conversation Circles are categorized as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.

Professionally Led Group Psychotherapy

Self-help groups are not intended to provide “deep” psychotherapy. Nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.

Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.

Professional Affiliation and Group Lifespan

If self-help groups are not affiliated with a national organisation, professional involvement increases their life expectancy. Conversely, if particular groups are affiliated with a national organisation professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group’s effectiveness.

Typology of Self-Help Groups

In 1991 researchers Marsha A. Schubert and Thomasina Borkman created five conceptual categorisations for self-help groups.

Unaffiliated Groups

Unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. These groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. Leaders serve to help the groups function by collecting donations not through controlling the members. Experiential knowledge is mostly found, and there is a high emphasis on sharing. An example of an unaffiliated group includes Wildflowers’ Movement in Los Angeles.

Federated Groups

Federated groups have superordinate levels of their own self-help organisation at state or national levels which makes publicity and literature available. The local unit of the federated self-help group retains full control of its decisions. These groups tend to rely on experiential knowledge, and professionals rarely directly interact. The leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. Leaders do not need to have formal training to gain their title. Examples of a federated self-help group would be Depression and Bipolar Support Alliance (DBSA) and Recovery International.

Affiliated Groups

Affiliated groups are subordinate to another group, a regional or national level of their own organisation. Local groups conform to the guidelines of the regional/national groups. Leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. Examples of an affiliated self-help group would be the National Alliance on Mental Illness (NAMI).

Managed Groups

Managed groups are based on a combination of self-help and professional techniques. These groups are populated generally through referrals and group activities are led by group members. Managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. Examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion.

Hybrid Groups

The hybrid group has characteristics of the affiliated and managed groups. Like affiliated groups, hybrid groups are organised by another level of their own organisation. To participate in specialised roles, training is developed by a higher level and enforced through trained leaders or facilitators. Like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge.

Group Processes

No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioural techniques, and complicated cognitive-restructuring methods are not necessary.

Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited to: acceptance, behavioural rehearsal, changing member’s perspectives of themselves, changing member’s perspectives of the world, catharsis, extinction, role modelling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalisation, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or “opening up”), and showing empathy.

Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.

  • Social support: Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
  • Experiential knowledge: Members obtain specialised information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increases their confidence.
  • Social learning theory: Members with experience become credible role models.
  • Social comparison theory: Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
  • Helper theory: Those helping each other feel greater interpersonal competence from changing other’s lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive “personalised learning” from working with helpees. The helpers’ self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others.

A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behaviour. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.

Relationship with Mental Health Professionals

A 1978 survey of mental health professionals in the United States found they had a relatively favourable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.

The 1987 Surgeon’s General Workshop marked a publicized call for egalitarian relationships with self-help groups. Surgeon General C. Everett Koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations.

A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.

Surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is “Doctors know better than we do how sickness can be treated. We know better than doctors how sick people can be treated as humans.”

Referrals

A large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. Professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. While twelve-step groups, such as Alcoholics Anonymous, make an indispensable contribution to the mental and/or substance use (M/SU) professional services system, a vast number of non-twelve-step groups remain underutilised within that system.

Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one-third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals.

Effectiveness

Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalisations, and shorter hospitalisations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programs, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalisation and shorter durations of hospitalisation indicate that self-help groups result in financial savings for the health care system, as hospitalisation is one of the most expensive mental health services. Similarly, reduced utilisation of other mental health services may translate into additional savings for the system.

While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.

Members of self-help groups for mental health rated their perception of the group’s effectiveness on average at 4.3 on a 5-point Likert scale.

Social support, in general, can lead to added benefits in managing stress, a factor that can exacerbate mental illness.

List

Emotions Anonymous

Refer to Emotions Anonymous.

Emotions Anonymous (EA) is a derivative programme of Neurotics Anonymous and open to anyone who wants to achieve emotional well-being. Following the Twelve Traditions, EA groups cannot accept outside contributions.

GROW

Refer to GROW (Support Group).

GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organisation now known as Recovery International) and integrated its processes into their programme. GROW’s original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.

Neurotics Anonymous

Refer to Neurotics Anonymous.

Neurotics Anonymous is a twelve-step programme open to anyone with a desire to become emotionally well. According to the Twelve Traditions followed in the programme, Neurotics Anonymous is unable to accept outside contributions. The term “neurotics” or “neuroses” has since fallen out of favour with mental health professionals, with the movement away from the psychoanalytic principles of a DSM-II. Branches of Neurotics Anonymous have since changed their name to Emotions Anonymous, which is currently the name in favor with the Minnesota Groups. Groups in Mexico, however, called Neuróticos Anónimos still are referred to by the same name, due to the term “neuroticos” having a less pejorative connotation in Spanish. This branch continues to flourish in Mexico City as well as largely Spanish-speaking cities in the United States, such as Los Angeles.

Recovery International

Refer to Recovery International.

Recovery, Inc. was founded in Chicago, Illinois, in 1937 by psychiatrist Abraham Low using principles in contrast to those popularised by psychoanalysis. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise between the loaded term neurotic and the colloquial phrase “nervous breakdown”); strictly encourages members to follow their physician’s, social worker’s, psychologist’s or psychiatrist’s orders; and does not operate with funding restrictions.

Fundamentally, Low believes “Adult life is not driven by instincts but guided by Will,” using a definition of will opposite of Arthur Schopenhauer’s. Low’s programme is based on increasing determination to act, self-control, and self-confidence. Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encouraged to attend Recovery International meetings in addition to their twelve-step group participation.

Criticism

There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognise a “newcomer” presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups’ formulaic approach, attrition rates, over-generalisation, and “panacea complex”.

Formulaic Approach

Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticised self-help group structure as being too rigid.

High Attrition Rates

There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.

Overgeneralisation

Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.

Panacea Complex

There is a risk that self-help group members may come to believe that group participation is a panacea—that the group’s processes can remedy any problem.

Sexual Predation and Opportunism

Often membership of non-associated self-help groups is run by volunteers. Monitoring of relationships and standards of conduct are seldom formalised within a group and are done on a self-regulating basis. This can mean undesirable and unethical initiation of sexual and intimate encounters are facilitated in these settings. Predatory and opportunistic behaviour in these environments which by association involve divulging volatile mental states, medication changes and life circumstances mean opportunities by those willing to leverage information that is often normally guarded and deeply personal, is a risk more-so than in other social meetup settings or professionally governed bodies.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Self-help_groups_for_mental_health >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Invisible Support?

Published on by Andrew MarshallLeave a comment

Introduction

In psychology, invisible support is a type of social support in which supportive exchanges are not visible to recipients.

There are two possible situations that can qualify as acts of invisible support. The first possibility entails a situation where “recipients are completely unaware of the supportive transaction between themselves and support-givers”. For example, a spouse may choose to spontaneously take care of housework without mentioning it to the other couple-member. Invisible support also occurs when “recipients are aware of an act that takes place but do not interpret the act as a supportive exchange”. In this case, a friend or family member may subtly provide advice in an indirect manner as a means to preserve the recipient’s self-esteem or to defer his or her attention from a stressful situation. Invisible support can be viewed on both ends of an exchange, in which the recipient is unaware of the support received and the provider enacts support in a skilful, subtle way.

Background

It is known that perceptions of social support availability predict better adjustment to stressful life events; it has been found that the perception of support availability is inherently comforting, and can serve as a psychological safety-net that motivates self-reliant coping efforts in the face of stress. Although the perception of support availability is associated with better adjustment, the knowledge that one has been the recipient of specific supportive acts has often been unhelpful to effectively reduce stress. The knowledge of receiving help may come at a cost with decreased feelings of self-esteem and self-efficacy, because it increases recipients’ awareness towards their personal difficulties to manage stressors. People’s well-intentioned support attempts may also be miscarried, and their efforts could either fail or even worsen the situation for a person under stress. Since supportive acts benefit recipients but their actual knowledge of receiving support is sometimes harmful, it has been theorised that the most effective support exchange would involve one in which the provider reports giving support but the recipient does not notice that support has occurred. From a cost-benefit point of view, invisible support would be optimal for the recipient because the benefits of provision are accrued while the costs of receipt are avoided. Using the same idea, it also implies that the least effective type of support would be one in which the provider does not report providing support but the recipient reports receiving it.

The first investigation of invisible support involved a couples study in which one member was preparing for the New York State Bar Exam. Support receipt and provision were measured by having both couple members complete daily diary entries. Over the course of one month, stressed individuals who reported low frequency of received support (but whose partner ranked their own actions as highly supportive) rated themselves low on anxiety and depression compared to other individuals who reported high frequency of received support.

Compared to Visible Support

A substantial body of work has evidence to suggest that support is most effective when it is invisible or goes unnoticed by recipients. While invisible support has been shown to benefit recipients over visibly supportive acts in some cases, there have also been instances where recipients have benefitted from visible support as well. For example, greater observed support enacted by intimate partners during couples’ support-relevant exchanges have been shown to build feelings of closeness and support, boost positive mood and self-esteem, and foster greater goal achievement and relationship quality across time.

It has been recently suggested that acts of invisible support and visible support may be beneficial or costly depending on different circumstances. To investigate this idea, a recent study in 2013 compared the short-term and long-term effects of visible and invisible support reception during romantic couples’ discussions of each partner’s personal goal. It was found that either type of support was more beneficial depending on the emotional distress that recipients felt at the time. Visible emotional support (support through reassurance, encouragement, and understanding) was associated with perceptions of greater support and discussion success for recipients who felt greater distress during the discussion. In contrast, invisible emotional support was not associated with recipients’ post-discussion perceptions of support or discussion success. For long-term support effects, it was found that only invisible emotional support predicted greater goal achievement across the following year.

When put together, these findings suggest that visible support and invisible support have unique functions for well-being. When people are under distress, visible support appears to be a short-term remedy to reassure recipients that they are cared for and supported. These benefits are only present when recipients are actually distressed during the time that the supportive act takes place. On the other hand, while invisible support tends to go unnoticed by recipients, it seems to play an integral role in the long-term success of goal-maintenance. This increasingly complex view of the implications of support visibility is reinforced by a growing body of research suggesting the effects of invisible social support – as with visible support – are moderated by provider, recipient, and contextual factors such as recipients’ perceptions of providers’ responsiveness to their needs, or the quality of the relationship between the support provider and recipient.

Effects on Support Providers

Refer to Social Support, Psychology, Stress (Psychological; Eustress and Distress), Coping (Psychology), Self-Esteem, and Self-Efficacy.

The effects of invisible support on recipients have been extensively investigated, but the consequences of invisible support on providers are less known. One study in 2016 investigated the benefits and costs of invisible support on couple-members who enacted supportive behaviours by differentiating the processes of invisible emotional support (support through reassurance, encouragement, and understanding) from processes of invisible instrumental support (providing tangible aid such as sending money or childcare). No costs of support-giving were found for providers when they demonstrated acts of invisible emotional support. The effects for invisible instrumental support told a different story, where providers who reported high relationship satisfaction were unaffected, but providers who reported low relationship satisfaction were negatively affected by their acts of invisible instrumental support with an increase in negative mood. These findings suggest that emotional comfort may be a more central function to maintain close relationships than instrumental support. Therefore, providing invisible emotional support may lead to less perceptions of a costly inequity than providing invisible instrumental support on average. However, since invisible instrumental support did not incur costs for providers who reported high relationship satisfaction, it implies that high relationship satisfaction may buffer potential costs that would otherwise be felt by support-providers. The differential results between invisible instrumental and emotional support indicate that a solid distinction between instrumental and emotional social support may be useful to take into account when investigating effects of invisible support as a whole.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Invisible_support >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Social Support?

Published on by Andrew Marshall4 Comments

Introduction

Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be:

  • Emotional (e.g. nurturance);
  • Informational (e.g. advice);
  • Companionship (e.g. sense of belonging);
  • Tangible (e.g. financial assistance); and/or
  • Intangible (e.g. personal advice).

Social support can be measured as the perception that one has assistance available, the actual received assistance, or the degree to which a person is integrated in a social network. Support can come from many sources, such as family, friends, pets, neighbours, co-workers, organisations, etc.

Government-provided social support may be referred to as public aid in some nations.

Social support is studied across a wide range of disciplines including psychology, communications, medicine, sociology, nursing, public health, education, rehabilitation, and social work. Social support has been linked to many benefits for both physical and mental health, but “social support” (e.g. gossiping about friends) is not always beneficial.

Social support theories and models were prevalent as intensive academic studies in the 1980s and 1990s, and are linked to the development of caregiver and payment models, and community delivery systems in the US and around the world. Two main models have been proposed to describe the link between social support and health: the buffering hypothesis and the direct effects hypothesis. Gender and cultural differences in social support have been found in fields such as education “which may not control for age, disability, income and social status, ethnic and racial, or other significant factors”.

Refer to Social Support Questionnaire, Communal Coping, and Invisible Support.

Categories and Definitions

Distinctions in Measurement

Social support can be categorised and measured in several different ways.

There are four common functions of social support:

  • Emotional support is the offering of empathy, concern, affection, love, trust, acceptance, intimacy, encouragement, or caring. It is the warmth and nurturance provided by sources of social support. Providing emotional support can let the individual know that he or she is valued.
  • Tangible support is the provision of financial assistance, material goods, or services. Also called instrumental support, this form of social support encompasses the concrete, direct ways people assist others.
  • Informational support is the provision of advice, guidance, suggestions, or useful information to someone. This type of information has the potential to help others problem-solve.
  • Companionship support is the type of support that gives someone a sense of social belonging (and is also called belonging). This can be seen as the presence of companions to engage in shared social activities. Formerly, it was also referred to as “esteem support” or “appraisal support,” but these have since developed into alternative forms of support under the name “appraisal support” along with normative and instrumental support.

Researchers also commonly make a distinction between perceived and received support. Perceived support refers to a recipient’s subjective judgement that providers will offer (or have offered) effective help during times of need. Received support (also called enacted support) refers to specific supportive actions (e.g. advice or reassurance) offered by providers during times of need.

Furthermore, social support can be measured in terms of structural support or functional support. Structural support (also called social integration) refers to the extent to which a recipient is connected within a social network, like the number of social ties or how integrated a person is within his or her social network. Family relationships, friends, and membership in clubs and organisations contribute to social integration. Functional support looks at the specific functions that members in this social network can provide, such as the emotional, instrumental, informational, and companionship support listed above. Data suggests that emotional support may play a more significant role in protecting individuals from the deleterious effects of stress than structural means of support, such as social involvement or activity.

These different types of social support have different patterns of correlations with health, personality, and personal relationships. For example, perceived support is consistently linked to better mental health whereas received support and social integration are not. In fact, research indicates that perceived social support that is untapped can be more effective and beneficial than utilised social support. Some have suggested that invisible support, a form of support where the person has support without his or her awareness, may be the most beneficial. This view has been complicated, however, by more recent research suggesting the effects of invisible social support – as with visible support – are moderated by provider, recipient, and contextual factors such as recipients’ perceptions of providers’ responsiveness to their needs, or the quality of the relationship between the support provider and recipient.

Sources

Social support can come from a variety of sources, including (but not limited to): family, friends, romantic partners, pets, community ties, and co-workers. Sources of support can be natural (e.g. family and friends) or more formal (e.g. mental health specialists or community organisations). The source of the social support is an important determinant of its effectiveness as a coping strategy. Support from a romantic partner is associated with health benefits, particularly for men. However, one study has found that although support from spouses buffered the negative effects of work stress, it did not buffer the relationship between marital and parental stresses, because the spouses were implicated in these situations. However, work-family specific support worked more to alleviate work-family stress that feeds into marital and parental stress. Employee humour is negatively associated with burnout, and positively with, stress, health and stress coping effectiveness. Additionally, social support from friends did provide a buffer in response to marital stress, because they were less implicated in the marital dynamic.

Early familial social support has been shown to be important in children’s abilities to develop social competencies, and supportive parental relationships have also had benefits for college-aged students. Teacher and school personnel support have been shown to be stronger than other relationships of support. This is hypothesized to be a result of family and friend social relationships to be subject to conflicts whereas school relationships are more stable.

Online Social Support

Social support is also available among social media sites. As technology advances, the availability for online support increases. Social support can be offered through social media websites such as blogs, Facebook groups, health forums, and online support groups.

Early theories and research into Internet use tended to suggest negative implications for offline social networks (e.g. fears that Internet use would undermine desire for face-to-face interaction) and users’ well-being. However, additional work showed null or even positive effects, contributing to a more nuanced understanding of online social processes. Emerging data increasingly suggest that, as with offline support, the effects of online social support are shaped by support provider, recipient, and contextual factors. For example, the interpersonal-connection-behaviours framework reconciles conflicts in the research literature by suggesting that social network site use is likely to contribute to well-being when users engage in ways that foster meaningful interpersonal connection. Conversely, use may harm well-being when users engage in passive consumption of social media.

Online support can be similar to face-to-face social support, but may also offer convenience, anonymity, and non-judgmental interactions. Online sources such as social media may be less redundant sources of social support for users with relatively little in-person support compared to persons with high in-person support. Online sources may be especially important as potential social support resources for individuals with limited offline support, and may be related to physical and psychological well-being. However, socially isolated individuals may also be more drawn to computer-mediated vs. in-person forms of interaction, which may contribute to bidirectional associations between online social activity and isolation or depression.

Support sought through social media can also provide users with emotional comfort that relates them to others while creating awareness about particular health issues. Research conducted by Winzelberg et al. evaluated an online support group for women with breast cancer finding participants were able to form fulfilling supportive relationships in an asynchronous format and this form of support proved to be effective in reducing participants’ scores on depression, perceived stress, and cancer-related trauma measures. This type of online communication can increase the ability to cope with stress. Social support through social media is potentially available to anyone with Internet access and allows users to create relationships and receive encouragement for a variety of issues, including rare conditions or circumstances.

Coulson claims online support groups provide a unique opportunity for health professionals to learn about the experiences and views of individuals. This type of social support can also benefit users by providing them with a variety of information. Seeking informational social support allows users to access suggestions, advice, and information regarding health concerns or recovery. Many need social support, and its availability on social media may broaden access to a wider range of people in need. Both experimental and correlational research have indicated that increased social network site use can lead to greater perceived social support and increased social capital, both of which predict enhanced well-being.

An increasing number of interventions aim to create or enhance social support in online communities. While preliminary data often suggest such programmes may be well-received by users and may yield benefits, additional research is needed to more clearly establish the effectiveness of many such interventions.

Until the late 2010s, research examining online social support tended to use ad hoc instruments or measures that were adapted from offline research, resulting in the possibility that measures were not well-suited for measuring online support, or had weak or unknown psychometric properties. Instruments specifically developed to measure social support in online contexts include the Online Social Support Scale (which has sub scales for esteem/emotional support, social companionship, informational support, and instrumental support) and the Online Social Experiences Measure (which simultaneously assesses positive and negative aspects of online social activity and has predictive validity regarding cardiovascular implications of online social support).

Links to Mental and Physical Health

Benefits

Mental Health

Social support profile is associated with increased psychological well-being in the workplace and in response to important life events. There has been an ample amount of evidence showing that social support aids in lowering problems related to one’s mental health. As reported by Cutrona, Russell, and Rose, in the elderly population that was in their studies, their results showed that elderly individuals who had relationships where their self-esteem was elevated were less likely to have a decline in their health. In stressful times, social support helps people reduce psychological distress (e.g. anxiety or depression). Social support can simultaneously function as a problem-focused (e.g. receiving tangible information that helps resolve an issue) and emotion-focused coping strategy (e.g. used to regulate emotional responses that arise from the stressful event) Social support has been found to promote psychological adjustment in conditions with chronic high stress like HIV, rheumatoid arthritis, cancer, stroke, and coronary artery disease. Whereas a lack of social support has been associated with a risk for an individuals mental health. This study also shows that the social support acts as a buffer to protect individuals from different aspects in regards to their mental and physical health, such as helping against certain life stressors. Additionally, social support has been associated with various acute and chronic pain variables (for more information, see Chronic pain).

People with low social support report more sub-clinical symptoms of depression and anxiety than do people with high social support. In addition, people with low social support have higher rates of major mental disorder than those with high support. These include post traumatic stress disorder, panic disorder, social phobia, major depressive disorder, dysthymic disorder, and eating disorders. Among people with schizophrenia, those with low social support have more symptoms of the disorder. In addition, people with low support have more suicidal ideation, and more alcohol and (illicit and prescription) drug problems. Similar results have been found among children. Religious coping has especially been shown to correlate positively with positive psychological adjustment to stressors with enhancement of faith-based social support hypothesized as the likely mechanism of effect. However, more recent research reveals the role of religiosity/spirituality in enhancing social support may be overstated and in fact disappears when the personality traits of “agreeableness” and “conscientiousness” are also included as predictors.

In a 2013 study, Akey et al. did a qualitative study of 34 men and women diagnosed with an eating disorder and used the Health Belief Model (HBM) to explain the reasons for which they forgo seeking social support. Many people with eating disorders have a low perceived susceptibility, which can be explained as a sense of denial about their illness. Their perceived severity of the illness is affected by those to whom they compare themselves to, often resulting in people believing their illness is not severe enough to seek support. Due to poor past experiences or educated speculation, the perception of benefits for seeking social support is relatively low. The number of perceived barriers towards seeking social support often prevents people with eating disorders from getting the support they need to better cope with their illness. Such barriers include fear of social stigma, financial resources, and availability and quality of support. Self-efficacy may also explain why people with eating disorders do not seek social support, because they may not know how to properly express their need for help. This research has helped to create a better understanding of why individuals with eating disorders do not seek social support, and may lead to increased efforts to make such support more available. Eating disorders are classified as mental illnesses but can also have physical health repercussions. Creating a strong social support system for those affected by eating disorders may help such individuals to have a higher quality of both mental and physical health.

Various studies have been performed examining the effects of social support on psychological distress. Interest in the implications of social support were triggered by a series of articles published in the mid-1970s, each reviewing literature examining the association between psychiatric disorders and factors such as change in marital status, geographic mobility, and social disintegration. Researchers realised that the theme present in each of these situations is the absence of adequate social support and the disruption of social networks. This observed relationship sparked numerous studies concerning the effects of social support on mental health.

One particular study documented the effects of social support as a coping strategy on psychological distress in response to stressful work and life events among police officers. Talking things over among co-workers was the most frequent form of coping utilized while on duty, whereas most police officers kept issues to themselves while off duty. The study found that the social support between co-workers significantly buffered the relationship between work-related events and distress.

Other studies have examined the social support systems of single mothers. One study by D’Ercole demonstrated that the effects of social support vary in both form and function and will have drastically different effects depending upon the individual. The study found that supportive relationships with friends and co-workers, rather than task-related support from family, was positively related to the mother’s psychological well-being. D’Ercole hypothesizes that friends of a single parent offer a chance to socialise, match experiences, and be part of a network of peers. These types of exchanges may be more spontaneous and less obligatory than those between relatives. Additionally, co-workers can provide a community away from domestic life, relief from family demands, a source of recognition, and feelings of competence. D’Ercole also found an interesting statistical interaction whereby social support from co-workers decreased the experience of stress only in lower income individuals. The author hypothesizes that single women who earn more money are more likely to hold more demanding jobs which require more formal and less dependent relationships. Additionally, those women who earn higher incomes are more likely to be in positions of power, where relationships are more competitive than supportive.

Many studies have been dedicated specifically to understanding the effects of social support in individuals with post traumatic stress disorder (PTSD). In a study by Haden et al., when victims of severe trauma perceived high levels of social support and engaged in interpersonal coping styles, they were less likely to develop severe PTSD when compared to those who perceived lower levels of social support. These results suggest that high levels of social support alleviate the strong positive association between level of injury and severity of PTSD, and thus serves as a powerful protective factor. In general, data shows that the support of family and friends has a positive influence on an individual’s ability to cope with trauma. In fact, a meta-analysis by Brewin et al. found that social support was the strongest predictor, accounting for 40%, of variance in PTSD severity. However, perceived social support may be directly affected by the severity of the trauma. In some cases, support decreases with increases in trauma severity.

College students have also been the target of various studies on the effects of social support on coping. Reports between 1990 and 2003 showed college stresses were increasing in severity. Studies have also shown that college students’ perceptions of social support have shifted from viewing support as stable to viewing them as variable and fluctuating. In the face of such mounting stress, students naturally seek support from family and friends in order to alleviate psychological distress. A study by Chao found a significant two-way correlation between perceived stress and social support, as well as a significant three-way correlation between perceived stress, social support, and dysfunctional coping. The results indicated that high levels of dysfunctional coping deteriorated the association between stress and well-being at both high and low levels of social support, suggesting that dysfunctional coping can deteriorate the positive buffering action of social support on well-being. Students who reported social support were found more likely to engage in less healthy activities, including sedentary behaviour, drug and alcohol use, and too much or too little sleep. Lack of social support in college students is also strongly related to life dissatisfaction and suicidal behaviour.

Physical Health

Social support has a clearly demonstrated link to physical health outcomes in individuals, with numerous ties to physical health including mortality. People with low social support are at a much higher risk of death from a variety of diseases (e.g. cancer or cardiovascular disease). Numerous studies have shown that people with higher social support have an increased likelihood for survival.

Individuals with lower levels of social support have: more cardiovascular disease, more inflammation and less effective immune system functioning, more complications during pregnancy, and more functional disability and pain associated with rheumatoid arthritis, among many other findings. Conversely, higher rates of social support have been associated with numerous positive outcomes, including faster recovery from coronary artery surgery, less susceptibility to herpes attacks, a lowered likelihood to show age-related cognitive decline, and better diabetes control. People with higher social support are also less likely to develop colds and are able to recover faster if they are ill from a cold. There is sufficient evidence linking cardiovascular, neuroendocrine, and immune system function with higher levels of social support. Social support predicts less atherosclerosis and can slow the progression of an already diagnosed cardiovascular disease. There is also a clearly demonstrated link between social support and better immune function, especially in older adults. While links have been shown between neuroendocrine functionality and social support, further understanding is required before specific significant claims can be made. Social support is also hypothesized to be beneficial in the recovery from less severe cancers. Research focuses on breast cancers, but in more serious cancers factors such as severity and spread are difficult to measure in the context of impacts of social support. The field of physical health often struggles with the combination of variables set by external factors that are difficult to control, such as the entangled impact of life events on social support and the buffering impact these events have. There are serious ethical concerns involved with controlling too many factors of social support in individuals, leading to an interesting crossroads in the research.

Costs

Social support is integrated into service delivery schemes and sometimes are a primary service provided by governmental contracted entities (e.g. companionship, peer services, family caregivers). Community services known by the nomenclature community support, and workers by a similar title, Direct Support Professional, have a base in social and community support “ideology”. All supportive services from supported employment to supported housing, family support, educational support, and supported living are based upon the relationship between “informal and formal” supports, and “paid and unpaid caregivers”. Inclusion studies, based upon affiliation and friendship, or the conversely, have a similar theoretical basis as do “person-centred support” strategies.

Social support theories are often found in “real life” in cultural, music and arts communities, and as might be expected within religious communities. Social support is integral in theories of aging, and the “social care systems” have often been challenged (e.g. creativity throughout the lifespan, extra retirement hours). Ed Skarnulis’ (state director) adage, “Support, don’t supplant the family” applies to other forms of social support networks.

Although there are many benefits to social support, it is not always beneficial. It has been proposed that in order for social support to be beneficial, the social support desired by the individual has to match the support given to him or her; this is known as the matching hypothesis. Psychological stress may increase if a different type of support is provided than what the recipient wishes to receive (e.g. informational is given when emotional support is sought). Additionally, elevated levels of perceived stress can impact the effect of social support on health-related outcomes.

Other costs have been associated with social support. For example, received support has not been linked consistently to either physical or mental health; perhaps surprisingly, received support has sometimes been linked to worse mental health. Additionally, if social support is overly intrusive, it can increase stress. It is important when discussing social support to always consider the possibility that the social support system is actually an antagonistic influence on an individual.

Two Dominant Models

There are two dominant hypotheses addressing the link between social support and health: the buffering hypothesis and the direct effects hypothesis. The main difference between these two hypotheses is that the direct effects hypothesis predicts that social support is beneficial all the time, while the buffering hypothesis predicts that social support is mostly beneficial during stressful times. Evidence has been found for both hypotheses.

In the buffering hypothesis, social support protects (or “buffers”) people from the bad effects of stressful life events (e.g. death of a spouse, job loss). Evidence for stress buffering is found when the correlation between stressful events and poor health is weaker for people with high social support than for people with low social support. The weak correlation between stress and health for people with high social support is often interpreted to mean that social support has protected people from stress. Stress buffering is more likely to be observed for perceived support than for social integration or received support. The theoretical concept or construct of resiliency is associated with coping theories.

In the direct effects (also called main effects) hypothesis, people with high social support are in better health than people with low social support, regardless of stress. In addition to showing buffering effects, perceived support also shows consistent direct effects for mental health outcomes. Both perceived support and social integration show main effects for physical health outcomes. However, received (enacted) support rarely shows main effects.

Theories to Explain the Links

Several theories have been proposed to explain social support’s link to health. Stress and coping social support theory dominates social support research and is designed to explain the buffering hypothesis described above. According to this theory, social support protects people from the bad health effects of stressful events (i.e. stress buffering) by influencing how people think about and cope with the events. An example in 2018 are the effects of school shootings on the well being and future of children and children’s health. According to stress and coping theory, events are stressful insofar as people have negative thoughts about the event (appraisal) and cope ineffectively. Coping consists of deliberate, conscious actions such as problem solving or relaxation. As applied to social support, stress and coping theory suggests that social support promotes adaptive appraisal and coping. Evidence for stress and coping social support theory is found in studies that observe stress buffering effects for perceived social support. One problem with this theory is that, as described previously, stress buffering is not seen for social integration, and that received support is typically not linked to better health outcomes.

Relational regulation theory (RRT) is another theory, which is designed to explain main effects (the direct effects hypothesis) between perceived support and mental health. As mentioned previously, perceived support has been found to have both buffering and direct effects on mental health. RRT was proposed in order to explain perceived support’s main effects on mental health which cannot be explained by the stress and coping theory. RRT hypothesizes that the link between perceived support and mental health comes from people regulating their emotions through ordinary conversations and shared activities rather than through conversations on how to cope with stress. This regulation is relational in that the support providers, conversation topics and activities that help regulate emotion are primarily a matter of personal taste. This is supported by previous work showing that the largest part of perceived support is relational in nature.

Life-span theory is another theory to explain the links of social support and health, which emphasizes the differences between perceived and received support. According to this theory, social support develops throughout the life span, but especially in childhood attachment with parents. Social support develops along with adaptive personality traits such as low hostility, low neuroticism, high optimism, as well as social and coping skills. Together, support and other aspects of personality (“psychological theories”) influence health largely by promoting health practices (e.g. exercise and weight management) and by preventing health-related stressors (e.g. job loss, divorce). Evidence for life-span theory includes that a portion of perceived support is trait-like, and that perceived support is linked to adaptive personality characteristics and attachment experiences. Lifespan theories are popular from their origins in Schools of Human Ecology at the universities, aligned with family theories, and researched through federal centres over decades (e.g. University of Kansas, Beach Centre for Families; Cornell University, School of Human Ecology).

Of the Big Five Personality Traits, agreeableness is associated with people receiving the most social support and having the least-strained relationships at work and home. Receiving support from a supervisor in the workplace is associated with alleviating tensions both at work and at home, as are inter-dependency and idiocentrism of an employee.

Biological Pathways

Many studies have tried to identify biopsychosocial pathways for the link between social support and health. Social support has been found to positively impact the immune, neuroendocrine, and cardiovascular systems. Although these systems are listed separately here, evidence has shown that these systems can interact and affect each other.

  • Immune system: Social support is generally associated with better immune function. For example, being more socially integrated is correlated with lower levels of inflammation (as measured by C-reactive protein, a marker of inflammation), and people with more social support have a lower susceptibility to the common cold.
  • Neuroendocrine system: Social support has been linked to lower cortisol (“stress hormone”) levels in response to stress. Neuroimaging work has found that social support decreases activation of regions in the brain associated with social distress, and that this diminished activity was also related to lowered cortisol levels.
  • Cardiovascular system: Social support has been found to lower cardiovascular reactivity to stressors. It has been found to lower blood pressure and heart rates, which are known to benefit the cardiovascular system.

Though many benefits have been found, not all research indicates positive effects of social support on these systems. For example, sometimes the presence of a support figure can lead to increased neuroendocrine and physiological activity.

Support Groups

Refer to Support Group.

Social support groups can be a source of informational support, by providing valuable educational information, and emotional support, including encouragement from people experiencing similar circumstances. Studies have generally found beneficial effects for social support group interventions for various conditions, including Internet support groups. These groups may be termed “self help” groups in nation-states, may be offered by non-profit organisations, and in 2018, may be paid for as part of governmental reimbursement schemes. According to Drebing, previous studies have shown that those going to support groups later show enhanced social support… in regard to groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), were shown to have a positive correlation with participation in their subsequent groups and abstaining from their addiction. Because correlation does not equal causation, going to those meeting does not cause one to abstain from divulging back into old habits rather that this been shown to be helpful in establishing sobriety. While many support groups are held where the discussions can be face to face there has been evidence that shows online support offers the same amount of benefits. Coulson found that through discussion forums several benefits can be added such as being able to cope with things and having an overall sense of well being.

Providing Support

There are both costs and benefits to providing support to others. Providing long-term care or support for someone else is a chronic stressor that has been associated with anxiety, depression, alterations in the immune system, and increased mortality. Thus, family caregivers and “university personnel” alike have advocated for both respite or relief, and higher payments related to ongoing, long-term care giving. However, providing support has also been associated with health benefits. In fact, providing instrumental support to friends, relatives, and neighbours, or emotional support to spouses has been linked to a significant decrease in the risk for mortality. Researchers found that within couples where one has been diagnosed with breast cancer, not only does the spouse with the illness benefit from the provision and receipt of support but so does the spouse with no illness. It was found that the relationship well being was the area that benefited for the spouses of those with breast cancer. Also, a recent neuroimaging study found that giving support to a significant other during a distressful experience increased activation in reward areas of the brain.

Social Defence System

In 1959 Isabel Menzies Lyth identified that threat to a person’s identity in a group where they share similar characteristics develops a defence system inside the group which stems from emotions experienced by members of the group, which are difficult to articulate, cope with and finds solutions to. Together with an external pressure on efficiency, a collusive and injunctive system develops that is resistant to change, supports their activities and prohibit others from performing their major tasks.

Gender and Culture

Gender Differences

Gender differences have been found in social support research. Women provide more social support to others and are more engaged in their social networks. Evidence has also supported the notion that women may be better providers of social support. In addition to being more involved in the giving of support, women are also more likely to seek out social support to deal with stress, especially from their spouses. However, one study indicates that there are no differences in the extent to which men and women seek appraisal, informational, and instrumental types of support. Rather, the big difference lies in seeking emotional support. Additionally, social support may be more beneficial to women. Shelley Taylor and her colleagues have suggested that these gender differences in social support may stem from the biological difference between men and women in how they respond to stress (i.e. flight or fight versus tend and befriend). Married men are less likely to be depressed compared to non-married men after the presence of a particular stressor because men are able to delegate their emotional burdens to their partner, and women have been shown to be influenced and act more in reaction to social context compared to men. It has been found that men’s behaviours are overall more asocial, with less regard to the impact their coping may have upon others, and women more prosocial with importance stressed on how their coping affects people around them. This may explain why women are more likely to experience negative psychological problems such as depression and anxiety based on how women receive and process stressors. In general, women are likely to find situations more stressful than males are. It is important to note that when the perceived stress level is the same, men and women have much fewer differences in how they seek and use social support.

Cultural Differences

Although social support is thought to be a universal resource, cultural differences exist in social support. In many Asian cultures, the person is seen as more of a collective unit of society, whereas Western cultures are more individualistic and conceptualise social support as a transaction in which one person seeks help from another. In more interdependent Eastern cultures, people are less inclined to enlist the help of others. For example, European Americans have been found to call upon their social relationships for social support more often than Asian Americans or Asians during stressful occasions, and Asian Americans expect social support to be less helpful than European Americans. These differences in social support may be rooted in different cultural ideas about social groups. It is important to note that these differences are stronger in emotional support than instrumental support. Additionally, ethnic differences in social support from family and friends have been found.

Cultural differences in coping strategies other than social support also exist. One study shows that Koreans are more likely to report substance abuse than European Americans are. Further, European Americans are more likely to exercise in order to cope than Koreans. Some cultural explanations are that Asians are less likely to seek it from fear of disrupting the harmony of their relationships and that they are more inclined to settle their problems independently and avoid criticism. However, these differences are not found among Asian Americans relative to their Europeans American counterparts.

Different cultures have different ways of socials support. In African American households support is limited. Many black mothers raise their children without a male figure. Women struggle with job opportunities due to job biases and racial discrimination. Many Black women face this harsh reality causing them to go through poverty. When there is poverty within home, the main focus is to make sure the bills are paid. Sometimes causing children to play adult roles at a very young age. Women trying to balance the mom and dad role, takes away from the moral support certain kids need.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Social_support >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

A Bus Called Friendship

Published on by Andrew MarshallLeave a comment

Manufacturer: My Heart.

Year: 1974.

Seats: Not sure, although in good condition as many unused.

Description:

There are several features that come as standard for this model.

  1. Air conditioning: Blows hot and cold, but with some ENCOURAGEMENT the right temperature is achieved.
  2. Wired for CCTV: We CARE that you have a safe and comfortable journey.
  3. Fully carpeted: It is important to feel SUPPORTed.
  4. To be HONEST generally handles well, being a DEPENDABLE drive, even with bumps in the road.
  5. Can get stuck in a rut now and again, but with SYMPATHY/EMPATHY usually drives out, even with the deep ones.
  6. A GENEROUS luggage compartment comes as standard; it is important make space for the luggage carried rather than cram in to much.
  7. Slower than other models, but this means more TIME to cater to onboard needs.
  8. Recently added some headrests and armrests after LISTENING to some FEEDBACK.
  9. A TRUSTy manual gearbox which we know you will LOVE.
  10. Seat Belts: Fitted as standard to provide a SAFE environment on the journey.
  11. Reclining seats: Fitted as standard to provide a COMFORTABLE journey.
  12. Comes with TV, DVD player, fridge, USB, WIFI, and power sockets to CATER for different NEEDS.
  13. Reverse Camera: Fitted as standard to avoid bumping into any nasty surprises BEHIND you before driving FORWARD.
  14. Ramp access: To AID those having difficulty getting onboard.

Given years of LOYAL service and had a number of modifications over the years that have added VALUE.

Viewing welcome, please contact to arrange.

I will LISTEN to and consider any REASONABLE offers.

What is an Intensive Outpatient Programme?

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Introduction

An intensive outpatient programme (IOP) is a kind of treatment service and support programme used primarily to treat eating disorders, bipolar disorder (including mania; and for Bipolar I and Bipolar II), unipolar depression, self harm and chemical dependency that does not rely on detoxification.

Refer to Partial Hospitalisation.

Background

IOP operates on a small scale and does not require the intensive residential or partial day services typically offered by the larger, more comprehensive treatment facilities.

The typical IOP programme offers group therapy and generally facilitates 6-30 hours a week of programming for addiction treatment. IOP allows the individual to be able to participate in their daily affairs, such as work, and then participate in treatment at an appropriate facility in the morning or at the end of the day. With an IOP, classes, sessions, meetings, and workshops are scheduled throughout the day, and individuals are expected to adhere to the strict structure of the program. Online IOP has shown to be effective, as well.

The typical IOP programme encourages active participation in 12-step programmes in addition to IOP participation. IOP can be more effective than individual therapy for chemical dependency.

IOP is also used by some HMOs as transitional treatment for patients just released from treatment in a psychiatric ward.

New Mental Health Care App for RN Families

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Royal Navy families can now access mental health support online.

The Naval Families Federation has launched a 12-month pilot scheme to provide free access to the Headspace app for families of regular and reserve RN personnel.

Working with support from Navy Command and the Royal Navy Family and People Support organisation, 3,000 licences have been bought.

To access the offer, the family member should visit www.nff.org.uk/headspace where they will be guided through the verification process.