Tag: Support Group

What is Role Suction?

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Introduction

Role suction is a term introduced in the United States by Fritz Redl in the mid-20th century to describe the power of a social group to allocate roles to its members.

W.R. Bion’s group dynamics further explored the ways whereby the group (unconsciously) allocates particular functions to particular individuals in order to have its covert emotional needs met; and the process has recently been highlighted anew within the systems-centred therapy of Yvonne Agazarian.

Among regularly occurring group roles are those of the scapegoat for the group’s troubles; the joker; the peacemaker; the critic/spokesperson for group standards; the idol, or upholder of the group ideal; and the identified patient. In mixed gender groups, women may be disproportionately pressured by role suction into playing a nurturing/peacemaker role.

Driving Forces

The ease whereby people pick out those who play complementary games, and the psychological splitting of good and bad help fuel such role differentiation.

Behind role suction, such forces as projective identification and countertransference have been singled out as operating at an unconscious level in the group.

Role lock – confirming mutual suction into complementary roles, such as victim and abuser – is ensured by the intermeshing of projective identifications.

Wider Systems

The British anti-psychiatrists explored the theme of group suction in connection with role attribution in the family nexus, as well as with the allocations of roles in the wider social system, David Cooper suggesting that “there are always good or bad, loved or hated ‘mothers’ and ‘fathers’, older or younger ‘brothers’ and ‘sisters’…in any institutional structure”.

A wider variety of roles can however be found in organisational life, the person-in-role acting as a container for the (unconscious) group forces.

Role of the Therapist

Bion has described his experience as a group therapist when he:

“feels he is being manipulated so as to be playing a part, no matter how difficult to recognize, in somebody else’s phantasy…a temporary loss of insight, a sense of experiencing strong feelings, and at the same time a belief that their existence is quite adequately justified by the objective situation”.

Bion’s work has also been used to illustrate the part played by role suction in the selection of group leaders – dependent groups favouring narcissistic leaders, the fight/flight group paranoids.

R.D. Laing considered that a central part of the therapist’s job was “not to allow himself to collude with the patients in adopting a position in their phantasy-system: and, alternatively, not to use the patients to embody any phantasy of their own” – to resist role suction. Later therapists however have explored how a measure of adaptation to patients’ role suction – a degree of role responsiveness – can be a useful element in the therapeutic use of the countertransference

Criticism

From the point of view of systems centred therapy, the debate relates to the interface between a personal system and the psycho-dynamics of social systems themselves.

Debate has arisen about how far the group imposes roles, and how far the individual’s own personality goes to meet the group halfway. Earl Hopper has used the term personification to challenge Redl’s concept, suggesting instead that group roles reflect the underlying personality of the individual involved. However, Kibel objects that in many cases the roles imposed are in fact ego-dystonic; with others pointing to how personal tendencies combine with group expectations with varying degrees of fit.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Role_suction >; 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 are Drug Addiction Recovery Groups?

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Introduction

Drug addiction recovery groups are voluntary associations of people who share a common desire to overcome their drug addiction.

Outline

Different groups use different methods, ranging from completely secular to explicitly spiritual. Some programmes may advocate a reduction in the use of drugs rather than outright abstention. One survey of members who found active involvement in any addiction recovery group correlates with higher chances of maintaining sobriety. Although there is not a difference in whether group or individual therapy is better for the patient, studies show that any therapy increases positive outcomes for patients with substance use disorder. The survey found group participation increased when the individual members’ beliefs matched those of their primary support group (many addicts are members of multiple addiction recovery groups). Analysis of the survey results found a significant positive correlation between the religiosity of members and their participation in twelve-step programs (these programs describe themselves as spiritual rather than religious) and to a lesser level in non-religious SMART Recovery groups, the correlation factor being three times smaller for SMART Recovery than for the twelve-step addiction recovery groups. Religiosity was inversely related to participation in Secular Organisations for Sobriety.

A survey of a cross-sectional sample of clinicians working in outpatient facilities (selected from the SAMHSA On-line Treatment Facility Locator) found that clinicians only referring clients to twelve-step groups were more likely than those referring their clients to twelve-step groups and “twelve-step alternatives” to believe less strongly in the effectiveness of Cognitive Behavioural and psychodynamic-oriented therapy, and were likely to be unfamiliar with twelve-step alternatives. A logistic regression of clinician’s knowledge and awareness of Cognitive Behavioural Therapy effectiveness and preference for the twelve-step model was correlated with referring exclusively to twelve-step groups.

Twelve-Step Recovery Groups

Twelve-step programs are mutual aid organizations for the purpose of recovery from substance addictions, behavioural addictions and compulsions. Developed in the 1930s by alcoholics, the first twelve-step programme, Alcoholics Anonymous (AA), 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.

Participants attend meetings and are able to make new connections with other members who are striving towards a similar goal. If a person is unable to attend a meeting face-to-face, many of the groups have meetings by phone or online as another option. Each group has its own textbook, workbooks or both, which provide information about their program of recovery and suggestions on how to “work the steps”. Often, free literature is available for anyone who asks for it at a meeting. This provides potential new members or family members with relevant information about both the addiction and that specific groups’ version of the twelve-step process of recovery. New members are invited to work with another member who has already been through the twelve-steps at least once. That person serves as a guide to the new member, answers questions and provides feedback as the new member goes through the steps. These groups are spiritually based and encourage a belief in a power greater than the members. Most do not have one specific conception of what that means and allow the member to decide what spirituality means to them as it applies to their recovery. The groups emphasize living on a spiritual yet not necessarily religious basis. Groups typically advocate for complete abstinence, usually from all drugs including alcohol. This is because of the perceived potential for cross-addiction, the idea that there is a tendency to trade one addiction for another. Despite the idea of cross-addiction being accepted as real in many addiction recovery groups, there is said to be little empirical evidence to support it and recent research suggests that the opposite is more likely to be true.

The following is a list of twelve-step drug addiction recovery groups. Twelve-step programmes for problems other than drug addiction also exist.

  • Alcoholics Anonymous (AA) – This group gave birth to the twelve-step programme of recovery. Meetings are focused on alcoholism only and advocate complete abstinence. Meetings are held all over the world.
  • Cocaine Anonymous (CA) – This group is focused on cessation of cocaine and all other mind-altering substances. The programme advocates complete abstinence from all mind-altering substances in order to recover from the disease of addiction. Meetings are held all over the world.
  • Celebrate Recovery (CR) – Celebrate recovery is a recovery programme for any life problem, including addiction to alcohol and other drugs. In contrast to most 12-step programmes, the group recognises Jesus Christ as their higher power. Their groups are located in the United States.
  • Crystal Meth Anonymous (CMA) – This group focuses on abstinence from crystal meth although it does recognise the potential for cross-addiction, the tendency for an addict to substitute one addiction for another. Meetings are currently available in eight countries.
  • Heroin Anonymous (HA) – This group is focused on abstinence from heroin along with all other drugs including alcohol. Meetings are held in England and the United States.
  • Marijuana Anonymous (MA) – This group focuses of recovery from marijuana addiction. Groups meet in eleven countries.
  • Nicotine Anonymous (NicA) – This group is for those desiring to stop the use of nicotine in all forms. Groups are available in many countries.
  • Narcotics Anonymous (NA) – This group has meetings in 139 countries and focuses on recovery from the use of all drugs and alcohol. The group makes no distinction between any mood or mind-altering substance and encourages members to look for similarities the common problem they all share, rather than focusing on the differences.
  • Pagans in Recovery (PIR) – Pagans in recovery have adapted the twelve-step programme of recovery into language that is not overtly Christian as it was originally written so that those with other belief systems can more comfortably work the programme. They have their own literature but do not currently have an official site for meeting availability.
  • Pills Anonymous (PA) – This group is focused on addiction to pills and all other mind-altering substances. Groups are available in seven countries.

Non-Twelve-Step Recovery Groups

These groups do not follow the twelve-step recovery method, although their members may also attend twelve-step meetings. It is common for individuals to try many different meetings and groups while in recovery. What works for one may not work for another, so trying different types of meetings can be helpful to someone seeking recovery from drugs and alcohol.

  • The Washingtonians – A defunct 19th Century mutual aid society founded by alcoholics with a desire to maintain sobriety
  • Association of Recovering Motorcyclists (ARM) – This association of recovering motorcyclists is a brotherhood of men recovering from alcohol and/or drug addiction. They support one another in remaining abstinent from drugs and alcohol while continuing to ride motorcycles together regularly.
  • Recovering Women Riders (RWR) – Recovering women riders is a sisterhood of recovering women motorcyclists. Affiliated with the association of recovering motorcyclists, they also seek to support one another in remaining abstinent from drugs and alcohol while continuing to enjoy the lifestyle of riding bikes together.
  • LifeRing Secular Recovery (LSR)
  • Moderation Management (MM)
  • Rational Recovery (largely defunct)
  • Recovery Dharma (RD)
  • Refuge Recovery (RR)
  • Secular Organizations for Sobriety (SOS)
  • SMART Recovery
  • Women for Sobriety (WFS)

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Drug_addiction_recovery_groups >; 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 are Personal Boundaries?

Published on by Andrew Marshall1 Comment

Introduction

Personal boundaries or the act of setting boundaries is a life skill that has been popularised by self help authors and support groups since the mid 1980s.

It is the practice of openly communicating and asserting personal values as way to preserve and protect against having them compromised or violated. The term “boundary” is a metaphor – with in-bounds meaning acceptable and out-of-bounds meaning unacceptable. Without values and boundaries our identities become diffused and often controlled by the definitions offered by others. The concept of boundaries has been widely adopted by the counselling profession.

Usage and Application

This life skill is particularly applicable in environments with controlling people or people not taking responsibility for their own life.

Co-Dependents Anonymous recommends setting limits on what members will do to and for people and on what members will allow people to do to and for them, as part of their efforts to establish autonomy from being controlled by other people’s thoughts, feelings and problems.

The National Alliance on Mental Illness (NAMI) tells its members that establishing and maintaining values and boundaries will improve the sense of security, stability, predictability and order, in a family even when some members of the family resist. NAMI contends that boundaries encourage a more relaxed, non-judgemental atmosphere and that the presence of boundaries need not conflict with the need for maintaining an understanding atmosphere.

Overview

The three critical aspects of managing personal boundaries are:

AspectOutline
Defining ValuesA healthy relationship is an “inter-dependent” relationship of two “independent” people. Healthy individuals should establish values that they honour and defend regardless of the nature of a relationship (core or independent values). Healthy individuals should also have values that they negotiate and adapt in an effort to bond with and collaborate with others (inter-dependent values).
Asserting BoundariesIn this model, individuals use verbal and nonverbal communications to assert intentions, preferences and define what is inbounds and out-of-bounds with respect to their core or independent values. When asserting values and boundaries, communications should be present, appropriate, clear, firm, protective, flexible, receptive, and collaborative.
Honouring and DefendingMaking decision consistent with the personal values when presented with life choices or confronted or challenged by controlling people or people not taking responsibility for their own life.

Having healthy values and boundaries is a lifestyle, not a quick fix to an relationship dispute.

Values are constructed from a mix of conclusions, beliefs, opinions, attitudes, past experiences and social learning. Jacques Lacan considers values to be layered in a hierarchy, reflecting “all the successive envelopes of the biological and social status of the person” from the most primitive to the most advanced.

Personal values and boundaries operate in two directions, affecting both the incoming and outgoing interactions between people. These are sometimes referred to as the ‘protection’ and ‘containment’ functions.

Scope

The three most commonly mentioned categories of values and boundaries are:

  • Physical: Personal space and touch considerations; physical intimacy.
  • Mental: Thoughts and opinions.
  • Emotional: Feelings; emotional intimacy.

Some authors have expanded this list with additional or specialised categories such as spirituality, truth, and time/punctuality.

Assertiveness Levels

Nina Brown proposed four boundary types:

Boundary TypeOutline
SoftA person with soft boundaries merges with other people’s boundaries. Someone with a soft boundary is easily a victim of psychological manipulation.
SpongyA person with spongy boundaries is like a combination of having soft and rigid boundaries. They permit less emotional contagion than soft boundaries but more than those with rigid. People with spongy boundaries are unsure of what to let in and what to keep out.
RigidA person with rigid boundaries is closed or walled off so nobody can get close either physically or emotionally. This is often the case if someone has been the victim of physical, emotional, psychological, or sexual abuse. Rigid boundaries can be selective which depend on time, place or circumstances and are usually based on a bad previous experience in a similar situation.
FlexibleSimilar to spongy rigid boundaries but the person exercises more control. The person decides what to let in and what to keep out, is resistant to emotional contagion and psychological manipulation, and is difficult to exploit.

Unilateral vs Collaborative

There are also two main ways that boundaries are constructed:

  • Unilateral boundaries: One person decides to impose a standard on the relationship, regardless of whether others support it. For example, one person may decide to never mention an unwanted subject and to make a habit of leaving the room, ending phone calls, or deleting messages without replying if the subject is mentioned by others.
  • Collaborative boundaries: Everyone in the relationship group agrees, either tacitly or explicitly, that a particular standard should be upheld. For example, the group may decide not to discuss an unwanted subject, and then all members individually avoid mentioning it and work together to change the subject if someone mentions it.

Setting boundaries does not always require telling anyone what the boundary is or what the consequences are for transgressing it. For example, if a person decides to leave a discussion, that person may give an unrelated excuse, such as claiming that it’s time to do something else, rather than saying that the subject must not be mentioned.

Situations that can Challenge Personal Boundaries

Communal Influences

Freud described the loss of conscious boundaries that may occur when an individual is in a unified, fast-moving crowd.

Almost a century later, Steven Pinker took up the theme of the loss of personal boundaries in a communal experience, noting that such occurrences could be triggered by intense shared ordeals like hunger, fear or pain, and that such methods were traditionally used to create liminal conditions in initiation rites. Jung had described this as the absorption of identity into the collective unconscious.

Rave culture has also been said to involve a dissolution of personal boundaries, and a merger into a binding sense of communality.

Unequal Power Relationships

Also unequal relations of political and social power influence the possibilities for marking cultural boundaries and more generally the quality of life of individuals. Unequal power in personal relationships, including abusive relationships, can make it difficult for individuals to mark boundaries.

Dysfunctional Families

Overly Demanding ParentsIn the dysfunctional family the child learns to become attuned to the parent’s needs and feelings instead of the other way around.
Overly Demanding ChildrenParenting is a role that requires a certain amount of self-sacrifice and giving a child’s needs a high priority. A parent can, nevertheless, be codependent towards a child if the caretaking or parental sacrifice reaches unhealthy or destructive levels.
Codependent RelationshipsCodependency often involves placing a lower priority on one’s own needs, while being excessively preoccupied with the needs of others. Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships.
While a healthy relationship depends on the emotional space provided by personal boundaries, codependent personalities have difficulties in setting such limits, so that defining and protecting boundaries efficiently may be for them a vital part of regaining mental health.
In a codependent relationship, the codependent’s sense of purpose is based on making extreme sacrifices to satisfy their partner’s needs. Codependent relationships signify a degree of unhealthy clinginess, where one person does not have self-sufficiency or autonomy. One or both parties depend on the other for fulfilment. There is usually an unconscious reason for continuing to put another person’s life first - often the mistaken notion that self-worth comes from other people.
Mental Illness in the FamilyPeople with certain mental conditions are predisposed to controlling behaviour including those with obsessive compulsive disorder, paranoid personality disorder, borderline personality disorder, and narcissistic personality disorder, attention deficit disorder, and the manic state of bipolar disorder.
Borderline personality disorder (BPD): There is a tendency for loved ones of people with BPD to slip into caretaker roles, giving priority and focus to problems in the life of the person with BPD rather than to issues in their own lives. Too often in these relationships, the codependent will gain a sense of worth by being “the sane one” or “the responsible one”. Often, this shows up prominently in families with strong Asian cultures because of beliefs tied to the cultures.
Narcissistic personality disorder (NPD): For those involved with a person with NPD, values and boundaries are often challenged as narcissists have a poor sense of self and often do not recognise that others are fully separate and not extensions of themselves. Those who meet their needs and those who provide gratification may be treated as if they are part of the narcissist and expected to live up to their expectations.


Anger

Anger is a normal emotion that involves a strong uncomfortable and emotional response to a perceived provocation. Often, it indicates when one’s personal boundaries are violated. Anger may be utilised effectively by setting boundaries or escaping from dangerous situations.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Personal_boundaries >; 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.

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What is BPDFamily.com?

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Introduction

BPDFamily.com is an online support group for the family members of individuals with borderline personality disorder (BPD).

The group is one of the first “cyber” support groups to be recognised by the medical providers and receive professional referrals.

Outline

BPDFamily.com provides articles and message boards for family members to learn and share their experiences. The articles explain borderline personality disorder in understandable terms, and the discussion groups help to normalise the experiences of family members. The site appeals to family members who care about someone with BPD, but are frustrated with the relationship demands and conflict.

The site educates its members on concepts developed by Shari Manning PhD, Margalis Fjelstad PhD, Robert O. Friedel MD, and the NEA-BPD Family Connections Programme and reached out to academia for collaborations. The site has an interactive web program that teaches the basic principles of cognitive behavioural therapy (CBT).

The website and support group are certified as a reputable health information resource by the Health On the Net Foundation.

Funding has come from benefactors and member donations.

Use by Healthcare Professionals

BPDFamily.com is a listed reference site of the National Health Service (England), the National Alliance on Mental Illness, the National Education Alliance for Borderline Personality Disorder, and the Personality Disorders Awareness Network.

The group’s services and programmes are recommended in Primer on Borderline Personality Disorder, Abnormal and Clinical Psychology: An Introductory Textbook, Resources to Improve Emotional Health and Strengthen Relationships, I Hate You–Don’t Leave Me: Understanding the Borderline Personality, The Essential Family Guide to Borderline Personality Disorder, Stop Walking on Eggshells, and Discovering Your Inner Child: Transforming Toxic Patterns and Finding Your Joy. The site has been recommended by about.com expert Kristalyn Salters-Pedneault, PhD, Salon advice columnist Cary Tennis, PsychCentral columnist Kate Thieda, and by Randi Kreger at BPDCentral.

The organisation has been involved and referenced in clinical research studies conducted by: Columbia University, University of Wollongong (Australia), California State University, Sacramento, University of Toronto (Canada), University of Nevada, Bowling Green State University, Wright Institute (California), Colorado School of Professional Psychology, Long Island University, Alliant International University (California), Macquarie University (Australia), Middle Tennessee State University, Simon Fraser University (Canada) and Walden University. The organisation also supports industry research studies conducted by the Treatment and Research Advancements Association for Personality Disorder (TARA-APD).

In a January 2013 column, Kristalyn Salters-Pedneault at Boston University School of Medicine says that although she highly recommends this group for family members, readers with borderline personality disorder should keep in mind that some people have been hurt by their family member with BPD and are speaking from this perspective

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What is Schizophrenics Anonymous?

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Introduction

Schizophrenics Anonymous is a peer support group to help people who are affected by schizophrenia and related disorders including bipolar disorder, schizoaffective disorder, psychotic depression and psychosis.

Brief History

The programme was established in Detroit in 1985. The founder was Joanne Verbanic, who was diagnosed with schizophrenia in 1970. Shortly before forming SA, Verbanic publicly disclosed her diagnosis and discussed her illness on national television in an effort to challenge the stigma associated with the condition. She was a 2006 recipient of a Lilly Reintegration Award in recognition of her lifetime contributions to the mental health community, and she continued to be active as a spokesperson for persons with schizophrenia and other mental illness until her death on 07 May 2015.

By 2007, more than 150 local SA groups operated in 31 of the 50 United States, and in Australia, Brazil, Canada, Mexico, France, India and Venezuela.

Technical support for Schizophrenics Anonymous was provided by the National Schizophrenia Foundation (NSF) until 2007 when NSF ceased operations. In response to the loss of a national sponsor, a group of consumers, family members, and mental health providers came together to form a not-for-profit organisation, Schizophrenia and Related Disorders Alliance of America (SARDAA).

SARDAA promotes recovery for persons with schizophrenia and related brain disorders including bipolar disorder, schizoaffective disorder, depression with psychosis, and experience with psychosis. They envision a future in which every person with a schizophrenia-related brain disorder has the opportunity to recover from their disorders. The name Schizophrenics Anonymous was changed to Schizophrenia Alliance in 2015 and added Psychosis Support and Acceptance in 2018. They provide an online directory of SA groups, sponsor five weekly SA conference calls, and one Family and Friends conference call. At their annual conference, the group trains individuals and groups who have started or would like to start an SA group.

Although some SA groups are organised by mental health professionals, research has suggested that peer-led SA groups are more sustainable and longer lasting. Some groups are organised in psychiatric hospitals or jails and are not open to the public.

Programme Principles

The SA programme is based on the twelve-step model, but includes just six steps. The organisation describes the programme’s purpose of helping participants to learn about schizophrenia, “restore dignity and sense of purpose,” obtain “fellowship, positive support, and companionship,” improve their attitudes about their lives and their illnesses, and take “positive steps towards recovery.”

Joanne Verbanic wrote the original “Schizophrenics Anonymous” book, better known as “The Blue Book,” which describes the six steps to recovery. The steps require members to admit they need help, take responsibility for their choices and consequences, believe they have the inner strength to help themselves and others, forgive themselves and others, understand that false beliefs contribute to their problems and change those beliefs, and decide to turn their lives over to a higher power.

Research

One study about the risks of professional partnerships centres on the partnership between Schizophrenics Anonymous (SA) and the Mental Health Association of Michigan (MHAM) over a 14-year period. The study shows that the professional partnership resulted in increased access to SA Groups across Michigan and organisation expansion and development within SA. The professional influence also lead more SA Groups to be held in more traditional mental health treatment settings and led to more professional-led SA groups.

Self-help groups are more available to people who live independently. Researchers at Michigan State University studied whether SA would be successful in group homes. The results were positive: the groups had high attendance and participation and were well liked. However, staff members controlled who could lead and who could attend the meetings, and how the meetings should be run. The programs fell apart. The same obstacle occurred in SA groups started in prisons and monitored by employees.

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What is GROW (Support Group)?

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Introduction

GROW is a peer support and mutual-aid organisation for recovery from, and prevention of, serious mental illness. GROW was founded in Sydney, Australia in 1957 by Father Cornelius B. “Con” Keogh, a Roman Catholic priest, and psychiatric patients who sought help with their mental illness in Alcoholics Anonymous (AA).

Consequently, GROW adapted many of AA’s principles and practices. As the organisation matured, GROW members learned of Recovery International, an organisation also created to help people with serious mental illness, and integrated pieces of its will-training methods. As of 2005 there were more than 800 GROW groups active worldwide. GROW groups are open to anyone who would like to join, though they specifically seek out those who have a history of psychiatric hospitalisation or are socioeconomically disadvantaged. Despite the capitalisation, GROW is not an acronym. Much of GROW’s initial development was made possible with support from Orval Hobart Mowrer, Reuben F. Scarf, W. Clement Stone and Lions Clubs International.

Processes

GROW’s literature includes the Twelve Stages of Decline, which indicate that emotional illness begins with self-centeredness, and the Twelve Steps of Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW members view recovery as an ongoing life process rather than an outcome and are expected to continue following the Steps after completing them in order to maintain their mental health.

The Twelve Stages of Decline

  1. We gave too much importance to ourselves and our feelings.
  2. We grew inattentive to God’s presence and providence and God’s natural order in our lives.
  3. We let competitive motives, in our dealings with others, prevail over our common personal welfare.
  4. We expressed our suppressed certain feelings against the better judgement of conscience or sound advice.
  5. We began thinking in isolation from others, following feelings and imagination instead of reason.
  6. We neglected the care and control of our bodies.
  7. We avoided recognising our personal decline and shrank from the task of changing.
  8. We systematically disguised in our imaginations the real nature of our unhealthy conduct.
  9. We became a prey to obsessions, delusions and hallucinations.
  10. We practised irrational habits, under elated feelings of irresponsibility or despairing feelings of inability or compulsion.
  11. We rejected advice and refused to co-operate with help.
  12. We lost all insight into our condition.

The Twelve Steps of Recovery and Personal Growth

  1. We admitted to personal disorder in our lives.
  2. We firmly resolved to restore order in our lives and co-operated with the help that we needed.
  3. We surrendered to the healing power God or We surrendered to the healing power of truth.
  4. We made personal inventory and accepted ourselves.
  5. We made moral inventory and cleaned out our hearts.
  6. We endured until ‘cured’.
  7. We took care and control of our bodies.
  8. We learned to think by reason rather than by feelings and imagination.
  9. We trained our wills to regulate our feelings.
  10. We took our responsible and caring place in the wider community.
  11. We grew daily closer to maturity.
  12. We carried GROW’s hopeful, healing, and transforming message to others in need.

GROW suggests atheists and agnostics use “We became inattentive to objective natural order in our lives” and “We trusted in a health-giving power in our lives as a whole” for the Second Stage of Decline and Third Step of Personal Growth, respectively.

Results of Qualitative Analysis

Statistical evaluations of interviews with GROW members found they identified self-reliance, industriousness, peer support, and gaining a sense of personal value or self-esteem as the essential ingredients of recovery. Similar evaluations of GROW’s literature revealed thirteen core principles of GROW’s program. They are reproduced in the list below by order of relevance, with a quote from GROW’s literature, explaining the principle.

  1. Be Reasonable: “We learned to think by reason rather than by feelings and imagination.”
  2. Decentralize, participate in community: “…decentralization from self and participation in a community of persons is the very process of recovery or personal growth.”
  3. Surrender to the Healing Power of a wise and loving God: “God, who made me and everything connected with me, can overcome any and every evil that affects my life.”
  4. Grow Closer to Maturity: “Maturity is a coming to terms with oneself, with others, and with life as a whole.”
  5. Activate One’s Self to Recover and Grow “Take your fingers off your pulse and start living.”
  6. Become Hopeful: “I can, and ultimately will, become completely well; God who made me can restore me and enable me to do my part. The best in life and love and happiness is ahead of me.”
  7. Settle for Disorder: “Settle for disorder in lesser things for the sake of order in greater things; and therefore be content to be discontent in many things.”
  8. Be Ordinary: “I can do whatever ordinary good people do, and avoid whatever ordinary good people avoid. My special abilities will develop in harmony only if my foremost aim is to be a good ordinary human being.”
  9. Help Others: We carried the GROW message to others in need.
  10. Accept One’s Personal Value: “No matter how bad my physical, mental, social or spiritual condition I am always a human person, loved by God and a connecting link between persons; I am still valuable, my life has a purpose, and I have my unique place and my unique part in my Creator’s own saving, healing and transforming work.”
  11. Use GROW: “Use the hopeful and cheerful language of GROW.”
  12. Gain Insight: “We made moral inventory and cleaned out our hearts.”
  13. Accept Help: “We firmly resolved to get well and co-operated with the help that we needed.”

Effectiveness

Participation in GROW has been shown to decrease the number of hospitalisations per member as well as the duration of hospitalisations when they occur. Members report an increased sense of security and self-esteem, and decreased anxiety. A longitudinal study of GROW membership found time involved in the programme correlated with increased autonomy, environmental mastery, personal growth, self-acceptance and social skills. Women in particular experience positive identity transformation, build friendships and find a sense of community in GROW groups.

Literature

The Programme of Growth to Maturity, generally referred to as the ‘Blue Book’, is the principal literature used in GROW groups. The book is divided into three sections based on the developmental stages of members: ‘Beginning Growers’, ‘Progressing Growers’ and ‘Seasoned Growers’. Additionally, there are three related books written by Cornelius B. Keogh, and one by Anne Waters, used in conjunction with the Blue Book.

  • GROW (1983). GROW: World Community Mental Health Movement: The Program of Growth to Maturity (the “Blue Book”). Sydney, Australia: GROW Publications. OCLC 66288113.
  • Keogh, Cornelius B. (1975). Readings for mental health (the “Brown Book”). Sydney, Australia: GROW Publications. ISBN 0-909114-00-5. OCLC 47699449.
  • Keogh, Cornelius B.; GROW (Australia) (1967). Readings for recovery (the “Red Book”). Sydney Australia: GROW. OCLC 154602570.
  • Keogh, Cornelius B. (1967). Recovery. Sydney, Australia. OCLC 57499165.
  • Waters, Anne (2005). GROWing to Maturity: A Potpourri of Readings for Mental Health (the “Lavender Book”). GROW in Ireland Ltd. ISBN 0-9529198-2-6.