Attachment, self and social knowledge, and distress in psychosis: a research portfolio
Potter, Hannah Iris
Background/Aims: People with a diagnosis of psychosis often experience stigmatising social encounters. These social encounters may influence the beliefs people hold, as research suggests that people develop a range of processes in an attempt to interpret information about both themselves and others. The internalisation of negative stereotypes about psychosis is one process used to explain how people's beliefs are influenced. Cognitive models highlight the relationship between self and social knowledge and mood. How people process social information might therefore have an important role in pathways to distress in psychosis. There is limited understanding of how different expressions of emotional distress might relate to the processing of social information. This research portfolio therefore has two aims. Firstly it aims to systematically review literature on the relationship between internalised stigma and distress for people with a schizophrenia spectrum diagnosis. It also aims to explore the relationship between attachment style, reflective functioning, personal beliefs about illness, and emotional distress in people who experience psychosis. Method: These two aims are addressed through two studies. The first study is reported in Chapter 1, where literature exploring the relationship between internalised stigma and measures of emotional distress was systematically reviewed. For this review, a search of electronic databases was conducted, included studies were assessed for quality, and results were outlined through a narrative synthesis. The empirical project reported in Chapter 2 employed a cross-sectional design to gather quantitative data from people who had a diagnosis related to psychosis. Mediation modelling was then used to explore cognitive appraisals as mediatory variables between attachment anxiety and emotional distress whilst controlling for psychotic symptomatology as a potential confounding variable. Results: Thirty studies were included in the systematic review, with over half of these being cross-sectional in design. Systematic review findings indicate a significant association between internalised stigma and depression, however the association with other measures of distress was inconsistent. Limited data was therefore available regarding the utility of cognitive interventions focusing upon internalised stigma for improving symptoms of distress in psychosis. Results from the empirical study indicate associations between attachment anxiety, cognitive appraisals, and emotional distress but not reflective functioning. Personal beliefs about illness regarding shame and control were found to mediate the relationship between attachment anxiety and distress. Conclusions: When reviewed systematically the relationship between internalised stigma and distress remained unclear. This is due in part to methodological limitations of included studies which did not allow the exploration of whether these negative beliefs about the self in relation to others around them leads to distress. However, findings from the empirical study suggested personal beliefs about illness could influence the relationship between attachment and emotional distress. Future interventions focusing upon internalised stigma as a vehicle for improving symptoms of distress in psychosis might therefore target perceptions of shame and control whilst recognising a wider range of outcomes for distress.