Understanding and ameliorating stigma towards clients with a personality disorder: an acceptance and commitment therapy-based approach

Abstract

It is regrettably common for mental health staff to act without sufficient compassion towards the people they serve. Professionals’ judgmental attitudes and stigmatising actions harm not only their clients but also the staff themselves. This thesis aimed (a) to model the relationships between stigma and client and staff outcomes, and (b) to evaluate the effectiveness of a new form of self-management training, based on the principles of Acceptance and Commitment Therapy, in reducing levels of staff stigma towards individuals with personality disorder (PDs), a particularly complex and intransigent mental health problem.

Five studies examined the theoretical underpinnings and application of ACT-based training (ACTr) for staff working with PDs. Studies 1 and 2 determined that two key ACT processes, thought believability and psychological inflexibility, underpinned the relationships between staff stigma and both negative client and staff outcomes. Study 3 provided a novel, comparative evaluation of ACTr and Dialectical Behaviour Therapy based client-management training (DBTr) for 100 mental health staff working with PDs. Both interventions produced positive and sustained changes in staff attitudes and client outcomes but no differential group effects emerged. Based on these findings, extensive refinements were made to the original ACT training protocol and evaluated in Study 4, in preparation for the final comparative study. Study 5 incorporated these changes, comparing the revised ACTr protocol with psycho-educational training (PETr) for 95 non-specialist staff. Results indicated positive and sustained changes in staff attitudes and client outcomes but no differential group effects or sustained changes in process variables were found. Potential problems and pitfalls in applying ACT-based training with clinical staff are considered

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