Skip to main content

Advertisement

SpringerLink
Log in

Mindfulness Model of Stigma Resistance Among Individuals with Psychiatric Disorders

  • ORIGINAL PAPER
  • Published:
Mindfulness Aims and scope Submit manuscript

Abstract

Research shows that mindfulness may help individuals with psychiatric disorders resist stigma and improve their well-being. Less is known, however, about the underlying processes. The present study examined whether mindfulness was associated with stigma resistance and, in turn, life satisfaction among individuals with psychiatric disorders, as well as the potential mechanism underlying these associations. Cross-sectional questionnaire data were collected from 311 individuals with psychiatric disorders residing in Hong Kong, China. Structural equation modeling showed that mindfulness was positively associated with stigma resistance, and this association was mediated by self-compassion and psychological flexibility. Moreover, stigma resistance was positively associated with life satisfaction, and this association was mediated by self-stigma content and self-stigma process. Findings contributed to the literature by revealing the potential pathways through which mindfulness may help individuals with psychiatric disorders build resilience against stigma and improve their subjective quality of life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Birnie, K., Speca, M., & Carlson, L. E. (2010). Exploring self-compassion and empathy in the context of mindfulness-based stress reduction (MBSR). Stress and Health, 26(5), 359–371.

    Article  Google Scholar 

  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688.

    Article  PubMed  Google Scholar 

  • Bowen, N. K., & Guo, S. (2012). Structural equation modeling. New York: Oxford University Press.

    Google Scholar 

  • Brach, T. (2003). Radical acceptance: embracing your life with the heart of a Buddha. New York: Bantam.

    Google Scholar 

  • Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848.

    Article  PubMed  Google Scholar 

  • Caron, J., Mercier, C., Diaz, P., & Martin, A. (2005). Socio-demographic and clinical predictors of quality of life in patients with schizophrenia or schizo-affective disorder. Psychiatry Research, 137(3), 203–213.

    Article  PubMed  Google Scholar 

  • Chan, K. K. S., & Lam, C. B. (2017). Trait mindfulness attenuates the adverse psychological impact of stigma on parents of children with autism spectrum disorders. Mindfulness, 8(4), 984–994.

    Article  Google Scholar 

  • Chan, K. K. S., & Lam, C. B. (in press). The impact of familial expressed emotion on clinical and personal recovery among patients with psychiatric disorders: the mediating roles of self-stigma content and process.

  • Chan, K. K. S., & Mak, W. W. S. (2014). The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community. Quality of Life Research, 23(9), 2559–2568.

    Article  PubMed  Google Scholar 

  • Chan, K. K. S., & Mak, W. W. S. (2017). The content and process of self-stigma in people with mental illness. American Journal of Orthopsychiatry, 87(1), 34–43.

    Article  PubMed  Google Scholar 

  • Chan, H. L., Lo, L. Y., Lin, M., & Thompson, N. (2016). Revalidation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R) with its newly developed Chinese version (Ch-CAMS-R). Journal of Pacific Rim Psychology, 10(e1), 1–10.

    Article  Google Scholar 

  • Chang, C. C., Wu, T. H., Chen, C. Y., Wang, J. D., & Lin, C. Y. (2014). Psychometric evaluation of the Internalized Stigma of Mental Illness Scale for patients with mental illnesses: measurement invariance across time. PLoS One, 9(6), e98767.

    Article  PubMed  PubMed Central  Google Scholar 

  • Chen, J., Yan, L. S., & Zhou, L. H. (2011). Reliability and validity of Chinese version of Self-compassion Scale. Chinese Journal of Clinical Psychology, 19(6), 734–736.

    Google Scholar 

  • Corrigan, P. W., & Shapiro, J. R. (2010). Measuring the impact of programs that challenge the public stigma of mental illness. Clinical Psychology Review, 30(8), 907–922.

    Article  PubMed  PubMed Central  Google Scholar 

  • Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53.

    Google Scholar 

  • Diener, E. D., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75.

    Article  PubMed  Google Scholar 

  • Feldman, C. (2005). Compassion: listening to the cries of the world. Berkeley, CA: Rodmell Press.

    Google Scholar 

  • Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. P. (2007). Mindfulness and emotion regulation: the development and initial validation of the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29(3), 177–190.

    Article  Google Scholar 

  • Firmin, R. L., Luther, L., Lysaker, P. H., Minor, K. S., & Salyers, M. P. (2016). Stigma resistance is positively associated with psychiatric and psychosocial outcomes: a meta-analysis. Schizophrenia Research, 175(1–3), 118–128.

    Article  PubMed  Google Scholar 

  • Fung, K. M., Tsang, H. W., Corrigan, P. W., Lam, C. S., & Cheng, W. M. (2007). Measuring self-stigma of mental illness in China and its implications for recovery. International Journal of Social Psychiatry, 53(5), 408–418.

    Article  PubMed  Google Scholar 

  • Girma, E., Tesfaye, M., Froeschl, G., Möller-Leimkühler, A. M., Dehning, S., & Müller, N. (2013). Facility based cross-sectional study of self stigma among people with mental illness: towards patient empowerment approach. International Journal of Mental Health Systems, 7, 21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hall, G. C. N., Hong, J. J., Zane, N. W. S., & Meyer, O. L. (2011). Culturally-competent treatments for Asian Americans: the relevance of mindfulness and acceptance-based psychotherapies. Clinical Psychology: Science and Practice, 18(3), 215–231.

    Google Scholar 

  • Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639–665.

    Article  Google Scholar 

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.

    Article  PubMed  Google Scholar 

  • Ho, R. W., Chang, W. C., Kwong, V. W., Lau, E. S., Chan, G. H., Jim, O. T., et al. (in press). Prediction of self-stigma in early psychosis: 3-year follow-up of the randomized-controlled trial on extended early intervention. Schizophrenia Research.

  • Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.

    Article  Google Scholar 

  • Kabat-Zinn, J. (1994). Wherever you go, there you are: mindfulness meditation in everyday life. New York: Hyperion.

    Google Scholar 

  • Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: a review of empirical studies. Clinical Psychology Review, 31(6), 1041–1056.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kornfield, J. (1993). A path with heart. New York: Bantam Books.

    Google Scholar 

  • Lam, C. S., Tsang, H. W., Corrigan, P. W., Lee, Y. T., Angell, B., Shi, K., et al. (2010). Chinese lay theory and mental illness stigma: implications for research and practices. Journal of Rehabilitation, 76(1), 35–40.

    Google Scholar 

  • Lau, Y. W., Picco, L., Pang, S., Jeyagurunathan, A., Satghare, P., Chong, S. A., & Subramaniam, M. (2017). Stigma resistance and its association with internalised stigma and psychosocial outcomes among psychiatric outpatients. Psychiatry Research, 257, 72–78.

    Article  PubMed  Google Scholar 

  • Lien, Y. J., Kao, Y. C., Liu, Y. P., Chang, H. A., Tzeng, N. S., Lu, C. W., & Loh, C. H. (2015). Internalized stigma and stigma resistance among patients with mental illness in Han Chinese population. Psychiatric Quarterly, 86(2), 181–197.

    Article  PubMed  Google Scholar 

  • Lillis, J., Hayes, S. C., Bunting, K., & Masuda, A. (2009). Teaching acceptance and mindfulness to improve the lives of the obese: a preliminary test of a theoretical model. Annals of Behavioral Medicine, 37(1), 58–69.

    Article  PubMed  Google Scholar 

  • Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.

    Article  Google Scholar 

  • Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Social Science and Medicine, 71(12), 2150–2161.

    Article  PubMed  Google Scholar 

  • Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: model, manual development, and pilot outcomes. Addiction Research and Theory, 16(2), 149–165.

    Article  PubMed  Google Scholar 

  • Luoma, J., Drake, C. E., Kohlenberg, B. S., & Hayes, S. C. (2011). Substance abuse and psychological flexibility: the development of a new measure. Addiction Research and Theory, 19(1), 3–13.

    Article  Google Scholar 

  • Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2012). Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Journal of Consulting and Clinical Psychology, 80(1), 43–53.

    Article  PubMed  Google Scholar 

  • MacBeth, A., & Gumley, A. (2012). Exploring compassion: a meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32(6), 545–552.

    Article  PubMed  Google Scholar 

  • Mak, W. W., & Cheung, R. Y. (2010). Self-stigma among concealable minorities in Hong Kong: conceptualization and unified measurement. American Journal of Orthopsychiatry, 80(2), 267–281.

    Article  PubMed  Google Scholar 

  • Mak, W. W., Poon, C. Y., Pun, L. Y., & Cheung, S. F. (2007). Meta-analysis of stigma and mental health. Social Science and Medicine, 65(2), 245–261.

    Article  PubMed  Google Scholar 

  • Mak, W. W., Chan, R. C., Pang, I. H., Chung, N. Y., Yau, S. S., & Tang, J. P. (2016). Effectiveness of Wellness Recovery Action Planning (WRAP) for Chinese in Hong Kong. American Journal of Psychiatric Rehabilitation, 19(3), 235–251.

    Article  Google Scholar 

  • Mak, W. W., Chan, R. C., Wong, S. Y., Lau, J. T., Tang, W. K., Tang, A. K., et al. (2017). A cross-diagnostic investigation of the differential impact of discrimination on clinical and personal recovery. Psychiatric Services, 68(2), 159–166.

    Article  PubMed  Google Scholar 

  • Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250.

    Article  Google Scholar 

  • Neff, K. D., & Pommier, E. (2013). The relationship between self-compassion and other-focused concern among college undergraduates, community adults, and practicing meditators. Self and Identity, 12(2), 160–176.

    Article  Google Scholar 

  • Neff, K. D., & Tirch, D. (2013). Self-compassion and ACT. In T. B. Kashdan & J. Ciarrochi (Eds.), Mindfulness, acceptance, and positive psychology: the seven foundations of well-being (pp. 78–106). Oakland: Context Press/New Harbinger Publications.

    Google Scholar 

  • Palmeira, L., Pinto-Gouveia, J., & Cunha, M. (2017). Exploring the efficacy of an acceptance, mindfulness & compassionate-based group intervention for women struggling with their weight (Kg-Free): a randomized controlled trial. Appetite, 112, 107–116.

    Article  PubMed  Google Scholar 

  • Papadopoulos, C., Foster, J., & Caldwell, K. (2013). ‘Individualism-collectivism’ as an explanatory device for mental illness stigma. Community Mental Health Journal, 49(3), 270–280.

    Article  PubMed  Google Scholar 

  • Patsiopoulos, A. T., & Buchanan, M. J. (2011). The practice of self-compassion in counseling: a narrative inquiry. Professional Psychology: Research and Practice, 42(4), 301–307.

    Article  Google Scholar 

  • Quinn, D. M., Williams, M. K., & Weisz, B. M. (2015). From discrimination to internalized mental illness stigma: the mediating roles of anticipated discrimination and anticipated stigma. Psychiatric Rehabilitation Journal, 38(2), 103–108.

    Article  PubMed  PubMed Central  Google Scholar 

  • Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self-compassion scale. Clinical Psychology and Psychotherapy, 18(3), 250–255.

    Article  PubMed  Google Scholar 

  • Rapgay, L., & Bystrisky, A. (2009). Classical mindfulness: an introduction to its theory and practice for clinical application. Annals of the New York Academy of Sciences, 1172, 148–162.

    Article  PubMed  Google Scholar 

  • Ritsher, J. B., Otilingam, P. G., & Grajales, M. (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Research, 121(1), 31–49.

    Article  PubMed  Google Scholar 

  • Ritsner, M., Ponizovsky, A., Endicott, J., Nechamkin, Y., Rauchverger, B., Silver, H., & Modai, I. (2002). The impact of side-effects of antipsychotic agents on life satisfaction of schizophrenia patients: a naturalistic study. European Neuropsychopharmacology, 12(1), 31–38.

    Article  PubMed  Google Scholar 

  • Rogers, W. M., & Schmitt, N. (2004). Parameter recovery and model fit using multidimensional composites: a comparison of four empirical parceling algorithms. Multivariate Behavioral Research, 39(3), 379–412.

    Article  Google Scholar 

  • Salzberg, S. (1997). Lovingkindness: the revolutionary art of happiness. Boston, MA: Shambala.

    Google Scholar 

  • Salzberg, S. (2005). The force of kindness: change your life with love and compassion. Boulder, CO: Sounds True.

    Google Scholar 

  • Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological Methods, 7(4), 422–445.

    Article  PubMed  Google Scholar 

  • Sibitz, I., Unger, A., Woppmann, A., Zidek, T., & Amering, M. (2011). Stigma resistance in patients with schizophrenia. Schizophrenia Bulletin, 37(2), 316–323.

    Article  PubMed  Google Scholar 

  • Skinta, M. D., Lezama, M., Wells, G., & Dilley, J. W. (2015). Acceptance and compassion-based group therapy to reduce HIV stigma. Cognitive and Behavioral Practice, 22(4), 481–490.

    Article  Google Scholar 

  • Slade, M. (2009). Personal recovery and mental illness: a guide for mental health professionals. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Strauss, C., Taylor, B. L., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47, 15–27.

    Article  PubMed  Google Scholar 

  • Stuart, H. (2008). Fighting the stigma caused by mental disorders: past perspectives, present activities, and future directions. World Psychiatry, 7(3), 185–188.

    Article  PubMed  PubMed Central  Google Scholar 

  • Teddlie, C., & Tashakkori, A. (2009). Foundations of mixed methods research: integrating quantitative and qualitative approaches in the social and behavioral sciences. Newbury Park, CA: Sage.

    Google Scholar 

  • Thoits, P. A. (2011). Resisting the stigma of mental illness. Social Psychology Quarterly, 74(1), 6–28.

    Article  Google Scholar 

  • Tsang, H. W., Angell, B., Corrigan, P. W., Lee, Y. T., Shi, K., Lam, C. S., et al. (2007). A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: implications for recovery. Social Psychiatry and Psychiatric Epidemiology, 42(9), 723–733.

    Article  PubMed  Google Scholar 

  • Verhaeghe, M., Bracke, P., & Bruynooghe, K. (2008). Stigmatization and self-esteem of persons in recovery from mental illness: the role of peer support. International Journal of Social Psychiatry, 54(3), 206–218.

    Article  PubMed  Google Scholar 

  • Weng, H. Y., Fox, A. S., Shackman, A. J., Stodola, D. E., Caldwell, J. Z., Olson, M. C., et al. (2013). Compassion training alters altruism and neural responses to suffering. Psychological Science, 24(7), 1171–1180.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wu, C. H., & Wu, C. Y. (2008). Life satisfaction in persons with schizophrenia living in the community: validation of the satisfaction with life scale. Social Indicators Research, 85(3), 447–460.

    Article  Google Scholar 

  • Yadavaia, J. E., & Hayes, S. C. (2012). Acceptance and commitment therapy for self-stigma around sexual orientation: a multiple baseline evaluation. Cognitive and Behavioral Practice, 19(4), 545–559.

    Article  Google Scholar 

  • Yang, X., & Mak, W. W. S. (2017). The differential moderating roles of self-compassion and mindfulness in self-stigma and well-being among people living with mental illness or HIV. Mindfulness, 8(3), 595–602.

    Article  Google Scholar 

  • Ye, J., Chen, T. F., Paul, D., McCahon, R., Shankar, S., Rosen, A., & O’Reilly, C. L. (2016). Stigma and discrimination experienced by people living with severe and persistent mental illness in assertive community treatment settings. International Journal of Social Psychiatry, 62(6), 532–541.

    Article  PubMed  Google Scholar 

  • Zhang, C. Q., Chung, P. K., Si, G., & Liu, J. D. (2014). Psychometric properties of the Acceptance and Action Questionnaire–II for Chinese college students and elite Chinese athletes. Measurement and Evaluation in Counseling and Development, 47(4), 256–270.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to express our sincere gratitude to the following non-governmental organizations (in alphabetical order) for facilitating us in recruiting eligible participants from their service users: Baptist Oi Kwan Social Service; New Life Psychiatric Rehabilitation Association; The Mental Health Association of Hong Kong; and The Society of Rehabilitation and Crime Prevention.

Funding

The present study was funded by the Early Career Scheme of the Research Grants Council of Hong Kong (Project Number: 28611515).

Author information

Authors and Affiliations

  1. Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong

    Kevin Ka Shing Chan & Christina W. L. Lee

  2. Centre for Psychosocial Health, The Education University of Hong Kong, Tai Po, Hong Kong

    Kevin Ka Shing Chan

  3. Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong

    Winnie W. S. Mak

Authors
  1. Kevin Ka Shing Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina W. L. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Winnie W. S. Mak
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KKSC designed and executed the study, analyzed the data, and wrote the article. CWLL assisted with the data analyses and collaborated in writing the article. WWSM collaborated in writing the article.

Corresponding author

Correspondence to Kevin Ka Shing Chan.

Ethics declarations

Written informed consent was obtained from all participants prior to participation. The present study was approved by the Human Research Ethics Committee of The Education University of Hong Kong.

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chan, K.K.S., Lee, C.W.L. & Mak, W.W.S. Mindfulness Model of Stigma Resistance Among Individuals with Psychiatric Disorders. Mindfulness 9, 1433–1442 (2018). https://doi.org/10.1007/s12671-018-0887-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12671-018-0887-2

Keywords

Search

Navigation