552648
research-article2014
JAPXXX10.1177/1078390314552648Journal of the American Psychiatric Nurses AssociationStein
Editorial
Self-Management in Persons With Major Mental Disorders: A Common but Complex Treatment Goal
Journal of the American Psychiatric Nurses Association 2014, Vol. 20(6) 367–368 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078390314564148 jap.sagepub.com
Karen Farchaus Stein1 The critical issue of self-management is addressed in two original articles and a commentary included in this issue of JAPNA. The first article, authored by van Bendegem and colleagues, addresses Life Chart Methodology (LCM) and reactions of adults with bipolar disorder to its use. As described by the authors, the overall goal of LCM is to teach persons with bipolar disorder how to monitor their symptoms over time. The intent is to enhance self-management, that is, help individuals recognize meaningful changes in their mood and other symptoms, thereby enabling them to avert relapse. The second article, authored by Lee, focuses on the use of a telephone-delivered support intervention to promote increased physical activity in persons with the diagnosis of schizophrenia. This article too focuses on the issue of self-management. The goal here is to help individuals regulate their body weight by daily moderate-intensity walking. Also included in this issue is a commentary written by Lysaker and colleagues, who address the issue of self-management but take a more cautionary stance. The authors remind us of the complexities of the process of self-management and the risk that our implicit assumptions and enthusiasm to help can lead to blind spots and even unintentional harm. The concept of self-management is typically used in the context of chronic illness (both physical and psychological). It refers to the set of actions taken by the individual to manage the symptoms, treatment, physical, and psychological and social consequences of the illness and the associated lifestyle changes (Barlow, Wright, Sheaby, Turner, & Hainsworth, 2002). Central to current conceptions of self-management is the recognition that the individual is not simply the passive recipient of treatment. Rather, self-management is grounded on the concept of the self—with the individual at the center as the active decision-maker controlling the treatments and the effects on his or her life (Newman, Steed, & Mulligan, 2004). Consistent with this core value of self-management, Lysaker reminds us of the risks associated with universal prescription and the failure to work within the individual’s unique, personalized “agenda.” Self-management is a complex set of purposeful activities that engage the individual’s cognitive, emotional, and behavioral resources. Self-management includes
three sets of tasks: (a) activities associated with the medical management of the illness such as taking medications as prescribed, keeping follow-up appointments;(b) activities that enable involvements (either new or continued) in meaningful activities, roles, and life goals such as finding a rewarding part-time job or volunteer activities if the demands of a full-time job are too stressful; and (c) efforts to handle the emotional consequences of the illness and related limitations including sadness or depression stemming from the realization that one’s future may be different than planned (Corbin & Strauss, 1988, as cited in Lorig & Holmes, 2003). Self-management includes the ability to self-monitor and to self-regulate, each of which is a complex and multidimensional process. Self-monitoring is an ongoing process of conceptualizing one’s current state and comparing it to previous states that were similarly conceptualized and stored in long-term memory. Dissimilarities or gaps between the current state and the desired state must be recognized and behavioral responses planned and implemented. Similarly, self-regulation is a dynamic process that includes the ability to set goals for the self, prioritize, and coordinate sets of goals including competing goals (Karoly, 1993). Of course, to be effective these goals have to be detailed, specific, and personalized (Markus & Nurius, 1986). Furthermore, they have to be associated with a sense of self-efficacy and the motivation or energy to sustain activities to achieve the desired end state (Bandura, 2001). Knowledge, skills, and capabilities also are needed both to set and achieve the desired outcomes and goals (Barlow et al., 2002). Competing goals, lack of clarity or elaboration of a goal, a limited sense of efficacy, ambivalence, and a lack of skill can all interfere with complex self-regulatory processes. Furthermore, cognitive limitations such as limited self-reflective capacity (Lysaker et al., 2005) or an unstable sense of oneself, as well as emotional reactions 1
Karen Farchaus Stein, PhD, RN, FAAN, University of Rochester, Rochester, NY, USA Corresponding Author: Karen Farchaus Stein, University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642, USA. Email: [email protected]
368
Journal of the American Psychiatric Nurses Association 20(6)
such as grief, fear, or depression can all limit the individual’s self-monitoring and self-regulatory efforts. The articles that comprise this issue provide an excellent opportunity for all psychiatric and mental nurses and clinicians to reconsider the complexity of a critical but common, everyday issue in the treatment of persons with major mental disorders. Supporting and enabling self-management requires informed and empathic intervention. It necessitates knowledge of the cognitive, emotional, and behavioral challenges that persons with major mental disorders experience and skills enabling application of that knowledge in an empathic individualized manner. Many thanks to the authors who contributed to this issue and stimulated our continued thinking about this common but critical issue encountered everyday as a part of our care.
Barlow, J., Wright, C., Sheaby J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: A review. Patient Education and Counseling, 48, 177-187. Karoly, P. (1993). Mechanisms of self-regulation: A systems view. Annual Review of Psychology, 44, 23-52. Lorig, K., & Holmes, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26, 1-7. Lysaker, P., Carcione, A., Dimaggio, G., Johannesen, J., Nicolo, G., Procacci, M., & Semerari, A. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with neurocognition, symptoms, insight and quality. Acta Psychatrica Scandinavica, 112, 64-71. Markus, H., & Nurius, P. (1986). Possible selves. American Psychologist, 41, 954-969. Newman, S., Steed, L., & Mulligan, K. (2004). Self-management interventions for chronic illness. Lancet, 364, 23-29.
References Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26.
research-article2014
JAPXXX10.1177/1078390314552648Journal of the American Psychiatric Nurses AssociationStein
Editorial
Self-Management in Persons With Major Mental Disorders: A Common but Complex Treatment Goal
Journal of the American Psychiatric Nurses Association 2014, Vol. 20(6) 367–368 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078390314564148 jap.sagepub.com
Karen Farchaus Stein1 The critical issue of self-management is addressed in two original articles and a commentary included in this issue of JAPNA. The first article, authored by van Bendegem and colleagues, addresses Life Chart Methodology (LCM) and reactions of adults with bipolar disorder to its use. As described by the authors, the overall goal of LCM is to teach persons with bipolar disorder how to monitor their symptoms over time. The intent is to enhance self-management, that is, help individuals recognize meaningful changes in their mood and other symptoms, thereby enabling them to avert relapse. The second article, authored by Lee, focuses on the use of a telephone-delivered support intervention to promote increased physical activity in persons with the diagnosis of schizophrenia. This article too focuses on the issue of self-management. The goal here is to help individuals regulate their body weight by daily moderate-intensity walking. Also included in this issue is a commentary written by Lysaker and colleagues, who address the issue of self-management but take a more cautionary stance. The authors remind us of the complexities of the process of self-management and the risk that our implicit assumptions and enthusiasm to help can lead to blind spots and even unintentional harm. The concept of self-management is typically used in the context of chronic illness (both physical and psychological). It refers to the set of actions taken by the individual to manage the symptoms, treatment, physical, and psychological and social consequences of the illness and the associated lifestyle changes (Barlow, Wright, Sheaby, Turner, & Hainsworth, 2002). Central to current conceptions of self-management is the recognition that the individual is not simply the passive recipient of treatment. Rather, self-management is grounded on the concept of the self—with the individual at the center as the active decision-maker controlling the treatments and the effects on his or her life (Newman, Steed, & Mulligan, 2004). Consistent with this core value of self-management, Lysaker reminds us of the risks associated with universal prescription and the failure to work within the individual’s unique, personalized “agenda.” Self-management is a complex set of purposeful activities that engage the individual’s cognitive, emotional, and behavioral resources. Self-management includes
three sets of tasks: (a) activities associated with the medical management of the illness such as taking medications as prescribed, keeping follow-up appointments;(b) activities that enable involvements (either new or continued) in meaningful activities, roles, and life goals such as finding a rewarding part-time job or volunteer activities if the demands of a full-time job are too stressful; and (c) efforts to handle the emotional consequences of the illness and related limitations including sadness or depression stemming from the realization that one’s future may be different than planned (Corbin & Strauss, 1988, as cited in Lorig & Holmes, 2003). Self-management includes the ability to self-monitor and to self-regulate, each of which is a complex and multidimensional process. Self-monitoring is an ongoing process of conceptualizing one’s current state and comparing it to previous states that were similarly conceptualized and stored in long-term memory. Dissimilarities or gaps between the current state and the desired state must be recognized and behavioral responses planned and implemented. Similarly, self-regulation is a dynamic process that includes the ability to set goals for the self, prioritize, and coordinate sets of goals including competing goals (Karoly, 1993). Of course, to be effective these goals have to be detailed, specific, and personalized (Markus & Nurius, 1986). Furthermore, they have to be associated with a sense of self-efficacy and the motivation or energy to sustain activities to achieve the desired end state (Bandura, 2001). Knowledge, skills, and capabilities also are needed both to set and achieve the desired outcomes and goals (Barlow et al., 2002). Competing goals, lack of clarity or elaboration of a goal, a limited sense of efficacy, ambivalence, and a lack of skill can all interfere with complex self-regulatory processes. Furthermore, cognitive limitations such as limited self-reflective capacity (Lysaker et al., 2005) or an unstable sense of oneself, as well as emotional reactions 1
Karen Farchaus Stein, PhD, RN, FAAN, University of Rochester, Rochester, NY, USA Corresponding Author: Karen Farchaus Stein, University of Rochester School of Nursing, 601 Elmwood Avenue, Box SON, Rochester, NY 14642, USA. Email: [email protected]
368
Journal of the American Psychiatric Nurses Association 20(6)
such as grief, fear, or depression can all limit the individual’s self-monitoring and self-regulatory efforts. The articles that comprise this issue provide an excellent opportunity for all psychiatric and mental nurses and clinicians to reconsider the complexity of a critical but common, everyday issue in the treatment of persons with major mental disorders. Supporting and enabling self-management requires informed and empathic intervention. It necessitates knowledge of the cognitive, emotional, and behavioral challenges that persons with major mental disorders experience and skills enabling application of that knowledge in an empathic individualized manner. Many thanks to the authors who contributed to this issue and stimulated our continued thinking about this common but critical issue encountered everyday as a part of our care.
Barlow, J., Wright, C., Sheaby J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: A review. Patient Education and Counseling, 48, 177-187. Karoly, P. (1993). Mechanisms of self-regulation: A systems view. Annual Review of Psychology, 44, 23-52. Lorig, K., & Holmes, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26, 1-7. Lysaker, P., Carcione, A., Dimaggio, G., Johannesen, J., Nicolo, G., Procacci, M., & Semerari, A. (2005). Metacognition amidst narratives of self and illness in schizophrenia: Associations with neurocognition, symptoms, insight and quality. Acta Psychatrica Scandinavica, 112, 64-71. Markus, H., & Nurius, P. (1986). Possible selves. American Psychologist, 41, 954-969. Newman, S., Steed, L., & Mulligan, K. (2004). Self-management interventions for chronic illness. Lancet, 364, 23-29.
References Bandura, A. (2001). Social cognitive theory: An agentic perspective. Annual Review of Psychology, 52, 1-26.
