Better together?: a social identity approach to psychological adjustment groups for people with multiple sclerosis

Smale, Kathryn (2016) Better together?: a social identity approach to psychological adjustment groups for people with multiple sclerosis. PhD thesis, University of Nottingham.

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People with multiple sclerosis (MS) commonly experience psychological problems including anxiety and depression. Evidence indicates that psychological interventions based on cognitive behavioural principles can help improve mental health. Such interventions are often delivered in groups and a common assumption is that the social interaction afforded by a group format is beneficial. The aim of this thesis is to explore this assumption and, drawing on social identity theory, investigate why and for whom MS psychological adjustment interventions are effective (or not) when delivered in a group.

Social identity refers to the part of an individual’s self-concept that is derived from belonging to social groups. In the first study, a survey was conducted to establish an evidence base for the relationship between psychological wellbeing and social identity processes in people with MS (n=203). Continued membership of groups belonged to prior to diagnosis was associated with reduced psychological distress, highlighting the importance of social identity continuity. Increased anticipation of stigma as a result of having MS was associated with increased psychological distress. Identification with an MS group was associated with a small decrease in psychological distress when the effect of the other variables was accounted for. This raised the possibility that positive effects of MS group identification may be suppressed by an underlying negative influence of identifying with a socially devalued group.

A realist synthesis was undertaken to gain further insight into how these processes may contribute to intervention success or failure. This identified several benefits of group format, but indicated that these benefits were more readily obtained when MS was not experienced as posing a threat to identity. When the identity threat from MS was high, there were indications that a group format could have negative consequences for psychological wellbeing.

The identity-related benefits and drawbacks of individual and group interventions were explored further in a thematic analysis of interviews with 16 people with MS. Participants had taken part in a feasibility randomised controlled trial (RCT) of group versus individual cognitive behavioural therapy (CBT). Several benefits of group delivery were identified, including shared understanding, normalisation of illness and the opportunity to socialise, share information and challenge negative stereotypes. Perceived drawbacks included unhelpful group norms, putting on a mask and confrontation with a feared identity. Identity threat was found to be especially marked in the group delivery format and appeared to reduce intervention engagement. Identity threat varied depending on social identity continuity, incorporation of MS into identity, stigma, time since diagnosis, symptom progression, ageing and illness narrative. A narrative analysis of two of the interview transcripts highlighted the power of narrative perspective to influence how people respond to MS and offered an explanation for the differing responses to the prospect of taking part in group or individual interventions.

This thesis makes valuable contribution to the literature in making explicit those aspects of group intervention format that confer benefit. It also draws attention to the identity-related drawbacks of a group format. The finding that identity threat may influence perceptions of, and engagement with, interventions offers an explanation for the mixed results in the literature regarding the efficacy of group interventions. The thesis findings begin to establish a theoretical basis for clinical decisions regarding whether to offer group or individual psychological adjustment interventions. An important implication is the need to frame, design and deliver group interventions in such a way as to reduce identity threat and promote a positive shared identity.

Further research is now needed to investigate whether the proposed identity-related mechanisms impact intervention efficacy. In the planned multi-site RCT of group versus individual CBT it would be valuable to incorporate measures of MS group identification and identity threat. This would enable quantitative investigation of the degree to which these variables influence intervention engagement and efficacy.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Lincoln, N.B.
Hunt, N.
das Nair, R.
Keywords: Multiple sclerosis, Psychological adjustment interventions, Social identity
Subjects: W Medicine and related subjects (NLM Classification) > WL Nervous system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 38067
Depositing User: Smale, Kathryn
Date Deposited: 16 Dec 2016 06:40
Last Modified: 14 Oct 2017 23:17

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