Understanding reduced activity in psychosis: the roles of stigma and illness appraisals

Increasing activity and social inclusion for people with psychosis is a primary goal of mental health services. Understanding
the psychological mechanisms underlying reduced activity will inform more carefully targeted and effective interventions.
Anxiety, depression, positive symptom distress and negative symptoms all make a contribution, but much of the variance in
activity remains unaccounted for and is poorly understood. Appraisals of illness impact on adjustment to illness: mood, engagement
in treatment and quality of life are all affected. It is plausible that illness appraisals will also influence activity. This
study investigated the extent to which three components of illness appraisal accounted for variance in activity.

50 people with psychosis completed measures of activity, positive and negative symptoms, anxiety and depression, cognitive
functioning, stigma, insight and illness perceptions.

Multiple regression revealed that internalised stigma, but not insight or illness perception, was significantly correlated
with reduced activity. 42% of the variance in activity was accounted for by stigma, negative symptoms, positive symptom distress
and social support. Affect, cognitive functioning and positive symptoms were not associated with activity.

For people with psychosis, activity levels appear to be compromised particularly by fears of what others think of them and
how they will be treated by others. Directly targeting these fears should improve the impact of psychological interventions
on functioning. Specific, individualised cognitive behavioural interventions could be a useful adjunct to recovery-focused
narrative therapies and complement public information campaigns to reduce discriminatory attitudes and behaviours.