Aplicaciones de las nuevas tecnologías en la reducción del estigma hacia el tmg en contextos educativos

Abstract

Stigma towards mental disorders is not a new phenomenon, although it is refractory to intervention and has devastating consequences both for those who suffer from it in the first person and for their closest family members and ultimately a social scourge. Exclusion from social life, difficulties in accessing the world of work and housing and, in short, rejection, are major barriers to treatment and subsequent recovery and social integration. Numerous labels have been attributed to people with a Serious Mental Disorder (hereafter referred to as SMD) in the literature, including "dangerous, unpredictable and with little independent functional capacity". In general terms, beliefs about dangerousness, fear of unpredictability or unexpected reactions are a constant. In the case of young people, research on stigma is not very abundant and the literature is full of contradictory data, most of them with important methodological biases and, with the added handicap of the scarcity of available and validated assessment tools in our context. Moreover, so far there are no assessment resources that address stigma from thenovel vision provided by Behavior Analysis, an eminently functional approach. More specifically, there are significant shortcomings when it comes to approaching stigma from the perspective provided by Relational Frame Theory (RFT), from which conceptssuch as psychological flexibility emerge, understood as the ability to actively embrace private experiences (cognitions, sensations or emotions, whatever their nature, even of an aversive nature) and commit to patterns of behavior in the service of what the person considers valuable (Hayes et al., 2011). Thus, psychological inflexibility would be at the basis of the different topographies of psychopathology (Hayes et al., 2006; Ruiz, 2010), and may play a central role in stigma as a generalized process, in a pattern in which at all costs one tries to avoid, escape or control thoughts, sensations or emotions experienced as aversive, despite the personal cost that this escape implies. On the other hand, as far as new technologies are concerned, Serious Games and Virtual Reality (VR) have a lot of potential to offer. Given their appeal to young people and the numerous advantages that their use brings, it is particularly interesting to design and integrate these tools into anti-stigma work, something that, to date, remains a largely unexplored area. With regard to the target population with which we worked, the sample of participants was made up of adolescents and young people, justifying this choice for powerful reasons such as the high prevalence rate of mental disorders that has been occurring in this population in recent years, the fact that their beliefs are still developing, the fact that they are not yet fully established and present a certain permeability to change, and their innate interest in new technologies, which leads us to hypothesize the success of the VR program, This leads us to hypothesize the success of the VR program, especially considering the positive results of the tool that preceded it, aSerious Game to raise awareness against mental health stigma (Stigma-Stop). Thus, the first of the studies, continuing with the line of research inaugurated in the previous doctoral thesis, shows further evidence of the benefits of a Serious Game such as Stigma-Stop applied both individually and in combination with other tools, with the intention of isolating the effects and determining whether they are maintained over time. A non-random sample of 556 participants from 6 randomly selected schools in the provinces of León and Zamora (Spain), aged between 14 and 19 years (M =16.69; SD =3.81), was divided into 3 experimental groups (Experimental Group 1: n=136; Experimental Group 2: n= 278; Experimental Group 3: n=73 and Control Group: n= 69). Experimental group 1 only underwent the Stigma-Stop intervention, group 2, Stigma-Stop + professional and experimental group 3, in addition to these two interventions, benefited from contact with a mental health service user. The results from the analysis of the responses to the Questionnaire of Students' Attitudes towards Schizophrenia (CAEE; Schülze et al., 2003) showed the effectiveness of the Serious Game as well as the contact with users, with the educational talk being the intervention that revealed the most modest results. This justifies the need to emphasize the biographical and contextual aspects surrounding the occurrence of TMD, which encourages empathy with these people, in whom symptomatology could well be a way of coping with adverse life situations, rather than focusing on supposed biological entities from a biomedical explanation, as was done in the professional's talk. The second study consisted of a first part in which a measurement instrument was adapted and validated to measure psychological flexibility, and a second part in which it was applied to quantify possible changes that would show the weight of psychological flexibility in the stigmatization process after a brief intervention with a VR program, such as Inclúyete-VR. More specifically, we worked with the Acceptance and Action-Stigma Questionnaire, AAQ-S, a tool developed by Levin et al. (2014), which consists of 21 items divided into two factors: psychological flexibility (11 items) and psychological inflexibility (10 items using reverse scoring). For this purpose, after translating and adapting the questionnaire to the Spanish context, a confirmatory factor analysis was carried out by applying this translation of the AAQ-S to 1212 adolescents in the first and second year of Secondary Compulsory Education from 15 to 19 years of age (M = 17.12; SD = 1.30). On the other hand, for the subsequent exploratory factor analysis we used a sample of 304 adolescents aged 15-17 years (M = 15.92; SD = .68) and for the temporal stability analysis we used an independent sample of 64 adolescents (34 males and 30 females), aged 15-17 years (M = 15.73; SD = .72). Statistical analyses confirm the bifactorial structure of the instrument (flexibility and psychological inflexibility), as well as its adequate psychometric properties, namely, its temporal stability, invariance with respect to gender and age, which shows its versatility when making comparisons involving these variables. Subsequently, a VR software, Inclúyete- VR, was applied, which allows us to experience what it feels like when positive symptomatology is present, while at the same time offering informative information on different psychosocial intervention strategies. As a measuring instrument, a previously validated questionnaire was used to investigate the relationship between stigma and psychological flexibility. To this end, a sample of 100 students selected by means of incidental non-random sampling from the 2nd year of the Degree in Primary Education at the University of Almeria, aged between 18 and 20 years (MS=18.45; SD=.46), were randomly assigned to the experimental and control conditions (Include yourself VR vs. avideo game simulating a roller coaster). Taking advantage of the previous validation of the AAQ-S questionnaire and with the intention of testing it, this was applied together with the Attribution Questionnaire-14 (Saavedra et al., 2021) to carry out a mediational analysis that allowed us to clarify the existence of relationships between psychological flexibility and stigma. In short, an assessment tool has been provided that represents a paradigm shift in the conceptualization of stigma, based on the concept of psychological flexibility. The tool has already been tested in the field of homophobia, overweight stigma, or stigmatizing attitudes towards people with mental health problems (Gold et al., 2009; Lillis et al., 2010; Masuda & Latzman, 2011). Furthermore, its value is supported by the numerous evidence of efficacy of treatments focused on enhancing psychological flexibility (see Krafft et al., 2018; Navarro, 2021, for a review). On the other hand, we would be able to confirm the possibilities of applying new technologies in addressing stigma, particularly about TMG. Thus, both Serious Games and VR are intervention resources to be considered, to which we are inaugurating a long-term appeal. In this way, more evidence has been provided about the benefits of Stigma-Stop, while a new VRbased tool (Inclúyete-VR) has been presented, which promotes empathy with those suffering from a mental disorder and points out intervention alternatives that focus on social integration (canine therapy, art therapy, radio workshops, gardening, computer science, inclusive sports...) complementary to traditional pharmacological and psychological therapies. On the other hand, the role of psychological flexibility as a mediating variable in the reduction of stigma has been shown. This would have important implications for work on stigma, which should focus on providing the keys to respond in a context-sensitive way, rather than trying to control emotions or thoughts. Inother words, it would be about being open to the emotions, sensations, memories, etc. that come up and behaving in a way that is in line with personal values. The central objective of any psychosocial rehabilitation process for people with mental disorders is to achieve family, community, and work reintegration in such a way as to give biographical continuity to their life project. The existence of barriers for the adequate development of these processes causes the person to become socially isolated, to enter a state of vulnerability and exclusion, and also generates significant individual and collective suffering, producing difficulties for the search and continuity of psychiatric care, also interfering in the adherence to the therapeutic regime (Pedersen, 2009), all of which motivates the development of intervention strategies that involve thefamily and the community in order to generate an inclusive context where the person can complete his or her rehabilitation process.