title: Insight in paranoia: The role of experiential avoidance and internalized stigma.
abstract: Evidence suggests that insight in psychosis has been related to treatment adherence, recovery and good prognosis, but also to depression, low self-esteem, and diminished quality of life. Thus, insight might not be advantageous under all circumstances. Internalized-stigma (i.e. self-acceptance of stigmatizing images of illness) and experiential avoidance (i.e. unwillingness to experience negative private events) have been proposed as moderating variables between insight, and psychological health variables and/or distress. We investigated the patterns of association of insight with satisfaction with life, self-esteem, depression, anxiety and psychotic psychopathology as moderated by self-stigmatizing beliefs and experiential avoidance, in a sample of 47 participants with persecutory beliefs and diagnosed with schizophrenia or other psychotic disorder. Moderation analyses confirm the importance of internalized-stigma and experiential avoidance. The presence of insight was associated with more depression when there were high levels of self-stigma. Whereas, the absence of insight was associated with a greater life satisfaction when there were high levels of experiential avoidance. To summarize, our results help understand the complex relationship between insight, psychological health variables and emotional distress, pointing to a differential pattern of moderation for negative and positive outcomes. We discuss the implications of these results for research and treatment of paranoia.
authors.affiliation: Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain. Electronic address: mcvaliente@pdi.ucm.es.
authors.forename: Carmen
authors.initials: C
authors.lastname: Valiente
authors.affiliation: Psychiatry Department, Autonomous University of Madrid, Health Research Institute, University Hospital La Princesa, Madrid, Spain; Carlos III Health Institute, Center for Biomedical Research on Mental Health, Madrid, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Provencio
authors.affiliation: Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain; Department of Psychology, School of Health Sciences, Camilo Jose Cela University, Madrid, Spain.
authors.forename: Regina
authors.initials: R
authors.lastname: Espinosa
authors.affiliation: Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain.
authors.forename: Almudena
authors.initials: A
authors.lastname: Duque
authors.affiliation: Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Spain; San Juan de Dios Hospital, Ciempozuelos, Spain.
authors.forename: Franziska
authors.initials: F
authors.lastname: Everts
mesh_terms: D000328:Adult; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D010259:Paranoid Disorders / Q000150:complications* / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D012649:Self Concept; D057545:Social Stigma; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Experiential avoidance; Insight; Internalized stigma; Persecutory delusions; Satisfaction with life; Schizophrenia