MiiND

Social recovery
activation methodology

For people with a serious psychiatric disorder (EPA) and psychosis susceptibility

Client perspective

After the crisis, I was happy to go home. Now at least I can decide for myself when I go outside and what I eat for dinner. But I don't have a job anymore, I lost my friends and a lot of things don't work out. I sit at home a lot now, then I smoke only one and watch television.

Background

77% of people with a serious psychiatric disorder with psychosensitivity are in serious isolation from which they cannot come out on their own. When we compare this group of people with other vulnerable groups, they turn out to be the (undesirable) leader in loneliness (Coalition erbij, 2014). Loneliness and not finding a connection is often problem no. 1 for these clients. In addition to isolation, there is often a social withdrawal impulse (negative social symptom), which further prevents them from seeking affiliation. The result is a self-reinforcing negative spiral in which no access is gained to a supportive network and people withdraw because no connection is found.

Experiencing isolation and lack of support are the main factors to significantly reduce the chance of recovery (Ritsner & Lyman 2014; Slade, 2018). Stimulation of the withdrawal impulse is also undesirable because it is the most important biomarker for further mental degeneration and (clinical) relapse. The situation discussed has a marginalizing effect and impedes recovery and is therefore undesirable.

To break this negative spiral, the MiiND project was started a number of years ago.

Who

Characteristics of clients eligible for the MiiND intervention

• Psychosensitivity with EPA
• Weak narrative ability to express oneself, his/her disorder, behaviour, thoughts, interpretations, feelings, needs, sensations and environment in coherence and weak ability to cooperate with his/her environment.
• Significant risk of relapse, possibly periodic (clinical) relapse Good results can
  
  also be achieved with other EPA groups (PTSD, anxiety disorders) (according to a first pilot).

MiiND methodology

Our development towards an effective methodology for social recovery activation, breaking the negative spiral of loneliness and mental degeneration, has yielded seven principles that combine to activate social recovery.

These seven principles are:

Clients need a safe, transparent and accessible exercise environment to access social recovery activities at home, at their own pace and without experiencing pressure or setbacks. So that they have the opportunity to work on building and deepening their social skills, to build a network, to gain social experiences, to revive stagnant social processes, to develop activities and to activate social recovery. The MindFinder platform is very suitable for this.

• Ensures approachability
• Gives minimal user stress

Self-steering with a minimum of control

This principle stimulates recovery of affective processes, so that patients experience it as coming home. Central to this is the concept of 'self-management with a minimum of control'. Previous research into groups of fellow sufferers (Castelein, 2008) has shown that fully self-directed organisation, as is done in other groups of fellow sufferers, is generally not feasible for people with serious psychiatric disorders. The peer groups then fall apart over time. To compensate for this, activation is necessary, attuning to the client's world and providing structure from a counsellor.

Because of the slow learning curve, clients feel the need to be able to work on improving their social competencies over a longer period of time, at their own time and level.

• Support slow learning curve

Check contact intensity

A verifiable intensity of contact is important in order not to overburden clients. The concept behind this is that social contacts are quickly too intense and overwhelming, because many stimuli are partly interpreted on the basis of incorrect conditioning, creating tension with the here and now (Smit, 2019). A normal environment causes a lot of stress, making it difficult for clients to actively think about the here and now. Environments with a low intensity in the contact minimally trigger incorrect conditioning because the (limited) self-healing mechanisms that the client has been able to correct, so that tension is kept to a minimum (Smit, 2019). By controlling the intensity of the contact, clients experience minimal stress from incorrect conditioning and can actively dwell on social activities in the here and now.

The intensity of the contact is attuned to the client by the counsellor and initiated on the basis of the measured social capacity. There is a need for a lower intensity of contact when clients suffer from disruptive characteristics such as delusions, projections, withdrawal behaviour, fears, strong emotions and difficulty in making oneself known. The control of the intensity of the contact is determined by means of concise text messages, group video conversations and physical activities, among other things.  

• Makes contact manageable
• Stimulates self-healing mechanisms

The (chronic) group of EPA clients benefits significantly from peer support: on the one hand, because they tend to experience isolation as their greatest source of suffering and it provides them with an approachable network of a supportive group of peers at their disposal to gain new experiences, to break their (unwanted) isolation and, on the other hand, because it gives them access to a collective of experiential wisdom and recognition to learn new coping strategies and to activate their insight process.

Through this source of nutrition, clients are empowered in the process of becoming actors about their own challenges, discovering the success factors of their recovery and learning to relate personally to their disorder. Working together for recovery is not only more effective, it also meets the meaningful needs of clients for whom social isolation, lack of intimacy and meaninglessness cause the greatest suffering.

• Improves the social network by promoting mutual relationships.
• Supports a more active role of the client in his/her own treatment by sharing and applying coping strategies and learning to avoid non-coping strategies.
• Learns tests of conclusions (reality test)
• Gives positive examples and activates hope
• Gives an invitation to practice new recovery behaviour
• Is a recognized intervention technique
• Activates recognition and insight processes
• Learns to help himself and the other in his power

Adjusting in case of disturbance behaviour

This principle is based on the fact that social disruptive behaviour can occur every now and then, because incorrect conditioning has been activated. As a result, clients leave their own needs and find it difficult to actively stand still in the here and now in the social process. If disruptive characteristics prevail too much in the contact, a light variant of EMDR or CBT can be considered to reduce this disruptive influence in combination with lowering the intensity of the contact.

• Learning to be an actor in the here and now

In order to exercise control over the process, three parameters are measured: social recovery probability, social competence and recovery activation. This to get a good picture of the process and its impact on the individual level.

The influence of the intervention on the parameter 'social recovery chance' indicates whether it is significantly stimulated and whether there is a chance of recovery activation (Slade 2018).

The social competence parameter indicates the social capacity, social disruptive behaviour and social recovery of the client over time. It is based on fifteen behavioural measurement points that are leading for measuring social competencies, in which a distinction can be made between two categories of 'making oneself known' and 'working together'. On the basis of this, the intensity can be adjusted and the client's challenges determined. In addition, this social competence is also an indicator of the client's social empowerment.

• Measuring recovery opportunity and social competence to quantify impact

Results

The first indication is that the MiiND social activation intervention is an effective tool to activate personal recovery in EPA (psychosis) clients. It can be observed that in about 25 to 50% of the (EPA) clients social recovery is activated (in the groups that start up successfully). This is visible through direct observation, feedback from clients, but also through observations from treatment specialists. By personal (social) recovery activation is meant 'entering a life path that is fulfilling, hopeful and life-giving within the limitations of the disease. In which a profoundly unique process of personal change, including attitude, values, feelings, goals, skills and/or roles, is present'. (Provencher, 2002). Personal recovery in the social domain is especially visible in the areas of 'cooperation' and 'making oneself known'.

Initial results show that even for EPA clients who are therapist (and with whom it has not been possible to achieve results so far) it offers a path to recovery that is appreciated by the clients and practitioner. The first MiiND groups show that MiiND is highly valued by clients; EPA psychosis, EPA anxiety, EPA autism and EPA PTSD complex, as well as a first indication in clients with borderline and depression. They experience an improved quality of life and that MiiND activates a significant recovery potential.

For professionals and financiers there is also the additional benefit of improving the effectiveness of the treatment. As fellow sufferers and software take on a significant part of the support, capacity is freed up to be deployed at those moments where the client's recovery process is at risk of stalling.

Result

• Reduced relapse risk
  
  
• Strengthened social capacity; Narrative ability to express oneself, his/her disorder, behaviour, feelings, needs, sensations and environment in cohesion. Capacity to work together with the environment
  
  
• Activates social recovery

We are currently looking for healthcare professionals who want to work together.
Interested? Send an email to [email protected]
(We are specifically looking for professionals who work directly with client groups and or on FACT teams)