Self-help groups for mental health

There are several international mental health self-help organizations including Recovery, Inc., Emotions Anonymous, and GROW. Recovery, Inc. uses a cognitive therapy approach and Emotions Anonymous uses a twelve step approach, whereas GROW incorporates a combination of the cognitive therapy and twelve-step methods. Despite the different approaches, many of the psychosocial processes in the groups are the same and they share similar relationships with mental health professionals.

Classifying
Research on self-help groups for mental health have characterized them in different ways. In a broad sense they are considered organizations for mutual support and peer support. Mutual support is a process by which people voluntarily come together to help each other address common problems. Peer support is social, emotional or instrumental support that is mutually offered or provided by persons having similar mental health conditions where there is some mutual agreement on what is helpful.

The definitions of mutual support and peer support include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. In the former set members seek to improve themselves, and the latter set are advocacy organizations such as NAMA, NAMI and USPRA.

Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. They are also less bureaucratic and work on a more grassroots level. Self-help Organizations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favor of those affected.

Behavior Control and Stress Coping groups
Of Individual Therapy groups, researchers distinguish between Behavior Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.

Significant differences exist between Behavioral Control groups and Stress Coping groups. Meetings of Behavior Control groups tend to be significantly larger than their Stress Coping counterparts (by more than a factor of two). Behavior Control group members also have a longer average tenure in the group than members of Stress Coping groups (45 months compared to 11 months), and were less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behavior Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.

Talking Groups
In Germany a specific subset of Conversation Circles are categorized as Talking Groups (Gesprachsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge. Any group following the Twelve Traditions (including EA, NAIL, EHA) meets these requirements.

Emotions Anonymous
Emotions Anonymous (EA) is a Twelve Step program similar to Alcoholics Anonymous (AA), but for the purpose of helping its members recover from depression and other mental illnesses. EA is the largest of three organizations that have adapted AA's Twelve Steps to create a program for people suffering from mental or emotional illness, replacing the word "alcohol" with "our emotions" in the First Step. The smaller organizations are Neurotics Anonymous and Emotional Health Anonymous (EHA). EA is a successor organization of Neurotics Anonymous. To avoid confusion with the more well known Twelve Step program, Narcotics Anonymous (NA), Neurotics Anonymous is abbreviated N/A or NAIL.

EA and NAIL are open to anyone who desires to become emotionally well. EHA is also open to anyone with a desire to become emotionally well, if they are not suffering from problems that are specifically addressed by other Twelve Step groups (e.g. substance abuse, eating disorders, sexual addiction, compulsive gambling, etc). According to the Twelve Traditions, EA, NAIL, and EHA groups cannot not accept outside contributions.

GROW
GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and some people who had sought help with their mental illness by attending AA meetings. After its inception, GROW members learned of Recovery, Inc. and integrated some of its processes into their program. GROW's original literature includes The Twelve Stages of Decline, which indicate that emotional illness begins with self-centeredness, and The Twelve Steps of Personal Growth, a blend of AA's Twelve Steps and will-training methods from Recovery, Inc. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.

Recovery, Inc.
Recovery, Inc. was founded in Chicago, Illinois in 1937 by psychiatrist Abraham Low using principles in contrast to those popularized by psychoanalysis. Low wrote the principle book used in organization, Mental Health Through Will Training. Recovery, Inc. is open to anyone identifying as "nervous" (a term that when Recovery, Inc. was created more closely meant neurotic). Recovery, Inc. admonishes members if they do not follow their physician's, psychologist's or psychiatrist's orders. Recovery, Inc. does not operate with funding restrictions and has received state and outside funding in the past.

Fundamentally, Low believes "Adult life is not driven by instincts but guided by Will," using a definition of will opposite of Arthur Schopenhauer's. Low's program is based on increasing determination to act, self-control and self-confidence. Sociologist Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué's psychotherapy. In this way, the message of Recovery, Inc. is almost the opposite of that in Twelve Step programs.

The First Step of the Twelve Steps beings with "We admitted we were powerless over..." followed by the crux of whatever the program deals with (e.g. alcohol, addictions, emotions, etc). For those in such programs, this is an acknowledgment that they will stop trying to control things beyond their control. For example, in this view, when alcoholics attempt to control (moderate) their drinking, they encounter their powerlessness and a relapse is imminent. When alcoholics let go of their attempts to to control their drinking, they can focus on controlling what they are able to  change. Despite the apparent contradiction between the philosophical basis of Recovery, Inc. and Twelve Step programs, Recovery, Inc. is friendly to Twelve Step group members and encourages them to attend.

Professional lead group psychotherapy
Self-help groups are not intended to provide "deep" psychotherapy. Nevertheless, their emphasis on psychosocial processes does achieve constructive treatment goals. People with the same mental share similar feelings and experiences. This feature is not always present in psychotherapy.

Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing, is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.

Group processes
No two self-help group are exactly alike. The make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioral techniques, and complicated cognitive-restructuring methods are not necessary.

Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited too: acceptance, behavioral rehearsal, changing member's perspectives of themselves, changing member's perspectives of the world, catharsis, extinction, role modeling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalization, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or "opening up"), and showing empathy.

Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.
 * 1) Social support: Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
 * 2) Experiential knowledge: Members obtain specialized information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increase their confidence.
 * 3) Social learning theory: Members with experience become creditable role models.
 * 4) Social comparison theory: Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
 * 5) Helper Theory: Those helping each other feel greater interpersonal competence from changing other's lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive "personalized learning" from working with helpees. The helpers' self-esteem improves with the social approval received from those they have helped, which puts them in an even better position to help more people.

Relationship with mental health professionals
A 1978 survey of mental health professionals in the United States found they had a relatively favorable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. Since then, the role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members has become widely accepted in many areas both inside and outside of the general medical community.

A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.

Similarly, research with members of self-help groups has shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is "Doctors know better than we do how a sickness can be treated. We know better than doctors how sick people can be treated as humans."

Referrals
Referrals to self-help groups for mental health have been found not to be as effective as arranging a meeting for prospective Self-help members with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about the their group from friends and relatives, and relatively few learned about them from professional referrals.

Effectiveness
Self-help groups have been found to be beneficial in helping people cope with and recover from a wide variety of problems. Studies on Talking Groups in Germany has found them to be very effective (comparable to psychoanalytically orientated group therapy).

Participation in self-help groups for mental health has consistently been correlated with reductions in hospitalizations, and shorter hospitalizations when they occur. Members coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental has also been shown to encourage more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programs, and how proactive the members are in them, has also been correlated with increased benefits.

Decreased hospitalization and shorter durations of hospitalization indicate that self-help groups result in financial savings for the health care system, as hospitalization is one of the most expensive mental health services. Similarly, reduced utilization of other mental health services may translate into additional savings for the system.

One survey of members in self-help groups for serious mental illness found they rated their perception of the group's effectiveness on average at 4.3 on a 5-point Likert scale.

Some studies have found no difference in expression of psychiatric symptomatology between those in self-help groups, and control groups, while others have found the opposite. Looking only at changes in symptomatology, however, ignores the other potential benefits of self-help groups, such as increasing self-esteem, reducing stigma, accelerating rehabilitation, better decision-making, decreasing tendency to decompensate under stress, and improving social functioning. "Opening up" has even been associated with health-building qualities, such as increasing particular immune defense cells.

If self-help groups are not affiliated with a national organization, professional involvement increases their "lifespan." Conversely, if particular groups are affiliated with a national organization professional involvement decreases their lifespan. Rules enforcing self-regulation in Talking Groups are essential for the group's effectiveness.

Criticism
There are several limitations of self-help groups for mental health, including but not limited to their: inability to keep detailed records, lack of formal procedure to follow-up with members, absence of formal screening procedures for new members, lack formal leadership training, likely inability of members to recognize a "newcomer" presenting with a serious illness requiring immediate treatment; additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups' formulaic approach, attrition rates, overgeneralization, and "panacea complex."

Formulaic approach
Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticized self-help group structure as being too rigid.

High attrition rates
There is not a universal appeal of self-help groups, researchers have found that as little as 17% of persons invited to attend a self-help group do so. Of those people, only one third stayed past four months. Those who continue are people who value the meetings and the self-help group experience.

Overgeneralization
Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups.

Panacea complex
There is a risk that self-help group members may come to believe that participation in the group can cure anything, or at least more than what it was designed to.