Activity 2.4.1 Stories and rules about stigma

ACT Processes:

• Present moment
• Defusion

Objectives:

• To support participants in identifying unspoken, internalized rules or stories (i.e. thoughts) that perpetuate internalized and enacted stigma;
• To support participants in making the connection between these rules or stories and behaviours;
• To highlight the suffering associated with actions based on these internalized rules or stories.

Participation Format:

• Participants sit in a large horseshoe; co-facilitators sit across from each other at the open end of the horseshoe.
• Part A – each participant works on his/her own; Part B – participants share their internal dialogue and rules; and Part C – facilitator debriefs the exercise.

Number of Facilitators:

• 2

Time Required:

• 45 mins

Materials Required:

• A copy of the Activity Worksheet for each participant
• Pens, flip chart paper, water-based markers and masking tape
• Provide each participant with a pen and an Appendix 2.4.1 Worksheet on exploring rules and stories about stigma of mental illness

Activities & Instructions

Setup

• Facilitators print appendix 2.4.1 as a worksheet for participants.

Instructions for participants

Part A (10 minutes):

• Facilitators provide each participant with Activity Worksheet 2.4 and a pen.
• Facilitator #1: We have just given everyone an activity worksheet. On this worksheet, you will find a list of issues, ideas, or situations related to the stigma of mental illness. We invite you to take a moment to fill out your thoughts on three of these contexts/situations. What kinds of thoughts come to mind when you hear “mental illness” paired with these other items on the worksheet? You may have certain opinions about it or certain stories may come immediately to your mind. Write these thoughts down, and how these thoughts have guided your actions – including what you DO and what you DON’T DO because of it. See if you can complete 3 of the items that seem most important to you. You have about 8 minutes to do this.”
• Facilitators check with participants after 8 minutes to ensure that participants have completed at least one item in the worksheet

Part B (20 minutes):

• Facilitator #1: We now invite you share with us what you have written down. Who would like to share with us?
• Facilitator #2 writes down what participants share on flip chart using two columns.
  • In Column A, make notes on what the participants share about the thoughts/rules related to the contexts/situations listed in the worksheet.
  • In Column B, make notes on the participants’ reported behaviours or action related to the different context/situation as a result of Column A thoughts/rules.

Part C (15 minutes):

• When participants finish sharing, Facilitator #1 debriefs the activity by pointing out the connection between the thoughts (or internal rules) described by the participants and the behaviours or action of the participants. The key purpose is to highlight how following these internalized rules (thoughts) contribute to suffering and act as barriers for participants to follow their chosen values, affecting our personal lives, how we interact with others, and participation in activism to address the stigma of mental illness.
• This pattern of rule-following behaviors may apply both at the individual level as well as at the societal level.
• There may be interactions between the individual and societal levels. For example, societal rules may have an impact on individual rules, and an individual may follow these rules or react in opposition against it.

References & Sources

• Fung, K. P., & Zurowski, M. (2011). ACT protocols for CHAMP Study. Toronto, ON: Committee for Accessible AIDS Treatment.
• Inspired by Dahl, J., & Lundgren, T. (2006). Living beyond your pain: Using acceptance and commitment therapy to ease chronic pain. New Harbinger Publications. (See p.64)

Appendix 2.4.1 – Worksheet on exploring rules and stories about stigma of mental illness

Instructions:

The following is a list of common topics/contexts about mental illness:

1. Mental illness and violence
2. Mental illness and recovery
3. Mental illness and the future
4. Mental illness and acceptance
5. Mental illness and the family
6. Mental illness and community / society
7. Mental illness and social justice / advocacy

Choose 3 topics from the above list. Use the worksheet below to explore some of your own and societal rules or stories about mental illness. Do not think too hard about it – just write down any rules/stories that pop into your head for 3 of the topics we have suggested. Once you’ve written down your rules in the left-hand column, write what each rule/story leads to in the right-hand column.