The increased stress of competitions can cause athletes to react both physically and mentally in a manner that can negatively affect their performance abilities. They may become tense, their heart rates race, they break into a cold sweat, they worry about the outcome of the competition, they find it hard to concentrate on the task at hand.

This has led coaches to take an increasing interest in the field of sports psychology and in particular in the area of competitive anxiety. That interest has focused on techniques that athletes can use in the competitive situation to maintain control and optimise their performance. Once learned, these techniques allow the athlete to relax and to focus his/her attention in a positive manner on the task of preparing for and participating in the competition. Psychology is another weapon in the athlete's armoury in gaining the winning edge.

Concentration, confidence, control and commitment (the 4C's) are generally considered the main mental qualities that are important for successful performance in most sports.

The techniques of relaxation, centering and mental imagery can assist an athlete to achieve the 4C's.

This is the mental quality to focus on the task at hand. If the athlete lacks concentration, then their athletic abilities will not be effectively or efficiently applied to the task. Research has identified the following types of attention focus:

The demand for concentration varies with the sport:

Common distractions are anxiety, mistakes, fatigue, weather, public announcements, coach, manager, opponent, negative thoughts etc.

Strategies to improve concentration are very personal. One way to maintain focus is to set process goals for each session or competition. The athlete will have an overall goal for which the athlete will identify a number of process goals that help focus on specific aspects of the task. For each of these goals, the athlete can use a trigger word (a word which instantly refocuses the athlete's concentration to the goal) e.g. sprinting technique requires the athlete to focus on being tall, relaxed, smooth and to drive with the elbows - trigger word could be "technique"

Athletes will develop a routine for competition that may include the night before, the morning, pre-competition, competition and post-competition routines. If these routines are appropriately structured, then they can prove a useful aid to concentration.

Confidence results from the comparison an athlete makes between the goal and their ability. The athlete will have self-confidence if they believe they can achieve their goal. (Comes back to a quote of mine - "You only achieve what you believe").

When an athlete has self-confidence they will tend to: persevere even when things are not going to plan, show enthusiasm, be positive in their approach and take their share of the responsibility in success and fail.

To improve their self-confidence, an athlete can use mental imagery to:

Good goal setting (challenging yet realistic) can bring feelings of success. If athletes can see that they are achieving their short-term goals and moving towards their long-term goals, then confidence grows.

Confidence is a positive state of mind and a belief that you can meet the challenge ahead - a feeling of being in control. It is not the situation that directly affects confidence; thoughts, assumptions and expectations can build or destroy confidence.

High self-confidence

Low self-confidence

Identifying when an athlete feels a particular emotion and understanding the reason for the feelings is an important stage of helping an athlete gain emotional control. An athlete's ability to maintain control of their emotions in the face of adversity and remain positive is essential to successful performance. Two emotions that are often associated with poor performance are anxiety and anger.

Anxiety comes in two forms - Physical (butterflies, sweating, nausea, needing the toilet) and Mental (worry, negative thoughts, confusion, lack of concentration). Relaxation is a technique that can be used to reduce anxiety.

When an athlete becomes angry, the cause of the anger often becomes the focus of attention. This then leads to a lack of concentration on the task, performance deteriorates and confidence in ability is lost which fuels the anger - a slippery slope to failure.

Sports performance depends on the athlete being fully committed to numerous goals over many years. In competition with these goals, the athlete will have many aspects of daily life to manage. The many competing interests and commitments include work, studies, family/partner, friends, social life and other hobbies/sports

Within the athlete's sport, commitment can be undermined by:

Setting goals with the athlete will raise their feelings of value, give them joint ownership of the goals and therefore become more committed to achieving them. All goals should be SMARTER.

Many people (coach, medical support team, manager, friends, etc) can contribute to an athlete's levels of commitment with appropriate levels of support and positive feedback, especially during times of injury, illness and poor performance.

The following are emotional states experienced with successful performance:

Psychology skills training for the athlete should aim to improve their mental skills, such as self-confidence, motivation, the ability to relax under great pressure, and the ability to concentrate and usually has three phases:

The following references provide additional information on this topic:

If you quote information from this page in your work, then the reference for this page is:

The following Sports Coach pages provide additional information on this topic:

Continued here:
Sports Psychology - BrianMac

21 January 2019

TheNuffield Foundation has awarded funding to Mathematics in Education and Industry (MEI) to investigate the feasibility of a new mathematics GCSE curriculum for post-16 resit students.

The aim of this new project is to start a fresh consideration of appropriate mathematical content and qualifications for GCSE resit students, in line with the recommendations of the Smith review. It is hoped this will improve outcomes for young people, and the wider population, by improving knowledge of, and attitudes towards, mathematics.

In England, young people aged 16-18 who have not achieved grade 4 or higher in GCSE Mathematics are required to continue to work towards achieving it. Those studying full-time who achieved grade 3 are required to resit it, which often results in young people lacking confidence in mathematics and the prospect of more of the same can be very de-motivating. The resit success rate is also very low. Over 170,000 young people resat GCSE Mathematics in the summer of 2018, but only 23.7% achieved at least a grade 4 or equivalent. As a result, many young people do not achieve their full potential and can be left with a lasting sense of failure and a reinforced negative attitude towards mathematics. This may prevent them from engaging with learning and using mathematics in the future.

The standard GCSE Mathematics curriculum, which is designed for 14-16 year olds, attempts to do two things: prepare students for further academic study of mathematics, and develop the knowledge and skills to apply mathematics to practical problems encountered in the workplace and other aspects of life. Most resit students need to focus on the latter.

The project will report towards the end of 2019.

Josh Hillman, Director of Education at the Nuffield Foundation, said:

Performance in GCSE maths has both immediate and long-term impact on the education, training and employment trajectories of 16 year olds. Previous Nuffield Foundation funded research has found that students past experiences mean they lack both motivation and confidence when required to retake their maths GCSE, and the resit success rate remains stubbornly low. This feasibility study responds to the Smith Review recommendation that current maths qualifications could and should be reformed to increase the proportion of 18-year-olds with a good understanding of maths. We are pleased to support this new study which aims to develop much needed curriculum options in post-16 maths.

Charlie Stripp, Chief Executive of MEI, said:

Re-sitting a GCSE Mathematics qualification designed for 16 year olds does not meet the mathematical needs of the large majority of students who do not succeed in maths at age 16. These students need a different post-16 GCSE maths curriculum that can motivate them to develop fluency and confidence in the fundamental maths skills they need for everyday life and employment. MEI is delighted that the Nuffield Foundation has agreed to support our work to try to develop such a curriculum.

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A new mathematics GCSE curriculum for post-16 resit ...

It is easy to write about the need for a positive mental attitude in coping with severe illness. It is easy to philosophize and to write abstract ideas about attitudes. The main point to consider, however, is: How do people act who do have a positive mental attitude in the face of a serious illness? What do they do? If we in the healing arts are to help people, then we must provide guidelines pertaining to mental attitude.

In my experience I have noticed certain characteristics or qualities in those people who in fact do have good mental attitudes. These characteristics are:

"Drainage is the term applied to the physiological processes by which all waste and toxic matters are eliminated from the cells and the tissues and, in turn, eliminated from the body. It is the means by which internal cleanliness is maintained. It is believed by the greatest authorities that defective drainage is responsible for almost every disease known to man, except the infectious diseases and accidents." By William F. Haack

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Resources | Magazine Articles | Mental Attitude and Cancer ...

A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a proposition. Several of these states are a combination of mental representations and propositional attitudes. There are several paradigmatic states of mind that an agent has: love, hate, pleasure and pain, and attitudes toward propositions such as: believing that, conceiving that, hoping and fearing that, etc.

Discussions about mental states can be found in many areas of study.

In cognitive psychology and the philosophy of mind, a mental state is a kind of hypothetical state that corresponds to thinking and feeling, and consists of a conglomeration of mental representations and propositional attitudes. Several theories in philosophy and psychology try to determine the relationship between the agent's mental state and a proposition.[1][2][3][4]

Instead of looking into what a mental state is, in itself, clinical psychology and psychiatry determine a person's mental health through a mental status examination.[5]

Mental states also include attitudes towards propositions, of which there are at least twofactive, non-factive, both of which entail the mental state of acquaintance. To be acquainted with a proposition is to understand its meaning and be able to entertain it. The proposition can be true or false, and acquaintance requires no specific attitude towards that truth or falsity. Factive attitudes include those mental states that are attached to the truth of the propositioni.e. the proposition entails truth. Some factive mental states include "perceiving that", "remembering that", "regretting that", and (more controversially) "knowing that".[6] Non-factive attitudes do not entail the truth of the propositions to which they are attached. That is, one can be in one of these mental states and the proposition can be false. An example of a non-factive attitude is believingyou can believe a false proposition and you can believe a true proposition. Since you have the possibility of both, such mental states do not entail truth, and therefore, are not factive. However, belief does entail an attitude of assent toward the presumed truth of the proposition (whether or not it's so), making it and other non-factive attitudes different than mere acquaintance.

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Mental state - Wikipedia

It's likely our species survived because of our knack for detecting danger. But our worry-filled thoughts can present dangers of their own: Thinking negatively can drag down our moods, our actions and even our health.

Experts say it's worthwhileand possibleto learn how to think more positively.

Consider what researchers found about the benefits of staying positive:

Trying to be optimistic doesn't mean ignoring the uglier sides of life. It just means focusing on the positive as much as possible-and it gets easier with practice.

If you want to pump up your optimism, you might:

Noticing and appreciating the positives in our lives offers a great mood boost.

To increase your gratefulness, you can:

If you want to feel positive, it pays to decrease the downers in your life. With practice, you can resist worrisome thoughts and perhaps even transform your internal critic into more of a cheering squad.

Reviewed by Sonja Lyubomirsky, PhD, a University of California, Riverside professor and author ofThe How of Happiness: A New Approach to Getting the Life You Want(Penguin Press).

These proven tools can help you feel stronger and more hopeful. Check out each page for specific, easy-to-follow tips.

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Stay Positive | Mental Health America

Home Positive Emotions What is Positive Mindset and 89 Ways to Achieve a Positive Mental Attitude

Last Updated on August 30, 2018

It is probably not a surprise to you that positivity is, inherently, at the center of positive psychology.

Positivity doesnt always refer to simply smiling and looking cheerful, howeverpositivity is more about ones overall perspective on life and their tendency to focus on all that is good in life.

In this piece, well cover the basics of positivity within positive psychology, identify some of the many benefits of approaching life from a positive point of view, and explore some tips and techniques for cultivating a positive mindset.

This piece is a long one, so settle in and get comfortable. Ready to get started? Then read on!

The Positive Psychology Toolkit

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The Positive Psychology toolkit is a science-based, online platform containing 200+ exercises, activities, interventions, questionnaires, assessments and scales.

You probably have an idea of what a positive mindset or positive attitude is already, but its always helpful to start with a definition.

This definition from Remez Sasson (n.d.) is a good general description:

Positive thinking is a mental and emotional attitude that focuses on the bright side of life and expects positive results.

Another, more comprehensive definition comes from Kendra Cherry at Very Well Mind (2017B):

[P]ositive thinking actually means approaching lifes challenges with a positive outlook. It does not necessarily mean avoiding or ignoring the bad things; instead, it involves making the most of the potentially bad situations, trying to see the best in other people, and viewing yourself and your abilities in a positive light.

We can extrapolate from these definitions and come up with a good description of positive mindset as the tendency to focus on the bright side, expect positive results, and approach challenges with a positive outlook. Having a positive mindset means making positive thinking a habit, continually searching for the silver lining and making the best out of any situation you find yourself in.

So, now we know what a positive mindset is, we can dive into the next important question: What does it look like?

There are many traits and characteristics associated with a positive mindset, including:

Not only are these characteristics of a positive mindset, they may also work in the other directionactively adopting optimism, acceptance, resilience, gratitude, mindfulness, and integrity in your life will help you develop and maintain a positive mindset.

If you found the list above still too vague, there are many more specific examples of a positive attitude in action.

For example, positive attitudes can include:

Now we know a little bit more about what a positive mindset looks like, we can turn to one of the biggest questions of all: Whats the deal with having a positive attitude?

What is it about having a positive mindset that is so important, so impactful, so life-changing?

Well, the traits and characteristics listed above give us a hint; if you comb through the literature, youll see a plethora of benefits linked to optimism, resilience, and mindfulness. Youll see that awareness and integrity are linked to better quality of life, and acceptance and gratitude can take you from the okay life to the good life.

Developing a truly positive mindset and gaining these benefits is a function of the thoughts you cultivate.

Dont worrythis piece isnt about the kind of positive thinking that is all positive, all the time. We dont claim that just thinking happy thoughts will bring you all the success you desire in life, and we certainly dont believe that optimism is warranted in every situation, every minute of the day.

Developing the right thoughts is not about being constantly happy or cheerful, and its not about ignoring anything negative or unpleasant in your life. Its about incorporating both the positive and negative into your perspective and choosing to still be generally optimistic.

Its about acknowledging that you will not always be happy and learning to accept bad moods and difficult emotions when they come.

Above all, its about increasing your control over your own attitude in the face of whatever comes your way. You cannot control your mood, and you cannot always control the thoughts that pop into your head, but you can choose how you handle them.

When you choose to give in to the negativity, pessimism, and doom-and-gloom view of the world, you are not only submitting to a loss of control and potentially wallowing in unhappinessyou are missing out on an important opportunity for growth and development.

According to positive psychologist Barbara Fredrickson, negative thinking, and negative emotions have their place: they allow you to sharpen your focus on dangers, threats, and vulnerabilities. This is vital for survival, although perhaps not as much as it was for our ancestors. On the other hand, positive thinking and positive emotions broaden and build our resources and skills, and open us up to possibilities (Fredrickson, 2004).

Building a positive framework for your thoughts is not about being bubbly and annoyingly cheerful, but making an investment in yourself and your future. Its okay to feel down or think pessimistically sometimes, but choosing to respond with optimism, resilience, and gratitude will benefit you far more in the long run.

Aside from enhancing your skills and personal resources, there are many other benefits of cultivating a positive mindset, including better overall health, better ability to cope with stress, and greater well-being (Cherry, 2017A). According to the experts at the Mayo Clinic, positive thinking can increase your lifespan, reduce rates of depression and levels of distress, give you greater resistance to the common cold, improve your overall psychological and physical well-being, improve your cardiovascular health and protect you from cardiovascular disease, and help you build coping skills to keep you afloat during challenging times (2017).

Youve probably heard of all these generic benefits before, so well get more specific and explore the benefits of a positive mindset in several different contexts:

No construct better captures the essence of a positive attitude in the workplace quite like psychological capital (or PsyCap for short). This multicomponent construct is made up of four psychological resources:

PsyCap was first conceptualized as positive psychological capital by renowned management and leadership researchers Luthans and Youssef in 2004. The concept quickly took off among positive organizational psychologists, and by 2011 there were already hundreds of citations of PsyCap in the literature.

The first meta-analysis of all the research on PsyCap was conducted in 2011, and it outlined some of the many benefits of PsyCap in the workplace:

It seems pretty straightforward that positive attitudes like optimism and resilience lead to positive outcomes for the organization and for the employees!

Another study by a few of the giants in the field of positive psychology (Sonja Lyubomirsky, Laura King, and Ed Diener, 2005) investigated the relationship between happiness and benefits to employees. They showed that positive attitudes in the workplace also benefit the employee in addition to the organization:

So, a positive attitude can have great benefits for the organization as a whole and for all of its employees. It turns out that positive attitude can also result in benefits for leaders and their followers (as well as spreading positivity throughout the organization).

As important as a positive mindset is for the rank-and-file, its easy to see why it is vital for those in a position of leadership.

Researchers Hannah, Woolfolk, and Lord (2009) outlined a framework for positive leadership that rests on the idea that leaders with a positive self-concept (a positive idea of who they are and a habit of thinking positively about themselves) are more able to bring the right stuff to their leadership role. In their theory, a leader with a positive mindset is not only more likely to be actively engaged and to perform at a high level, he or she is also more able to influence followers toward a more positive mindset through role modeling and normative influence.

A study completed around the same time provides support for the relationship between leader and follower positivity; trust in management influenced positive PsyCap, which had a big impact on performance for leaders and followers (Clapp-Smith, Vogegesang, & Avey, 2008). Further, trust in management was linked to positive leadership and performance. While trust in management isnt necessarily indicative of a positive mindset in both leader and follower, it is certainly a likely outcome of a generally positive attitude in the workplace.

Forbes writer Victor Lipman (2017) puts findings like these in simpler terms:

Its always easier to follow someone with a positive outlook.

In other words, positive attitudes in a leader will draw followers and encourage motivation and engagement in subordinates. Lipman also notes that having a positive outlook and being resilient is vital in leadership positions because there is a lot of stress involved in managing and leading others. Leaders must always be on and spend much of their time performing as a strong, confident leader and perhaps even a public face. This role is a tiring one, and being optimistic and resilient will help leaders stay sane and healthy in challenging contexts.

Having a positive attitude is also a boon for those educating, interacting with, and caring for a disabled student, loved one, or patient.

A positive attitude toward disability facilitates disabled students education and helps them assimilate into postsecondary education (Rao, 2004). This makes it even more troubling to learn that, according to a 2012 study on UK primary schools, only 38% of them had a Disability Equality Scheme in place and only 30% had included a plan to promote positive attitudes towards disabled people (Beckett & Buckner). Further, 76% of schools reported that their staff had not received any training in the promotion of positive attitudes towards students with disabilities.

With so many resources available for promoting positive attitudes toward disability, there is ample opportunity to rectify this lack; for example, research by The Childrens Society in the UK identified several ways to promote positivity:

A 2009 study also established that formal instruction in disability awareness combined with hands-on fieldwork experiences with people who have a disability can have a significant impact on the positive attitudes toward those with disability (Campbell, Gilmore, & Cuskelly). The research found that teachers-in-training who participated in a one-semester course involving direct work with students who had Down syndrome greatly improved their knowledge of the syndrome as well as their attitudes toward those with Down syndrome.

All of these findings show that having a positive attitude towards those with a disability is not only the right thing to work toward, but it also has a significant positive influence on both those with disability and those around them. Unsurprisingly, its also important for nurses and other health professionals to cultivate a positive attitude towards their patients with a disabilitysomething that nurses sometimes struggle with (Tervo & Palmer, 2004).

On the subject of nursing and healthcare, this is another context where having a positive mindset (towards oneself and ones patientsdisabled or otherwise) can have a positive impact.

In fact, having a positive attitude is so important for nursing, expert Jean Watson describes nursing as the Caring Science (2009). Indeed, positivity and caring are ingrained in the field; just take a look at the five core nursing values:

These five values lay the foundation for a caring, positive mindset that is the hallmark of good nursing practice. Nurses who embrace these core values and adopt a positive mindset toward themselves, their work, and their patients can help them find the meaning and fulfillment that likely prompted them to enter the field in the first place.

Having a positive mindset in health care not only acts as a facilitator of meaning and purpose in the lives of healthcare professionals, it also:

Luckily, there are evidence-backed ways for nurses to implement a more positive outlook, including:

Speaking of the importance of positivity in health care, the benefits can extend to the patients as well.

Youve probably heard the common phrases and encouragements used when discussing someones cancer diagnosis.

A cancer patient will likely be told at least a few times that You have to stay positive! and You can fight this if you maintain a positive attitude.

This idea that being positive will help cancer patients to fight the disease is a common one, although the literature is a bit iffy on whether this phenomenon is real (Coyne & Tennen, 2010; OBaugh, Wilkes, Luke, & George, 2003).

Although it is unclear whether simply cultivating a positive mindset will help a patient beat cancer, theres no doubt that getting support, focusing on a healthy mental state, and maintaining a positive attitude will help patients reduce their tension, anxiety, fatigue, and depression, and improve their overall quality of life (Spiegel et al., 2007).

Cancer Treatment Centers of America expert Katherine Puckett agrees that positivity can be helpful for patients being treated for cancer, but clarifies that other emotions are perfectly acceptable as well.

So often I have heard a loved one say to a cancer patient who is crying, Stop crying. You know you have to be positive However, when we make space for people to express all of their feelings, rather than bottling them up inside, it is then easier for them to be optimistic. It is okay to allow tears to flowthese can be a healthy release. (Katherine Puckett, as reported in Fischer, 2016).

This indicates that the most important factor regarding positivity in cancer recovery is that it is authentic. False smiles and superficial cheerfulness will likely do nothing for the cancer patient, but working on cultivating an authentically positive mindset and focusing on the activities and techniques that build well-being can have a significant impact on a cancer patients quality of life andpossiblytheir chances of beating cancer.

Do a quick Google search on how to cultivate a more positive mindset, and youll see that there are tons of suggestions out there! Weve gathered some of the most popular and most evidence-backed methods here, but dont hesitate to search for more if you need them.

Larry Alton from Success.com lists 7 practical tips to help you get more positive:

Successful author, speaker, and coach Brian Tracy (n.d.) echoes some of these tips and adds a couple more:

For a more specific list of habits and actions you can take to develop a more positive mindset, try these 10 suggestions from Megan Wycklendt (2014) of Fulfillment Daily:

Finally, these 11 techniques from Dr. Tchiki Davis (2018) can also help you adopt a more positive attitude:

To pass along the benefits of developing a positive mindset to students, you can encourage them to try the techniques listed above. However, there are some methods for improving students attitude towards learning and school that may be even more effective.

Elliot Seif from the ASCDs Edge website outlines 13 ways you can help students cultivate this mindset:

However, these techniques are not always within a teachers (or parents) realm of control. If you these techniques are too overwhelming or the scope is out of your control, try these 7 strategies that you will likely have the power to implement:

For more tips and suggestions from the Association for Supervision and Curriculum Development, check out their excellent resource on instilling positive attitudes and perceptions about learning here.

If youre interested in fun, engaging, and hands-on ways to improve your positivity and enhance your positive mindset, youve come to the right place! There are many activities and games you can use to boost your positive thinking. Some of the most popular ones are listed here, but feel free to search for more if none of them align with your intereststhere are a lot to choose from out there!

Zdravko Lukovski from the Enlightenment Portal website has 10 exercises and activities that you can implement in your own life or encourage your clients to try in order to think more positively:

This list from Thought Catalogs Kathy Mitchell (2017) has some of the same ideas as Lukovski, but she adds a few more activities as well:

If youre more interested in games you can play to boost positive thinking, try these suggested games from Mary Osborne (2017) at Live Strong.

Recognizing Positive Behavior

Gather your team (or family, friends, etc.) and review a list of a generic individuals positive behaviors (like giving credit to others, smiling, saying thank you, and listening nonjudgmentally).

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What is Positive Mindset and 89 Ways to Achieve a Positive ...

The study authors said, ``It is commonly believed that a person's mental attitude affects his or her chances of surviving cancer and the psychological coping factors that are most well known in this respect are fighting spirit and helplessness/ hopelessness.We have been questioned over our mental attitude but we have young players and they can give more and they have given more now.No matter how good your swing is or how well you strike the ball, if you don't have the correct mental attitude to play golf you will always struggle.McIntosh said: 'We've now got the mental attitude that the Cup and the Trophy are behind us.I needed to re-establish my mental attitude and I did that really, really well.That's the mental attitude out there because (John) Wooden set a standard that's unprecedented today.The swimmers took in the competition during their heaviest period of training in the season, so it was particularly pleasing to see them respond with a tougher mental attitude,'' said Coventry coach Nick Sellwood.I think we're going into CIF with a very positive mental attitude - the team likes winning.I just sensed a different mental attitude within the dressing room when the Blades only had to draw.We lost Alonso there because of a late injury and we need that same mental attitude and teamwork in this game.Researchers measured results using standard tests and questionnaires to rate health, mental attitude and life satisfaction.We will also have to show the right mental attitude and be professional in the way we approach this tie.While you learn to defend yourself you also learn how to improve your mental attitude and perseverance.Such a modest exercise regimen does not work wonders - it does not cause weight loss - but it can increase muscle flexibility and mental attitude, said Toni McBride, director of Cornell's Wellness Program.But what will be will be, it's God's will and that is a great mental attitude to have.

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Mental attitude synonyms, mental attitude antonyms ...

The American Teilhard Association, since its foundation in 1967, is committed to making the thought and vision of Teilhard more widely available. the Association seeks to bring an encompassing perspective to this great task of shaping the well-being of the Earth community at a time when so many disintegrating forces are at work. Teilhards vision of the sequential evolution of the universe provides a firm and inspiring basis upon which to envision a sustainable future. This vision flows through his unified narrative of the evolutionary sequence of the emerging universe - the galaxies, the solar system, the Earth with its living forms, human history, and humanity's place in the evolving cosmos. This narrative from its origin to the human phenomenon can provide a firm and inspiring basis upon which to proceed. Now, for the first time, humanity is converging towards a new unity in diversity in shaping a multiform planetary civilization. To assist in this work, the Association, since its foundation in 1967, has sponsored annual conferences, lecture series, and a variety of publications. Learn More

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American Teilhard Association / index

Keywords

Knowledge; Attitude; Mental illnesses; Nigeria

Understanding mental illness in Nigeria is something that has to be taken contextually and historically. There is a large misconception and misinformation on the context of the subject amongst Nigerians. The general belief is that preternatural or supernatural forces, witches, evil spirits and even God cause mental illness [1-7]. These beliefs have influenced the attitude of Nigerians towards the mentally ill. Historically, people with mental illnesses were burned, hanged, mutilated, abandoned and restrained with chains, all in the bid to save their souls, or bring redemption to their families and curb the iniquities causing mental illness within the families [1,7]. These beliefs on the etiology of mental illness shape attitudes and have been shown to have a huge impact on the acceptance of the mentally ill amongst Nigerians [8].

Research has linked negative societal attitude with the behaviour of the mentally ill, rather than the cause of these mental illnesses [1,8,9]. Thus, mentally ill persons are frequently referred to as dangerous, suspicious, unstable, unreliable, irresponsible, and homicidal [1]. These labels on the mental behaviour of the mentally ill have aggravated stereotypes and provoked further prejudices on people with mental illnesses [9].

The impact of the stigmatizing attitude and poor knowledge of mental illness among Nigerians have shown to be a major hurdle to improving mental health in Nigeria. Current evidence points to the paucity of basic knowledge about mental illness, its causes and characteristics. This in turn affects the needed priorities on what services or facilities are required to manage them. Conversely, there is a growing evidence that changing the perception of Nigerians to mental illness will result in a better and more improved mental health care within the country [1]. This scoping review was designed in a bid to evaluate the level of peer-reviewed literature and information on the knowledge of, perceptions and attitude of Nigerians towards mental illness. The results summarize the views of Nigerians on mental health issues, challenges, existing gaps in literature and possible interventions that could help unravel this issue. It is hoped that this review will instigate feasible and practical interventions, raise policies and health education programs that will improve mental health literacy among Nigerians.

Scoping reviews are exploratory studies that systematically map literature on select topics with the goal of determining the feasibility of conducting a systematic review, summarizing and disseminating research findings to knowledge users and identifying gaps where further research may be required. As a form of synthesis, or systematic reviewing, scoping reviews are nascent and methodological frameworks being refined [10]. This scoping review employed the methodological framework and advancements put forward by several authors [11-13]. They involve six stages, which include:

1. Identifying the research question

2. Identifying relevant studies

3. Selecting the studies

4. Charting the data

5. Collating, summarizing and reporting of the results, and

6. Conducting consultation exercises (optional)

The review methodology helped provide flexibility for synthesis of a variety of study designs and article types [11,12]. Although presented in steps, the process was not linear as some steps were repeated to ensure a comprehensive assessment of the study.

Stage 1: Identification of the research question

Research questions used in scoping studies are initially broad as the focus is to summarize the breadth of evidence by linking a clear purpose to a well-defined set of literature [11]. The primary question that guided this scoping review was: What are the knowledge of and attitude towards mental disease among residents in Nigeria?

Stage 2: Identification of studies relevant to the research question

This stage involved identifying relevant studies by developing a search strategy, keywords, search sources, time span and language filters [11,12]. With the involvement of the Saskatchewan College of Medicine librarian, a broad search strategy was designed using the following keyword combinations and their synonyms: Knowledge, Attitude, Mental illness and Nigeria (Table 1). Six electronic bibliographic databases (Web of Knowledge, PUBMED/ MEDLINE, EMBASE, Scopus, PsycINFO, and PsychARTICLES) were searched using a syntax composed of all identified keywords and their synonyms. Table 1 also provides the search strings and queries used in identifying relevant articles for the review. The initial article search was commenced on April 17, 2016 and completed on May 28, 2016. A second search was carried out from June 09 to June 10, 2016 using all identified electronic bibliographic. Thirty (30) articles were retrieved randomly based on title and abstract screening, and their references searched to avoid missing relevant articles. Hand searching of articles cited in full text articles retrieved, were completed (the snowball phenomenon). To ensure completeness, a third search was carried out from July 18 to July 20 2016 using same syntax and bibliographic databases. No grey literature was used or retrieved in this study.

Table 1: Keywords (with synonyms) and search strings used for literature search.

Citation management: All citations were imported or manually entered using the reference managers Endnote X7 and Mendeley Desktop 13.8. Associated full text articles were thereafter added to citations for further reviewing. Duplicates were removed manually after assembling citations.

Stage 3: Study selection

At this stage, the search strategy was refined based on title and/or abstracts retrieved for the initial search results. This was achieved by applying a pre-developed eligibility criteria and selection process.

Eligibility criteria: Owing to the large number of anticipated articles for this topic, this study was limited to the following;

1. Peer-reviewed journal articles,

2. Review articles written in English or English/French, and

3. Review articles that assessed a combination of any of the keywords; knowledge (or its synonyms), attitude (or synonyms), Mental illness (or its synonyms) and Nigeria.

No timeline restrictions were placed. All articles that failed to fall within these criteria were excluded.

Selection process: A two-stage selection process was used to assess the relevance of articles identified from the search. After deduplication and application of the inclusion criteria, all identified articles were manually screened for relevance by checking their titles and abstracts for identified keywords. Full text articles (FTAs) were retrieved at this stage, if they had at least one or more identified keyword combinations. The second level screening process involved reading the full text articles retrieved from the first stage to ensure selected articles reflect an answer to the research question [11]. Thus, several iterations of stages 1 to 3 occurred. The selection process was carried out by two reviewers and a reviewer agreement score calculated. The overall kappa was 0.91, which represents a high level of agreement.

Stage 4: Charting the data within included studies

This step involved reading and re-reading the full text articles from those selected to identify and chart key themes that may support or contradict ideas identified from other included scoping review articles on a standard data extraction sheet [11]. For this scoping study, a tabular spreadsheet was created using Microsoft Excel 2013 for data entry and coding. The following title fields were entered for selected scoping articles:

Author(s): Names of leading author and co-authors

Year: Year of publication in identified journal

Title: Title of publication article or research

Study design: Research design (cross-sectional, case-control, cohort, case studies, etc.)

Study type: Quantitative, qualitative or mixed study type

Setting: Location of study

Summary/Abstract

Knowledge of mental illness among residents in Nigerian community

Attitude towards mental illness among residents in Nigerian community

Comparisons noted

Study strengths

Limitations to study (Table 2).

Table 2: Summary of articles included in scoping review (n=25).

Stage 5: Collating, summarizing and reporting results of the review synthesis

This stage is aimed to provide a coherent structure from the scoping review results, so the chart, using descriptive numerical summaries and thematic analysis [11]. In this study, the data gathered was subsequently analysed thematically and quantitatively, using QSR International's NVivo 10 qualitative data analysis Software and IBM SPSS Statistics for Macintosh, Version 21.0. Results of analysis and frequency tables are displayed in Tables 2-5.

Study selection

A total of 2079 peer-reviewed articles were retrieved from the overall search; with 2063 collected from the six bibliographical databases selected, and 16 from hand-searching of references and snowball phenomenon. Following deduplication and relevance screening, 111 articles were found to meet the eligibility criteria (based on their titles and/or abstracts). All 111 Full Text Articles (FTAs) were thereafter reviewed for inclusion based on their relevance to the research question. Of the 111 FTAs read, 86 articles failed to meet these eligibility criteria, leaving a total of 25 peer-reviewed articles for inclusion into the final scoping review (Figure 1).

Figure 1: Flowchart showing selection of articles for scoping review (n=25).

Descriptive numerical summary

The overall characteristics for the scoping articles are shown in Table 3. The peer-reviewed articles included fourteen (56%) published between the years 2000 and 2010, seven (28%) published before the year 2000, and four (16%) published after the year 2010.

Table 3: General attributes of publications included in the scoping review (n=25).

Word terminologies used to describe the keywords for the search strategy in this scoping review were consistent across selected articles. Of the 25 articles, 11 (44%) articles used beliefs to describe the knowledge of mental illnesses, six (24%) used the word perception alternatively for knowledge and 8 (32%) used knowledge as keyword terminology. Similarly, 17 of the 25 (68%) articles used attitude as keyword terminology describing attitude to mental illness, and 15 (60%) used the key word terminology mental illness (Table 3). Only one article however, defined beliefs in the context of mental health. Definition of terms used was rare except where belief was described as an acceptable knowledge and a cognitive information an individual accepts about an object. In other words, a subset of knowledge [7]. The term attitudes were not defined in any selected publication.

Reported methods from scoping articles

The methodological characteristics of reviewed articles are summarized in Table 4. Twenty-four (96%) studies used crosssectional research design with one applying a community-based participatory (CBP) approach. With regards to study type, 22 (92%) were quantitative studies and two (8%) mixed studies. All data provided in these studies were primary data (Tables 2 and 4). The largest data set contained information on 2342 respondents from three different communities participating in the study [8,14].

*Refer to Table 2 for key to study titles and authors.

Table 4: Methodological characteristics of publications included in the scoping review (n=25).

Questionnaires and survey instruments were used as primary source of data collection for all identified articles including the CBP research. Focus group discussion was used in collecting qualitative data from participants in one study which also utilized standardized questionnaires [15].

Methodological strengths and limitations of the scoping articles

The methodological strengths and limitations of identified scoping studies are summarized in Table 2. Fourteen (56%) articles acknowledged possible strengths, limitations and bias with their respective studies and research designs. Notable limitations reported were poor sample size (A, B, K, M, Y), social desirability bias (D, E, L, O) and cultural differences which may influences beliefs and choices (H, I, J, O, V,). For example, in a cross-sectional quantitative study set out to determine the attitude of high school teachers to mental illness. The lack of a comparison group was dully recognised as a major limitation to the study as well as poor validity and a possible social desirability bias given that the respondents were educated and well enlightened [16].

Authors of selected scoping studies generally attributed their study strengths to the large sample sizes they got (G, H, I) and an intervention arm of the study (B). The attitudinal change ascribed to an educational program was noted to be significant in a community based intervention [17].

Although not all scoping articles reported limitations in their respective studies, we inferred further researcher limitations from the results and nature of data of these respective studies as, language biases, selection biases, reporting biases and possibly confounding especially with the mixed method studies (D, F).

Thematic analysis and study findings

We grouped the findings of the scoping review into two groups; 1) Knowledge of mental illnesses among Nigerians and 2) Attitude towards mental illness among Nigerians. Results for each are summarized in Table 5.

*Refer to Table 2 for key to study titles and authors

Table 5: Overview summary of major primary outcomes in Knowledge and Attitude towards the mentally ill described in publications included in the scoping review (N=25).

Knowledge of mental illnesses among Nigerians: Knowledge, perceptions and beliefs of Nigerians about mental health and illness was assessed quantitatively in all of the scoping articles (92% (23/25) assessed purely quantitatively and 2/25(8%) assessed both qualitatively and quantitatively). Standardized structured questionnaires like the Familiarity with mental illness questionnaire (B), the Opinion on Mental Illness (OMI) scale(T,U), the Taylor and Dear Inventory of Community Attitude to Mental Illness(CAMI) (A,W), the modified version of Bogardus Social Distance Scale(B,G), the Discrimination and Stigma Scale (DISC 12) (F) and the Community Screening Interview for Dementia and Blessed Dementia Scale(Y) among other tested survey instruments were used to assess the knowledge of and attitude towards mental illness.

After analysing results of individual articles across all 25 scoping articles, we categorized the knowledge of causal attribution of mental illness based on common responses to;

a) Medical-which included hereditary, brain dysfunction, and other biological factors,

b) Supernatural- witchcraft, juju (sorcery), evil spirits, divine punishment, etc. and

c) Psychosocial-poverty, stress, drugs and alcohol abuse, traumatic event, shock, etc.

The most common causal attribution to mental illness noted was ascribed to supernatural causes. This was reported as a primary outcome for knowledge of causes of mental illness in 36% (9/25) (A,C,E,H,K,N,Q,R,X). Six articles (24%) recorded psychosocial causes (I,J,K,O,P,W) as a major cause of mental illness while only two articles (8%) reported medical causes (D,Y).

Several studies also assessed the knowledge and preference of treatment options for people with mental illness, in addition to knowledge and attitude. Of the 25 articles scoped, six (24%) expressed a preference for unorthodox (traditional) treatment options (C,N,O,Q,R,X) while 20% (5/25) expressed a preference for orthodox (western) treatment options (D,L,P,W,Y). Mental illness was generally viewed in a bad light Nigerians, in articles reviewed. Three scoping articles (12%) reported a bad prognosis of mental illness as one of the primary outcomes assessing the knowledge of prognosis of mental health (H,J,V) (Table 5).

Attitude towards mental illness among Nigerians: The scoping review also scoped the attitude of Nigerians towards people with mental illness. After analysing data charts from all 25 scoping articles, we thematically categorized attitude(s) of Nigerians towards mental illness into seven categories (Table 5);

a) Social distance and avoidance: This is the degree to which someone is willing to accept or associate with people having different social characteristics-in this case mental illnesses [14,18].

b) Marriage stigma: This included the willingness to marry, to stay in marriage or be given in marriage to someone with mental illness.

c) Job entrustment stigma: This included the freedom for a mentally ill person to work among or be employed among healthy or non-mentally ill persons.

d) Perceived dangerousness: This is the perception that an individual with a mental illness is extremely dangerous [18,19].

e) Social acceptance: This included acceptance at work, home and society where they lived in)

f) Sympathy: The awareness of someones distress and expressed compassion for them [1]

g) Indifference: A condition in which the person is unconcerned with symptoms of others [20]

The most prevalent attitude expressed as a primary outcome from all 25 articles scoped was social distance and avoidance (B,C,F,G,H,I,J,K,L,M,Q,S,W). Social distance was expressed in 52% (13/25) of scoping articles. Following that was perceived dangerousness due to fear, anger or mistrust towards mentally ill persons (A,B,F,H,J,L,O,P,T,U,V,W). Perceived dangerousness was expressed in twelve (48%) of scoping articles. Marriage stigma was recorded in 16% (4/25) of scoping articles (C,L,O,S). Job entrustment stigma (C,L), Social acceptance(O,L) and sympathy (O,D) were noted as primary outcomes of attitude towards mental illness in 8% (2/25) of scoping articles respectively. Only one article recorded and indifference to mental illness (L) (Table 5).

This scoping review applied a systematic approach to assess the knowledge and attitude toward mental illness by Nigerians. The findings show some cross-cultural variations, however, still similar in outcomes. Evaluating attitude towards mental illness through the knowledge of the causes of mental illness was critical and important for future service organization. Such findings have linked causal attribution and stigmatising attitude to mental illness [8,21,22]. Results from the scoping review showed a poor knowledge and widespread belief that mental illnesses were caused by supernatural forces including sorcery, witchcraft and punishment from God for sins. Culturally, Nigerians regardless of education seem to adhere in varying degrees to a belief in supernatural causation for any illness or outcome [20]. Results from the scoping review even showed that this belief was not limited to the public alone, but also popular among the workers in health care sectors (A,J,K,M,S,T,U,W,X). A belief in supernatural causation project people with mental illness as dangerous and distasteful [8].

Psychological causes such as alcohol, drugs and substance abuse, stress, and trauma were also implicated as common causes of mental illness. Again, this is a common belief among Nigerians who tend to attribute mental illness causation to psychological or social influences.

The downside to this view is that it tends to instigate more stigmatization rather than sympathy as the society views the mental illnesses as being self-inflicted or self-deserving [1,4,20,22]. All these objectionable views and beliefs on causes of mental illness by Nigerians, further complicates the preference for type of care. A supernatural view of the cause of mental illness will imply that unorthodox (traditional) means of treatment supersedes the orthodox means. Hence, spiritualists and traditional healers are then patronized. Although results from our scoping review showed that a few studies reported preference for a combination of both treatment options (J,Q,R), it is likely that the element of cultural misconception, which has been shown in the Nigerian society to affect their health seeking behaviour, may still make them choose the traditional means of treatment over the western approach. This behaviour doesnt only relate in reference to mental illness but in other illness types. The issue is that a lot of Nigerians who have lost hope in the health-care system, will resort to spiritual answers by going to prayer houses, traditional healers and spiritualists. No articles were found comparing the treatment approaches. Findings of such studies potentially will reduce stigma and impact attitudinal beliefs about mental illness.

Although studies have claimed that there is less stigmatizing attitude towards mental illness in Nigeria [23], this scoping study showed otherwise. Several studies have shown that stigmatizing attitude to mental illness is significantly associated with stereotypes and discrimination [1,21]. It was concerning the report that the Nigerians seem to despise people with mental disorders more than their illnesses (D,F,G,H,I). Overall, negative views were expressed in all scoping articles reviewed in this study (A-Y). In some studies, negative attitude expressed were indicative of age, gender, educational or economic status (A,B,C,F,G,H,I,J,K,L,M,Q,S,W). A notable article was a study carried out in Lagos, Nigerias most populous state, supposedly laden with the educated and elite (F). Results from this study revealed a widespread negative attitude towards mental illness even after previous studies may have said otherwise [3]. The most common views about the mentally ill reported from the scoping review, was perceived dangerousness (A,B,F,H,J,L,O,P,T,U,V,W) and social distance (B,C,F,G,H,I,J,K,L,M,Q,S,W). Studies have shown that these two negative views stimulate social resentment [21] and foster social distance [14,15]. Regrettably, there were also no changes in knowledge and attitude views over time, comparing older articles (below the year 2000) and newer articles (abover the year 2000).

There were a few research gaps observed from this scoping review. One striking observation was a rarity of studies carried out in the eastern part of Nigeria. Nigeria is a culturally assorted country with dissimilarities in access to mental health services which could affect knowledge and attitude to mental illness [24]. Nevertheless, several studies among other ethnic groups in this scoping review have suggested a widespread poor knowledge of and attitude towards mental illness which have been shown to have a strong validity and reliability (A,B,C,E,J,K,L,M,N,O,P, Q,R,T,U,X,Y). Secondly, the focus on mental illness as a general term rather than on specific mental disorder may have created a bias to respondents in individual studies, who have little or no knowledge about the term mental illness or may possess a narrow view of what the term means.

However, the findings of this scoping review support observations from other studies done outside Nigeria even though methodological differences may preclude comparability [25-30]. This corroborates the notion that stigma is a universal phenomenon, but experiences are local [27]. Thus, the need for mental health literacy is a global subject. The impact of education on the knowledge and attitude of Nigerians to mental illness was studied in a few of the scoping reviews (B,I,K,M,P,S,U,W,X,Y) and showed that mental health literacy was significantly associated with positive attitude towards mental illness. It has been said that an increase in literacy and education regarding the mental health and illnesses, will result in an improvement in attitude toward people with mental illness [8] as mental health illiteracy is a renowned source of stigmatizing attitude towards the mentally ill [22]. A potential direction this finding leads is the need to demonstrate effective interventions so as to curb the attitudinal excesses [40].

The outcome of this scoping review is a validation of a chronic widespread public stigmatization of the mentally ill. This demonstrates the need for mental health literacy in all levels of education. A better understanding of mental illness would significantly improve knowledge and attitude towards mentally ill persons. There is an urgent necessity, to improve the health care system in Nigeria, by developing strategies that would improve mental health literacy, and change stigmatizing attitude at both institutional and community levels. This will in the long run improve the quality of the societal attitude towards mental illness and the socio-economy of the mentally ill.

One practical yet feasible way to improve literacy in mental health, is by instituting age-appropriate school-based educational programmes. Although complexities may arise in creating these educational programs, reason being that stigmatizing attitude and beliefs in supernatural causation have been shown to still exist among educated health workers, however, its a good place to start from. Another practical recommendation is to increase psychiatry clerkship rotations for medical students, beyond 4 weeks. This will help familiarize students more with mental health diseases outside their pre-conceived misconceptions. In addition, it is necessary to encourage health workers (nurses, psychologists, psychiatrists and other health care professionals) to show positive attitude towards mentally ill persons as this play an important role in influencing their response to treatment. Missing in the scoping review was the role of the media in propagating attitudinal observation or changes. Future studies to examine how the media can play a role in education or reducing stigma.

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Knowledge of and Attitude to Mental Illnesses in Nigeria ...

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Your Mental Attitude determines everything about you. Don't go through life expecting things to change. Life becomes hard and unfair when we decide to complain about things rather than to change them ourselves. Wake up to the truth that life is not a practice - run, which bring about the discussion about MENTAL ATTITUDE........

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