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Journals / Ege Üniversitesi Hemşirelik Fakültesi Dergisi / 2025 / Cilt: 41 Sayı: 3

Internalized Stigma and Perception of Recovery: A Comparative Study of Participation in terms of Therapeutic Milieu Activities Applied in a Psychiatric Clinic

İçselleştirilmiş Damgalama ve İyileşme Algısı: Psikiyatri Kiniğinde Uygulanan Terapötik Ortam Aktivitelerine Katılım Açısından Karşılaştırmalı Bir Çalışma

Münire Temel(NAMIK KEMAL ÜNİVERSİTESİ)0000-0002-8099-6287
Gamze Özyiğit(TEKİRDAĞ NAMIK KEMAL ÜNİVERSİTESİ)0000-0001-8449-2353
Nurhan Akkaya(TEKİRDAĞ NAMIK KEMAL ÜNİVERSİTESİ)0009-0006-7624-4388
Ezgi Güner(TEKİRDAĞ NAMIK KEMAL ÜNİVERSİTESİ)0009-0004-8464-3827
Ahmet Erol(TEKİRDAĞ NAMIK KEMAL ÜNİVERSİTESİ)0009-0003-5863-0427
Sabri Kaya(TEKİRDAĞ NAMIK KEMAL ÜNİVERSİTESİ)0009-0003-8657-9999
Pages
585–595
Publication Date
2025-12-25
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AI Summary & Key Takeaways

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⚡ TL;DR(Too Long; Didn't Read)

Available from: https://doi.org/10.5152/npa.2015.0120148

📌 3 Key Takeaways

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Objective & Hypothesis:Internalized Stigma and Perception of Recovery: A Comparative Study in Terms of Therapeutic Milieu Activities Applied in a Psychiatric Clinic Abstract Objective: Internalized stigma and perception of recovery are important for psychiatric patients' treatment-seeking, treatment-maintaining, and recovery processes.
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Key Findings & Data:The study was carried out at a psychiatric clinic with 100 patients between April and December 2021.
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Conclusion & Impact:Available from: https://doi.org/10.5152/npa.2015.0120148
🔬Design:Review & Systematic Survey
📍Scope:2021 Verileri
⚙️Variables:içselleştirilmiş damgalama · iyileşme · psikiyatri kliniği

Abstract

Internalized Stigma and Perception of Recovery: A Comparative Study in Terms of Therapeutic Milieu Activities Applied in a Psychiatric Clinic Abstract Objective: Internalized stigma and perception of recovery are important for psychiatric patients' treatment-seeking, treatment-maintaining, and recovery processes. The therapeutic milieu forms part of psychiatric inpatient treatment. One of its components is structured activities. This study aims to compare patients' internalized stigma and perception of recovery based on their participation in therapeutic milieu activities in the psychiatric clinic. Method: The study is descriptive-comparative. The study was carried out at a psychiatric clinic with 100 patients between April and December 2021. Patients were divided into three groups based on their therapeutic milieu activity involvement level: low, moderate, and high. The data were collected using the participation form for therapeutic milieu activities, recovery assessment scale, and internalized stigma of mental illness scale. Results: It was determined that the recovery assessment scale scores did not differ according to the patients' participation in the therapeutic milieu activities (p>0.05). However it was determined that internalized stigma of mental illness scale scores differed according to the patients' participation in therapeutic milieu activities. Patients who participated more in activities were found to have lower levels of internalised stigma (p<0.05) Additionally, 85% of the patients believe that these therapeutic milieu activities have a positive impact on their treatment. Patients who believed that the therapeutic milieu activities had a positive impact on their treatment achieved significantly higher scores in recovery and lower scores in internalized stigma (p<0.05). Conclusion: This study highlights the role of therapeutic milieu activities in patients’ internalized stigma and perception of recovery. Activities offered in psychiatry clinics should not be viewed solely as a means of occupying patient's free time, but rather recognised as a crucial component of treatment for patients and healthcare professionals alike. Keywords: Internalized stigma; recovery; psychiatric nursing; psychiatry clinic; therapeutic milieu activities. REFERENCES Ådnanes, M., Melby, L., Cresswell-Smith, J. Westerlund, H., Rabbi, L., Dernovsek, M.Z., …..Donisi, V. (2018). Mental health service users’ experiences of psychiatric re-hospitalisation - an explorative focus group study in six European countries. BMC Health Serv Res,18(516), 1-8. Available from: https://doi.org/10.1186/s12913-018-3317-1 Agrest, M., Barruti, S., Gabriel, R., Zalazar, V., Wikinski, S., & Ardila-Gómez S. (2018). Day hospital treatment for people with severe mental illness according to users’ perspectives: what helps and what hinders recovery? J Ment Health, 27(1), 52–58. Available from: https://doi.org/10.1080/09638237.2016.1276526 Asan, Ö. (2019). Mental illnesses and stigmatization; Inside community, press, health professionals and everywhere… Sakarya Med J, 9(2), 199-205. Available from: https://doi.org/10.31832/smj.470300 Bakken, T.L. & Hoidal, S.H. (2019). Specialized psychiatric services: patient characteristics, referral practice and length of stay in a representative clinical sample 2010-2016. Int J Dev Disabil, 65(4), 277-284. Available from: https://doi.org/10.1080/20473869.2018.1438961 Belsiyal-Chellappan, X., Rentala, S. & Das, A. (2021). Effectiveness of therapeutic milieu intervention on inpatients with depressive disorder: A feasibility study from North India. Perspect Psychiatr Care, 57(4), 1604-1615. Available from: https://doi.org/10.1111/ppc.12725 Beyazyüz, M., Beyazyüz, E., Albayrak ,Y., Baykal, S. & Göka, E. (2015). Association between internalized stigma and some diagnostic subgroups, socio-demographic variables, and self-esteem levels in patients that refer to the psychiatry clinic of an education and research. New Symposium, 53, 2-13. Available from: https://doi.org/10.5455/NYS.20150609121944 Corrigan, P.W., Giffort, D., Rashid, F., Leary, M. & Okeke, I. (1999). Recovery as a psychological construct. Community Ment Health J, 35(3), 231-239. Available from: https://doi.org/10.1023/a:1018741302682 Çakmak, S., Süt, H., Öztürk, S., Tamam, L. & Bal, U. (2016). The effects of occupational therapy and psychosocial ınterventions on interpersonal functioning and personal and social performance levels of corresponding patients. Arch Neuropsychiatry, 53, 234-240. Available from: https://doi.org/10.5152/npa.2015.10130 Çam, O. & Yalçıner, N. (2018). Mental illness and recovery. J Psychiatric Nurs, 9(1), 55-60. Available from: https://doi.org/10.14744/phd.2017.49469 Doğan, R., Mercan, N. & Yüksel, Ç. (2020). Recovery in mental illness: Concept analysis. Current Approaches in Psychiatry, 12(1), 91-99. Available from: https://doi.org/10.18863/pgy.478241 Ergun, G., Isik, I. & Dikec, G. (2017). Roles of Psychiatry Nurses Within a Therapeutic Environment of Psychiatry Clinics in Turkey. Arch Psychiatr Nurs, 31(3), 248-255. Available from: https://doi.org/10.1016/j.apnu.2016.11.003 Ersoy, M.E. & Varan, A. (2007). Reliability and validity of the Turkish version of the internalized stigma of mental ıllness scale. Turk Psikiyatri Derg, 18(2), 163-171. Fırat, M., Demir Gökmen, B. & Cengiz, M. (2020). Investigation of the relationship between internalized stigmatization and social loneliness in psychiatric inpatients. J Psychiatric Nurs, 11(4), 268-274. Available from: https://doi.org/10.14744/phd.2020.09226 Giffort, D., Schmook, A., Woody, C., Vollendorf, C. & Gervain, M. (1995). Construction of a scale to measure consumer recovery. Illinois Office of Mental Health. Grech, P., Scerri, J., Cilia-Vincenti, S., Sammut, A., Galea, M., Calleja-Bitar, D., Dimech Sant, S. (2020). Service users' perception of the therapeutic milieu in a mental health rehabilitation unit. Issues Ment Health Nurs, 41(11), 1019-1026. Available from: https://doi.org/10.1080/01612840.2020.1757797 Guler, C. & Gurkan, A. (2019). Validity and reliability of the Turkish version of the Recovery Assessment Scale. Dusunen Adam The Journal of Psychiatry and Neurological Sciences, 32, 309-319. Available from: https://doi.org/10.14744/DAJPNS.2019.00045 Ilyas, A., Astuti, P. & Zahri, K. (2020). A milieu therapy perspective: fundamental values in mental health care delivery. EAS J Nurs Midwifery, 2(2), 129-135. Available from: https://doi.org/10.36349/EASJNM.2020.v02i02.020 Kaşli, S., Al, O. & Bademli, K. (2021). Internalized stigmatization and subjective recovery in individuals with chronic mental illness. Int J Soc Psychiatry, 67(5), 415-420. Available from: https://doi.org/10.1177/0020764020960762 Kurt, A., Erşan, E.E. & Savaş, İ. (2021). Comparison of self-stigma and subjective recovery status of patients receiving Community Mental Health Service and outpatient psychiatry policlinic. J Psychiatric Nurs, 12(2), 103-112. Available from: https://doi.org/10.14744/phd.2020.73383 Llewellyn-Beardsley, J., Rennick-Egglestone, S., Callard, F., Crawford, P., Farkas, M., Hui, A., …Slade M. (2019). Characteristics of mental health recovery narratives: Systematic review and narrative synthesis. PLoS ONE, 14(3), e0214678. Available from: https://doi.org/10.1371/journal.pone.0214678 Livingston, J.D. & Boyd, J.E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis, Soc Sci Med, 71(12), 2150-2161. Available from: https://doi.org/10.1016/j.socscimed.2010.09.030 Macpherson, R., Pesola, F., Leamy, M., Bird, V., Le Boutillier, C., Williams, J., Slade, M. (2016). The relationship between clinical and recovery dimensions of outcome in mental health. Schizophr Res., 175(1-3), 142-147. Available from: https://doi.org/10.1016/j.schres.2015.10.031. Mahoney, J.S., Palyo, N., Napier, G. & Giordano, J. (2009). The therapeutic milieu reconceptualized for the 21st century. Arch Psychiatr Nurs, 23(6), 423-9. Available from: https://doi.org/10.1016/j.apnu.2009.03.002 Millard, H., Parke, S., Wilson, C., Qayyum, Z., Kim, H.J. & Van Deusen, T. (2020). Inpatient milieu therapy: Considerations for adolescent and tansitional age youth. Adolescent Psychiatry, 10, 7-16. Available from: https://doi.org/10.2174/2210676609666190617150025 Morgades-Bamba, C.I., Fuster-Ruizdeapodaca, M.J. & Molero, F. (2019). The impact of internalized stigma on the well-being of people with Schizophrenia. Psychiatry Res, 271, 621-27. Available from: https://doi.org/10.1016/j.psychres.2018.12.060 Nåvik, M,, Hauge, S. & Sagen, U. (2020). Milieu therapy for hospitalized patients with late-life anxiety and depression: a qualitative study. Nord J Psychiatry, 74(7), 511-517. Available from: https://doi.org/ 10.1080/08039488.2020.1751879 Pearl, R. L., Forgeard, M. J. C., Rifkin, L., Beard, C., & Björgvinsson, T. (2017). Internalized stigma of mental illness: Changes and associations with treatment outcomes. Stigma and Health, 2(1), 2–15. Available from: https://doi.org/10.1037/sah0000036 Ritsher, J.B., Otilingam, P.G., & Grajales, M. (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res, 121(1), 31-49. Available from: https://doi.org/ 10.1016/j.psychres.2003.08.008 Soygür, H., Yüksel, M.M., Eraslan, P. & Attepe-Özden, S. (2017). Lessons Learned from Experiencing Mavi At Café (Blue Horse Café) during six years: A Qualitative Analysis of Factors Contributing to Recovery from the Perspective of Schizophrenia Patients. Turk Psikiyatri Derg, 28(2), 75-80. Available from: https://doi: 10.5080/u18141 Sharac, J., McCrone, .P, Sabes-Figuera, R., Csipke, E., Wood, A. & Wykes, T. (2010). Nurse and patient activities and interaction on psychiatric inpatients wards: a literature review. Int J Nurs Stud, 47(7), 909-17. Available from: https://doi.org/10.1016/j.ijnurstu.2010.03.012. Sibitz, I., Provaznikova, K., Lipp, M., Lakeman, R. & Amering, M. (2013). The impact of recovery-oriented day clinic treatment on internalized stigma: preliminary report. Psychiatry Res, 209(3), 326-32. Available from: https://doi.org/10.1016/j.psychres.2013.02.001 Stacy, M.A. & Rosenheck, R. (2019). The association of recovery orientation and stigmatizing beliefs, Journal of Mental Health, 28(3), 276-281. Available from: https://doi.org/10.1080/09638237.2017.1417573 Staniszewska, S., Mockford, C., Chadburn, G., Fenton, S.J., Bhui, K., Larkin, M., …Weich, S. (2019). Experiences of in-patient mental health services: systematic review. Br J Psychiatry, 214(6), 329-338. Available from: https://doi.org/10.1192/bjp.2019.22 Tsang, H.W., Ching, S.C., Tang, K.H., Lam, H.T., Law, P.Y. & Wan, C.N. (2016). Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophr Res, 173(1-2), 45-53. Available from: https://doi.org/10.1016/j.schres.2016.02.013 Towsend, M.C. (2013). Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice. F.A. Davis Company. Vass, V., Morrison, A.P., Law, H., Dudley, J., Taylor, P., Bennett, K.M. Bentall, R. (2015). How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry Res, 230(2), 487-95. Available from: https://doi.org/10.1016/j.psychres.2015.09.042 Waldemar, A.K., Arnfred, S.M., Petersen, L. & Korsbek, L. (2016). Recovery-Oriented practice in mental health ınpatient settings: a literature review. Psychiatr Serv, 67(6), 596-602. Available from: https://doi.org/10.1176/appi.ps.201400469 Yildirim, T. & Kavak-Budak, F. (2020). The relationship between internalized stigma and loneliness in patients with schizophrenia. Perspect Psychiatr Care, 56(1), 168-174. Available from: https://doi.org/10.1111/ppc.12399 Yıldız, M. (2015). Recovery as a process in severe mental illnesses. Arch Neuropsychiatr, 52(1), 1-3. Available from: https://doi.org/10.5152/npa.2015.0120148

Özet

İçselleştirilmiş Damgalama ve İyileşme Algısı: Psikiyatri Kiniğinde Uygulanan Terapotik Ortam Aktiviteleri Açısından Karşılaştırmalı Bir Çalışma Amaç: Amaç Psikiyatri hastalarının tedavi arayışı, tedaviyi sürdürme ve iyileşme süreçlerinde içselleştirilmiş damgalanma ve iyileşme algısı önemlidir. Terapötik ortam, psikiyatrik yatarak tedavinin bir parçası olup, bileşenlerinden biri de yapılandırılmış aktivitelerdir. Bu çalışmanın amacı, hastaların içselleştirilmiş damgalanma ve iyileşme algılarını psikiyatri kliniğindeki terapötik ortam aktivitelerine katılımlarına göre karşılaştırmaktı. Yöntem: Bu çalışma tanımlayıcı-karşılaştırmalı niteliktedir. Çalışma Nisan-Aralık 2021 tarihleri arasında bir psikiyatri kliniğinde 100 hasta ile gerçekleştirildi. Hastalar terapötik ortam etkinliklerine katılım düzeylerine göre düşük, orta ve yüksek olmak üzere üç gruba ayrıldı. Veriler, terapötik ortam aktivitelerine katılım formu, iyileşme değerlendirme ölçeği ve ruhsal hastalıklarda içselleştirilmiş damgalama ölçeği kullanılarak toplandı. Bulgular: Hastaların iyileşme değerlendirme ölçeği puanlarının terapötik ortam aktivitelerine katılımlarına göre farklılaşmadığı belirlendi (p>0.05). Ancak hastaların içselleştirilmiş damgalama puanlarının terapötik ortam aktivitelerine katılımlarına göre fark gösterdiği, daha fazla katılan hastaların içselleştirilmiş damgalama düzeyinin daha düşük olduğu belirlendi (p<0,05) Ayrıca hastaların %85'i terapötik ortam etkinliklerinin tedavilerini olumlu etkilediğini bildirdi. Terapötik ortam faaliyetlerinin tedavilerine katkısı olduğunu düşünen hastaların iyileşme değerlendirme ölçeği puanları yüksek, içselleştirilmiş damgalama puanları ise düşüktü (p<0,05). Sonuç: Bu çalışma, psikiyatri kliniğinde yatan hastalarının içselleştirilmiş damgalama ve iyileşme algılarında terapötik ortam faaliyetlerinin rolüne vurgu yapmaktadır. Psikiyatri kliniklerinde sunulan terapotik aktiviteler yalnızca hastaların boş zamanlarını değerlendirmek için bir araç olarak görülmemeli, hem hastalar hem de sağlık çalışanları için tedavinin önemli bir bileşeni olarak kabul edilmelidir. Anahtar Kelimeler: İçselleştirilmiş damgalama; iyileşme; psikiyatri hemşireliği; psikiyatri kliniği; terapotik ortam aktiviteleri. REFERENCES Ådnanes, M., Melby, L., Cresswell-Smith, J. Westerlund, H., Rabbi, L., Dernovsek, M.Z., …..Donisi, V. (2018). Mental health service users’ experiences of psychiatric re-hospitalisation - an explorative focus group study in six European countries. BMC Health Serv Res,18(516), 1-8. Available from: https://doi.org/10.1186/s12913-018-3317-1 Agrest, M., Barruti, S., Gabriel, R., Zalazar, V., Wikinski, S., & Ardila-Gómez S. (2018). Day hospital treatment for people with severe mental illness according to users’ perspectives: what helps and what hinders recovery? J Ment Health, 27(1), 52–58. Available from: https://doi.org/10.1080/09638237.2016.1276526 Asan, Ö. (2019). Mental illnesses and stigmatization; Inside community, press, health professionals and everywhere… Sakarya Med J, 9(2), 199-205. Available from: https://doi.org/10.31832/smj.470300 Bakken, T.L. & Hoidal, S.H. (2019). Specialized psychiatric services: patient characteristics, referral practice and length of stay in a representative clinical sample 2010-2016. Int J Dev Disabil, 65(4), 277-284. Available from: https://doi.org/10.1080/20473869.2018.1438961 Belsiyal-Chellappan, X., Rentala, S. & Das, A. (2021). Effectiveness of therapeutic milieu intervention on inpatients with depressive disorder: A feasibility study from North India. Perspect Psychiatr Care, 57(4), 1604-1615. Available from: https://doi.org/10.1111/ppc.12725 Beyazyüz, M., Beyazyüz, E., Albayrak ,Y., Baykal, S. & Göka, E. (2015). Association between internalized stigma and some diagnostic subgroups, socio-demographic variables, and self-esteem levels in patients that refer to the psychiatry clinic of an education and research. New Symposium, 53, 2-13. Available from: https://doi.org/10.5455/NYS.20150609121944 Corrigan, P.W., Giffort, D., Rashid, F., Leary, M. & Okeke, I. (1999). Recovery as a psychological construct. Community Ment Health J, 35(3), 231-239. Available from: https://doi.org/10.1023/a:1018741302682 Çakmak, S., Süt, H., Öztürk, S., Tamam, L. & Bal, U. (2016). The effects of occupational therapy and psychosocial ınterventions on interpersonal functioning and personal and social performance levels of corresponding patients. Arch Neuropsychiatry, 53, 234-240. Available from: https://doi.org/10.5152/npa.2015.10130 Çam, O. & Yalçıner, N. (2018). Mental illness and recovery. J Psychiatric Nurs, 9(1), 55-60. Available from: https://doi.org/10.14744/phd.2017.49469 Doğan, R., Mercan, N. & Yüksel, Ç. (2020). Recovery in mental illness: Concept analysis. Current Approaches in Psychiatry, 12(1), 91-99. Available from: https://doi.org/10.18863/pgy.478241 Ergun, G., Isik, I. & Dikec, G. (2017). Roles of Psychiatry Nurses Within a Therapeutic Environment of Psychiatry Clinics in Turkey. Arch Psychiatr Nurs, 31(3), 248-255. Available from: https://doi.org/10.1016/j.apnu.2016.11.003 Ersoy, M.E. & Varan, A. (2007). Reliability and validity of the Turkish version of the internalized stigma of mental ıllness scale. Turk Psikiyatri Derg, 18(2), 163-171. Fırat, M., Demir Gökmen, B. & Cengiz, M. (2020). Investigation of the relationship between internalized stigmatization and social loneliness in psychiatric inpatients. J Psychiatric Nurs, 11(4), 268-274. Available from: https://doi.org/10.14744/phd.2020.09226 Giffort, D., Schmook, A., Woody, C., Vollendorf, C. & Gervain, M. (1995). Construction of a scale to measure consumer recovery. Illinois Office of Mental Health. Grech, P., Scerri, J., Cilia-Vincenti, S., Sammut, A., Galea, M., Calleja-Bitar, D., Dimech Sant, S. (2020). Service users' perception of the therapeutic milieu in a mental health rehabilitation unit. Issues Ment Health Nurs, 41(11), 1019-1026. Available from: https://doi.org/10.1080/01612840.2020.1757797 Guler, C. & Gurkan, A. (2019). Validity and reliability of the Turkish version of the Recovery Assessment Scale. Dusunen Adam The Journal of Psychiatry and Neurological Sciences, 32, 309-319. Available from: https://doi.org/10.14744/DAJPNS.2019.00045 Ilyas, A., Astuti, P. & Zahri, K. (2020). A milieu therapy perspective: fundamental values in mental health care delivery. EAS J Nurs Midwifery, 2(2), 129-135. Available from: https://doi.org/10.36349/EASJNM.2020.v02i02.020 Kaşli, S., Al, O. & Bademli, K. (2021). Internalized stigmatization and subjective recovery in individuals with chronic mental illness. Int J Soc Psychiatry, 67(5), 415-420. Available from: https://doi.org/10.1177/0020764020960762 Kurt, A., Erşan, E.E. & Savaş, İ. (2021). Comparison of self-stigma and subjective recovery status of patients receiving Community Mental Health Service and outpatient psychiatry policlinic. J Psychiatric Nurs, 12(2), 103-112. Available from: https://doi.org/10.14744/phd.2020.73383 Llewellyn-Beardsley, J., Rennick-Egglestone, S., Callard, F., Crawford, P., Farkas, M., Hui, A., …Slade M. (2019). Characteristics of mental health recovery narratives: Systematic review and narrative synthesis. PLoS ONE, 14(3), e0214678. Available from: https://doi.org/10.1371/journal.pone.0214678 Livingston, J.D. & Boyd, J.E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis, Soc Sci Med, 71(12), 2150-2161. Available from: https://doi.org/10.1016/j.socscimed.2010.09.030 Macpherson, R., Pesola, F., Leamy, M., Bird, V., Le Boutillier, C., Williams, J., Slade, M. (2016). The relationship between clinical and recovery dimensions of outcome in mental health. Schizophr Res., 175(1-3), 142-147. Available from: https://doi.org/10.1016/j.schres.2015.10.031. Mahoney, J.S., Palyo, N., Napier, G. & Giordano, J. (2009). The therapeutic milieu reconceptualized for the 21st century. Arch Psychiatr Nurs, 23(6), 423-9. Available from: https://doi.org/10.1016/j.apnu.2009.03.002 Millard, H., Parke, S., Wilson, C., Qayyum, Z., Kim, H.J. & Van Deusen, T. (2020). Inpatient milieu therapy: Considerations for adolescent and tansitional age youth. Adolescent Psychiatry, 10, 7-16. Available from: https://doi.org/10.2174/2210676609666190617150025 Morgades-Bamba, C.I., Fuster-Ruizdeapodaca, M.J. & Molero, F. (2019). The impact of internalized stigma on the well-being of people with Schizophrenia. Psychiatry Res, 271, 621-27. Available from: https://doi.org/10.1016/j.psychres.2018.12.060 Nåvik, M,, Hauge, S. & Sagen, U. (2020). Milieu therapy for hospitalized patients with late-life anxiety and depression: a qualitative study. Nord J Psychiatry, 74(7), 511-517. Available from: https://doi.org/ 10.1080/08039488.2020.1751879 Pearl, R. L., Forgeard, M. J. C., Rifkin, L., Beard, C., & Björgvinsson, T. (2017). Internalized stigma of mental illness: Changes and associations with treatment outcomes. Stigma and Health, 2(1), 2–15. Available from: https://doi.org/10.1037/sah0000036 Ritsher, J.B., Otilingam, P.G., & Grajales, M. (2003). Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res, 121(1), 31-49. Available from: https://doi.org/ 10.1016/j.psychres.2003.08.008 Soygür, H., Yüksel, M.M., Eraslan, P. & Attepe-Özden, S. (2017). Lessons Learned from Experiencing Mavi At Café (Blue Horse Café) during six years: A Qualitative Analysis of Factors Contributing to Recovery from the Perspective of Schizophrenia Patients. Turk Psikiyatri Derg, 28(2), 75-80. Available from: https://doi: 10.5080/u18141 Sharac, J., McCrone, .P, Sabes-Figuera, R., Csipke, E., Wood, A. & Wykes, T. (2010). Nurse and patient activities and interaction on psychiatric inpatients wards: a literature review. Int J Nurs Stud, 47(7), 909-17. Available from: https://doi.org/10.1016/j.ijnurstu.2010.03.012. Sibitz, I., Provaznikova, K., Lipp, M., Lakeman, R. & Amering, M. (2013). The impact of recovery-oriented day clinic treatment on internalized stigma: preliminary report. Psychiatry Res, 209(3), 326-32. Available from: https://doi.org/10.1016/j.psychres.2013.02.001 Stacy, M.A. & Rosenheck, R. (2019). The association of recovery orientation and stigmatizing beliefs, Journal of Mental Health, 28(3), 276-281. Available from: https://doi.org/10.1080/09638237.2017.1417573 Staniszewska, S., Mockford, C., Chadburn, G., Fenton, S.J., Bhui, K., Larkin, M., …Weich, S. (2019). Experiences of in-patient mental health services: systematic review. Br J Psychiatry, 214(6), 329-338. Available from: https://doi.org/10.1192/bjp.2019.22 Tsang, H.W., Ching, S.C., Tang, K.H., Lam, H.T., Law, P.Y. & Wan, C.N. (2016). Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophr Res, 173(1-2), 45-53. Available from: https://doi.org/10.1016/j.schres.2016.02.013 Towsend, M.C. (2013). Essentials of Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice. F.A. Davis Company. Vass, V., Morrison, A.P., Law, H., Dudley, J., Taylor, P., Bennett, K.M. Bentall, R. (2015). How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences. Psychiatry Res, 230(2), 487-95. Available from: https://doi.org/10.1016/j.psychres.2015.09.042 Waldemar, A.K., Arnfred, S.M., Petersen, L. & Korsbek, L. (2016). Recovery-Oriented practice in mental health ınpatient settings: a literature review. Psychiatr Serv, 67(6), 596-602. Available from: https://doi.org/10.1176/appi.ps.201400469 Yildirim, T. & Kavak-Budak, F. (2020). The relationship between internalized stigma and loneliness in patients with schizophrenia. Perspect Psychiatr Care, 56(1), 168-174. Available from: https://doi.org/10.1111/ppc.12399 Yıldız, M. (2015). Recovery as a process in severe mental illnesses. Arch Neuropsychiatr, 52(1), 1-3. Available from: https://doi.org/10.5152/npa.2015.0120148

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Temel, M., Özyiğit, G., Akkaya, N., Güner, E., Erol, A., Kaya, S. (2025). Internalized Stigma and Perception of Recovery: A Comparative Study of Participation in terms of Therapeutic Milieu Activities Applied in a Psychiatric Clinic. Ege Üniversitesi Hemşirelik Fakültesi Dergisi, Cilt: 41 Sayı: 3, 585–595. https://doi.org/10.53490/egehemsire.1417322

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