Internalized (or self) stigma develops when people with mental illness become aware of stigmatizing attitudes held by many in society about mental illness (e.g., dangerousness, incompetence, inability to work), perceive these attitudes as being legitimate, and apply them to themselves. There is substantial evidence that internalized stigma is strongly negatively linked to both the objective (e.g., social functioning) and subjective (e.g. self- esteem and well-being) components of recovery for persons with schizophrenia, and that these effects operate independent of symptom-related disability. Nevertheless, few efforts have been made to develop treatment to address this issue. Previously, we were funded to develop a group-based intervention (R34MH082161) combining cognitive- behavioral therapy and narrative psychotherapy to address internalized stigma among people with severe mental illness. The purpose of the present study is to build upon our previous exploratory intervention development study by conducting an adequately- powered, randomized controlled trial of the Narrative Enhancement/Cognitive Therapy (NECT) intervention among persons with schizophrenia-spectrum disorders. We will screen 500 persons at two sites (Newark, NJ and Indianapolis, IN) for evidence of moderate or elevated internalized stigma. We will conduct a randomized study of NECT versus supportive group therapy in a sample of 175 individuals meeting SCID criteria for schizophrenia-spectrum disorders. Randomization will be stratified by baseline self- stigma severity (moderate or elevated), to ensure roughly equal numbers of participants for each stratum. Participants will complete baseline, post-treatment, 3-month post treatment and 6-month post treatment assessments of internalized stigma, psychiatric symptoms, insight, self-esteem, hopelessness, coping, narrative coherence and social functioning.
The specific aims of the project are: 1) Conduct a randomized study of the effectiveness of NECT, comparing outcomes for 175 persons with schizophrenia- spectrum disorder randomly assigned to NECT or supportive group therapy, 2) Examine the mediating impact of changes in narrative coherence and in the use of problem- centered coping strategies on outcomes for persons assigned to the NECT treatment. The intervention can have important implications for enhancing usual care services to reduce disability for people with schizophrenia, and therefore has potentially important implications for improving the public health.

Public Health Relevance

There is substantial evidence that internalized stigma is strongly negatively linked to both the objective (e.g., social functioning) and subjective (e.g., self-esteem and well- being) components of recovery for persons with schizophrenia, and that these effects operate independent of symptom-related disability. The purpose of the present study is to build upon our previous exploratory intervention development study by conducting an adequately-powered, randomized controlled trial of the Narrative Enhancement/ Cognitive Therapy (NECT) intervention designed to reduce internalized stigma and improve psychological and functional outcomes among people with schizophrenia- spectrum disorders. The intervention, if found to be effective, can have important implications for enhancing usual care services to facilitate recovery and reduce disability for people with schizophrenia, and therefore has potentially important implications for improving the public health.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH094310-01A1
Application #
8436762
Study Section
Special Emphasis Panel (SERV)
Program Officer
Juliano-Bult, Denise M
Project Start
2013-03-22
Project End
2017-01-31
Budget Start
2013-03-22
Budget End
2014-01-31
Support Year
1
Fiscal Year
2013
Total Cost
$650,773
Indirect Cost
$133,373
Name
John Jay College of Criminal Justice
Department
Psychology
Type
Other Domestic Higher Education
DUNS #
620128863
City
New York
State
NY
Country
United States
Zip Code
10019
Yanos, Philip T; Lucksted, Alicia; Drapalski, Amy L et al. (2015) Interventions targeting mental health self-stigma: A review and comparison. Psychiatr Rehabil J 38:171-8