Cognitive therapy for internalised stigma in people experiencing psychosis: A pilot randomised controlled trial

Abstract

We aimed to evaluate the feasibility of Cognitive Therapy (CT) as an intervention for internalised stigma in people with psychosis. We conducted a single-blind randomised controlled pilot trial comparing CT plus treatment as usual (TAU) with TAU only. Participants were assessed at end of treatment (4 months) and follow-up (7 months). Twenty-nine participants with schizophrenia spectrum disorders were randomised. CT incorporated up to 12 sessions over 4 months (mean sessions=9.3). Primary outcome was the Internalised Stigma of Mental Illness Scale - Revised (ISMI-R) total score, which provides a continuous measure of internalised stigma associated with mental health problems. Secondary outcomes included self-rated recovery, internalised shame, emotional problems, hopelessness and self-esteem. Recruitment rates and retention for this trial were good. Changes in outcomes were analysed following the intention-to-treat principle, using ANCOVAs adjusted for baseline symptoms. There was no effect on our primary outcome, with a sizable reduction observed in both groups, but several secondary outcomes were significantly improved in the group assigned to CT, in comparison with TAU, including internalised shame, hopelessness and self-rated recovery. Stigma-focused CT appears feasible and acceptable in people with psychosis who have high levels of internalised stigma. A larger, definitive trial is required.

The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem

“…This study also has a number of limitations. It was a secondary analysis of data collected for a research trial and validation of the SIMS measure (Morrison et al, 2016;Wood et al, 2016) . Therefore, the outcome variables examined in this study were limited to what was included in these studies.…”

“…Participants for this current study were recruited from the sample (n=79) of the semistructured interview measure of stigma (SIMS) study (Wood et al, 2016). Participants were either recruited from (a) an inner London acute psychiatric inpatient unit and identified via nursing staff or (b) a trial examining the efficacy of Cognitive Therapy for internalised stigma in psychosis (Morrison et al, 2016). Participants were included if they were (i) aged between 18-65, and (ii) met ICD-10 criteria for schizophrenia, schizoaffective disorder or delusional disorder or met criteria for an Early Intervention service to allow for diagnostic uncertainty.…”

“…The Semi-structured Interview Measure of Stigma (SIMS) in psychosis was used as a measure of stigma (Wood et al, 2016). It is an eleven item semi-structured interview which examines interviewee's experienced stigma, perceived stigma and internalised stigma.…”

“…Pearson correlation coefficients and descriptive statistics can be found in table 2. The mean scores of the outcome variables illustrate a sample with moderate levels of stigma (Wood et al, 2016). The sample is experiencing relatively high levels of internalised shame (>50 indicating a problematic level (Cook, 1987), along with moderate depression and hopelessness (Beck et al, 1974;Beck et al, 1996).…”

The role of shame in people with a diagnosis of schizophrenia

“…Interventions aimed at reducing shame such as group Cognitive Behavioural Therapy (CBT) targeted at shame and self‐esteem (Knight, Wykes, & Hayward, ), or compassionate‐focused therapy (Braehler et al ., ; Gumley, Braehler, Laithwaite, MacBeth, & Gilbert, ) may be particularly helpful. A recent pilot randomized controlled trial of individual CBT aimed specifically at reducing internalized stigma also showed promising results in reducing internalized shame and other recovery‐related outcomes (Morrison et al ., ). The current findings are also in line with previous research, suggesting that accepting a label of mental illness is not always helpful to individuals diagnosed with schizophrenia in terms of reducing their distress (Brett, Heriot‐Maitland, McGuire, & Peters, ; Valiente, Provencio, Espinosa, Duque, & Everts, ), and may impact negatively on help‐seeking (Rusch, Muller, Ajdacic‐Gross, Corrigan, & Rossler, ), engagement with services (Mak et al ., ), and the therapeutic alliance with professionals (Kvrgic, Cavelti, Beck, Rusch, & Vauth, ).…”