Psychosocial interventions for internalised stigma in people with a schizophrenia-spectrum diagnosis: A systematic narrative synthesis and meta-analysis

Abstract

It is acknowledged that people with a schizophrenia-spectrum diagnosis experience higher levels of stigma compared to any other mental health diagnosis. As a consequence, their experience of internalised stigma is likely to be the most detrimental and pervasive. Internalised stigma interventions have shown some benefits in those who experience serious mental illness including those with a schizophrenia-spectrum diagnosis. A systematic narrative review and meta-analysis were conducted examining the efficacy of internalised stigma interventions for people with a schizophrenia-spectrum diagnosis. Randomised Controlled Trials, controlled trials, and cohort studies were included and assessed against quality criteria. The search identified 12 studies; 7 randomised controlled trials, 3 cohort studies and 2 controlled trials. A variety of psychosocial interventions were utilised with the majority employing Cognitive Behaviour Therapy (CBT), psychoeducation and social skills training. The core outcomes used to examine the efficacy of the intervention were internalised stigma, self-esteem, empowerment, and functioning. The meta-analysis revealed an improvement in internalised stigma favouring the internalised stigma intervention but was not significant (5 RCTs, n=200). Self-efficacy and insight were significantly improved favouring the internalised stigma intervention. Internalised stigma interventions show promise in those with schizophrenia-spectrum diagnoses. Existing interventions have demonstrated small effects and employed small samples. Large scale RCTs are required to further develop the evidence base of more targeted interventions.

Rehabilitation Interventions to Promote Recovery from Schizophrenia: A Systematic Review

“…In a recent meta-analysis, psychoeducation was the most commonly used technique in controlled randomized studies on stigma intervention. This work could not statistically determine which interventions significantly reduced internalized stigma outcomes due to the scarcity of the studies; but most of the studies similarly found that psychoeducation and cognitive challenging were key components (51). …”

How Do People Experiencing Schizophrenia Spectrum Disorders or Other Psychotic Disorders Use the Internet to Get Information on Their Mental Health? Literature Review and Recommendations

“…As a population suffering from especially strong stigma [20-23] and self-stigma [21], a way of internalizing negative stereotypes [50-53], people experiencing schizophrenia spectrum disorders or other psychotic disorders may find ways to challenge those adverse stereotypes thanks to Internet use or Internet interventions. Precisely, interacting with peers online can create greater social connectedness and feelings of group belonging that strengthen stigma resistance [54].…”

“…The analysis of people experiencing schizophrenia spectrum disorders or other psychotic disorders’ Internet use being relatively recent, most of the studies in that field include small populations and heterogeneous methodologies, which presents an increased risk of error in the context of a meta-analysis [21]. Consequently, we have done as much as we could to approximate a systematic review by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; indeed, our motivation was not to measure the effectiveness of Internet use for our target population but to discuss specific aspects of the evolution in this matter in both a contextual and a theoretical approach.…”

The relationship between internalized stigma and quality of life among people with mental illness: are self-esteem and sense of coherence sequential mediators?

“…In a randomized controlled trial, this intervention was demonstrated to have a significant positive influence on the SOC of people with mental health problems [32]. In the light of the findings obtained, these types of interventions may have the potential to break the chain of negative effects triggered by self-stigma and leading to the impairment of QoL and may be a useful addition to the interventions directly targeting self-stigmatizing beliefs and attitudes, e.g., through psychoeducation or cognitive behavioral therapy (CBT) techniques [33, 34]. …”