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A randomized-controlled trial of treatment for self-stigma among persons diagnosed with schizophrenia-spectrum disorders

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Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

A substantial body of research indicates that self-stigma is associated with poorer outcomes related to recovery among people with severe mental illnesses. Narrative Enhancement and Cognitive Therapy (NECT) is a structured, group-based approach which targets the effects of self-stigma. A randomized-controlled trial was conducted to examine the efficacy of NECT.

Methods

One hundred and seventy persons, recruited from both outpatient and comprehensive treatment settings, meeting criteria for schizophrenia-spectrum disorders and moderate-to-elevated self-stigma, were randomly assigned to NECT or supportive group therapy and assessed at four time points over the course of nearly a year. Participants completed measures of self-stigma, hope, self-esteem, functioning, psychiatric symptoms, coping with symptoms, and narrative insight.

Results

Analyses indicated that NECT participants in outpatient sites improved significantly more over time in self-stigma compared to supportive group therapy participants in outpatient sites, while NECT participants in comprehensive (including day treatment and psychiatric rehabilitation program) sites improved significantly more in hopelessness and narrative insight than other participants. NECT participants as a group showed decreases in the social withdrawal component of self-stigma, decreased in their use of avoidant coping strategies, and were more engaged in treatment than supportive group therapy participants. There was no evidence for effects of NECT on social functioning or psychiatric symptoms.

Conclusions

Findings suggest that NECT primarily impacts self-stigma and related outcomes, and that the degree of its effects is partially dependent on the treatment context in which it is offered.

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References

  1. Angermeyer MC, Dietrich S (2006) Public beliefs and attitudes toward people with mental illness: a review of population studies. Acta Psychiatr Scand 113:163–179

    Article  CAS  Google Scholar 

  2. Pescosolido BA, Medina TR, Martin JK, Long JS (2013) The “backbone” of stigma: identifying the global core of public prejudice associated with mental illness. Am J Publ Health 103:853–860

    Article  Google Scholar 

  3. Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M (2009) Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373:408–415

    Article  Google Scholar 

  4. Brohan E, Elgie R, Sartorius N, Thornicroft G, GAMIAN-Europe Study Group (2010) Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 122:232–238

    Article  Google Scholar 

  5. Krajewski C, Burazeri G, Brand H (2013) Self-stigma, perceived discrimination and empowerment among people with a mental illness in six countries: pan European stigma study. Psychiatry Res 210:1136–1146

    Article  Google Scholar 

  6. Corrigan PW, Watson AC (2002) The paradox of self-stigma and mental illness. Clin Psychol 9:35–53

    Google Scholar 

  7. West ML, Yanos PT, Smith SM, Roe D, Lysaker PH (2011) Prevalence of internalized stigma among persons with severe mental illness. Stigma Res Action 1:54–59

    Article  Google Scholar 

  8. Livingston JD, Boyd JE (2010) Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med 71:2150–2161

    Article  Google Scholar 

  9. Yanos PT, Roe D, Lysaker PH (2010) The impact of illness identity on recovery from severe mental illness. Am J Psychiatr Rehab 13:73–93

    Article  Google Scholar 

  10. Yanos PT (2018) Written off: mental health stigma and the loss of human potential. Cambridge University Press, Cambridge

    Book  Google Scholar 

  11. Beck AT, Weisman A, Lester D, Trexler L (1974) The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 42:861–865

    Article  CAS  Google Scholar 

  12. Rosenberg M (1964) Society and the adolescent self-image. Princeton University Press, Princeton

    Google Scholar 

  13. Burns T, Patrick D (2007) Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatr Scand 116:403–418

    Article  CAS  Google Scholar 

  14. Yanos PT, Roe D, Markus K, Lysaker PH (2008) Pathways between internalized stigma and outcomes related to recovery in schizophrenia-spectrum disorders. Psychiatr Serv 59:1437–1442

    Article  Google Scholar 

  15. Cavelti M, Rusch N, Vauth R (2014) Is living with psychosis demoralizing? Insight, self-stigma, and clinical outcome among people with schizophrenia across 1 year. J Nerv Mental Dis 202:521–529

    Article  Google Scholar 

  16. Yanos PT, Lucksted A, Drapalski A, Roe D, Lysaker PH (2015) Interventions targeting mental health self-stigma: a review and comparison. Psychiatr Rehab J 38:171–178

    Article  Google Scholar 

  17. Yanos PT, Roe D, Lysaker PH (2011) Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness. Int J Group Psychother 61:577–595

    Article  Google Scholar 

  18. Yanos PT, Roe D, West ML, Smith SM, Lysaker PH (2012) Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial. Psychol Serv 9:248–258

    Article  Google Scholar 

  19. Roe D, Hasson-Ohayon I, Mashiach-Eizenberg M, Derhy O, Lysaker PH, Yanos PT (2014) Narrative enhancement and cognitive therapy (NECT) effectiveness: a quasi-experimental study. J Clin Psychol 70:303–312

    Article  Google Scholar 

  20. Hansson L, Lexen A, Holmen J (2017) The effectiveness of narrative enhancement and cognitive therapy: a randomized controlled study of a self-stigma intervention. Soc Psychiatry Psychiatr Epidemiol 52:1415–1423

    Article  Google Scholar 

  21. Brohan E, Gauci D, Thornicroft G, for the GAMIAN–Europe Study Group (2011) Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: the GAMIAN–Europe study. J Affective Dis 129:56–63

    Article  Google Scholar 

  22. Spitzer RL, Williams JB, Gibbon M, First M (1994) Structured clinical interview for DSM-IV. Biometrics Research, New York

    Google Scholar 

  23. Ritsher JB, Phelan JC (2004) Internalized stigma predicts erosion of morale among psychiatric outpatients. Psychiatry Res 129:257–265

    Article  Google Scholar 

  24. Heinrichs DW, Hanlon TE, Carpenter WT (1984) The quality of life scale: an instrument for assessing the schizophrenic deficit syndrome. Schizophr Bull 10:388–396

    Article  CAS  Google Scholar 

  25. Jaeger J, Berns SM, Czobor P (2003) The Multidimensional scale of independent functioning: a new instrument for measuring functional disability in psychiatric populations. Schizophr Bull 29:153–168

    Article  Google Scholar 

  26. Kay S, Fiszbein A, Opler L (1987) The positive and negative syndrome scale for schizophrenia. Schizophr Bull 13:261–276

    Article  CAS  Google Scholar 

  27. Yanos PT, Knight EL, Bremer L (2003) A new measure of coping with symptoms for use with persons diagnosed with severe mental illness. Psychiatr Rehab J 27:168–176

    Article  Google Scholar 

  28. Lysaker PH, Taylor A, Miller A, Beattie N, Strasburger A, Davis LW (2006) The scale to assess narrative development: associations with other measures of self and readiness for recovery in schizophrenia spectrum disorders. J Nerv Ment Dis 27:233–247

    Google Scholar 

  29. Lysaker PH, Clements CA, Placak-Hallberg C, Knipschure SJ, Wright DE (2002) Insight and personal narratives of illness in schizophrenia. Psychiatry 65:197–206

    Article  Google Scholar 

  30. Spaulding WD, Reed D, Sullivan M, Richardson C, Weiler M (1999) Effects of cognitive treatment in psychiatric rehabilitation. Schizophr Bull 25:657–676

    Article  CAS  Google Scholar 

  31. Hayes SA, Hope DA, Terryberry-Spohr LS et al (2006) Discriminating between cognitive and supportive group therapies for chronic mental illness. J Nerv Ment Dis 194:603–609

    Article  Google Scholar 

  32. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis for the social, behavioral, and biomedical sciences. Beh Res Methods 39:175–191

    Article  Google Scholar 

  33. Beck AT, Himelstein R, Bredemeier K, Silverstein SM, Grant P (2018) What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychol Med 48:2776–2785

    Article  Google Scholar 

  34. Silverstein SM, Bellack A (2008) A scientific agenda for the concept of recovery as it applies to schizophrenia. Clin Psychol Rev 28:1108–1124

    Article  Google Scholar 

  35. McGurk SR, Twamley EW, Sitzer DI, McHugo GJ, Mueser KT (2007) A meta-analysis of cognitive remediation in schizophrenia. Am J Psychiatry 164:1791–1802

    Article  Google Scholar 

  36. Silverstein SM (2010) Bridging the gap between extrinsic and instrinsic motivation in the cognitive remediation of schizophrenia. Schizophr Bull 36:949–956

    Article  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Institute of Mental Health, 1R01MH0094310.

Author information

Authors and Affiliations

  1. John Jay College of Criminal Justice, City University of New York, New York, USA

    Philip T. Yanos

  2. Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, USA

    Paul H. Lysaker

  3. Rutgers University, Piscataway, USA

    Steven M. Silverstein

  4. New York State Psychiatric Institute, New York, USA

    Beth Vayshenker

  5. Gordon F. Derner School of Psychology, Adelphi University, New York, USA

    Lauren Gonzales

  6. Harvard Medical School, Boston, USA

    Michelle L. West

  7. University of Haifa, Haifa, Israel

    David Roe

Authors
  1. Philip T. Yanos
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  2. Paul H. Lysaker
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  3. Steven M. Silverstein
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  4. Beth Vayshenker
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  5. Lauren Gonzales
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  6. Michelle L. West
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  7. David Roe
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Corresponding author

Correspondence to Philip T. Yanos.

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The authors report no conflicts of interest.

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Yanos, P.T., Lysaker, P.H., Silverstein, S.M. et al. A randomized-controlled trial of treatment for self-stigma among persons diagnosed with schizophrenia-spectrum disorders. Soc Psychiatry Psychiatr Epidemiol 54, 1363–1378 (2019). https://doi.org/10.1007/s00127-019-01702-0

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  • DOI: https://doi.org/10.1007/s00127-019-01702-0

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