Reducing Internalized Stigma In People with Serious Mental Illness

对退伍军人医疗保健的预期影响：精神疾病污名对治疗产生负面影响 寻求和坚持，并构成了严重的退伍军人康复的重大障碍， 精神疾病（SMI）。正如VA心理健康战略计划所概述的那样， 实施减少耻辱感和促进康复的战略是VHA的优先事项。 然而，到目前为止，还没有经过经验检验的循证实践，旨在最大限度地减少 污名化的负面影响和污名化信念的内化。目前的研究 将检查旨在帮助患有SMI的退伍军人的团体干预的有效性， 发展技能，以更有效地科普羞辱和歧视， 对精神疾病患者的污名化信念和刻板印象的内化。 项目背景：对精神疾病的污名化信念和态度很普遍， 在精神病患者中，遭受耻辱的情况很常见。污名化的负面影响 当患有SMI的老兵内化这些污名化的假设时， 刻板印象内化污名是指精神疾病患者 认知或情感上吸收关于精神疾病的负面信息或刻板印象， 相信他们并将其应用于自己。内在的耻辱感是显而易见的， 退伍军人与SMI，并可能导致自我效能下降，抑郁症增加，社会 退出，并减少了对恢复目标的追求。 项目目标：作为回应，我们开发了一个为期9天的小组， 采取干预措施，帮助患有重度精神分裂症的退伍军人发展技能，以有效科普污名化， 尽量减少污名化信仰和定型观念的内化。中试结果 这些干预措施是有希望：ESS与显著减少 内化的耻辱感和恢复取向的显着增加。的主要目标 这种更大规模的评估是比较ESS的效果，以一般的健康和福祉 组：1）减少内化的耻辱和2）改善近端的心理社会结果 （自我效能、归属感、恢复取向）。次要目标包括评估 ESS对改善远端心理社会结局（生活质量、社会功能）的影响， 检查治疗后6个月是否保持改善。我们希望退伍军人 在ESS中，将证明内化的耻辱感有更大的减少， 治疗后的近端和远端心理社会结果，这些收益将 在治疗后6个月维持。 项目方法：本研究将对276名患有SMI的退伍军人进行随机试验， VA马里兰州卫生保健系统的门诊服务，将ESS与普通 健康和保健组。所有参与者将在基线、术后 治疗后6个月。受试者将被随机分配至ESS或一般 健康和保健组。参加者将参加ESS或一般健康和 健康组每周一次，持续9周。调整的两水平混合效应模型 基线反应将用于实现主要和次要目标。定性数据 退伍军人的经验和应对内化耻辱的策略将收集自 两种情况下的退伍军人子集，以比较两组退伍军人的经历， 探索ESS脱落的任何原因。

Anticipated Impacts on Veteran's Healthcare: Mental illness stigma negatively impact treatment seeking and adherence and poses a significant barrier to the recovery of veterans with serious mental illness (SMI). As outlined in the VA Mental Health Strategic Plan, the development and implementation of strategies to reduce stigma and promote recovery is a VHA priority. However, to date, there are no empirically tested, evidence-based practices aimed at minimizing the negative effects of stigma and the internalization of stigmatizing beliefs. The current study will examine the effectiveness of a group intervention designed to assist veterans with SMI to develop skills to cope more effectively with stigma and discrimination and minimize the internalization of stigmatizing beliefs and stereotypes about people with mental illness. Project Background: Stigmatizing beliefs and attitudes about mental illness are prevalent and exposure to stigma is common among people with mental illness. The negative effects of stigma are compounded when a veteran with SMI internalizes these stigmatizing assumptions and stereotypes. Internalized stigma refers to the process in which a person with mental illness cognitively or emotionally absorbs negative messages or stereotypes about mental illness and comes to believe them and apply them to him/herself. Internalized stigma is evident among veterans with SMI and can lead to decreased self-efficacy, increased depression, social withdrawal, and curtailed pursuit of recovery goals. Project Objectives: In response, we developed Ending Self Stigma (ESS), a 9-session group intervention to assist veterans with SMI to develop skills to effectively cope with stigma and minimize the internalization of stigmatizing beliefs and stereotypes. Results from pilot testing of the intervention have been promising: ESS was associated with a significant reduction in internalized stigma and a significant increase in recovery-orientation. The primary objectives of this larger scale evaluation are to compare the effects of ESS to a general health and wellness group in: 1) reducing internalized stigma and 2) improving proximal psychosocial outcomes (self-efficacy, belonging, recovery orientation). Secondary objectives include assessing the effects of ESS on improving distal psychosocial outcomes (quality of life, social functioning) and examining if improvements are maintained 6-months post-treatment. We expect that veterans in ESS will evidence a greater reduction in internalized stigma and greater improvements in proximal and distal psychosocial outcomes at post-treatment and that these gains will be maintained at 6-months post-treatment. Project Methods: This study will be a randomized trial of 276 veterans with SMI receiving outpatient services in the VA Maryland Health Care System that compares ESS to a general health and wellness group. All participants will complete assessments at baseline, post- treatment, and 6 months post-treatment. Participants will be randomized to ESS or a general health and wellness group. Participants will attend either the ESS or the general health and wellness group once a week for 9 weeks. A two-level mixed effects model with adjustment for baseline response will be used to address the primary and secondary aims. Qualitative data on veterans' experiences of and strategies for coping with internalized stigma will be collected from a subset of veterans in both conditions to compare experiences of veterans in both groups and explore any reasons for ESS drop-out.