Randomized Controlled Trial of Treatment for Internalized Stigma in Schizophrenia

精神分裂症内化耻辱治疗的随机对照试验

• 批准号: 8640203
• 负责人: PHILIP T YANOS
• 金额: $ 54.23万
• 依托单位: JOHN JAY COLLEGE OF CRIMINAL JUSTICE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-03-22 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8640203
• 关键词: Address; Affect; Aftercare; Alcohol or Other Drugs use; Attitude; Client; Clinical Treatment; Cognitive Therapy; Dangerousness; Diagnosis; Disabled Persons; Disease; Effectiveness; Ensure; Feeling hopeless; Funding; Group Therapy; Indiana; Individual; Intervention; Intervention Studies; Link; Mediating; Mediator of activation protein; Mental disorders; National Institute of Mental Health; New Jersey; Outcome; Outcome Study; Participant; Personal Satisfaction; Persons; Process; Psychotherapy; Public Health; Randomized; Randomized Controlled Trials; Recovery; Recruitment Activity; Research; Sampling; Schizophrenia; Services; Severities; Site; Social Functioning; Societies; Staging; Strategic Planning; Symptoms; Work; base; clinically significant; coping; disability; experience; follow-up; functional outcomes; improved; inclusion criteria; innovation; insight; interest; intervention effect; meetings; programs; psychological outcomes; public health relevance; self esteem; severe mental illness; social stigma; therapy design; therapy development; treatment as usual

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：当精神疾病患者意识到社会上许多人对精神疾病持有的污名化态度时，内化（或自我）污名就会发展起来（例如，不称职，不能工作），认为这些态度是合法的，并将其应用于自己。有大量证据表明，内化的耻辱感与目标（例如，社会功能）和主观（如自尊和幸福）方面的影响，这些影响与精神分裂症患者的残疾无关。然而，很少有人努力开发治疗方法来解决这个问题。此前，我们获得资助开发一种基于团体的干预（R34 MH 082161），将认知行为疗法和叙事心理疗法相结合，以解决严重精神疾病患者的内化污名。本研究的目的是建立在我们以前的探索性干预开发研究的基础上，通过在精神分裂症谱系障碍患者中进行叙事增强/认知疗法（NECT）干预的充分把握度、随机对照试验。我们将筛选500人在两个地点（纽瓦克，新泽西州和印第安纳波利斯，印第安纳州）的证据中度或高度内化的耻辱。我们将对175名符合SCID标准的精神分裂症谱系障碍患者进行NECT与支持性团体治疗的随机研究。随机化将根据基线自我污名严重程度（中度或升高）进行分层，以确保每个分层的参与者数量大致相等。参与者将完成基线、治疗后、治疗后3个月和治疗后6个月的内化污名、精神症状、洞察力、自尊、绝望、应对、叙事连贯性和社会功能评估。该项目的具体目标是：1）进行NECT有效性的随机研究，比较随机分配到NECT或支持性团体治疗的175名精神分裂症谱系障碍患者的结果，2）检查叙事连贯性和使用以问题为中心的应对策略对分配到NECT治疗的患者的结果的中介影响。干预措施可以有重要的意义，加强日常护理服务，以减少残疾的精神分裂症患者，因此，有潜在的重要意义，改善公众健康。