Development of a stage-specific adaptation of a self-stigma intervention for people recovering from a first episode of psychosis

摘要 当被诊断患有严重精神疾病（SMI）的人意识到自己的负面情绪时， 社会上许多人赞同的陈规定型观念（例如，危险、无能、无法工作），感知他们 并将其应用于自身。临床上显著的自我耻辱影响大约1/3或更多的 SMI患者，并且有大量证据表明它与治疗参与度呈强烈负相关， 以及关键目标（例如，社会功能）和主观（例如，（二）恢复的维度。 精神病首次发作（FEPs）通常发生在青年时期（15至24岁，对应于 青春期后期/成年早期），这是自我意识增强的时期，也是身份认同的关键时期 阵发展理论认为，身份障碍，如精神病（及其相关的负面影响）， 刻板印象），可能会削弱一个人的目的感，降低治疗参与度，影响对 生活目标（学校/工作）。对最近经历过FEP的人的研究发现，临床上 在这个阶段，严重的自我羞辱是常见的，与治疗参与度降低有关， 社会功能受损。因此，鉴于家庭暴力和种族歧视， 自我污名对身份发展的潜在深远影响。尽管有令人鼓舞的发现， 对于有针对性的FEP服务，如“协调专业”， 护理”[CSC]。考虑到自我污名和服务参与之间的关系， 有针对性的自我羞辱干预可以增加对CSC服务的参与，并改善 青年与FEP叙事增强和认知疗法（NECT）是一种旨在减少 在最近的随机对照试验中，与常规治疗相比， （RCTs）中年人。NECT可作为CSC的有效辅助治疗，但不适用于临床 与目前形式的FEP患者一起使用，也可能适合远程医疗修改，以更好地参与 青年提议的探索性干预开发申请的总体目的，与 RFA-MH-18-706的目的是进行研究，为NECT的适应和初步测试提供信息 修改为青年（15-24岁）与FEP，针对自我概念和疾病概念，以增加治疗 订婚该项目的具体目标是：1）进行定性研究，以描述经验 FEP青少年及其家庭中的耻辱感、自我耻辱感和相关干预偏好 成员，2）调整NECT以满足FEP青年的需求和偏好，以及3）评估 改良干预（NECT-YA）的可行性、可接受性和初步有效性， 在一项小型（n = 40）RCT中，与单独CSC服务相比，CSC服务。

Abstract Self-stigma develops when people diagnosed with severe mental illnesses (SMI) become aware of negative stereotypes endorsed by many in society (e.g., dangerousness, incompetence, inability to work), perceive them as legitimate, and apply them to themselves. Clinically significant self-stigma affects roughly 1/3 or more of persons with SMI, and there is substantial evidence that it is strongly negatively linked to treatment engagement, as well as critical objective (e.g., social functioning) and subjective (e.g., self-esteem) dimensions of recovery. First Episodes of Psychosis (FEPs) typically occur during youth (between ages 15 and 24, corresponding with late adolescence/early adulthood), a time of heightened self-consciousness and a crucial period for identity formation. Developmental theory posits that identity disruptions, such as psychosis (with its associated negative stereotypes), may diminish one’s sense of purpose, decreasing treatment engagement and impacting pursuit of life goals (school/work). Research with people who have recently experienced a FEP finds that clinically significant self-stigma is common at this stage and associated with diminished treatment engagement and impaired social functioning. The FEP period is therefore a critical time for addressing self-stigma given the potentially profound implications of self-stigma for identity development. Despite encouraging findings, treatment engagement and other outcomes are still suboptimal for targeted FEP services such as “Coordinated Specialty Care” [CSC]. Given the documented relationship between self-stigma and service engagement, it is plausible that targeted self-stigma intervention can increase engagement in CSC services and improve outcomes among youth with FEP. Narrative Enhancement and Cognitive Therapy (NECT) is an intervention designed to reduce self-stigma that was found to be effective compared to treatment as usual in recent randomized controlled-trials (RCTs) with middle-aged adults. NECT might serve as an effective adjunct to CSC, but it is not suitable for use with people with FEP in its current form, and may also be amenable to telehealth modification to better engage youth. The overall purpose of the proposed exploratory intervention development application, consistent with the aims of RFA-MH-18-706, is to conduct research that will inform the adaptation and preliminary testing of NECT modified for youth (aged 15-24) with FEP, targeting self-concept and illness conceptions to increase treatment engagement. The specific aims of the project are to: 1) Conduct a qualitative study to characterize experiences of stigma concern, self-stigma and associated intervention preferences among youth with FEP and their family members, 2) adapt NECT to be responsive to the needs and preferences of youth with FEP, and 3) Assess the feasibility, acceptability and preliminary effectiveness of the modified intervention (NECT-YA) combined with CSC services, compared to CSC services alone, in a small (n = 40) RCT.