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)的人意识到负面情绪时，就会产生自我耻辱 社会上许多人认可的刻板印象(例如，危险、无能、无法工作)，认为他们 作为合法的，并将它们应用于自己。临床上显著的自我耻辱影响大约三分之一或更多的 患有SMI的人，而且有大量证据表明，它与治疗参与度存在强烈的负面联系， 以及康复的关键目标(例如，社会功能)和主观(例如，自尊)方面。 首发精神病(FEPS)通常发生在青年时期(15至24岁之间，对应于 青春期晚期/成年期早期)，这是自我意识增强的时期，也是认同感的关键时期 队形。发展理论认为，身份认同障碍，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使命感，减少治疗参与度，并影响对 人生目标(学校/工作)。对最近经历过FEP的人进行的研究发现，在临床上 严重的自我羞辱在这个阶段很常见，并与治疗参与度和 社交功能受损。因此，FEP时期是解决自我耻辱的关键时期，因为 自我污名对身份发展的潜在深远影响。尽管发现令人鼓舞，但治疗 参与度和其他结果对于目标FEP服务来说仍然不是最理想的，例如协调专业 关爱“[CSC]。考虑到自我污名和服务承诺之间的关系，这似乎是合理的 有针对性的自我污名干预可以增加对CSC服务的参与度，并改善 患有FEP的年轻人。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发现，与常规治疗相比，自我污名是有效的 (RCT)与中年成年人。Nect可以作为CSC的有效附属物，但不适合使用 与当前形式的FEP患者进行合作，也可能接受远程医疗修改以更好地参与 青春年华。拟议的探索性干预开发应用程序的总体目的与 RFA-MH-18-706的目标是进行研究，为NECT的适应和初步测试提供信息 针对青少年(15-24岁)FEP进行修改，针对自我概念和疾病概念增加治疗 订婚。该项目的具体目标是：1)进行定性研究，以确定体验的特征 FEP青少年及其家庭的污名关注、自我污名及相关干预偏好的研究 成员，2)使NECT适应有FEP的青年的需要和偏好，以及3)评估 改良干预(NECT-YA)联合应用的可行性、可接受性和初步效果 CSC服务，与单独的CSC服务相比，RCT很小(n=40)。

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.