Transdiagnostic Intervention to Reduce Internalized Health-Related Stigma

项目总结/摘要 成见对身心健康产生不利影响。社会贬低或虐待他人 可能导致污名的内化（即，自我污名）在具有边缘化身份或特征的个人中。 内化的污名与心理健康受损和健康相关生活质量密切相关 （HRQOL），往往比人际间的耻辱经历（例如，歧视）。 专家建议，同伴支持或心理咨询可能有助于减少内化的耻辱感 及其相关的健康影响，尽管很少有研究调查这种干预措施。 与健康有关的污名是一个总括性术语，包括负面判断、责备、回避， 由于健康状况或疾病而对个人的拒绝、蔑视、歧视或非人化。 这些健康状况可能是可见的（如肥胖、皮肤病或导致毁容的癌症）， 或可隐藏的（如艾滋病、糖尿病或慢性疼痛）。内化健康相关污名的患者报告 避免卫生保健环境和脱离疾病管理行为，此外， 显示出生理压力的迹象因此，与健康有关的耻辱感加重了疾病负担，并威胁到 HRQOL超出了健康状况本身的直接影响。关于健康相关污名的先前研究 一直是孤立的，这样的研究调查一种类型的耻辱，其影响，并在孤立的可能解决方案 因其他健康状况而受到歧视。一致的证据表明耻辱对身心健康的危害 健康状况，以及干预发展的共同理论基础，表明 需要一个统一的方法。一项干预措施，减少不同性别人群的内在耻辱感， 健康状况将产生广泛的影响，并将改变目前如何处理污名化问题的模式。 目前的项目旨在确定一种新颖的、跨诊断的、以小组为基础的咨询的效果 旨在帮助患者科普和减少与健康有关的污名化的干预措施。一个 干预措施和自我报告措施，这些措施以前只针对一种形式的健康- 将对相关的污名进行调整，以推广到其他健康状况的患者。试点后，一个随机 本研究采用对照试验的方法，检验团体心理咨询干预对大学生自我内化的影响 污名、心理健康和HRQOL。咨询条件（也包括同伴支持）将是 与一般的同伴支持组和候补名单对照组相比。参加者将是195名男子和 妇女报告说，由于其健康状况，她们在很大程度上受到了内在的羞辱。所有研究程序将 在线进行，包括评估和治疗。参与者的咨询和同伴支持 小组将接受12次每周小组会议，然后是2次每隔一周和2次每月会议， 总共26周。这项研究的结果将为最有效和最有效的方法提供新的见解 减少内化的耻辱，并改善HRQOL，在患者的各种健康状况。

PROJECT SUMMARY/ABSTRACT Stigma adversely affects mental and physical health. Societal devaluation or mistreatment from others can lead to internalization of stigma (i.e., self-stigma) among individuals with marginalized identities or traits. Internalized stigma is robustly associated with impaired mental health and health-related quality of life (HRQOL), often to a stronger degree than are interpersonal experiences of stigma (e.g., discrimination). Experts have suggested that peer support or psychological counseling may help to reduce internalized stigma and its associated health impacts, although very few studies have investigated such interventions. Health-related stigma is an umbrella term that encompasses negative judgment, blame, avoidance, rejection, disparagement, discrimination, or dehumanization of individuals due to a health condition or disease. Such health conditions may be visible (such as obesity, skin diseases, or cancers that result in disfigurement), or concealable (such as HIV, diabetes, or chronic pain). Patients who internalize health-related stigma report avoidance of health care settings and disengagement from disease management behaviors, in addition to showing signs of physiological stress. Thus, health-related stigma compounds disease burden and threatens HRQOL beyond the direct effects of the health conditions themselves. Prior research on health-related stigma has been siloed, such that studies investigate one type of stigma, its effects, and possible solutions in isolation from stigma due to other health conditions. Consistent evidence of stigma’s harms on mental and physical health across health conditions, and shared theoretical foundations for intervention development, indicate the need for a unifying approach. An intervention that reduces internalized stigma among individuals with varying health conditions would have broad impact and would shift the paradigm of how stigma is currently addressed. The current project seeks to determine the effects of a novel, transdiagnostic, group-based counseling intervention designed to help patients cope with and to reduce the internalization of health-related stigma. An intervention and a self-report measure that were previously developed to address only one form of health- related stigma will be adapted to generalize to patients of other health conditions. After piloting, a randomized controlled trial will be conducted to test the effects of the group-based counseling intervention on internalized stigma, mental health, and HRQOL. The counseling condition (which also includes peer support) will be compared to a general peer support group and a waitlist control group. Participants will be 195 men and women who report high levels of internalized stigma due to their health condition. All study procedures will be conducted online, including assessments and treatment. Participants in the counseling and peer support groups will receive 12 weekly group sessions, followed by 2 every-other-week and 2 monthly sessions, for a total of 26 weeks. Findings from this study will provide new insights into the most effective and efficient method for reducing internalized stigma, and improving HRQOL, in patients with a wide array of health conditions.