Treating Internalized Stigma in Severe Mental Illness

描述（由申请人提供）：有大量证据表明，内化的耻辱和相关过程对目标（例如，社会功能）和主观（例如，严重精神疾病患者的康复（包括自尊和幸福）部分持续存在，与症状的严重程度无关;然而，很少有人努力开发治疗方法来解决这一问题。尽管如此，认知行为疗法和叙事心理疗法都是解决SMI患者自我概念化的有希望的方法。本探索性干预开发研究的目的是开发和研究一种结构化的、基于小组的叙事增强/认知疗法（NECT）干预，旨在减少SMI患者的内化污名并改善相关结局。这种干预开发的重点是识别和挑战内化的耻辱信念，并将促进与SMI的人的综合康复为导向的叙事心理治疗的原则。在对一组10人的干预措施进行开发和试点测试后，我们将在两个地点（纽约和印第安纳州）对150名SMI患者进行筛查，以寻找高度内化耻辱的证据。然后，我们将在50名符合高度内化耻辱标准的SMI患者中进行NECT与常规治疗的初步随机研究。该项目的具体目标是：（1）为患有重度重度精神分裂症、内心有高度成见的人制定一种可在常规环境中实施的、以小组为基础的手动NECT治疗;（2）对以小组为基础的治疗的有效性进行初步随机研究，比较随机分配接受NECT治疗的人与继续照常治疗的人的结果;以及3）检查以问题为中心的应对策略的使用变化对分配到NECT治疗的人的结果的中介影响。拟议的研究响应PAR-06-248“从干预发展到服务：探索性研究赠款（R34）。“如果发现干预措施有效，则可以对加强常规护理服务以促进SMI患者的康复和减少残疾产生重要影响，因此对改善公共卫生具有潜在的重要影响。

DESCRIPTION (provided by applicant): There is substantial evidence that internalized stigma and related processes have profound negative effects upon both the objective (e.g., social functioning) and subjective (e.g., self-esteem and well-being) components of recovery for persons with severe mental illness (SMI) that persist independent of the severity of symptoms; however, few efforts have been made to develop treatment to address this issue. There is nevertheless support that both cognitive-behavioral therapy and narrative psychotherapy are promising approaches for addressing self-conceptualizations among people with SMI. The purpose of the present Exploratory Intervention Development study is to develop and study a structured, group-based Narrative Enhancement/Cognitive Therapy (NECT) intervention geared toward reducing internalized stigma and improving related outcomes among people with SMI. This intervention developed will focus on identifying and challenging internalized stigma beliefs, and will be facilitated by principles of an integrative recovery-oriented narrative psychotherapy for people with SMI. After developing and pilot testing the intervention with a group of 10 persons, we will screen 150 persons with SMI at two sites (New York and Indiana) for evidence of high internalized stigma. We will then conduct an initial randomized study of NECT vs. treatment as usual in a sample of 50 individuals with SMI meeting criteria for high internalized stigma. The specific aims of the project are to: 1) Develop a manualized group-based NECT treatment for persons with SMI who have high internalized stigma that can be implemented in routine settings; 2) conduct an initial randomized study of the effectiveness of the group-based treatment, comparing outcomes for persons randomly assigned to the NECT treatment with outcomes for persons remaining in treatment as usual; and 3) examine the mediating impact of changes in use of problem-centered coping strategies on outcomes for persons assigned to the NECT treatment. The proposed research responds to PAR-06-248 "From Intervention Development to Services: Exploratory Research Grants (R34)." The intervention, if found to be effective, can have important implications for enhancing usual care services to facilitate recovery and reduce disability for people with SMI, and therefore has potentially important implications for improving the public health.