RCT to Improve Internalized Stigma and Services Engagement Among People with SMI

描述(由申请人提供)：内在化污名--认为对严重精神疾病(SMI)的负面刻板印象是真实的自我，对许多患有SMI的成年人来说是一个常见的有害问题。它会导致士气低落、抑郁、绝望，并降低朝着康复目标努力的动力(2-17)。它可能会降低一个人对所需的精神健康服务、其他援助和生活质量的使用(16-20)。然而，目前还没有现成的干预措施来解决这个问题。结束自我污名的目的是为了补救这一点-一个赋权的，9节课，手动心理教育课程，整合来自不同领域的知识和工具，为参与者提供一套个性化的策略，以减少或消除他们自己生活中的内化污名。根据NIMH战略目标2和3(22)，ESS旨在改善内在化污名，将其作为不良病程的个人一级风险因素(21)，并解决广泛的以功能康复为导向的结果，同时帮助参与者个性化使用其提供的战略，以最适合他们的个人需求、背景和偏好。在一项前景看好但有限的初步研究之后，该应用程序寻求严格测试ESS(A)减少内在化耻辱，(B)改善相关的心理社会和行为结果，以及(C)通过一项基于社区的随机试验，从马里兰州的两个大型心理社会康复计划招募患有SMI的成年人，并在六个月内保持成果。在完全知情同意之后，符合条件的志愿者将接受访谈(时间1)，以评估上述变量和人口统计特征，然后立即随机(50：50机会)到其所在机构参加ESS的干预条件-或继续在该机构继续常规护理的对照条件，通过关于内化耻辱的简短教育讨论和分发最低限度地加强。九周后，两种条件下的参与者将再次接受访谈(时间2；在干预条件参与者的ESS结束后)。在这两个时间点对这两组人进行统计比较，将使我们能够确定ESS是否具有我们假设的有益效果。然后，在时间2之后的6个月，我们将再次评估所有参与者(时间3)，以测试服用ESS的任何好处是否随着时间的推移而持续。如果拟议的试验证明是有效的，ESS将提供一种高度便携的干预措施，以减少人类痛苦以及内在化耻辱的多层次风险和危害。然后，研究小组打算向国内和国际上感兴趣的专业和同行精神健康机构提供手册、辅助材料和促进者指导。此外，一旦核心干预措施被测试，该团队将继续开发针对其他独特耻辱(和自我耻辱)情况的变体，如双重诊断、药物滥用、创伤后应激障碍，以及一种旨在帮助防止最近诊断的个人发展自我耻辱的变体。

DESCRIPTION (provided by applicant): Internalized stigma -- believing that negative stereotypes about serious mental illnesses (SMI) are true of one's self -- is a common and harmful problem for many adults with SMI. It causes demoralization, depression, hopelessness, and reduced motivation to work toward recovery goals (2-17). It can degrade a person's use of needed mental health services, other assistance, and quality of life (16-20). Yet there are no readily available interventions addressing it. Ending Self Stigma is designed to remedy this - an empowering, 9 session, manualized psycho-educational class that integrates knowledge and tools from diverse domains to offer participants an individualized set of strategies for reducing or eliminating internalized stigma in their own lives. In accord with NIMH Strategic Objectives 2 and 3 (22), ESS is designed to ameliorate internalized stigma as an individual-level risk factor for poor illness course (21) and to address a broad range of functional recovery- oriented outcomes, while helping participants personalize their use of the strategies it offers to best fit their individual needs, backgrounds, and preferences. Following a promising but limited pilot study, this application seeks to rigorously test whether ESS (a) reduces internalized stigma, (b) improves related psychosocial and behavioral outcomes, and (c) gains are retained over six months, via a community-based randomized trial enrolling adults with SMI from two large Maryland psychosocial rehabilitation programs. Following full informed consent, eligible volunteers will be interviewed (Time 1) to assess the variables listed above and demographic characteristics and then immediately randomized (50:50 chance) to either the intervention condition of attending ESS at their home agency -or- to the control condition of continuing with usual care at that agency, minimally enhanced by a brief educational discussion and handout about internalized stigma. Nine weeks later, participants in both conditions will be interviewed again (Time 2; after the conclusion of ESS for the intervention condition participants). Statistically comparing these two groups at these two time points will allow us to ascertain whether ESS has the beneficial effects we have hypothesized. Then, 6 months after Time 2 we will again assess all participants (Time 3) to test whether any benefits of taking ESS are sustained over time. If the proposed trial shows it to be effective, ESS will offer a highly-portable intervention to reduce the human suffering and multi-level risks and harms of internalized stigma. The study team intends to then offer its manual, ancillary materials, and facilitator guidance to interested professional and peer mental health agencies nationally, and internationally. Additionally, once the core intervention is tested, the team will proceed with developing variations tailored to other uniquely-stigmatized (and self stigmatizing) conditions such as dual diagnosis, substance abuse, post-traumatic stress disorder, and a variation designed to help prevent the development of self stigma in recently diagnosed individuals.