Randomized Controlled Trial of Treatment for Internalized Stigma in Schizophrenia

描述(由申请人提供)：当精神疾病患者意识到社会上许多人对精神疾病持有的污名化态度(例如，危险、无能、无法工作)，认为这些态度是合法的，并将其应用于自己时，就会形成内在化(或自我)污名。有大量证据表明，内在化耻辱与精神分裂症患者康复的客观(如社会功能)和主观(如自尊和幸福感)部分存在强烈的负面联系，而且这些影响独立于症状相关的残疾而起作用。然而，几乎没有人努力开发治疗方法来解决这个问题。此前，我们被资助开发一种基于群体的干预(R34MH082161)，将认知行为疗法和叙事心理疗法结合起来，以解决严重精神疾病患者的内在化污名问题。本研究的目的是在我们之前的探索性干预发展研究的基础上，通过对精神分裂症谱系障碍患者进行叙事增强/认知治疗(NECT)干预的充分动力的随机对照试验来进行。我们将在两个地点(新泽西州纽瓦克和印第安纳波利斯，IN)对500人进行筛查，以寻找中度或高度内化污名的证据。我们将在175名符合精神分裂症谱系障碍的SCID标准的个体中进行一项关于NECT和支持性团体治疗的随机研究。随机化将根据基线自我污名严重程度(中等或升高)进行分层，以确保每个阶层的参与者数量大致相等。参与者将完成基线、治疗后、治疗后3个月和治疗后6个月的内在化污名、精神症状、自知力、自尊、绝望、应对、叙述一致性和社会功能的评估。该项目的具体目标是：1)对NECT的有效性进行随机研究，比较175名精神分裂症谱系障碍患者随机分配到NECT或支持性团体治疗的结果；2)检查叙事连贯性的变化和以问题为中心的应对策略的使用对分配到NECT治疗的患者的结果的中介影响。这项干预对加强日常护理服务以减少精神分裂症患者的残疾具有重要意义，因此对改善公共健康具有潜在的重要意义。

DESCRIPTION (provided by applicant): Internalized (or self) stigma develops when people with mental illness become aware of stigmatizing attitudes held by many in society about mental illness (e.g., dangerousness, incompetence, inability to work), perceive these attitudes as being legitimate, and apply them to themselves. There is substantial evidence that internalized stigma is strongly negatively linked to both the objective (e.g., social functioning) and subjective (e.g. self- esteem and well-being) components of recovery for persons with schizophrenia, and that these effects operate independent of symptom-related disability. Nevertheless, few efforts have been made to develop treatment to address this issue. Previously, we were funded to develop a group-based intervention (R34MH082161) combining cognitive- behavioral therapy and narrative psychotherapy to address internalized stigma among people with severe mental illness. The purpose of the present study is to build upon our previous exploratory intervention development study by conducting an adequately- powered, randomized controlled trial of the Narrative Enhancement/Cognitive Therapy (NECT) intervention among persons with schizophrenia-spectrum disorders. We will screen 500 persons at two sites (Newark, NJ and Indianapolis, IN) for evidence of moderate or elevated internalized stigma. We will conduct a randomized study of NECT versus supportive group therapy in a sample of 175 individuals meeting SCID criteria for schizophrenia-spectrum disorders. Randomization will be stratified by baseline self- stigma severity (moderate or elevated), to ensure roughly equal numbers of participants for each stratum. Participants will complete baseline, post-treatment, 3-month post treatment and 6-month post treatment assessments of internalized stigma, psychiatric symptoms, insight, self-esteem, hopelessness, coping, narrative coherence and social functioning. The specific aims of the project are: 1) Conduct a randomized study of the effectiveness of NECT, comparing outcomes for 175 persons with schizophrenia- spectrum disorder randomly assigned to NECT or supportive group therapy, 2) Examine the mediating impact of changes in narrative coherence and in the use of problem- centered coping strategies on outcomes for persons assigned to the NECT treatment. The intervention can have important implications for enhancing usual care services to reduce disability for people with schizophrenia, and therefore has potentially important implications for improving the public health.