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严重精神疾病（SMI）患者康复的客观（例如，社会功能）和主观（例如，自尊和幸福感）成分都有深刻的负面影响，这些负面影响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个问题。然而，认知行为疗法和叙事心理疗法都是解决重度精神障碍患者自我概念化问题的有希望的方法，这一点得到了支持。本探索性干预发展研究的目的是开发和研究一种结构化的、基于群体的叙事增强/认知治疗（NECT）干预，旨在减少SMI患者的内化耻辱和改善相关结果。这种干预将侧重于识别和挑战内化的耻辱信念，并将通过对重度精神障碍患者的综合康复导向叙事心理治疗原则来促进。在对一组10人进行干预开发和试点测试后，我们将在两个地点（纽约和印第安纳州）筛选150名重度精神障碍患者，以寻找高度内化耻辱的证据。然后，我们将在50名符合高内化污名标准的重度精神障碍患者中进行NECT与常规治疗的初步随机研究。该项目的具体目标是：1)为具有高度内化耻辱感的重度精神分裂症患者开发一种可在日常环境中实施的基于群体的手动NECT治疗；2)对基于小组的治疗的有效性进行初步随机研究，比较随机分配到NECT治疗的人的结果与照常治疗的人的结果；3)研究以问题为中心的应对策略的使用改变对NECT治疗结果的中介影响。拟议的研究响应PAR-06-248“从干预发展到服务：探索性研究资助（R34）”。如果发现干预措施是有效的，可以对加强日常护理服务以促进重度精神障碍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.