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

描述（由申请人提供）：内化的耻辱感——相信关于严重精神疾病（SMI）的负面刻板印象对自己来说是真实的——对许多患有严重精神疾病的成年人来说是一个普遍而有害的问题。它会导致士气低落、抑郁、绝望，并减少为恢复目标而努力的动力（2-17）。它可以降低一个人使用所需的精神卫生服务、其他援助和生活质量（16-20）。然而，目前还没有现成的干预措施来解决这个问题。“结束自我耻辱”旨在解决这一问题——这是一个授权的、个性化的心理教育课程，整合了不同领域的知识和工具，为参与者提供了一套个性化的策略，以减少或消除他们自己生活中的内化耻辱。根据NIMH战略目标2和3 (22)，ESS旨在改善作为不良病程的个人层面风险因素的内化污名（21），并解决以功能恢复为导向的广泛结果，同时帮助参与者个性化使用其提供的策略，以最适合他们的个人需求、背景和偏好。在一项有希望但有限的试点研究之后，本应用程序旨在严格测试ESS是否(a)减少内化的耻辱，(b)改善相关的社会心理和行为结果，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社会心理康复项目中招募患有重度精神障碍的成年人，并在六个月内保持收益。在完全知情同意后，将对符合条件的志愿者进行访谈（时间1），以评估上述变量和人口统计学特征，然后立即随机（50:50的机会）分配到在其家庭机构参加ESS的干预条件或继续在该机构进行常规护理的控制条件，并通过简短的教育讨论和关于内化耻辱的讲义进行最低限度的加强。9周后，两组参与者再次接受访谈（时间2；干预组参与者ESS结束后）。在这两个时间点对这两组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 6个月后，我们将再次评估所有参与者（时间3），以测试服用ESS的任何益处是否持续一段时间。如果拟议的试验表明它是有效的，ESS将提供一种高度可移植的干预措施，以减少人类的痛苦和内化耻辱的多层次风险和伤害。然后，研究小组打算向国内和国际上感兴趣的专业和同伴精神卫生机构提供手册、辅助材料和促进指南。此外，一旦核心干预措施得到测试，该团队将继续开发针对其他独特的污名化（和自我污名化）条件的变体，如双重诊断、药物滥用、创伤后应激障碍，以及旨在帮助防止最近诊断的个体出现自我污名化的变体。

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. PUBLIC HEALTH RELEVANCE: Internalized stigma - when a person with a mental illness believes that negative stereotypes about mental illness are true of his/her self -- commonly causes demoralization, depression, reduced motivation to work toward recovery goals, and reduced use of helpful treatments and services among adults with mental illness. Ending Self Stigma is a new class-format intervention to help such individuals reduce or eliminate their own internalized stigma and its harmful effects, using a flexible set of strategies drawn from research and experience. This proposal seeks to test ESS in a community-based randomized study so that it may be made widely available if it proves effective.