Two group interventions have been found to help reduce internalized stigma in people with serious mental illness (SMI), but one of the interventions showed superiority for participants who had psychotic symptoms, according to a study in Psychiatric Services in Advance.
“ ‘Internalized stigma’ or ‘self-stigma’ refers to the process by which one cognitively or emotionally absorbs negative messages about mental illness and comes to believe and apply them to one’s self,” wrote Amy L. Drapalski, Ph.D., and colleagues. “Internalized stigma has been linked to many negative outcomes, including depression and demoralization, decreased hope and self-esteem, degraded persistence regarding illness management, and social avoidance.”
Several programs have been developed to specifically target self-stigma, including a group intervention called Ending Self-Stigma, but few have been evaluated in a randomized, controlled trial, the authors noted. Drapalski and colleagues randomly assigned 248 veterans aged 18 to 80 with schizophrenia disorder, schizoaffective disorder, bipolar disorder, or major depression with psychotic features to the Ending Self-Stigma or Health and Wellness intervention.
Participants in the Ending Self-Stigma group were taught different strategies for addressing self-stigma, shared personal experiences, and practiced exercises to address stigma in their daily lives. Participants in the Health and Wellness group discussed such topics as physical activity, healthy eating, sleep, and medication management (they did not specifically address topics of stigma or self-stigma). Participants in both groups attended 75- to 90-minute sessions weekly for nine weeks. The researchers evaluated the participants’ symptoms, internalized stigma, recovery, and sense of belonging at the start of the study, after treatment, and at a six-month follow-up.
Participants in both groups experienced significant reductions in self-stigma and increases in a sense of belonging following the interventions. In addition, there were no differences in primary (self-stigma) or secondary (self-efficacy, sense of belonging, or recovery) between the two groups. However, additional analysis revealed that among veterans experiencing significant psychotic symptoms at the start of the study, those who participated in Ending Self-Stigma had a significantly greater reduction in internalized stigma than those in the Health and Wellness group.
“Individuals experiencing significant psychotic symptoms may be more likely to benefit from interventions specifically focused on self-stigma. Additional research is needed to better understand the impact of these interventions on self-stigma and when and for whom targeted interventions would be most beneficial,” the authors concluded.
For more information on how language contributes to stigma against people with mental illness, see the recent Psychiatric News column by APA President Jeffrey Geller, M.D., M.P.H.: “Keeping the Label ‘Insane’ Out of Our Public Discourse.”
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