Randomized controlled trial of the self-stigma reduction program among individuals with schizophrenia

Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Psychiatry Research (Impact Factor: 2.47). 03/2011; 189(2):208-14. DOI: 10.1016/j.psychres.2011.02.013
Source: PubMed


Research evidence suggests that individuals with schizophrenia are prone to self-stigmatization, which reduces their psychosocial treatment adherence. A self-stigma reduction program was developed based on a theoretical framework proposed by our team. The effectiveness of such program to reduce self-stigma, enhance readiness for change, and promote adherent behaviors among individuals with schizophrenia was investigated. This program consisted of 12 group and four individual follow-up sessions. An integrative approach including psychoeductaion, cognitive behavioral therapy, motivational interviewing, social skills training, and goal attainment program was adopted. Sixty-six self-stigmatized individuals with schizophrenia were recruited. They were randomly allocated to the self-stigma reduction program (N=34; experimental protocol) or the newspaper reading group (N=32; comparison protocol). Measures on participants' level of self-stigma, readiness for change, insight, general self-efficacy, and treatment adherence were taken for six assessment intervals. The findings suggested that the self-stigma reduction program has potential to reduce self-esteem decrement, promote readiness for changing own problematic behaviors, and enhance psychosocial treatment adherence among the self-stigmatized individuals with schizophrenia during the active interventional stage. However, there was a lack of therapeutic maintenance effects during the 6-month follow-up period. Recommendations for further improving the effectiveness of self-stigma reduction program are suggested.

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    • "Research has shown that CBT shows promise in terms of improving self-esteem in clients with psychosis (Hall and Tarrier, 2003) and it has been suggested that it would be the most appropriate approach to addressing issues such as feelings of hopelessness regarding recovery (Yanos et al., 2008; Wood et al., 2014b) Moreover, when CBT is utilised as a group therapy there is preliminary evidence from uncontrolled studies to suggest it may be successful at reducing internalised stigma, improving self-esteem, and advancing recovery (Knight et al., 2003; MacInnes and Lewis, 2008; Lucksted et al., 2011), and a recent randomised controlled trial found that a cognitive behavioural self-stigma reduction programme had significant benefits on self-esteem (Fung et al., 2011). Other interventions that aim to promote optimism and improve self-esteem, such as peer support, may also be worth evaluating in terms of effects on internalised stigma (Pyle and Morrison, 2013). "
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    ABSTRACT: This study aimed to examine how stigma impacts on symptomatic and subjective recovery from psychosis, both concurrently and longitudinally. We also aimed to investigate whether self-esteem and hopelessness mediated the observed associations between stigma and outcomes. 80 service-users with psychosis completed symptom (Positive and Negative Syndrome Scale) and subjective recovery measures (Process of Recovery Questionnaire) at baseline and 6-months later, and also completed the King Stigma Scale, the Self-Esteem Rating Scale and the Beck Hopelessness Scale at baseline. In cross sectional regression and multiple mediation analyses of the baseline data, we found that stigma predicted both symptomatic and subjective recovery, and the effects of stigma on these outcomes were mediated by hopelessness and self-esteem. When the follow-up data were examined, stigma at baseline continued to predict recovery judgements and symptoms. However, self-esteem only mediated the effect of stigma on PANSS passive social withdrawal. Self-esteem and hopelessness should be considered in interventions to reduce the effects of stigma. Interventions that address the current and long-term effects of stigma may positively affect outcome for people being treated for psychosis.
    09/2015; DOI:10.1016/j.psychres.2015.09.042
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    • "Based on our review of the literature, we identified six intervention approaches meeting our criteria: a) Healthy Self-Concept (McCay et al., 2006), b) Self-Stigma Reduction Program (Fung, Tsang, & Cheung, 2011), c) Ending Self-Stigma (ESS; Lucksted et al., 2011), d) Narrative Enhancement and Cognitive Therapy (NECT; Yanos, Roe, & Lysaker, 2011), e) Coming Out Proud (Corrigan, Kosyluk, & Rüsch, 2013), and f) Anti-Stigma Photo- Voice Intervention (Russinova et al., 2014). Table 1 presents an overview of each treatment approach, format, group-leader backgrounds , languages, number of sessions, primary mechanisms of action, and the current state of data on its efficacy. "
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    ABSTRACT: Objective: With growing awareness of the impact of mental illness self-stigma, interest has arisen in the development of interventions to combat it. The present article briefly reviews and compares interventions targeting self-stigma to clarify the similarities and important differences between the interventions. Method: We conducted a narrative review of published literature on interventions targeting self-stigma. Results: Six intervention approaches (Healthy Self-Concept, Self-Stigma Reduction Program, Ending Self-Stigma, Narrative Enhancement and Cognitive Therapy, Coming Out Proud, and Anti-Stigma Photo-Voice Intervention) were identified and are discussed, and data is reviewed on format, group-leader backgrounds, languages, number of sessions, primary mechanisms of action, and the current state of data on their efficacy. Conclusions and implications for practice: We conclude with a discussion of common elements and important distinctions between the interventions and a consideration of which interventions might be best suited to particular populations or settings.
    Psychiatric Rehabilitation Journal 10/2014; 38(2). DOI:10.1037/prj0000100 · 0.75 Impact Factor
    • "The majority of the self-stigma literature focuses on people with severe mental illness. In particular, intervention studies (e.g., Fung et al., 2011; Knight et al., 2006) have included individuals diagnosed with schizophrenia or schizophrenia spectrum disorders . However, self-stigmatization is not exclusive to severe mental illness and affects individuals diagnosed with nonschizophrenic disorders (e.g., bipolar affective disorder, major depression; Borecki et al., 2010; Perlick et al., 2001; Sirey et al., 2001). "
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    ABSTRACT: Objective There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. Methods We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age = 38.57 years, SD = 8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. Results Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. Conclusions Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.
    Asian Journal of Psychiatry 08/2014; 10. DOI:10.1016/j.ajp.2014.02.006
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