Trial of Treatment for Internalized Stigma in Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      The purpose of the present study is to build upon the investigators' 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.
    

Detailed description: 
      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, the investigators 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 the investigators' 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. The investigators will screen 500 persons at
      two sites (Newark, New Jersey and Indianapolis, IN) for evidence of moderate or elevated
      internalized stigma. They will conduct a randomized study of NECT versus supportive group
      therapy in a sample of 175 individuals meeting Structured Clinical Interview 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.
    

Intervention name(s): Narrative Enhancement and Cognitive Therapy; Supportive Group Therapy
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment