Reducing Internalized Stigma in People With Serious Mental Illness
Condition: Schizophrenia; Schizoaffective Disorder; Bipolar Disorder; Major Depression With Psychotic Features
MeSH terms: Schizophrenia; Bipolar Disorder; Mental Disorders; Psychotic Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      The purpose of this study is to determine if Ending Self-Stigma (ESS), a 9-session group
      intervention designed to assist veterans with serious mental illness to develop skills (SMI)
      to effectively cope with stigma and minimize the internalization of stigmatizing beliefs and
      stereotypes, is more effective in reducing internalized stigma and its associated effects
      than an active comparison group.
    

Detailed description: 
      Background:

      Stigmatizing beliefs and attitudes about mental illness are prevalent and exposure to stigma
      is common among people with mental illness. The negative effects of stigma are compounded
      when a veteran with Serious Mental Illness (SMI) internalizes these stigmatizing assumptions
      and stereotypes. Internalized stigma refers to the process in which a person with mental
      illness cognitively or emotionally absorbs negative messages or stereotypes about mental
      illness and comes to believe them and apply them to him/herself. Internalized stigma is
      evident among veterans with SMI and can lead to decreased self-efficacy, increased
      depression, social withdrawal, and curtailed pursuit of recovery goals.

      Objectives:

      The investigators developed Ending Self Stigma (ESS), a 9-session group intervention to
      assist veterans with SMI to develop skills to effectively cope with stigma and minimize the
      internalization of stigmatizing beliefs and stereotypes. The primary objectives of this
      project are to compare the effects of ESS to a general health and wellness group in: 1)
      reducing internalized stigma and 2) improving proximal psychosocial outcomes (e.g.,
      self-efficacy, belonging, recovery orientation). Secondary objectives include assessing the
      effects of ESS on improving distal psychosocial outcomes (e.g., quality of life, social
      functioning) and examining if improvements are maintained 6-months post-treatment.

      Methods:

      This study is a randomized trial of veterans with SMI receiving outpatient mental health
      services from three VA Medical Centers. Participants are randomly assigned to ESS or a
      general health and wellness group, which they attend once a week for 9 weeks. ESS focuses on
      teaching strategies/tools to help participants address self-stigma. The health and wellness
      group focuses on providing information/ education to help participants better manage
      health-related concerns (e.g. physical activity, nutrition). Participants complete
      assessments at baseline, post-treatment, and 6-months post-treatment. A two-level mixed
      effects model with adjustment for baseline response will be used to address the primary and
      secondary aims. Qualitative data on veterans' experiences of and strategies for coping with
      internalized stigma are being collected from a subset of veterans from both conditions to
      compare experiences of veterans in both groups and explore any reasons for ESS drop-out.

      Status:

      Data collection for the project is completed. Analysis of 6-month post-treatment assessments
      and qualitative interviews are currently being conducted.
    

Intervention name(s): Ending Self Stigma (ESS); Health and Wellness Group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Ending Self Stigma (ESS) is a 9-session small-group (4-8 persons) course designed to help individuals with serious mental Illness (SMI) develop skills to effectively cope with stigma and minimize the internalization of stigmatizing beliefs and stereotypes. Sessions combine in-class lecture, discussion of relevance to group members' personal experiences, review and practice of strategies and skills, and group sharing, support, and problem-solving. Each session is designed to focus on a specific strategy for addressing self-stigma.; The Health and Wellness group is a 9-session small-group (4-8 persons) course designed for individuals with serious mental illness (SMI). Each session focuses on discussion of specific health and wellness related issues and education on ways to better manage health related concerns (e.g., physical activity/exercise, nutrition, managing fatigue/sleep, tobacco and other substance use, etc).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mental Disorders; Psychotic Disorders; Schizophrenia; Stigmatization; Mood Disorders; Schizophrenia and Disorders with Psychotic Feature