Cognitive therapy for internalised stigma in people experiencing psychosis: A pilot randomised controlled trial.
We aimed to evaluate the feasibility of Cognitive Therapy (CT) as an intervention for internalised stigma in people with psychosis. We conducted a single-blind randomised controlled pilot trial comparing CT plus treatment as usual (TAU) with TAU only. Participants were assessed at end of treatment (4 months) and follow-up (7 months). Twenty-nine participants with schizophrenia spectrum disorders were randomised. CT incorporated up to 12 sessions over 4 months (mean sessions=9.3). Primary outcome was the Internalised Stigma of Mental Illness Scale - Revised (ISMI-R) total score, which provides a continuous measure of internalised stigma associated with mental health problems. Secondary outcomes included self-rated recovery, internalised shame, emotional problems, hopelessness and self-esteem. Recruitment rates and retention for this trial were good. Changes in outcomes were analysed following the intention-to-treat principle, using ANCOVAs adjusted for baseline symptoms. There was no effect on our primary outcome, with a sizable reduction observed in both groups, but several secondary outcomes were significantly improved in the group assigned to CT, in comparison with TAU, including internalised shame, hopelessness and self-rated recovery. Stigma-focused CT appears feasible and acceptable in people with psychosis who have high levels of internalised stigma. A larger, definitive trial is required.
School of Psychological Sciences, University of Manchester, Manchester M13 9PL, United Kingdom; Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom. Electronic address: tony.morrison@manchester.ac.uk.
Anthony P
AP
Morrison
School of Psychological Sciences, University of Manchester, Manchester M13 9PL, United Kingdom; Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Eilish
E
Burke
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Elizabeth
E
Murphy
School of Psychological Sciences, University of Manchester, Manchester M13 9PL, United Kingdom; Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Melissa
M
Pyle
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Samantha
S
Bowe
School of Psychological Sciences, University of Manchester, Manchester M13 9PL, United Kingdom.
Filippo
F
Varese
Biostatistics Research Group, School of Medicine, University of Manchester, Manchester, United Kingdom.
Graham
G
Dunn
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Nicola
N
Chapman
University of Edinburgh, Edinburgh, United Kingdom.
Paul
P
Hutton
Greater Manchester West NHS Mental Health Foundation Trust, Manchester, United Kingdom.
Mary
M
Welford
School of Psychological Sciences, University of Manchester, Manchester M13 9PL, United Kingdom; North East London NHS Foundation Trust, London, United Kingdom.
Lisa J
LJ
Wood
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003674:Defense Mechanisms; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D012559:Schizophrenia / Q000175:diagnosis; D012649:Self Concept; D012752:Shame; D016037:Single-Blind Method; D057545:Social Stigma; D016896:Treatment Outcome
Cognitive therapy; Psychosis; Schizophrenia; Stigma