Reducing Internalized Stigma in People With Serious Mental Illness

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.

Inclusion Criteria:

- Diagnosis of Schizophrenia

- Schizoaffective disorder

- Bipolar Disorder

- or Major Depression with Psychotic Features

- Age 18 to 80

- Receiving services at one of VA Medical Center study sites

- Ability and willingness to provide consent to participate

- Agreement obtained from the treating clinician that the patient is clinically stable
enough to participate in the study

Exclusion Criteria:

- Severe or profound mental retardation by chart review