Trial of Treatment for Internalized Stigma in Schizophrenia

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.

Inclusion Criteria:

- Schizophrenia-spectrum disorder (schizophrenia or schizoaffective)

- Elevated internalized stigma

Exclusion Criteria:

- Current substance dependence

- Inability to speak English

- Inability to provide informed consent