Stigma towards mental illness is one of the greatest barriers to functional recovery that people with psychotic disorders face. Internalization of stigma (self-stigma) is associated with increased depressive symptoms, treatment non-adherence, and reduced quality of life. Self-stigma also has functional consequences, such as social avoidance and decreased help-seeking behaviour, which may worsen symptoms and impede recovery. Despite a growing awareness of the negative outcomes associated with self-stigma, few interventions have been designed to specifically address this experience in first episode psychosis. This project proposes to determine the effectiveness of an innovative, youth-oriented, group-based intervention known as Be Outspoken and Overcome Stigmatizing Thoughts (BOOST), which aims to reduce self-stigma and promote effective communication skills for adults (16-65 years old) experiencing a first episode of psychosis.
BOOST is a manualized intervention that combines psychoeducation and cognitive restructuring to replace stigmatizing views about early psychosis and help patients challenge negative self-evaluations. Assertiveness skills training is a unique component that was added to the group to empower individuals and provide them with the behavioural skills to fight back against self-stigma and get their needs met during social interactions. Sessions are 60 minutes long and occur once a week for 8 weeks. Groups comprise 4-6 outpatients enrolled in a specialized outpatient clinic for early psychosis. Session are led by one therapist and co-facilitated with a peer support worker who has "lived experience" with early psychosis to provide unique insights on living with and overcoming self-stigma. The group format is informal and discussion-based, with an emphasis on sharing personal experiences. Early sessions (1-4) focus on dispelling popular myths associated with psychosis and challenging erroneous beliefs, as a way to provide psychoeducation to patients. Additionally, time is spent identifying the impact of self-labelling, how this can lead to self-fulfilling prophecies, and getting participants to reflect on examples of when self-stigma might have behavioural consequences. Cognitive behavioural therapy techniques are used as a basis for the intervention, with an initial focus on cognitive restructuring to fight back against negative, stigmatizing thoughts. Later sessions (5-8) target behavioural approaches for self-empowerment through assertiveness skills training and goal setting. Discussions are focused on the verbal and non-verbal characteristics of passive, aggressive, and assertive communication, in addition to techniques for speaking in an assertive manner. Role play scenarios that are specific to young people with psychosis provide opportunities to practice these skills in session. For example, Speaking up to a psychiatrist about the negative side effects of a medication or reaching out to a friend for support after returning from a hospitalization. Weekly "missions" (i.e., home practice activities) are administered following each session to build on group content and help participants fight back against self-stigmatizing thoughts and attitudes in everyday contexts.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
40
A cognitive and behavioural group therapy designed to reduce self-stigma and promote effective communication skills for adults (16-65 years old) experiencing a first episode of psychosis.
Participants on the waitlist will still receive treatment as usual, which includes medical, psychosocial, and occupational interventions to help maximize patients' integration within the community and support recovery from a first episode of psychosis.
St. Joseph's Healthcare Hamilton, West 5th Campus
Hamilton, Ontario, Canada
RECRUITINGChange in Self-Stigma - Internalized Stigma of Mental Illness Scale (ISMI) from Baseline
The ISMI (Ritsher, Otilingam, \& Grajales, 2003) is a 29-item self-report questionnaire designed to assess subjective experience of stigma.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
Change in Self-Esteem - Rosenberg Self-Esteem Scale (RSES) from Baseline
The RSES (Rosenberg et al., 1995) is a 10-item self-report questionnaire that IS used to measure self-esteem.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
Change in Quality of Life - Satisfaction with Life Safe (SWLS) from Baseline
The SWLS (Kobau et al., 2010) is a short 5-item instrument designed to measure global cognitive judgments of satisfactions with one's life.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
Change in Stigma Stress - Cognitive Appraisal of Stigma Stress (CogApp)
The CogApp (Rüsch et al., 2009) is an 8-item measure that yields a difference score of stigma stress by subtracting perceived resources to cope with stigma from perceived stigma-related harm.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
Change in Depression - Beck Depression Inventory-II (BDI)
The BDI-II (Beck, Steer, \& Brown, 1996) is a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
Change in Social Anxiety - Social Interaction Anxiety Scale (SIAS)
The SIAS (Mattick \& Clarke, 1998) is a 20 item self-report scale designed to measure social interaction anxiety.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
Change in Personal Recovery - Questionnaire about the Process of Recovery (QPR)
The QPR (Williams et al., 2015) is a 22-item, service user-rated measure of personal recovery.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
Change in Functioning - Sheehan Disability Scale (SDS)
The SDS (Sheehan et al., 1996) is a brief, 5-item self-report tool that assesses functional impairment in work/school, social life, and family life.
Time frame: Post-treatment (within 2 weeks following the end of treatment)
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