Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial

Elevated internalized stigma is common and is linked to subjective and objective outcomes for severe mental illness. The authors developed a manualized group-based intervention (Narrative Enhancement/Cognitive Therapy; NECT) to address internalized stigma in severe mental illness. The purpose of the present study was to evaluate the feasibility and effectiveness of NECT. In total, 144 individuals were screened at two sites to evaluate if they met criteria for "elevated" internalized stigma; 39 and were eligible were randomized to NECT or to treatment as usual (TAU) and were assessed at baseline, posttreatment, and 3-month follow-up. Fifteen of the 21 individuals assigned to NECT were classified as "exposed" to treatment. Intent-to-treat analyses found no significant difference between the NECT and TAU groups. A comparison of exposed versus unexposed participants noted trends for exposed participants to have improved more in two aspects of self-stigma as well as insight. We conclude that NECT is feasible and tolerable, but findings did not support the hypothesis that NECT was more effective than TAU, although small sample size and significant dropout may have restricted the ability to detect an effect.     

Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness

Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed "narrative enhancement and cognitive therapy (NECT)". We describe the treatment approach and offer an illustration of it by way of a case vignette.     

The stigma of having a parent with mental illness: Genetic attributions and associative stigma

Children often report associative stigma because they are ‘contaminated’ by association with a parent who has a mental illness. An exploratory study was conducted to investigate the role of genetic attributions in the aetiology of associative stigma. The first hypothesis was that genetic attributions would predict associative stigma over and above the contribution of biochemical and stressful‐event attributions, while the second hypothesis was that the relationship between genetic attributions and associative stigma would be mediated by the perceived likelihood that children would develop the same disorder as their parents. Two‐hundred‐and‐two individuals were asked to read a hypothetical scenario describing a teenage girl whose mother had been diagnosed with either schizophrenia or depression. Both hypotheses were supported. The findings of the study have implications for a number of professions working in the community such as teachers and psychologists. Additional avenues for future research are also explored.     

Evidence for blatant dehumanization of mental illness and its relation to stigma

ABSTRACT

People with mental illness face stigma, and due to their low social status, they may also face blatant dehumanization that denies their status as fully evolved human beings. In the current research, three studies documented the existence of blatant dehumanization of mental illness. Study 1 (N = 112) showed that participants rated people with mental illness in general as being significantly less human than other dehumanized social groups such as Mexican immigrants and Muslims. Study 2 (N = 158) showed that dehumanization occurs for specific mental disorders but that the level of dehumanization varies widely among disorders. Study 3 (N = 223) documented significant correlations between dehumanization of mental illness and standard measures of stigma such as fear, pity, and social distance. Overall, the results establish the relevance of blatant dehumanization to mental illness stigma and suggest new directions for understanding stigma.     

The stigma of mental illness: Explanatory models and methods for change

For people with mental illness, diminished quality of life and loss of personal goals does not result solely from the symptoms, distress, and disabilities caused by their psychiatric disorder. Quality of life and personal goals are also hindered by people who embrace the stigma that accompanies mental illness and mental health care. This paper reviews evidence of the impact of mental illness stigma and strategies for seeking to ease its impact. To achieve these goals, we (a) describe the ways in which stigma harm people with mental illness, (b) summarize models that explain the development and maintenance of these stigmatizing effects, and (c) review strategies that have been shown to decrease the impact of stigma. Concerns about stigma are on the political agendas of many mental health advocacy groups. It has recently also become the focus of extensive research. Our goal in this paper is to balance the practical concerns raised by mental health advocates against data that support or contradicts specific assertions.     

Competence and warmth stereotypes prompt mental illness stigma through emotions

Public stigma toward mental illness subgroups (11 mental illness subgroups and 2 subgroups perceived to have mental illness) was examined. Competence and warmth stereotypes were used to predict emotional reactions posited to mediate behavioral inclinations ranging from passive to active harm or facilitation. Fear mediated the relationship between low competence and warmth stereotypes and passive harm. Anger, and to a lesser extent fear, mediated the relationship between low warmth and active harm. Pity mediated the relationship between warmth and active facilitation. Neither envy nor admiration linked stereotypes to behavioral reactions. Results suggest that emotions share motivational direction with behavior, to approach or to avoid, rather than simply sharing valence. Implications for research on stigma toward mental illness subgroups are discussed.     

非体面工作者职业污名的作用机制及其应对策略

“非体面工作”是指在身体上令人不悦、社会认知程度不高的工作,或者与我们道德观念中更英雄主义的东西背道而驰的工作类型。通过回顾非体面工作从业者职业污名的相关文献,对非体面工作和职业污名的概念内涵进行划分与辨析;基于认知评价理论构建了职业污名威胁感知过程模型,探讨了非体面工作从业者职业污名的前因、评估、应对策略以及可能产生的潜在后果;提出了未来潜在研究方向：(1)从动态视角探索职业污名的来源;(2)结合个体和情境因素探索职业污名管理的作用路径和作用效果;(3)考虑多样文化背景。     

Psychoanalytic concepts of the etiology of severe mental illness

In this paper I challenge some prevalent psychoanalytic concepts of the etiology and pathogenesis of severe mental illness which I believe to be in need of revision. There is insufficient evidence to conclude that the etiology of the two major adult psychoses, schizophrenia and manic-depressive illness, can be attributed to failures in development or fixations during the earliest years of life. Furthermore, I believe it incorrect to ascribe these failures of development to deficiencies in the early maternal environment. I base my disagreements on three main considerations: the misinterpretation of the etiological significance of regression, the relevance of new biological data, and erroneous conclusions drawn from lack of diagnostic distinctions. I also challenge the generally held concept of etiologic phase specificity which proposes that failures during various early phases of development can be correlated with different kinds of adult psychopathology. In calling this concept into question, I argue that current psychoanalytic concepts of the etiology of the borderline group of disorders also need to be reevaluated.     

Combating the mental health stigma with nostalgia

We report research implicating nostalgia as an intrapersonal means of warding off the stigmatization of persons with mental illness. We hypothesized and found that nostalgia about an encounter with a person with mental illness improves attitudes toward the mentally ill. In Experiment 1, undergraduates who recalled an encounter with a mentally ill person while focusing on central (vs. peripheral) features of the nostalgia prototype reported a more positive outgroup attitude. This beneficial effect of nostalgia was mediated by greater inclusion of the outgroup in the self (IOGS). In Experiment 2, undergraduates who recalled a nostalgic (vs. ordinary) interaction with a mentally ill person subsequently showed a more positive outgroup attitude. Results supported a serial mediation model whereby nostalgia increased social connectedness, which predicted greater IOGS and outgroup trust. IOGS and outgroup trust, in turn, predicted more positive outgroup attitudes. We ruled out alternative explanations for the results (i.e., mood, perceived positivity, and typicality of the recalled outgroup member). The findings speak to the intricate psychological processes underlying the prejudice‐reduction function of nostalgia and their interventional potential. Copyright © 2013 John Wiley & Sons, Ltd.     

Children's strategies for coping with depression

Rippere (1974-1983) has investigated adults' commonsense beliefs concerning behavioural strategies for coping with depression. The study report here was concerned with the developmental aspects of the concept of 'common knowledge'. It was designed in order to investigate, through conversations with children of various ages, the hypothesis that children may possess a common knowledge concerning the 'things to do' when they are feeling depressed. 120 children distributed across seven age groups (ranging from 4-11 yr) were asked in an open-ended interview "What's the thing to do when you're feeling depressed?". Their responses were subjected to frequency counts and content analysis. Content analysis of the data indicated that 50% of all responses mentioned 'Play' strategies, 12% mentioned 'Help and comfort seeking', and 11% mentioned 'avoidance' activities. There was an inverse relationship between the frequency with which items were mentioned and the number of items mentioned at that frequency. This finding supports the notion of the existence of a canon of commonsense 'things to do' when feeling unhappy, and accords well with the findings of Rippere.