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Impact of cognitive therapy on internalised stigma in people with at-risk mental states

  • Anthony P. Morrison (a1), Max Birchwood (a2), Melissa Pyle (a1), Clare Flach (a3), Suzanne L. K. Stewart (a4), Rory Byrne (a1), Paul Patterson (a2), Peter B. Jones (a5), David Fowler (a6), Andrew I. Gumley (a6) and Paul French (a7)...
Extract
Background

Internalised stigma in young people meeting criteria for at-risk mental states (ARMS) has been highlighted as an important issue, and it has been suggested that provision of cognitive therapy may increase such stigma.

Aims

To investigate the effects of cognitive therapy on internalised stigma using a secondary analysis of data from the EDIE-2 trial.

Method

Participants meeting criteria for ARMS were recruited as part of a multisite randomised controlled trial of cognitive therapy for prevention and amelioration of psychosis. Participants were assessed at baseline and at 6, 12, 18 and 24 months using measures of psychotic experiences, symptoms and internalised stigma.

Results

Negative appraisals of experiences were significantly reduced in the group assigned to cognitive therapy (estimated difference at 12 months was −1.36 (95% Cl −2.69 to −0.02), P = 0.047). There was no difference in social acceptability of experiences (estimated difference at 12 months was 0.46, 95% Cl −0.05 to 0.98, P = 0.079).

Conclusions

These findings suggest that, rather than increasing internalised stigma, cognitive therapy decreases negative appraisals of unusual experiences in young people at risk of psychosis; as such, it is a non-stigmatising intervention for this population.

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Copyright
Corresponding author
Anthony P. Morrison, School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK. Email: tony.morrison@manchester.ac.uk.
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Yung, AR, McGorry, PD, McFarlane, C, Jackson, HJ, Patton, GC, Rakkar, A. Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull 1996; 22: 283303.
2 Yang, LH, Wonpat-Borja, AJ, Opler, MG, Corcoran, CM. Potential stigma associated with inclusion of the psychosis risk syndrome in the DSM-V: an empirical question. Schizophr Res 2010; 120: 42–8.
3 Corcoran, CM, First, MB, Cornblatt, BA. The psychosis risk syndrome and its proposed inclusion in the DSM-V: a risk/benefit analysis. Schizophr Res 2010; 120: 1622.
4 Morrison, AP, Byrne, RE, Bentall, RP. DSM-5 and the ‘Psychosis Risk Syndrome’: whose best interests would it serve? Psychosis 2010; 2: 96–9.
5 Addington, J, Epstein, I, Liu, L, French, P, Boydell, KM, Zipursky, RB. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophr Res 2011; 125: 5461.
6 McGlashan, TH, Zipursky, RB, Perkins, D, Addington, J, Miller, T, Woods, SW, et al Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry 2006; 163: 790–9.
7 McGorry, PD, Yung, AR, Phillips, LJ, Yuen, HP, Francey, S, Cosgrave, EM, et al Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 2002; 59: 921–8.
8 Morrison, AP, French, P, Walford, L, Lewis, SW, Kilcommons, A, Green, J, et al Cognitive therapy for the prevention of psychosis in people at ultra-high risk. Randomised controlled trial. Br J Psychiatry 2004; 185: 291–7.
9 Amminger, GP, Schafer, MR, Papageorgiou, K, Klier, CM, Cotton, SM, Harrigan, SM, et al Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry 2010; 67: 146–54.
10 Bechdolf, A, Wagner, M, Ruhrmann, S, Harrigan, S, Putzfeld, V, Pukrop, R, et al Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry 2012; 200: 22–9.
11 Yung, AR, Phillips, LJ, Nelson, B, Francey, SM, PanYuen, H, Simmons, MB, et al Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis. J Clin Psychiatry 2011; 72: 430–40.
12 Morrison, AP, French, P, Stewart, S, Birchwood, M, Fowler, B, Gumley, AL. Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2): a multisite randomised controlled trial of cognitive therapy for at risk mental states. BMJ 2012; 344: e2233.
13 Stafford, MR, Jackson, H, Mayo-Wilson, E, Morrison, AP, Kendall, T. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346: f185.
14 Warner, R. The prevention of schizophrenia: what interventions are safe and effective? Schizophr Bull 2001; 27: 551–62.
15 Corcoran, C, Malaspina, D, Hercher, L. Prodromal interventions for schizophrenia vulnerability: the risks of being “at risk”. Schizophr Res 2005; 73: 173–84.
16 French, P, Morrison, AP. Early Detection and Cognitive Therapy for People at High Risk of Developing Psychosis: A Treatment Approach. Wiley, 2004.
17 Bentall, RP, Morrison, AP. More harm than good: the case against using antipsychotic drugs to prevent severe mental illness. J Ment Health 2002; 11: 351–65.
18 Link, BG, Yang, LH, Phelan, JC, Collins, PY. Measuring mental illness stigma. Schizophr Bull 2004; 30: 511–41.
19 Corrigan, PW, Watson, AC. The paradox of self-stigma and mental illness. Clin Psychol 2002; 9: 3553.
20 Ritsher, JB, Otilingam, PG, Grajales, M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003; 121: 3149.
21 Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, et al Mapping the onset of psychosis – the comprehensive assessment of at risk mental states (CAARMS). Aust N Z J Psychiatry 2005; 39: 964–71.
22 Birchwood, M, Mason, R, MacMillan, F, Healy, J. Depression, demoralization and control over psychotic illness: a comparison of depressed and nondepressed patients with a chronic psychosis. Psychol Med 1993; 23: 387–95.
23 Birchwood, M, Jackson, C, Brunet, K, Holden, J, Barton, K. Personal Beliefs about Illness Questionnaire-Revised (PBIQ-R): reliability and validation in a first episode sample. Br J Clin Psychology 2012; 51: 448–58.
24 Morrison, AP. The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychother 2001; 29: 257–76.
25 Little, RJA, Rubin, DB. Statistical Analysis with Missing Data. John Wiley and Sons, 2002.
26 Maracy, M, Dunn, G. Estimating dose-response effects in psychological treatment trials: the role of instrumental variables. Stat Methods Med Res 2011; 20: 191215.
27 Morrison, AP, Stewart, S, French, P, Bentall, RP, Birchwood, M, Byrne, R, et al Early Detection and Intervention Evaluation for people at high-risk of psychosis-2 (EDIE-2): trial rationale, design and baseline characteristics. Early Interv Psychiatry 2011; 5: 2432.
28 Carpenter, WT. Anticipating DSM-V: should psychosis risk become a diagnostic class? Schizophr Bull 2009; 35: 841–3.
29 Thornicroft, G, Brohan, E, Rose, D, Sartorius, N, Leese, M. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 2009; 373: 408–15.
30 Goffman, E. Stigma: Notes on the Management of Spoiled Identity. Penguin Books, 1963.
31 Brohan, E, Elgie, R, Sartorius, N, Thornicroft, G. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 2010; 122: 232–8.
32 Thornicroft, G. Most people with mental illness are not treated. Lancet 2007; 370: 807–8.
33 Thornicroft, G, Rose, D, Kassam, A. Discrimination in health care against people with mental illness. Int Rev Psychiatry 2007; 19: 113–22.
34 Corrigan, PW, Watson, AC, Barr, L. The self-stigma of mental illness: implications for self-esteem and self-efficacy. J Soc Clin Psychol 2006; 25: 875–84.
35 Birchwood, M, Trower, P, Brunet, K, Gilbert, P, Iqbal, Z, Jackson, C. Social anxiety and the shame of psychosis: a study in first episode psychosis. Behav Res Ther 2007; 45: 1025–37.
36 Livingston, JD, Boyd, JE. Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Soc Sci Med 2010; 71: 2150–61.
37 Byrne, R, Morrison, AP. Young people at risk of psychosis: their subjective experiences of monitoring and cognitive behaviour therapy in the EDIE 2 trial. Psychol Psychother, in press.
38 International Early Psychosis Association Writing Group. International clinical practice guidelines for early psychosis. Br J Psychiatry 2005; 187 (suppl 48): s1204.
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Impact of cognitive therapy on internalised stigma in people with at-risk mental states

  • Anthony P. Morrison (a1), Max Birchwood (a2), Melissa Pyle (a1), Clare Flach (a3), Suzanne L. K. Stewart (a4), Rory Byrne (a1), Paul Patterson (a2), Peter B. Jones (a5), David Fowler (a6), Andrew I. Gumley (a6) and Paul French (a7)...
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