Peer support is sometimes formalized and offered as an intervention in mental health services and organizations. Evidence suggests that empowerment, self-efficacy, and internalized stigma are theoretically linked and implicated in the change processes involved in peer support. This review aimed to synthesize quantitative evidence published in the English language from trials that introduced any type of peer support intervention on the outcomes of empowerment, self-efficacy, and internalized stigma for those in receipt of peer support. Literature searches were conducted between November 2016 and April 2017 on CENTRAL, CINAHL, Clinicaltrials.gov, EMBASE, MEDLINE, PsycINFO, and Web of Science databases. Study quality was appraised. Results were integrated first through narrative synthesis.Where data was available, effect sizes were calculated and meta-analyses conducted when there were at least four randomized trials with similar characteristics. Twenty-three studies met inclusion criteria and could be separated into three broad categories: peer-led group interventions, one-to-one peer support, and peer-run services. Most were moderate to weak in quality. Meta-analyses were conducted for group interventions only. Results suggested that peer-facilitated time-limited group interventions can result in small but significant improvements in empowerment and self-efficacy compared with treatment as usual.Evidence was inconclusive for one-to-one peer support, peer-run services, and for internalized stigma. Areas for future research include: equivalence trials of group interventions with nonpeer facilitators, developing peer-led group interventions specific to the needs of people with particular mental health difficulties, high-quality research on one-to-one peer support and peer-run services, and research to understand the essential components and change mechanisms involved in peer support.

We aimed to evaluate the feasibility of Cognitive Therapy (CT) as an intervention for internalised stigma in people with psychosis. We conducted a single-blind randomised controlled pilot trial comparing CT plus treatment as usual (TAU) with TAU only. Participants were assessed at end of treatment (4 months) and follow-up (7 months). Twenty-nine participants with schizophrenia spectrum disorders were randomised. CT incorporated up to 12 sessions over 4 months (mean sessions=9.3). Primary outcome was the Internalised Stigma of Mental Illness Scale - Revised (ISMI-R) total score, which provides a continuous measure of internalised stigma associated with mental health problems. Secondary outcomes included self-rated recovery, internalised shame, emotional problems, hopelessness and self-esteem. Recruitment rates and retention for this trial were good. Changes in outcomes were analysed following the intention-to-treat principle, using ANCOVAs adjusted for baseline symptoms. There was no effect on our primary outcome, with a sizable reduction observed in both groups, but several secondary outcomes were significantly improved in the group assigned to CT, in comparison with TAU, including internalised shame, hopelessness and self-rated recovery. Stigma-focused CT appears feasible and acceptable in people with psychosis who have high levels of internalised stigma. A larger, definitive trial is required.

Internalised shame and self-esteem have both been proposed to play an integral role in the relationship between stigma and its negative psychological sequelae in people who experience psychosis, but there has been little quantitative exploration to examine their roles further. The aim of this study was to examine the relationship of stigma (experienced and perceived) with emotional distress and recovery in psychosis, and to examine internalised shame and self-esteem as potential mediators. A total of 79 participants were included for the purposes of this study. Participants were administered a battery of assessment measures examining experienced and perceived stigma, internalised shame, self-esteem, depression, hopelessness, and personal recovery. Results illustrated that stigma (experienced and perceived) was significantly associated with internalised shame, low self-esteem, depression, hopelessness and poor personal recovery. Stigma (experienced and perceived) and its relationship with depression, hopelessness and personal recovery was mediated by both internalised shame and low self-esteem. In conclusion, stigma can have significant negative emotional consequences and impede recovery in people with psychosis. This may indicate that stigma needs to be addressed therapeutically for people with psychosis with a particular emphasis on addressing internalised shame and low self-esteem.