Compassion Focused Therapy (CFT) for the reduction of the self-stigma of mental disorders : The COMpassion for Psychiatric disorders And Self-Stigma (COMPASS) study protocol for a randomized controlled study.

Abstract

Background: People with mental disorders face frequent stigmatizing attitudes and behaviors from others. Importantly, they can internalize such negative attitudes and thus self-stigmatize. Self-stigma is involved in diminished coping skills leading to social avoidance and difficulties in adhering to care. Reducing self-stigma and its emotional corollary, shame, is thus crucial to attenuate the negative outcomes associated with mental illness. Compassion Focused Therapy (CFT) is a third wave cognitive behavioral therapy that targets shame reduction and hostile self-to-self relationship and allows for symptom improvement while increasing self-compassion. Although shame is a prominent part of the concept of self-stigma, the efficacy of CFT has never been evaluated in individuals with high levels of self-stigma. The purpose of this study is to evaluate the efficacy and acceptability of a group-based CFT program on self-stigma, compared to a psychoeducation program for self-stigma (Ending Self-Stigma) and to treatment as usual (TAU). We hypothesize that diminished shame and emotional dysregulation and increased self-compassion will mediate the relationship between self-stigma improvements post-therapy in the experimental group. Methods: This seven-center trial will involve 336 participants diagnosed with a severe mental illness and reporting high levels of self-stigma. Participants will be randomized into one of three treatment arms: 12 week-treatment of Compassion-Focused Therapy (experimental arm), 12 week-treatment of Psychoeducation (active control arm), and TAU (treatment as usual - passive control arm). The primary outcome is the decrease of self-stigma scores on a self-report scale, i.e., ISMI, at 12 weeks. Secondary endpoints include sustainability of self-stigma scores (ISMI) and self-reported scores regarding target psychological dimensions, e.g., shame and emotional regulation, social functioning and psychiatric symptoms. Assessments are scheduled at pretreatment, post-treatment (at 12 weeks), and at 6-month follow-up. Acceptability will be evaluated via (i) the Credibility and Expectancy Questionnaire at T0, the Consumer Satisfaction Questionnaire for Psychotherapeutic Services posttreatment and at 6-month follow-up, (iii) attendance and (iv) dropout rates. Discussion: This study will evaluate the potential efficacy and acceptability of a group-based CFT program on the decrease of self-stigma, and thereby contribute to the continuing development of evidence-based therapeutic interventions for the internalized stigma of mental disorders. ` Trial registration: This trial has been registered on January 26, 2023: clinicaltrials.gov NCT05698589 https://www.clinicaltrials.gov/ct2/show/NCT05698589

Compassion focused therapy for self-stigma and shame in autism: a single case pre-experimental study

“…A moderate decrease in self-stigma was nevertheless found between the baseline and the intervention phase, which was maintained at follow-up. Similar results were found on the daily reports of shame, consistent with the idea that shame is strongly associated with self-stigma in autistic and non-autistic people) ( 27 , 81 ). The moderate changes in self-stigma might be explained by different factors.…”

“…While numerous studies have investigated self-stigma associated with mental illness, studies concerning self-stigma in autism are scarce ( 22–26 ). This may seem surprising given the high prevalence of self-stigma in autistic adults, which ranges between 15% ( 22 ) and 45.2% ( 27 ) according to recent estimations. Furthermore, few studies have investigated shame and its relationship with self-stigma in autistic people.…”

“…Furthermore, few studies have investigated shame and its relationship with self-stigma in autistic people. In a recent study led by our team in a sample of 689 autistic adults, self-stigma was found to be highly correlated to shame and shame mediated the relationship between self-stigma and depression ( 27 ). These results highlight the need to develop and evaluate specific interventions to target shame and self-stigma in autistic adults in order to mitigate the negative outcomes associated with the internalization of autism-related public stigma (e.g., social isolation and depression).…”

“…Interestingly, self-compassion has been recently found to moderate the relationship between self-stigma and depression in autistic adults ( 27 ) suggesting that an intervention aiming at increasing self-compassion might be useful for reducing self-stigma. In particular, compassion focused therapy (CFT) seems relevant in the context of self-stigma as it has shown its efficacy for targeting shame and hostile self-to-self relationship ( 41 ).…”

“…However, a recent paper has provided strong theoretical support for the clinical relevance of CFT for the treatment of shame-related problems experienced by autistic adults ( 46 ). Hence, through its focus on self-compassion, CFT is likely to improve mental health by specifically targeting shame and self-blame ( 27 ).…”