Evidence for the Effectiveness of Psychological Interventions for Internalized Stigma among Adults with Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analyses

Abstract

In recent years, psychological interventions have been used to alleviate internalized stigma in people with schizophrenia spectrum disorders, but outcomes have been inconsistent. The aim of this review was to examine the existing evidence regarding this matter. Four electronic databases (EMBASE, MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials) were searched from inception until 8 September 2022, using appropriate strategies. The eligibility, quality, and strength of evidence of each study were all evaluated against the predetermined standards. Further quantitative analyses were performed using the RevMan software. A total of 27 studies were included in the systematic review. Eighteen studies with extractable data for meta-analysis yielded a statistically significant overall effect (Z = 3.00; p = 0.003; 95% CI: −0.69 [−1.15, −0.24]; n = 1633), although there was considerable heterogeneity (Tau2 = 0.89; Chi2 = 303.62, df = 17; p < 0.00001; I2 = 94%). Subgroup analyses for Narrative Enhancement and Cognitive Therapy (NECT) produced a statistically significant and highly homogenous effect (Z = 3.40; p = 0.0007; 95% CI: −0.44 [−0.70, −0.19]; n = 241; Tau2 = 0.00; Chi2 = 0.14, df = 2 (p = 0.93); I2 = 0%). In conclusion, the majority of the psychological interventions are successful in lowering levels of internalized stigma, especially NECT, and interventions that integrate multiple therapies may be more beneficial.

Rate and correlates of self-stigma in adult patients with early psychosis

“…Owing to the fact that self-stigma is prevalent in the initial course of illness and may impede the recovery process, comprehensive assessment of self-stigma and regular monitoring of its adverse impact on clinical outcome and psychosocial functioning should be performed on a regular basis to facilitate early detection of and prompt interventions to patients at risk of developing high self-stigma. In fact, recent metaanalytic reviews have indicted efficacy of various psychological interventions in lowering self-stigma in patients with psychotic 10.3389/fpsyt.2023.1200568 disorders (62,63), and group therapies (such as assertive training and psychoeducation programs) may be particularly useful for patients with significant though relatively less severe self-stigma (62). A conceptual framework has also recently been proposed to adequately address stigma for early psychosis patients by delineating how distinct forms of stigma (including self-stigma and perceived public stigma) are linked to different treatment stages of early intervention service (64).…”

Lived experience adaptation of a psychosocial intervention for young adults with bipolar spectrum disorders: Process description and adaptation outcomes

“…The intervention has demonstrated efficacy in its original version (Yanos et al, 2019), as well as promising feasibility, acceptability, and pilot findings in adapted versions and internationally, in Europe, North America, and Asia (Hansson et al, 2017;Huang et al, 2023;Oudejans et al, 2022;Roe et al, 2014). A recent meta-analysis (Jagan et al, 2023) found that studies involving NECT produced a 'statistically significant and highly homogenous effect' in reducing self-stigma among persons diagnosed with schizophrenia-spectrum disorders.…”