An exploration of personal stigma and anxiety in people who experience psychosis-related phenomena

Abstract

The aim of this thesis was to investigate the relationships between personal stigma and anxiety amongst individuals living with psychosis-related experiences. The thesis is presented as three papers. Paper One, presents a narrative systematic review and synthesis of the literature exploring associations between personal stigma and anxiety in psychosis. The review revealed internalised stigma dominated the literature, showing positive relationships with social anxiety and anxiety symptoms. The review emphasised the need for personal stigma to be considered in clinical practice. More research is needed into perceived and experienced stigma domains. Further research should aim to address methodological limitations of the evidence-base to enhance our knowledge of mechanisms involved in the observed relationships and inform targets for intervention. Paper Two is a secondary data analysis of the EDIE-2 trial, examining the relationships between internalised stigma, metacognitive beliefs, and social anxiety, in an At-Risk Mental State population. Structural equation modelling was performed to examine direct, indirect, and total effects, of the three constructs. Overall, significant direct associations were observed between internalised stigma, metacognitive beliefs, and social anxiety. Cognitive confidence was the only metacognitive belief to partially mediate the relationship between stigma and anxiety. These findings emphasised the need for destigmatising and de-pathologizing approaches in services. It is recommended that internalised stigma and metacognitive beliefs are considered in the treatment of social anxiety for those experiencing psychosis-related phenomena, even in the absence of a diagnosis. Finally, Paper Three offers a critical reflection of the previous two papers, clinical implications of the thesis, and a personal reflection on the research process overall. In conclusion, this thesis recommends personal stigma should be considered in psychological assessment, formulation, and intervention, particularly in the context of anxiety, across all phases of psychosis.

Date of Award	31 Dec 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anthony Morrison (Supervisor)