Personal stigma and psychosis: Exploration of lived experience, assessment, and therapeutic intervention.

Abstract

This thesis aimed to explore the construct of stigma and its relationship with experiences of psychosis. In particular, it sought to investigate the role of assessment, lived experience, and therapeutic response to stigma, with those who experience psychosis. To achieve these objectives multiple methods were utilised including qualitative interviews, cross-sectional and longitudinal methods, systematic narrative synthesis and meta-analysis, and a feasibility randomised controlled trial. Chapter one provides a review of the stigma literature applied to people who experience psychosis. Chapter two provides an overview of the methodology utilised in this thesis and outlines the six academic papers which comprise the bulk of this thesis. Chapter three (Study 1) describes a systematic narrative synthesis and meta-analysis of psychosocial interventions for internalised stigma in psychosis. This review identified that no current trials of psychosocial intervention improved internalised stigma, but low-quality evidence limited the conclusions drawn. Further research examining psychosocial interventions is required. Chapter four (Study 2; n=79) outlines the development of semi-structured interview measure of stigma (SIMS) in psychosis. A reliable, valid and clinically relevant measure of stigma was developed specifically for people who experience psychosis. Chapter five (Study 3; n=25) outlines a qualitative exploration of stigma experiences with psychiatric inpatients who experience psychosis. This study identified three superordinate themes of ‘stigmatising social environments and networks’, ‘stigmatised person with psychosis’, and ‘stigma interactions’. Chapter six (Study 4; n=79), explored relationships between stigma and psychological factors in psychosis. It identified that internalised shame and self-esteem were significant mediators between the relationships of experienced and perceived stigma with depression, hopelessness and recovery. Based on the evidence examined in chapters one to six, chapter seven (Study 5) outlined an integrative cognitive model of internalised stigma in psychosis. Chapter eight (Study 6), based on the model described in chapter seven, describes a feasibility randomised controlled trial (n=30) that was conducted examining the efficacy and acceptability of a brief internalised stigma CBT intervention, comparing it to a psychoeducational intervention, with acute inpatients who experience psychosis. The intervention was shown to be feasible and acceptable but a larger definitive trial is required. Finally chapter nine outlines an overall discussion and reflections on the previous chapters.

Date of Award	1 Aug 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Anthony Morrison (Supervisor) & Rory Byrne (Supervisor)