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24-07-2013 | Mental health | Article

Cognitive therapy for at-risk mental state stigma fears allayed


Free abstract

medwireNews: Cognitive therapy may help to prevent people with an at-risk mental state (ARMS) from regarding their experiences too negatively, a study shows.

This is contrary to the fear that offering therapy, even nonpharmacologic, to people with ARMS may run the risk for increasing internalized stigma, say researcher Anthony Morrison (University of Manchester, UK) and team.

They note that cognitive therapy should therefore “provide direct benefit given the toxic nature of internalised stigma.”

The researchers drew on data from the Early Detection and Intervention Evaluation 2 (EDIE-2) trial, which included 144 ARMS patients assigned to receive cognitive therapy and 144 assigned to receive monitoring only. After 12 months, random effects regression analysis revealed that scores on the negative appraisals section of the Personal Beliefs about Experiences Questionnaire were a significant 1.36 points lower with cognitive therapy than monitoring only.

The researchers observe that such a reduction may not be clinically significant, but stress that their results suggest cognitive therapy is “benign” at least in this respect. Also, they note that scores in both groups declined significantly over time, suggesting that patients in the monitoring-only group “inferred from the regular questions about unusual experiences that many people must experience them and, therefore, they are not as unusual or different as they had originally believed.”

This indicates that even routine monitoring “within a normalising framework” could protect patients against developing internalized stigma, Morrison et al believe.

Perceived social acceptability also improved over time, although this did not quite achieve statistical significance. Scores among patients receiving cognitive therapy tended to be higher than among those assigned to monitoring, “which is clearly incompatible with suggestions that it may worsen concerns about the social acceptability of psychotic experiences,” says the team.

“There is a strong negative relationship between internalised stigma and a range of psychosocial variables including hope, self-esteem, empowerment and adherence with treatment,” write the researchers in the British Journal of Psychiatry.

They add: “Therefore, a reduction in negative appraisals of unusual experiences and a trend towards increasing the perceived social acceptability of such experiences is an important finding.”

However, Morrison et al comment that the absence of a significant improvement in perceived social acceptability may be down to wider cultural issues, rather than simply the opinions of the patients, in which case such interventions should be “delivered in a context that includes campaigns designed to influence the general public.”

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Eleanor McDermid, Senior medwireNews Reporter