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Efficacy of Coming Out Proud to reduce stigma's impact among people with mental illness: pilot randomised controlled trial

Published online by Cambridge University Press:  02 January 2018

Nicolas Rüsch ,
Elvira Abbruzzese ,
Eva Hagedorn ,
Daniel Hartenhauer ,
Ilias Kaufmann ,
Jan Curschellas ,
Stephanie Ventling ,
Gianfranco Zuaboni ,
René Bridler  and
Manfred Olschewski
...Show all authors
Nicolas Rüsch*
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, Switzerland, and Department of Psychiatry II, University of Ulm, Germany
Elvira Abbruzzese
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Zürich, Switzerland
Eva Hagedorn
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Zürich, Switzerland
Daniel Hartenhauer
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Zürich, Switzerland
Ilias Kaufmann
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Zürich, Switzerland
Jan Curschellas
Affiliation:
Sanatorium Kilchberg, Switzerland
Stephanie Ventling
Affiliation:
Sanatorium Kilchberg, Switzerland
Gianfranco Zuaboni
Affiliation:
Sanatorium Kilchberg, Switzerland
René Bridler
Affiliation:
Sanatorium Kilchberg, Switzerland
Manfred Olschewski
Affiliation:
Department of Medical Biometry and Statistics, University of Freiburg, Germany
Wolfram Kawohl
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, Switzerland
Wulf Rössler
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zürich, Switzerland, and Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of São Paulo, Brazil
Birgit Kleim
Affiliation:
Department of Clinical Psychology and Psychotherapy, University of Zürich, Switzerland
Patrick W. Corrigan
Affiliation:
Illinois Institute of Technology, Chicago, USA
*
Nicolas Rüsch, Section Public Mental Health, Department of Psychiatry II, University of Ulm, Parkstrasse 11, D - 89073 Ulm, Germany. Email: nicolas.ruesch@uni-ulm.de
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Abstract

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Background

Facing frequent stigma and discrimination, many people with mental illness have to choose between secrecy and disclosure in different settings. Coming Out Proud (COP), a 3-week peer-led group intervention, offers support in this domain in order to reduce stigma's negative impact.

Aims

To examine COP's efficacy to reduce negative stigma-related outcomes and to promote adaptive coping styles (Current Controlled Trials number: ISRCTN43516734).

Method

In a pilot randomised controlled trial, 100 participants with mental illness were assigned to COP or a treatment-as-usual control condition. Outcomes included self-stigma, empowerment, stigma stress, secrecy and perceived benefits of disclosure.

Results

Intention-to-treat analyses found no effect of COP on self-stigma or empowerment, but positive effects on stigma stress, disclosure-related distress, secrecy and perceived benefits of disclosure. Some effects diminished during the 3-week follow-up period.

Conclusions

Coming Out Proud has immediate positive effects on disclosure- and stigma stress-related variables and may thus alleviate stigma's negative impact.

Type
Papers
Information
The British Journal of Psychiatry , Volume 204 , Issue 5 , May 2014 , pp. 391 - 397
Copyright
Copyright © Royal College of Psychiatrists, 2014 

Footnotes

This study was supported by Sanatorium Kilchberg, the Psychiatric University Hospital Zürich, the Zürich Impulse Program for the Sustainable Development of Mental Health Services (zinep.ch) as well as the National Institute of Mental Health, USA.

Declaration of interest

P.W.C. developed the Coming Out Proud programme.

References

1 Lasalvia, A, Zoppei, S, van Bortel, T, Bonetto, C, Cristofalo, D, Wahlbeck, K, et al. Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey. Lancet 2013; 381: 55–62.CrossRefGoogle ScholarPubMed
2 Henderson, C, Thornicroft, G. Evaluation of the Time to Change programme in England 2008–2011. Br J Psychiatry 2013; 202 (suppl 55): s45–8.Google Scholar
3 Schomerus, G, Schwahn, C, Holzinger, A, Corrigan, PW, Grabe, HJ, Carta, MG, et al. Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatr Scand 2012; 125: 440–52.Google Scholar
4 Brohan, E, Elgie, R, Sartorius, N, Thornicroft, G. Self-stigma, empowerment and perceived discrimination among people with schizophrenia in 14 European countries: the GAMIAN-Europe study. Schizophr Res 2010; 122: 232–8.Google Scholar
5 Rüsch, N, Lieb, K, Bohus, M, Corrigan, PW. Self-stigma, empowerment, and perceived legitimacy of discrimination among women with mental illness. Psychiatr Serv 2006; 57: 399–402.Google Scholar
6 Corrigan, PW, Larson, JE, Rüsch, N. Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 2009; 8: 75–81.Google Scholar
7 Link, BG, Mirotznik, J, Cullen, FT. The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? J Health Soc Behav 1991; 32: 302–20.Google Scholar
8 Rüsch, N, Corrigan, PW, Wassel, A, Michaels, P, Olschewski, M, Wilkniss, S, et al. A stress-coping model of mental illness stigma: I. Predictors of cognitive stress appraisal. Schizophr Res 2009; 110: 59–64.Google Scholar
9 Rüsch, N, Corrigan, PW, Powell, K, Rajah, A, Olschewski, M, Wilkniss, S, et al. A stress-coping model of mental illness stigma: II. Emotional stress responses, coping behavior and outcome. Schizophr Res 2009; 110: 65–71.CrossRefGoogle ScholarPubMed
10 Mittal, D, Sullivan, G, Chekuri, L, Allee, E, Corrigan, PW. Empirical studies of self-stigma reduction strategies: a critical review of the literature. Psychiatr Serv 2012; 63: 974–81.Google Scholar
11 Yanos, PT, Roe, D, Lysaker, PH. Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness. Int J Group Psychother 2011; 61: 576–95.Google Scholar
12 Knight, MTD, Wykes, T, Hayward, P. Group treatment of perceived stigma and self-esteem in schizophrenia: a waiting list trial of efficacy. Behav Cogn Psychother 2006; 34: 305–18.CrossRefGoogle Scholar
13 Lucksted, A, Drapalski, A, Calmes, C, Forbes, C, DeForge, B, Boyd, J. Ending self-stigma: pilot evaluation of a new intervention to reduce internalized stigma among people with mental illnesses. Psychiatr Rehab J 2011; 35: 51–4.Google Scholar
14 Luoma, JB, Kohlenberg, BS, Hayes, SC, Fletcher, L. Slow and steady wins the race: a randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. J Consult Clin Psychol 2012; 80: 43–53.Google Scholar
15 Sibitz, I, Provaznikova, K, Lipp, M, Lakeman, R, Amering, M. The impact of recovery-oriented day clinic treatment on internalized stigma: preliminary report. Psychiatry Res 2013; 209: 326–32.CrossRefGoogle ScholarPubMed
16 Morrison, AP, Birchwood, M, Pyle, M, Flach, C, Stewart, SLK, Byrne, R, et al. Impact of cognitive therapy on internalised stigma in people with at-risk mental states. Br J Psychiatry 2013; 203: 140–5.Google Scholar
17 Chaudoir, SR, Fisher, JD. The disclosure processes model: understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity. Psychol Bull 2010; 136: 236–56.Google Scholar
18 Pachankis, JE. The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. Psychol Bull 2007; 133: 328–45.CrossRefGoogle ScholarPubMed
19 Corrigan, PW, Morris, S, Larson, JE, Rafacz, J, Wassel, A, Michaels, P, et al. Self-stigma and coming out about one's mental illness. J Commun Psychol 2010; 38: 1–17.Google Scholar
20 Quinn, DM, Earnshaw, VA. Concealable stigmatized identities and psychological well-being. Soc Personal Psychol Compass 2013; 7: 40–51.Google Scholar
21 Corrigan, PW, Lundin, R. Don't Call Me Nuts! Coping with the Stigma of Mental Illness. Recovery Press, 2001.Google Scholar
22 Corrigan, PW, Kosyluk, KA, Rüsch, N. Reducing self-stigma by coming out proud. Am J Public Health 2013; 103: 794–800.Google Scholar
23 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). APA, 1994.Google Scholar
24 Corrigan, PW, Morris, SB, Michaels, PJ, Rafacz, JE, Rüsch, N. Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatr Serv 2012; 63: 963–73.CrossRefGoogle ScholarPubMed
25 Ritsher, JB, Otilingam, PG, Grajales, M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatr Res 2003; 121: 31–49.Google Scholar
26 Rogers, ES, Chamberlin, J, Ellison, ML, Crean, T. A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatr Serv 1997; 48: 1042–7.Google Scholar
27 Major, B, O'Brien, LT. The social psychology of stigma. Annu Rev Psychol 2005; 56: 393–421.Google Scholar
28 Hult, JR, Wrubel, J, Branstrom, R, Acree, M, Moskowitz, JT. Disclosure and nondisclosure among people newly diagnosed with HIV: an analysis from a stress and coping perspective. AIDS Patient Care STDS 2012; 26: 181–90.Google Scholar
29 Kaiser, CR, Major, B, McCoy, SK. Expectations about the future and the emotional consequences of perceiving prejudice. Pers Soc Psychol Bull 2004; 30: 173–84.Google Scholar
30 Lazarus, RS, Folkman, S. Stress, Appraisal, and Coping. Springer, 1984.Google Scholar
31 Rüsch, N, Müller, M, Lay, B, Corrigan, PW, Zahn, R, Schönenberger, T, et al. Emotional reactions to involuntary psychiatric hospitalization and stigma as a stressor among people with mental illness. Eur Arch Psychiatry Clin Neurosci 2014; doi: 10.1007/s00406-013-0412-5.Google Scholar
32 Hautzinger, M, Bailer, M. Allgemeine Depressionsskala [Center for Epidemiologic Studies Depression Scale, German version]. Beltz, 1993.Google Scholar
33 Vacha–Haase, T, Thompson, B. How to estimate and interpret various effect sizes. J Couns Psychol 2004; 51: 473–81.Google Scholar
34 Henderson, C, Brohan, E, Clement, S, Williams, P, Lassman, F, Schauman, O, et al. Decision aid on disclosure of mental health status to an employer: feasibility and outcomes of a randomised controlled trial. Br J Psychiatry 2013; 203: 350–7.CrossRefGoogle Scholar
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