O4.1. A NOVEL, BRIEF PSYCHOLOGICAL INTERVENTION TO TARGET ILLNESS ENGULFMENT IN ENDURING SCHIZOPHRENIA: IMPACT ON SELF-ESTEEM, INTERNALIZED STIGMA, AND BEYOND

Abstract

Abstract Background Illness engulfment, a process whereby an individual’s self-concept becomes defined solely by illness, mediates the association between good insight and increased depressive symptomatology in schizophrenia. The present pilot study aimed to examine the acceptability and effectiveness of a novel, brief intervention to reduce illness engulfment in people with enduring schizophrenia. Methods Thirty-nine individuals diagnosed with schizophrenia spectrum disorders and scoring above 75 points on the Modified Engulfment Scale (MES) were sequentially assigned to the intervention or wait-list control (treatment-as-usual or TAU). The intervention consisted of weekly 50-minute individual therapy sessions over four consecutive weeks. The therapists followed a structured intervention manual that used a cognitive-behavioural therapy approach. It consisted of four modules pertaining to normalization of engulfment, exploration of personal identity and self-awareness, personal narrative and the impact of mental health on identity and fostering a healthy self-concept. Participants were assessed pre- and post-intervention/wait-list, and the wait-list group underwent a third assessment after the intervention. The primary outcome measure was MES score. Secondary outcomes included measures of depressive symptomatology, insight, self-esteem, recovery style, self-reported quality of life, and self-stigma. Results Completion at follow-up was 74%. The intervention was highly acceptable to participants, with 97% of completers rating their experience attending the therapy sessions as “good” to “excellent”, 97% endorsing that the intervention helped them to explore who they are as a person, and 93% endorsing that they would recommend the therapy to another client. Using an intention-to-treat principle, analysis of covariance was conducted to compare groups on each outcome, with baseline score as the covariate. Participation in the intervention significantly reduced MES score (adjusted mean = 91.9) compared to TAU (adjusted mean = 100.0), F (1, 32) = 5.78, p = .02, partial η2 = .15. No changes were seen on secondary outcomes when comparing intervention and TAU. A paired samples t-test showed that among all participants who completed the intervention (n = 29), MES score was significantly lower post-intervention (M = 91.5, SE = 2.5) compared to pre-intervention (M = 98.2, SE = 2.6), t (28) = 3.30, p < .01, r = .53. The observed changes in MES score met three a priori thresholds for the minimal clinically important difference (MCID), when using the Recovery Style Questionnaire as an external anchor to establish the MCID, and when using distribution-based methods of standard error of measurement of baseline scores and effect size. Among intervention completers, there was also a significant improvement in self-esteem, t (28) = 2.94, p < .01, r = .49; an increase in integrative recovery style, t (28) = 2.70, p < .05, r = .45; and a decrease in overall self-stigma, t (27) = 2.25, p < .05, r = .40, as well as discrimination experience of stigma, t (27) = 2.28, p < .05, r = .40. Discussion A brief, manualized intervention aimed at helping individuals to re-examine their self-concept and engage with roles above and beyond the ‘patient’ role was effective in reducing illness engulfment in people with enduring schizophrenia. The results suggest that participation in the intervention may also contribute to increasing self-esteem and integrative recovery style, as well as decreasing internalized stigma. This intervention can be combined with treatments aimed at improving insight in order to minimize the associated risk of depressive symptomatology.