Targeting Internalized Stigma in First-Episode Psychosis Services

Abstract

Young people who first meet criteria for a schizophrenia-spectrum disorder are considered by the field to be experiencing first-episode psychosis (FEP). Early intervention for psychosis saves lives, and specialized early intervention programs have proliferated over the past two decades. However, critical gaps in such care related to access, equity, and inclusion are still being addressed. Within this article, we first provide a composite clinical vignette from our clinical and research experiences, followed by background and history on the early-stage psychosis field. We then focus on discussing evidence-based clinical practices in this area and gaps in current services, especially related to targeting intersectional stigma and related stressors in care. Psychosis is among the most stigmatized and misunderstood health conditions in the world and many young people diagnosed with FEP experience internalized (or self-) stigma (i.e., incorporating negative mental illness stereotypes into one's identity). Internalized stigma can prevent youth from fully engaging in care and has been consistently associated with a host of negative outcomes, including symptom severity, social isolation, suicidality, and functional deficits. Specific assessment and intervention tools are shared and discussed throughout.

Continuing Education Information

1 CE Credit, Instructional Level: Intermediate

1 Contact Hour (New York Board of Psychology)

Learning Objectives:

1. Identify the characteristics of internalized stigma in first-episode psychosis. 
2. Compare treatment strategies for first-episode psychosis from an intersectional perspective. 
3. Describe health inequities associated with first-episode psychosis services.

Disclosures: Conflicts of interest, external funding, and other disclosures: Dr. DeLuca currently has external funding from the American Psychological Association's Early Career Service Grant, and he is a consultant for Dr. Yanos' NIMH R34 grant, focused on internalized stigma in first-episode psychosis. Dr. DeLuca also serves as a Consulting Editor for JHSP. He has no conflicts of interests or other disclosures to report. Dr. Yanos is currently the Principal Investigator of a National Institute of Mental Health grant (R34MH122500; Development of a stage-specific adaptation of a self-stigma intervention for people recovering from a first episode of psychosis). He has no conflicts of interests or other disclosures to report.

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