Reducing patients’ self-stigmatization via mental health care professionals

Abstract

Background Previous studies have shown that a significant proportion of mental health care professionals (MHCPs) hold stigmatizing attitudes towards their patients, hereby increasing the chances of their patients to perceive and internalize these, allegedly self-stigmatization. Several studies into interventions to decrease self-stigmatization have been conducted. However, results vary and questions arise whether providing such treatments is not a form of stigmatization itself. Applying an indirect approach might reduce this risk. Acceptance and Commitment Therapy (ACT) has been found to decrease stigmatizing attitudes by changing the ‘us’ versus ‘them’ thinking. In the present study MHCPs were given an ACT-based training, thereby aiming to decrease stigmatization, and subsequently self-stigmatization of their patients. It was hypothesized that patients’ self-stigmatization would be reduced when their MHCP received an ACT-based training. Methods An RCT with a 2 (pre-test / post-test) x 2 (no training / training) design was conducted. A total of 41 MHCPs and 41 patients participated, 20 in the experimental and 21 in the control condition respectively. The MHCPs in the experimental condition received an ACT-based training, MHCPs in the control condition received no training. Patients’ self-stigmatization was measured before and after the training session. Results The hypothesis was not supported as no interaction effect was found. A significant effect of time occurred, indicating that solely addressing self-stigmatization tends to decrease it. Explorative analysis of subscales found significant decreases after the ACT-based training in internalization of mental illness stereotypes in patients. Conclusion The present study demonstrated that training MHCPs in ACT did not result in a decline in patients’ self-stigmatization, thereby indicating the ineffectiveness of ACT-based treatments which address self-stigmatization indirectly. The validity of the used instrument in regard to its subscales is questioned. Importantly, the explorative analysis showed more promising effects of ACT in reducing patients’ internalization of common mental illness stereotypes. Considering this study’s limitations, more research is necessary to determine the true effects of ACT in decreasing (self-)stigmatization.