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

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 th