Self-stigma and treatment effectiveness in patients with anxiety disorders – a mediation analysis

Marie Ociskova,¹ Jan Prasko,¹ Kristyna Vrbova,¹ Petra Kasalova,¹ Michaela Holubova,¹ Ales Grambal,¹ Klara Machu<sup>2

1</sup>Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, ²Department of Psychology, Faculty of Arts, University of Ostrava, Ostrava, The Czech Republic

Goal: The goal of this study was to explore the impact of self-stigma on the treatment outcomes in patients with anxiety disorders and to find possible mediators of this relationship.
Method: Two hundred and nine patients with anxiety disorders, who were hospitalized in a psychotherapeutic department, attended the study. The average age was 39.2±12.4 years; two-thirds were women. Most of the patients used a long-term medication. The participants underwent either cognitive behavioral therapy (CBT) or short psychodynamic therapy. The selection to the psychotherapy was not randomized. All individuals completed several scales – Beck Depression Inventory, the second edition (BDI-II), Beck Anxiety Inventory (BAI), Dissociative Experience Scale (DES), Sheehan Disability Scale (SDS), subjective Clinical Global Impression (subjCGI), and The Internalized Stigma of Mental Illness Scale (ISMI). A senior psychiatrist filled out the objective CGI (objCGI).
Results: The patients significantly improved in the severity of anxiety (BAI), depression (BDI-II), and overall severity of the mental disorder (objCGI). The self-stigma predicted a lower change of the objCGI, but not a change of the anxiety and depressive symptoms severity. Anxiety, depressive symptoms, dissociation, and disability were assessed as possible mediators of the relationship between the self-stigma and the treatment change. None of them were significant.
Conclusion: Self-stigma lowers the effectiveness of the combined treatment of anxiety disorders. Future research should explore other possible mediators influencing this relationship.

Keywords: self-stigma, anxiety disorders, treatment effectiveness, medication

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