Integrated Psychoeducation Program for Internalized Stigma in Schizophrenia

This study is conducted as part of the principal investigator's master's thesis in the Clinical Psychology Master's Program at Dokuz Eylul University, under the supervision of Dr. Elçin Yorulmaz. Background: Internalized stigma is common among people with schizophrenia and is associated with lower self-esteem, reduced hope, and poorer well-being. This study tests a manualized group program designed to address internalized stigma and its related outcomes. Intervention: The Integrated Psychoeducation Program consists of 8 weekly group sessions, each lasting approximately 80-90 minutes and divided into two parts separated by a 10-minute break. Each session includes thematic psychoeducation, a 10-minute expressive writing exercise with standardized instructions and a session-specific theme, group interaction, and a breathing/relaxation exercise (4-7-8 technique). The intervention is delivered in two cohorts starting in early November 2026. Randomization and allocation concealment: After baseline assessment, participants are randomly assigned (1:1) to the intervention or waitlist control group using block randomization with randomly mixed block sizes of 4, 6, and 8, generated with the Sealed Envelope online randomiser, without stratification. Allocation is concealed using sequentially numbered, opaque, sealed envelopes, opened by a psychiatric nurse who is not involved in delivering the intervention or assessing outcomes. Masking: The outcome assessor (the person who administers the questionnaires) is blinded to group allocation at all assessment points. The allocation list is held only by the nurse, the assessor has no contact with the sessions, and appointments are scheduled by another staff member. Control condition: Participants in the waitlist control group continue treatment as usual at the Community Mental Health Center during the study period and are offered the same program after completing the 3-month follow-up assessment. Data from this delayed delivery will not be included in the primary analyses. Sample size: As a pilot trial, the sample size is based on the recommended minimum of 12 participants per group for pilot studies (Julious, 2005), increased to 25 per group (total N = 50) to account for the high attrition expected in this population. Analysis: Changes in clinical outcomes will be compared between groups across assessment points, and feasibility outcomes will be summarized descriptively. Texts produced in the expressive writing exercises may also be explored qualitatively.