Riebel Marie, Krasny-Pacini Agata, Manolov Rumen, Rohmer Odile, Weiner Luisa
Laboratoire de Psychologie des Cognitions (LPC, UR 4440), Université de Strasbourg, Strasbourg, France.
Centre d'Excellence STRAS&ND, Strasbourg, France.
Front Psychiatry. 2024 Jan 8;14:1281428. doi: 10.3389/fpsyt.2023.1281428. eCollection 2023.
Exposure to public stigma can lead to the internalization of autism-related stigma (i.e., self-stigma), associated with negative health, occupational and social outcomes. Importantly, self-stigma is linked to shame and social isolation. Although elevated self-stigma has been reported in autistic adults, to the best of our knowledge, interventions designed to target this issue are lacking. Compassion is an effective way to reduce the emotional correlates of self-stigma (i.e., shame) and their impacts on mental health. However, no study has investigated whether compassion focused therapy (CFT) can effectively reduce self-stigma in autistic adults. The present study aims at investigating whether and how self-compassion improvement following CFT may reduce self-stigma and shame in an autistic individual.
A single case pre-experimental design (SCED) was used with weekly repeated measures during four phases: (i) pure baseline without any intervention (A), (ii) case conceptualization (A'), (iii) intervention (B) where CFT was delivered, (iv) follow-up without intervention (FU). The participant is a 46-year-old autistic man with high self-stigma and shame. Self-report measures of self-compassion and self-stigma and a daily idiographic measure of shame were used.
There was a large increase in self-compassion between pure baseline (A) and the intervention phase (A'B) (Tau-U = 0.99), maintained at follow-up. Similarly, there was a moderate decrease of self-stigma (Tau-U = 0.32). In contrast, when we compared the whole baseline phase AA' (i.e., considering the conceptualisation phase as baseline) to the intervention (B), there was no change in self-stigma (Tau-U = -0.09). There was no change in self-stigma between the intervention (B) and follow-up (Tau-U = -0.19). There was a moderate decrease in daily shame reports between the baseline (AA') and the intervention (B) (Tau-U = 0.31) and a moderate decrease between the pure baseline (A) and intervention phase (A'B) (Tau-U = 0.51).
CFT was feasible for this autistic client and our results show that CFT led to the improvement of self-compassion. Changes on self-stigma measures were moderate. Self-stigma may need more time to change. Because self-stigma is involved in poorer social functioning and mental health in autistic adults, our results are promising and suggesting conducting more large-scale studies on CFT in autistic adults.
遭受公众污名化会导致与自闭症相关的污名内化（即自我污名），这与负面的健康、职业和社会结果相关。重要的是，自我污名与羞耻感和社会孤立有关。尽管已有报道称自闭症成年人的自我污名化程度较高，但据我们所知，针对这一问题的干预措施尚缺乏。同情是减少自我污名相关情绪（即羞耻感）及其对心理健康影响的有效方法。然而，尚无研究调查以同情为中心的疗法（CFT）是否能有效降低自闭症成年人的自我污名。本研究旨在调查接受CFT后自我同情的改善是否以及如何能减少自闭症个体的自我污名和羞耻感。
采用单病例预实验设计（SCED），在四个阶段进行每周重复测量：（i）无任何干预的纯基线期（A），（ii）病例概念化阶段（A'），（iii）实施CFT的干预期（B），（iv）无干预的随访期（FU）。参与者是一名46岁的自闭症男性，自我污名和羞耻感较强。使用了自我同情和自我污名的自我报告测量方法以及羞耻感的每日个体化测量方法。
在纯基线期（A）和干预期（A'B）之间，自我同情有大幅提升（Tau-U = 0.99），随访期保持这一水平。同样，自我污名有适度下降（Tau-U = 0.32）。相比之下，当我们将整个基线期AA'（即将概念化阶段视为基线）与干预期（B）进行比较时，自我污名没有变化（Tau-U = -0.09）。干预期（B）和随访期之间自我污名没有变化（Tau-U = -0.19）。在基线期（AA'）和干预期（B）之间，每日羞耻感报告有适度下降（Tau-U = 0.31），在纯基线期（A）和干预期（A'B）之间也有适度下降（Tau-U = 0.51）。
CFT对这位自闭症患者是可行的，我们的结果表明CFT导致了自我同情的改善。自我污名测量的变化较为适度。自我污名可能需要更多时间来改变。由于自我污名与自闭症成年人较差的社会功能和心理健康有关，我们的结果很有前景，并建议对自闭症成年人的CFT开展更多大规模研究。
