The Role of Sex, Quality of Life, Self-Esteem and Cognitive Insight in Reducing Personal Stigma in Psychosis.

Personal stigma in psychosis, encompassing perceived and internalised stigma, poses a significant barrier to recovery and well-being. This study investigates the effectiveness of Individualised Metacognitive Training (MCT+) in reducing personal stigma among individuals with recent-onset psychosis, with a focus on sex-specific outcomes and the predictive roles of self-certainty, self-esteem and quality of life (QoL). A randomised controlled trial was conducted across multiple Spanish clinical sites, comparing MCT+ with treatment as usual. Participants were assessed at baseline, post-treatment and 6-month follow-up using validated measures of stigma, cognitive insight, QoL and self-esteem. Robust linear mixed models revealed that MCT+ significantly reduced perceived stigma over time, with QoL emerging as a strong predictor of perceived stigma levels. However, no significant effects were observed for internalised stigma, although self-certainty was positively associated with its severity. Exploratory analyses suggested potential sex differences in stigma trajectories, with males showing greater improvements in internalised stigma. These findings highlight the nuanced impact of metacognitive interventions on stigma and underscore the importance of tailoring treatments to individual psychosocial and cognitive profiles. Future research should explore gender-sensitive adaptations of MCT+ and the inclusion of targeted self-stigma modules to enhance intervention efficacy.