The effectiveness of narrative enhancement and cognitive therapy: a randomized controlled study of a self-stigma intervention

Abstract

PurposeStigma has been proposed to be one of the most serious obstacles to successful treatment, rehabilitation and inclusion in society of people with severe mental illness. An aspect of stigma which has been increasingly discussed is self-stigma, which refers to the internalization of negative stereotypes among people with severe mental illness. The aim of the present study was to investigate the effectiveness of a group-based anti self-stigma intervention, narrative enhancement and cognitive therapy (NECT) as an add-on to treatment as usual, with regard to changes in self-stigma, self-esteem, and subjective quality of life.MethodAfter screening for eligibility 106 participants were included in a randomized controlled trial using a wait-list control group, of which 87 completed the study. Assessments were made at baseline, at termination of the intervention, and at a 6-month follow-up (intervention group only).ResultsThe results showed that NECT was effective in reducing self-stigma and improving self-esteem compared to treatment as usual only. No differences were shown regarding subjective quality of life. Changes shown in the intervention group at termination of intervention were stable at the 6-month follow-up. A regression analysis showed that there was a positive relationship between exposure to the intervention and reduction of self-stigma.ConclusionsThe conclusion of the present study is that, using a sample size with adequate power, NECT seems to be an effective intervention with regard to diminishing self-stigma and improving self-esteem, and that these improvements were stable at a 6-month follow-up. There was a distinct relationship between number of sessions attended and improvements in self-stigma and self-esteem controlling for confounding factors. This puts attention to the importance of creating a group climate which facilitate and encourage participation through the various phases of the intervention.

The Adaptation and Feasibility of Narrative Enhancement and Cognitive Therapy (NECT) for Late-Onset Psychosis

“…This positivity and group cohesiveness is reflected in the zero withdrawal rate and high attendance. This result aligns with the recommendations to focus on group climate to improve attendance (Hansson et al 2017).…”

“…There is a small yet growing evidence base on the effectiveness of NECT. The manual was piloted in the United States (Roe et al 2010;Yanos et al 2012), Israel (Roe et al 2014), and Sweden (Hansson and Yanos 2016;Hansson et al 2017). It was delivered to individuals with schizophrenia, schizoaffective, bipolar disorders, and major depression.…”

Psychometric evaluation of the Swedish version of Rosenberg’s self-esteem scale

“…At re-assessment after the interventions, the participants' self-esteem scores were significantly higher than at baseline in both samples. The participants had improved on other measures as well, such as quality of life and activity engagement in Sample 1 [21] and reduced stigma in Sample 2 [22], which supports that the RSES detected a true change. The evidence of the ability of RSES to detect change is also acknowledged in other research [15,48].…”

“…Sample 2 consisted of participants in a study investigating the effectiveness of a group-based anti-self-stigma intervention, narrative enhancement and cognitive therapy (NECT), with regard to changes in self-stigma, self-esteem, and subjective quality of life [22]. NECT is a structured, group-based intervention comprising 20 weekly 1-h sessions [23].…”

The mechanisms and processes of connection: developing a causal chain model capturing impacts of receiving recorded mental health recovery narratives

“…Therefore, changes to an individual's self-narrative are theorised to reduce self-stigma. Randomised controlled trial evaluations of NECT have shown a positive impact on self-stigma, and associated outcomes such as hope, self-esteem and quality of life [17,18].…”