Promoting Recovery by Overcoming Self-stigma in Mental Health Disorders With a Narrative Enhancement and Cognitive Therapy (NECT) Group Intervention - A Randomized Controlled Trial and Qualitative Study
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 发起方
- 入组人数
- 106
- 试验地点
- 1
- 主要终点
- Change in personal recovery measured by the Recovery Assessment Scale
研究概览
简要总结
This study will evaluate whether Narrative Enhancement and Cognitive Therapy (NECT) can promote recovery among adults living with severe mental health disorders, including substance use disorders. NECT is a structured group intervention that combines education about stigma, cognitive techniques to challenge internalized negative beliefs, and narrative exercises that help participants develop a broader identity beyond their diagnosis.
Approximately 106 adults receiving outpatient or day-hospital psychiatric care at Geneva University Hospitals will be randomly assigned to receive either usual care plus 12 weekly NECT sessions or usual care plus 12 comparison group sessions that do not specifically address self-stigma or recovery. The study will examine whether NECT improves recovery after the intervention and whether any benefits are maintained over time.
详细描述
Self-stigma occurs when people internalize negative societal stereotypes about mental illness. It can contribute to shame, reduced self-esteem, hopelessness, social withdrawal, lower treatment engagement, and difficulties pursuing personal goals. Although recovery-oriented mental health care increasingly emphasizes empowerment, resilience, social inclusion, and quality of life, interventions specifically targeting self-stigma are not yet routinely available. This is particularly relevant for people with substance use disorders, who may experience strong moral judgment and stigmatizing attitudes.
Narrative Enhancement and Cognitive Therapy is a manualized, recovery-oriented group intervention developed to reduce self-stigma. The programme combines psychoeducation about stigma and common misconceptions, cognitive restructuring of negative beliefs about oneself, and narrative exercises in which participants reflect on and share personal experiences. Its purpose is to help participants develop a more integrated understanding of themselves that is not defined solely by mental illness. Previous studies have reported beneficial effects in people with psychotic disorders, but evidence remains limited for other psychiatric populations and for people with substance use disorders. The French-language programme has not yet been evaluated in routine clinical practice.
The study will use a prospective, multicentre, randomized controlled design with an additional qualitative component. Approximately 106 adults with psychiatric disorders will be recruited from three specialized outpatient or day-hospital settings within the Department of Psychiatry at Geneva University Hospitals. Participants will be randomly allocated in a 1:1 ratio to an intervention or control condition. Randomization will be stratified by participating centre.
Participants assigned to the intervention condition will continue their usual psychiatric care and attend 12 weekly NECT group sessions. Participants assigned to the control condition will continue their usual care and attend 12 weekly group sessions that do not include specific psychotherapeutic or psychoeducational content addressing self-stigma or recovery. The comparison sessions may focus, for example, on participants' weekly activities.
NECT will be delivered in groups of approximately eight participants. Each 90-minute session will be facilitated by two trained co-facilitators, including a mental health professional and a peer practitioner. The programme includes an introductory session, psychoeducation, cognitive restructuring, narrative enhancement, and a concluding session. Participants who miss a session may be offered an individual make-up session to review the content and reduce the risk of discontinuing the programme.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Written informed consent
- •DSM-5 psychiatric diagnosis within F10-F48, F60-F69, or F90, including substance use disorders
- •Receiving outpatient or day-hospital treatment
- •Diagnosed or in treatment for at least 12 months
- •Clinically stable for at least 3 months, with stable pharmacological treatment during this period
- •Clinical Global Impressions-Severity score below 6
排除标准
- •Participation in another program likely to affect social functioning or self-stigma, such as social cognitive remediation or social skills training
- •Acute psychiatric episode with a Clinical Global Impressions-Severity score above 6
- •Medical emergency or immediate life-threatening situation at inclusion
- •Unable to provide informed consent
- •Comorbid intellectual disability
- •Receiving care under constraint or deprived of liberty by judicial order Insufficient ability to speak and read French
研究组 & 干预措施
NECT
Treatment as usual plus 12 weekly 90-minute NECT group sessions combining psychoeducation, cognitive restructuring, and narrative exercises to reduce self-stigma and support recovery.
干预措施: Narrative Enhancement Cognitive Therapy (Behavioral)
Control Group
Treatment as usual plus 12 weekly group sessions without specific psychotherapeutic or psychoeducational content targeting self-stigma or recovery
干预措施: Control Group Sessions (Behavioral)
结局指标
主要结局
Change in personal recovery measured by the Recovery Assessment Scale
时间窗: Baseline to post-intervention, approximately 12 weeks.
Personal recovery will be assessed using the Recovery Assessment Scale (RAS). The total score ranges up to 205, with higher scores indicating greater recovery. An increase of at least 14 points is considered clinically meaningful.
次要结局
- Change in personal recovery at follow-up(Baseline to approximately 6 months after the intervention.)
- Change in self-stigma(Baseline, post-intervention, and approximately 6 months after the intervention.)
- Change in empowerment(Baseline, post-intervention, and approximately 6 months after the intervention.)
- Change in quality of life(Baseline, post-intervention, and approximately 6 months after the intervention.)
- Change in self-compassion(Baseline, post-intervention, and approximately 6 months after the intervention.)
- Change in psychological flexibility(Baseline, post-intervention, and approximately 6 months after the intervention.)
- Change in psychiatric symptoms(Baseline, post-intervention, and approximately 6 months after the intervention.)
- Change in substance use(Baseline, post-intervention at approximately 12 weeks, and 6 months after the intervention.)
研究者
Louise Penzenstadler
Principal investigator
University Hospital, Geneva