Abstract
BackgroundSelf-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Narrative enhancement and cognitive therapy (NECT) is a group-based intervention combining psychoeducation, cognitive restructuring and story-telling exercises to reduce self-stigma and its impact on recovery-related outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning.MethodsThis is a 12-centre stepped-wedge cluster randomized controlled trial of NECT effectiveness on social functioning in SMI, compared to treatment as usual. One hundred and twenty participants diagnosed with schizophrenia, bipolar disorder or borderline personality disorder will be recruited across the 12 sites. The 12 centres participating to the study will be randomized into two groups: one group (group 1) receiving the intervention at the beginning of the study (T0) and one group (group 2) being a control group for the first 6 months and receiving the intervention after (T1). Outcomes will be compared in both groups at T0 and T1, and 6-month and 12-month outcomes for groups 1 and 2 will be measured without a control group at T2 (to evaluate the stability of the effects over time). Evaluations will be conducted by assessors blind to treatment allocation. The primary outcome is personal and social performance compared across randomization groups. Secondary outcomes include self-stigma, self-esteem, wellbeing, quality of life, illness severity, depressive symptoms and personal recovery.DiscussionNECT is a promising intervention for reducing self-stigma and improving recovery-related outcomes in SMI. If shown to be effective in this trial, it is likely that NECT will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice.Trial registrationClinicalTrials.gov NCT03972735. Trial registration date 31 May 2019.
Highlights
If shown to be effective in this trial, it is likely that Narrative enhancement and cognitive therapy (NECT) will be implemented in psychiatric rehabilitation services with subsequent implications for routine clinical practice
Mental illness stigma refers to the negative beliefs, emotional reactions and attitudes towards people with serious mental illness (SMI) endorsed by the general population
The association of pharmacological treatment with psychiatric rehabilitation is recommended in all the international guidelines on SMI [49,50,51]
Summary
Mental illness stigma refers to the negative beliefs, emotional reactions and attitudes towards people with serious mental illness (SMI) endorsed by the general population ( referred to as public stigma [1]). The ‘illness identity model’ [5] proposed that self-stigma can have pervasive effects on outcomes related to recovery from SMI, including self-esteem, hopefulness, social interaction, employment and symptom severity. The evidence consistently supports many of the model’s predictions, including that self-stigma is negatively associated with self-esteem, motivation to achieve personal life goals, shared-decision making, adherence into treatment, well-being, quality of life, personal recovery and social function [6,7,8,9,10,11,12,13,14]. Self-stigma is highly prevalent in serious mental illness (SMI) and is associated with poorer clinical and functional outcomes. Despite evidence of its effectiveness on self-stigma in schizophrenia-related disorders, it is unclear whether NECT can impact social functioning
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