Promoting Recovery by Overcoming Self-stigma in Mental Health Disorders With a Narrative Enhancement and Cognitive Therapy (NECT) Group Intervention
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Narrative Enhancement Cognitive Therapy, Control Group Sessions.
- Who it may be relevant to
- Registry conditions: Mental Disorders, Substance Use Disorders. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Switzerland
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
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
Overview
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.
Detailed description
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.
The main objective is to determine whether participation in NECT improves personal recovery compared with the control condition. The study will also examine whether any changes are maintained approximately six months after the intervention and whether NECT influences self-stigma, empowerment, quality of life, self-esteem, self-compassion, psychological flexibility, psychiatric symptoms, and substance use.
In addition to the quantitative evaluation, participants who receive NECT may take part in semi-structured interviews after the intervention. These interviews will explore how participants experienced the programme, what they found useful, and how changes in self-stigma may contribute to recovery. The qualitative findings will complement the quantitative results and help inform the possible future implementation of NECT in routine psychiatric and addiction services.
Interventions
- Behavioral Narrative Enhancement Cognitive Therapy
NECT is a manualized group intervention comprising 12 weekly 90-minute sessions delivered to groups of approximately eight participants. It combines psychoeducation about stigma and self-stigma, cognitive restructuring of internalized negative beliefs, and narrative exercises that help participants develop a more integrated identity beyond mental illness. Sessions are co-facilitated by a trained mental health professional and a peer practitioner. Individual make-up sessions may be offered for mi - Behavioral Control Group Sessions
Twelve weekly group sessions in which participants discuss topics such as their weekly activities, without specific psychotherapeutic or psychoeducational content targeting self-stigma or recovery. Treatment as usual continues throughout.
Primary outcome measures
- Change in personal recovery measured by the Recovery Assessment Scale [Time frame: Baseline to post-intervention, approximately 12 weeks.]
Secondary outcome measures (8)
- Change in personal recovery at follow-up [Time frame: Baseline to approximately 6 months after the intervention.]
- Change in self-stigma [Time frame: Baseline, post-intervention, and approximately 6 months after the intervention.]
- Change in empowerment [Time frame: Baseline, post-intervention, and approximately 6 months after the intervention.]
- Change in quality of life [Time frame: Baseline, post-intervention, and approximately 6 months after the intervention.]
- Change in self-compassion [Time frame: Baseline, post-intervention, and approximately 6 months after the intervention.]
- Change in psychological flexibility [Time frame: Baseline, post-intervention, and approximately 6 months after the intervention.]
- Change in psychiatric symptoms [Time frame: Baseline, post-intervention, and approximately 6 months after the intervention.]
- Change in substance use [Time frame: Baseline, post-intervention at approximately 12 weeks, and 6 months after the intervention.]
Eligibility criteria
Inclusion criteria
- 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
Exclusion criteria
- 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
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Single blind
- Primary purpose
- Treatment
Study locations
Switzerland · 1 center
- Geneva University Hospital — Geneva
Identifiers
NCT: NCT07735481 · in preparation