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.
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
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
Parallel
Narrative Enhancement Cognitive Therapy
BehavioralNECT 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 missed sessions.
Control Group Sessions
BehavioralTwelve 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.
Change in personal recovery measured by the Recovery Assessment Scale
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.
Change in personal recovery at follow-up
Personal recovery measured with the Recovery Assessment Scale. The total score ranges up to 205, with higher scores indicating greater recovery. An increase of at least 14 points is considered clinically meaningful.
Change in self-stigma
Self-stigma measured with the 29-item Internalized Stigma of Mental Illness Scale. Items are rated from 1 to 4 and combined into a mean total score ranging from 29 to 116. The stigma-resistance items are reverse-scored. Higher scores indicate greater internalized stigma and therefore a worse outcome.
Change in empowerment
Sense of empowerment measured with the 28-item Empowerment Scale. an overall mean score will be calculated, ranging from 28 to 112. Higher scores indicate greater perceived empowerment and therefore a better outcome.
Change in quality of life
Subjective quality of life measured with the 26-item WHO Quality of Life-BREF. Scores will be calculated separately for the physical health, psychological health, social relationships, and environment domains and transformed to a scale ranging from 0 to 100. Higher scores indicate better quality of life and therefore a better outcome.
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Louise Penzenstadler
Lead sponsor
University Hospital, Geneva
Sponsor institution
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