Narrative Enhancement and Cognitive Therapy: A New Group-Based Treatment for Internalized Stigma Among Persons with Severe Mental Illness

Department of Psychology, John Jay College of Criminal Justice, City University of New York, NY 10019, USA.
International journal of group psychotherapy (Impact Factor: 0.52). 10/2011; 61(4):577-95. DOI: 10.1521/ijgp.2011.61.4.576
Source: PubMed


Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed "narrative enhancement and cognitive therapy (NECT)". We describe the treatment approach and offer an illustration of it by way of a case vignette.

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    • "s predicted the course of negative symptoms . Self - concepts can play a substantial role for subjective well being and for recovery . Especially self - esteem and self - efficacy have been pointed out as important personal traits within the recovery process ( Yanos and Moos , 2007 ) . Self - concepts are targets in narrative enhancement therapy ( Yanos et al . , 2011 ) , schema - therapy ( Bortolon et al . , 2013 ) , meta cognitive therapy ( Moritz et al . , 2014 ) , and acceptance , and commitment therapy ( Gaudiano and Herbert , 2006 ) . Especially in the narrative enhancement therapy fragmented self - narratives and self - stigma are targeted . These approaches could enrich cognitive behavioral t"
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    ABSTRACT: Cognitive models suggest that the self-concept of persons with psychosis can be fundamentally affected. Self-concepts were found to be related to different symptom domains when measured concurrently. Longitudinal investigations to disentangle the possible causal associations are rare. We examined a sample of 160 people with a diagnosis of schizophrenia who took part in a psychotherapy study. All participants had the DSM-IV diagnosis of a schizophrenia and pronounced negative symptoms. Neurocognition, symptoms, and self-concepts were assessed at two time points 12 months apart. Structural equation modeling was used to test whether symptoms influence self-concepts (scar-model) or self-concepts affect symptoms (vulnerability model). Negative symptoms correlated concurrently with self-concepts. Neurocognitive deficits are associated with more negative self-concepts 12 months later. Interpersonal self-concepts were found to be relevant for paranoia. The findings implicate that if deficits in neurocognition are present, fostering a positive self-concept should be an issue in therapy. Negative interpersonal self-concept indicates an increased risk for paranoid delusions in the course of 1 year. New aspects for cognitive models in schizophrenia and clinical implications are discussed.
    Frontiers in Psychology 07/2015; 6:917. DOI:10.3389/fpsyg.2015.00917 · 2.80 Impact Factor
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    • "The underlying conceptualisations of identity and narrative are relevant to mental illness stigma, especially self-stigma, for the following reason: 'Self-stigma is not merely a matter of inaccurate beliefs but also infects the stories one tells about oneself. To accept, for instance, that one is dangerous would seem necessarily to have an enormous range of consequences for how one might tell or not tell one's life narrative' (Yanos et al. 2011: 578). A direction for future research that this study suggests is in examining how disease conceptualisations of PWMI affect their therapeutic relationships with their doctors, as these can be either empowering or disempowering. "
    10/2014; 11(1):1-18. DOI:10.5130/portal.v11i1.3295
    • "Because psychopathology is highly stigmatized in Japanese society, self-stigmatization may occur with any type of mental illness, regardless of severity. Several recent studies assessing ways to reduce self-stigmatization have been published (e.g., Fung et al., 2011; Knight et al., 2006; MacInnes and Lewis, 2008; Yanos et al., 2011). However, there are few such studies (Shimotsu et al., 2004) and insufficient related interventions in Japan. "
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    ABSTRACT: Objective There is evidence that the stigma surrounding mental illness may be greater in Japan than elsewhere. However, few Japanese studies have focused on self-stigma (the internalization of social stigma), and few interventions to reduce self-stigma exist. To remedy this deficiency, we evaluated the efficacy of group cognitive-behavioral therapy (CBT) in reducing self-stigma and examined the relationship between cognitive restructuring and self-stigma. Methods We administered a 10-session group CBT program to 46 Japanese outpatients with anxiety and depressive symptoms (36 men, 10 women; mean age = 38.57 years, SD = 8.33; 20 diagnosed with mood disorders; 24 with neurotic, stress-related, or somatoform disorders; and 2 with other disorders). A pretest-posttest design was used to examine the relationship between cognitive restructuring and self-stigma. Outcomes were measured using the Japanese versions of the Devaluation-Discrimination Scale, Dysfunctional Attitude Scale, Beck Depression Inventory-II, State-Trait Anxiety Inventory State-Form, and Rosenberg's Self Esteem Scale. Results Participants exhibited significant improvements in depression, anxiety, and maladjusted cognitive bias and reductions in self-stigma. Cognitive bias was significantly correlated with self-stigma. Conclusions Group CBT is effective in improving both emotional symptoms and self-stigma in outpatients with anxiety and depressive symptoms. Reduction in self-stigma plays a mediating role in alleviating emotional symptoms and improving cognition.
    Asian Journal of Psychiatry 08/2014; 10. DOI:10.1016/j.ajp.2014.02.006
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