“Narrative Enhancement Cognitive Behavioral Therapy”

By: Yasharah Raza

There is no doubt that a stigma towards depression and mental illness exists in society, but when the stigma that is prevalent is internalized, there can be serious negative outcomes. Internalized stigma can lead to many complications, and can worsen the symptoms of already existing consequences of mental illness. Scientific evidence that shows that in 1 out of every 3 people suffering from mental illness, the rate of internalized stigma is higher, which compromises the outcomes of recovery (Yanos). A study performed by Philip Yanos explores an original idea known as Narrative Enhancement Cognitive Behavioral Therapy (NECT for short), which attempts to treat and address internalized stigma.  Self-stigma, as internalized stigma is termed in the study, can play a major role in the change in identity of an ostracized individual. As a consequence, the individual to lose hope, and begin to see themselves as deserving of the negative attitudes held about them. NECT is a group-based therapy treatment which attempts to aid in recovery from internalized stigma.

There are three main components to NECT:

1. Psychoeducation.

2. Cognitive Restructuring

3. Narrative and Positive Identity

 Psychoeducation is essential in that it provides current patients with a set of objectives, accurate facts about their mental illness, and also explains why societal stigmas and beliefs are incorrect (Yanos). The main focus of this aspect of treatment is to generate a dialogue between professionals and their patients.

Cognitive Restructuring is vital since self-stigma is often just a set of inaccurate, negative beliefs that an individual has conceptualized about themselves. It is necessary to restructure this set of beliefs because these beliefs are often the core issues of the individuals’ identity and can thwart recovery. This is different from psychoeducation in that cognitive restructuring takes the information learned and applies it to the individual. Yanos and his team takes this concept of cognitive restructuring, and apply it to individuals so that their dysfunctional beliefs can be challenged and replaced.

Narrative and positive identities are also important factors because, as Yanos puts it, “self-stigma is not merely a matter of inaccurate beliefs, but also infects the stories one tells about oneself”. The goal of this aspect of treatment is to help a person construct a new, positive story about his or her life in addition to debunking their false beliefs. Yanos states that a transformation of one’s own personal narrative is a central aspect of this treatment, however; for a patient who has undergone severe depression, or other severe mental illnesses, this can be a daunting task.

This is an incredibly interesting treatment approach. It may seem simple on the surface, but the difficulty lies in the transformation of perspectives in the patients. It is amazing how a personal story can empower as much as it can cause detriment. Through NECT it may be possible to rid society of internalized stigma, one story at a time.  

References:

Philip T. Yanos, David Roe, and Paul H. Lysaker (2011). Narrative Enhancement and Cognitive Therapy: A New Group-Based Treatment for Internalized Stigma Among Persons with Severe Mental Illness. International Journal of Group Psychotherapy: Vol. 61, No. 4, pp. 576-595. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191919/>