Past Research

NECT in Latino Population

 

 

Dr. Phil Yanos discussing NECT with UTEP Master of Rehabilitation Counseling trainees at the June 8th NECT Facilitator Workshop

 

 Narrative Enhancement Cognitive Therapy (NECT) in the Hispanic/Latino Population

There are several types of stigma surrounding mental illness, one of which—self-stigma—is the focus of this study (Corrigan & Kosyluk, 2013). Self-stigma (internalized stigma) occurs when individuals with mental illness endorse society’s misconceptions about mental illness themselves, internalizing these negative beliefs (Corrigan & Kosyluk, 2013). Accumulated evidence suggests one-third of individuals with SMI experience an elevation in internalized stigma, or self-stigma (Ritsher & Phelan, 2004; Lysaker, Roe & Yanos 2007). Research has fairly consistently shown self-stigma yields negative outcomes. Self-stigma is linked to both subjective and objective aspects of recovery, including hopelessness (McCay & Seeman 1998; Lysaker, Roe & Yanos 2007; Yanos, Roe, Markus, & Lysaker, 2008), diminished self-esteem (Watson, Corrigan, Larson, & Sells, 2007; Corrigan, Watson, & Barr, 2006; Yanos et al, 2008), and impaired social relationships (Lysaker, Roe, & Yanos, 2007). Self-stigma undermines the pursuit of personal goals (such as postsecondary education) that reflect psychosocial functioning. Self-stigma is associated with failing to take advantages of opportunities that promote vocation and independent living (Link, 1982). People with high self-stigma are also less likely to develop social networks related to leisure (Perlick et al., 2001), and to experience strained social interactions (Farina, Allen, & Saul, 1968) impacting one’s sense of belonging within their community (Link, Cullen, Struening, Shrout, & Dohrenwend, 1989; Newheiser & Barreto, 2014; Newheiser, Barreto, Ellemers, Derks, & Scheepers, 2015). Self-stigma is also associated with worse quality of life (Corrigan, Sokol, & Rusch, 2013; El-Badri & Mellsop, 2007; Sirey, Bruce et al., 2001a,b; Staring et al., 2009).

​One program developed to assist people with serious mental illness (SMI) to overcome self-stigma is Narrative Enhancement and Cognitive Therapy (NECT). NECT was developed in an effort to help individuals with SMI transform their narratives by engaging participants in a series of story-telling exercises where they are encouraged to write or dictate stories about themselves, and then receive feedback from facilitators and group members on alternative perspectives regarding the themes that their stories contain (Yanos, Roe, & Lysaker, 2011). When the focus of one’s personal story or narrative is on the deficits or dysfunctions associated with the experience of mental illness as is the case for many individuals who internalize stigma, this threatens one’s sense of identity and self (Carless and Douglas, 2008). NECT helps individuals with SMI to restore a healthy sense of identity by allowing them to re-story their life in a more positive way (Carless and Douglas, 2008). NECT, is designed to target self-stigma among people with SMI using structured, group-based treatment that combines (a) psychoeducation to help replace stigmatizing views about mental illness with beliefs about recovery using empirical findings, (b) cognitive restructuring geared towards teaching skills to challenge negative beliefs about the self, and (c) narrative therapy focused on enhancing one’s ability to narrate one’s life story (Yanos, Roe, & Lysaker, 2014).

An early qualitative study of the impact of NECT showed positive improvements among people with SMI participating in NECT in six domains: (experimental learning, positive change in experience of self, acquiring cognitive skills, enhanced hope, improved coping, and emotional change (Roe, Hasson-Ohayon, & Derhi, 2010). A later quasi-experimental study by Roe, Hasson-Ohayon, Mashiach-Eizenberg, Derhy, Lysaker, & Yanos (2014) examined the impact of NECT on individuals with SMI compared with those participating in treatment as usual (TAU) at pre-intervention and follow-up, finding that the NECT treatment group showed a significant reduction in self-stigma and increases in self-esteem, quality of life, and hope from pre-intervention to follow-up compared with the TAU group.

Click here to view a YouTube video of Dr. Yanos speaking about NECT and preliminary data on the efficacy of the program.

Research suggests that when compared to traditional interventions, culturally adapted mental health interventions produce moderate effect sizes (Griner & Smith, 2006). To date, there has not been a study of NECT specifically with a Hispanic/Latino population. We are currently planning for the implementation of NECT in the Paso del Norte region, as well as the evaluation of the program's efficacy with a predominantly Hispanic population. Below are the objectives of this project:

Objective 1: Establish a cadre of trained facilitators in the Paso del Norte Region equipped to deliver the NECT program.

Objective 2: Evaluate the efficacy of the program in terms of reduced self-stigma and recovery-oriented outcomes among Hispanic participants with serious mental illness.

Objective 3: Undertake work to produce a cultural adaptation of the program for Hispanic participants.

Objective 4: Follow precedence put forth in other areas of the United States (i.e. Rutgers-University Behavioral Health Care (UBHC) programs in New Jersey) to offer NECT as a billable service within the Paso del Norte region.

We are extremely fortunate that Dr. Phil Yanos visited the Paso del Norte region on June 8, 2017 to train UTEP students and area mental health providers as facilitators of the NECT program.