Recovery in Telling Life Stories

This project tests the Recovery In Telling Life Stories (RETELL) intervention, an intervention developed to support personal recovery in individuals with severe mental illness (SMI).

Research shows that many people with SMI experience low quality of life even when their symptoms are in remission and functional level, e.g. cognitive remediation. This is not only due to the illness itself but also to the consequences that often accompany it, such as the loss of social and occupational roles and the development of negative self-perceptions. These challenges are only to a limited extent addressed by existing treatments, which typically focus on symptom reduction.

Personal recovery is about living a satisfying and meaningful life despite the potential constraints associated with mental illness. A major barrier to this process can arise when a person develops an understanding of themself (a narrative identity) characterized by shame, low self-esteem, and self-stigmatization. When negative identity conclusions dominate, it can be difficult to experience well-being, meaning in life, or hope for the future.

Despite an increasing focus on personal recovery in mental health care systems globally, evidence-based methods to support the recovery process are limited. In this project, we develop and test the RETELL intervention, designed to support personal recovery by helping participants process the personal consequences of mental illness and identify and cultivate positive identity conclusions and personal strengths. In RETELL, the participants are guided through this process, which we refer to as narrative repair, over a structured sequence of 8-12 sessions. Across these sessions, participants are guided in telling their life story and in constructing preferred and empowering narratives about themselves and their future.

The intervention will be tested in a mixed methods study using a one-arm multiple single-case intervention design with an A-B-A structure. This includes a pre-intervention phase (T1) with four weeks of outcome measurements, an intervention phase (T2) continuing with the same measures every second week, 4 weeks of post-intervention measurements (T3), and 4 weeks of follow-up measurements starting 3 months after intervention completion (T4). Data will be collected in electronic surveys and qualitative interviews. The primary aim is to assess intervention feasibility including potential to improve recovery and quality of life. It is aimed to recruit 20 participants diagnosed with SMI within the timeframe allowed by the study plan.

Feasibility will be assessed in terms of both intervention and study procedure feasibility, as this study will form the basis for larger randomized controlled trials. Intervention feasibility will be evaluated based on treatment dropout, treatment satisfaction and trajectory of self-reported recovery compared to pre-intervention. Feasibility will be indicated by < 30% dropout, a mean sum score of ≥ 20 on the Client Satisfaction Questionnaire, and increase or stability of self-reported recovery throughout the study period compared to pre-intervention. Study procedure feasibility includes recruitment acceptance rate, questionnaire response rate and study dropout rate. We tentatively propose a ≥ 50% recruitment acceptance rate, ≥ 75% questionnaire response rate and ≤ 25% study dropout rate as indicating acceptable study feasibility.

Secondary outcomes include well-being, domain-specific recovery, overall functioning, symptom levels, and self-stigmatization. In addition, changes from pre- to post-intervention in personality trait scores will be explored. Statistical analyses will include dependent t-tests to examine effect sizes and changes in quantitative outcomes, and these will be interpreted with attention to clinical significance. Finally, interviews about participants' experiences with the intervention will be thematically analyzed to identify perceived helpful elements, potential mechanisms of change and to inform the refinement of the programme theory.

Inclusion criteria

• Adults between the ages of 18 and 65 years
• A self-reported principal diagnosis of one or more of the following: schizophrenia (F20), bipolar disorder (F31), personality disorders (F60), obsessive-compulsive disorder (F42), anxiety disorders (F41), recurrent depressive disorder (F33), eating disorders (F50), hyperkinetic disorders (F90), post-traumatic stress disorder (F43.1), Asperger syndrome (F84.5)
• Not in full recovery (Brief INSPIRE-O < 50)
• Danish language proficiency
• Medication stabilized (i.e., same type and dosage for a minimum of 8 weeks)
• Ability and willingness to give informed consent

Exclusion criteria

• Self-reported diagnosis of mental retardation (F70-79) and/or organic mental disorder (F00-09)
• Psychiatric symptoms, thoughts of self-harm and/or substance abuse of self-reported severity which are likely to prevent one or all of the following: attendance at scheduled sessions, completion of questionnaires before, during and after the intervention, meaningful engagement in the therapeutic process
• Psychiatric hospitalization in the past 4 weeks
• Prior conviction of violent crime
• Currently homeless
• Currently in psychotherapy initiated within the past 6 months.