Dr. Lisa D. Hawke is a staff scientist with Education Research at the Centre for Addiction and Mental Health (CAMH). She is also an assistant professor in the Department of Psychiatry at the University of Toronto. Dr. Hawke received her PhD from Université Laval in Québec City in psychology, then completed a post-doctoral research fellowship at Toronto’s University Health Network. At CAMH, Dr. Hawke's research focuses on the engagement of people with lived experience in mental health and substance use research. She also conducts research on topics of high priority to people with lived experience. She has a particular interest in improving engagement process, understanding lived experiences of mental health and mental health systems, and examining aspects of stigma and stigma reduction. Dr. Hawke has funding from the Canadian Institutes of Health Research and other funding bodies to pursue this line of work.
Discovering Our Best Selves: Narrative Enhancement and Cognitive Therapy for
self-stigma among youth (NECT-Y)
Stigma, including self-stigma, has been identified by Health Canada as a major public health priority and a key social determinant of health. Stigma toward mental illness includes a variety of harmful stereotypical attitudes and behaviors against people who have been labeled as mentally ill. Stigma intersects with culture and is found throughout society. The theoretical framework of stigma describes structural, social, and self-stigma. Self-stigma occurs when individuals with mental illness internalize negative stereotypes and direct them toward themselves. Self-stigma appears to be highest among those with serious mental illness. Self-stigma can be a major barrier to recovery.
When identity is influenced by self-stigma, people believe that they cannot recover, reducing hope and self-esteem. This increases the risk for depression and suicide and decreases social interaction. It may also lead to more passive coping styles, limiting treatment engagement. As individuals use more avoidant coping strategies, they may also avoid other activities, such as work, which can further reduce social connectedness and functioning. Avoidant coping, decreased treatment engagement (medication adherence, psychosocial treatment attendance, working alliance), social isolation, and decreased vocational functioning may increase symptom severity.
Reducing self-stigma is a prime target for recovery-oriented interventions requiring enhanced attention with the goal of creating a more inclusive healthcare system and improving health and wellbeing. This includes using group-based interventions to reduce self-stigma and to develop interventions and policies though patient engagement.
STUDY INTERVENTION
Narrative Enhancement and Cognitive Therapy (NECT) is a new intervention that was developed in the United States, with some work conducted in Israel, Sweden, Denmark, and France. It is a manualized, structured group intervention that targets self-stigma in severe mental illness, from a trauma-informed lens. NECT integrates evidence-based psychotherapies. Internalized negative stereotypes are addressed by increasing clients’ understanding of stigma (psychoeducation), helping them to restructure unproductive thoughts (cognitive therapy), and helping them build a meaningful life narrative and self-identity, where the illness is a component of their experience but does not encompass the entire identity (narrative therapy). NECT consists of 20 one-hour sessions led by two clinicians.
NECT-Y
Disorder- and population-specific adaptations of NECT has been conducted prior to this trial by a youth lived experience panel. The youth team improved the fit with lived experience of youth, reducing number of sessions and the reading level for accessibility, enhancing the strengths based lens, and creating an engaging graphic design. NECT-Y will be the first version of NECT to include peer-based interventions and goal-setting
modules. Our Lived Experience Panel identified roles in each module for peer workers to contribute meaningfully to the facilitation.
© 2024 CALM Study
© 2024 CALM Study
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Contact information for the CALM study CALM.Project@camh.ca
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