Adaptation of Narrative Enhancement and Cognitive Therapy for Youth Receiving Services for a First Episode of Psychosis

PURPOSE: There is evidence that anticipated and self-stigma are associated with decreased engagement in first episode psychosis (FEP) treatment. It is therefore plausible that addressing stigma in FEP treatment could potentially improve treatment engagement and facilitate outcomes related to recovery. Narrative Enhancement and Cognitive Therapy (NECT) is a structured group-based intervention that has been found to be effective at reducing self-stigma among persons diagnosed with severe mental illnesses in multiple RCTs; however, a review of the manual determined that it was not appropriate for use with people with FEP in its standard form. The purpose of the present study was to adapt NECT for FEP youth and determine its acceptability/feasibility. BASIC PROCEDURES: We discuss the process of manual adaptation, including: optimising fidelity, optimising fit, balancing fidelity and fit, and pilot testing. Acceptability and feasibility were assessed as a function of treatment fidelity, attendance, and treatment satisfaction in an initial implementation (using a modified version of the Narrative Evaluation of Intervention Interview [NEII]). A case example of a group implementation is also presented. MAIN FINDINGS: Mean overall fidelity ratings were good (4.33 on a 1-5 scale); among the three participants who attended at least one session, attendance was acceptable, with 77.8% of scheduled meetings attended. Findings from the NEII revealed that all participants perceived benefit from the intervention. PRINCIPAL CONCLUSIONS: Findings supported the potential acceptability and feasibility of the adapted form of NECT geared towards youth who have experienced FEP (NECT-YA).