What is NECT?

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Extra material:
WPA Together against Stigma Congress, Reykjavik June 2024
Daniel Abrams presentation:  Manuscript   Slides


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NECT (Narrative Enhancement – Cognitive Therapy) is a group intervention aimed at reducing self-stigmatization and is targeted towards individuals with mental illness or other groups experiencing self-stigmatization. Research demonstrating the effectiveness of this method has been conducted on individuals with mental illness. The training in NECT is provided through 2-day-courses either on-site or digitally.

NECT holds a priority 3 status in the guidelines for schizophrenia by the Swedish National Board of Health and Welfare. This means that the Board recommends it as a method that SHOULD be offered by healthcare and social services in municipalities. The existing research has been conducted on interventions for individuals with psychotic conditions, but there are good reasons to believe that the intervention is effective for other groups where self-stigmatization is a factor, such as in addiction or for family members.

Key principles: Sometimes, it can be more difficult to recover and feel hopefulness during mental illness when a person has started to believe that incorrect perceptions about mental illness are true and that they do apply to them. For example, that someone with schizophrenia cannot improve, cannot work, or cannot experience a meaningful life.

"Self-stigma involves an internalization of negative beliefs and prejudices from the surroundings, resulting in negative emotional reactions and behaviors directed towards oneself. Self-stigma is a common phenomenon among individuals with mental illness and has a negative correlation with future hope, empowerment, self-esteem, perceived quality of life, and social support. It can also lead to refraining from seeking employment, avoiding or delaying contact with healthcare, discontinuing treatment, or avoiding social interactions. The purpose of the NECT intervention is to learn to identify, address, and cope with self-stigmatization. The intervention is conducted in a group format and consists of 20 sessions. The content includes knowledge about self-stigmatization, psychoeducation, cognitive restructuring, and an extensive section on developing and reformulating one's personal story."
(Swedish National Board of Health and Welfare)

Content of the NECT training in brief:

  1. An orientation and introduction part in two sessions.
  2. A segment spanning three sessions, consisting of psychoeducational instruction about stigma, self-stigmatization, myths about mental illness, and facts that debunk these myths. Additionally, a section discussing the pros and cons of disclosing one's mental illness to others.
  3. A part over approximately seven sessions focusing on cognitive restructuring, i.e., how one's thoughts and feelings affect how they perceive themselves and their life. And how these thoughts and feelings influence their behavior. How can negative thoughts and feelings be changed, for example, through alternative perspectives?
  4. An additional part over approximately seven sessions dedicated to developing one's personal story. Participants write down stories about their thoughts and experiences, share them with the group, and receive feedback. This can be a way to gain control over events and stories, make them more understandable, and place them in a chronological context.
  5. Finally, one or possibly two sessions are dedicated to summarizing and concluding the training.