This project tests the Recovery In Telling Life Stories (RETELL) intervention, aimed at supporting personal recovery in people with severe mental illness (SMI). While many of those with SMI experience symptom control, their quality of life often remains low due to social loss, negative self-perceptions, and identity-related challenges not addressed by standard treatments. Through a process of narrative repair, the RETELL intervention helps participants explore the personal consequences of mental illness while supporting the enhancement of narratives that strengthen identity and foster well-being. The intervention is delivered across 8-12 sessions and will be assessed for feasibility of both the intervention and study procedures. We will also explore its preliminary impact on recovery, quality of life, symptoms, functioning, self-stigma, and personality, using a multiple single-case A-B-A design. We expect the intervention and study procedures to show acceptable feasibility. We further hypothesize that participants' scores on recovery and well-being will be low at baseline, improve during the intervention, and remain higher after the intervention ends and at 3-month follow-up. This study will provide a foundation for future randomized controlled trials.
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.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
20
The intervention is structured around 4 central tasks focusing on different aspects of narrative repair. Task 1: Introduction to life story exploration and building alliance. Task 2: Explore and process the impact of mental illness on identity, externalizing negative narratives, and making sense of emotional responses such as guilt, grief, or shame. Task 3: Identify positive identity conclusions (e.g., strengths, values, skills) from past or current life experiences, and support their integration into the personal narrative. Task 4: Support the imagining of a realistic and hopeful future narrative, grounded in insights of previous sessions. Tasks 1-4 are addressed in a total of 8-12 sessions, depending on the specific user needs. Sessions will have an app. duration of 45-60 mins and will be delivered by the PI who is a trained therapist and psychologist (MSc. Psych.), receiving ongoing supervision. The intervention manual will be made freely available in relation to study publication.
Aarhus Univerity
Aarhus C, Denmark
RECRUITINGIntervention feasibility: Treatment dropout rate
Treatment dropout is defined as participation in less than three out of the four therapeutic tasks of the intervention. Feasibility will be indicated by a dropout rate \< 30%.
Time frame: Through intervention phase (T2), between 8-12 weeks
Intervention feasibility: Satisfaction with treatment (quantitative)
Participant-reported treatment satisfaction using the using the Client Satisfaction Questionnaire (CSQ), a brief, standardized self-report measure designed to assess clients' overall satisfaction with healthcare or psychological services. It consists of 8 items rated on a Likert scale, covering aspects such as service quality, perceived helpfulness, and whether the service met the client's needs. Total score range: 8-32, with higher numbers indicating greater satisfaction. Feasibility will be indicated by a mean score of 20 or above.
Time frame: Post-intervention (T3)
Intervention feasibility: Change from pre-intervention throughout the intervention to post-intervention and follow-up in personal recovery
Recovery will be assessed using the Brief INSPIRE-O, consisting of 5 items reflecting five dimensions of personal recovery: connectedness with others, hope and optimism for the future, positive identity, meaning in life, and empowerment, with a score range of 0-100. Feasibility will be indicated by stability or increase throughout the study period compared to pre-intervention.
Time frame: Pre-intervention (T1), intervention (T2), post-intervention (T3) and follow-up (T4)
Intervention feasibility: Number of participants with treatment-related adverse events
Self-reported adverse events will be monitored during the intervention phase (T2) by systematic inquiry to hospitalization, thoughts of self-harm and suicide attempts, as well as at follow-up points (T3 and T4) by use of the DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure for Adults. Participants will also have the opportunity to anonymously report adverse events to a project staff member.
Time frame: From the beginning of the intervention (T2) to the final 3-month follow-up (T4)
Intervention feasibility: Satisfaction with the therapeutic alliance
Participant-reported quality of the therapeutic alliance using the Session Rating Scale (SRS), a visual analogue scale (ranging from 0 to 10) that allows individuals to provide feedback on key aspects of the session, such as the therapeutic alliance and overall experience.
Time frame: Intervention phase (T2)
Intervention feasibility: Satisfaction with treatment (qualitative)
Participant-reported treatment satisfaction in qualitative, semi-structured interviews
Time frame: Post-intervention (T3)
Change from pre-intervention throughout the intervention to post-intervention and follow-up in well-being
Well-being will be assessed using the 5-item World Health Organization's Well-Being Index (WHO-5), designed to measure subjective well-being. Score range: 0-100.
Time frame: Pre-intervention (T1), intervention (T2), post-intervention (T3) and follow-up (T4)
Change from pre-intervention to post-intervention and follow-up in domain-specific recovery
Domain-specific recovery will be assessed using the Recovery Assessment Scale-Domains and Stages (RAS-DS), a self-report measure designed to capture an individual's subjective experience of recovery across multiple life domains. The scale assesses four key domains: Doing Things I Value, Looking Forward, Mastering My Illness, and Connecting and Belonging, each reflecting different aspects of personal recovery. Items are rated on a 4-point Likert scale, ranging from 1 (Untrue) to 4 (Completely true). The total scale score ranges from 38-152, with higher scores indicating greater perceived recovery. The RAS-DS is grounded in a consumer-oriented understanding of recovery and has demonstrated good psychometric properties across various mental health populations.
Time frame: Pre-intervention (T1), post-intervention (T3) and follow-up (T4)
Change from pre-intervention to post-intervention and follow-up in functioning and disability
Functioning and disability will be assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS) 12-item version, a brief, standardized self-report instrument developed to assess difficulties in daily functioning across the past 30 days. Responses are scored on a 5 point Likert scale: None (0), Mild (1), Moderate (2), Severe (3), and Extreme/Cannot Do (4).
Time frame: Pre-intervention (T1), post-intervention (T3) and follow-up (T4)
Change from pre-intervention to post-intervention and follow-up in symptomatic status
Symptomatic status will be assessed using the DSM-5-TR Self-Rated Level 1 Cross-Cutting Symptom Measure for Adults, a standardized screening tool to assess a broad range of psychiatric symptoms across multiple diagnostic domains. The measure includes 23 items covering 13 symptom domains (e.g., depression, anxiety, psychosis, sleep problems, and substance use), each rated on a 5-point scale from 0 (none) to 4 (severe), reflecting symptom severity over the past two weeks.
Time frame: Pre-intervention (T1), post-intervention (T3) and follow-up (T4)
Change from pre-intervention to post-intervention and follow-up in self-stigmatization
Self-stigmatization will be assessed using the 10-item version of the Internalized Stigma of Mental Illness Scale (ISMI), a brief, validated self-report measure used to assess the degree to which individuals internalize negative beliefs and stereotypes about mental illness across the following subscales: Alienation, Discrimination Experience, Social Withdrawal, Stereotype Endorsement, and Stigma Resistance. Responses are a 4-point Likert scale ranging from strongly disagree (1) to strongly agree (4) for a total score range of 10 to 40, with higher scores representing more severe internalized stigmatization.
Time frame: Pre-intervention (T1), post-intervention (T3) and follow-up (T4)
Change from pre-intervention to follow-up in Big 5 personality traits
Big 5 personality traits will be assessed using the Big Five Inventory-2-S (BFI-2-S), a 30-item short form of the BFI-2 designed to measure the five broad personality domains: Extraversion, Agreeableness, Conscientiousness Neuroticism, and Openness to Experience. Each trait is assessed with 6 items rated on a 5-point Likert scale ranging from 1 (disagree strongly) to 5 (agree strongly).
Time frame: Pre-intervention (T1) and post-intervention (T3)
Study procedure feasibility: Acceptance rate
The proportion of participants enrolled from the number of individuals who received oral and written information about the study from the study coordinator, and were found to be eligble during screening.
Time frame: Study recruitment phase, approximately 15 months
Study procedure feasibility: Questionnaire response rate
The average percentage of questionnaires completed within each batch (e.g., T1) and overall (T1-T4).
Time frame: Throughout study completion, an average of approximately 35 weeks.
Study procedure feasibility: Study drop-out rate
Rate of nonresponse to any complete batch of questionnaires during intervention phase, at postintervention or follow-up
Time frame: Throughout study completion, an average of approximately 35 weeks.
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