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.
