Self-concept and Engagement in LiFe (SELF): A waitlist-controlled pilot study of a novel psychological intervention to target illness engulfment in enduring schizophrenia and related psychoses

Schizophr Res. 2021 Feb;228:567-574. doi: 10.1016/j.schres.2020.11.028. Epub 2020 Dec 4.


Background: Illness engulfment, a process whereby one's self-concept becomes defined entirely by illness, is implicated in the association between insight and depressive symptomatology in schizophrenia. We examined the feasibility and acceptability of a brief intervention called Self-concept and Engagement in LiFe (SELF) that aims to reduce engulfment and enhance personal recovery.

Methods: Forty individuals diagnosed with schizophrenia spectrum disorders were assigned to SELF intervention or waitlist-control (treatment-as-usual). Outcome measures included the Modified Engulfment Scale and measures of depressive symptomatology, self-esteem, recovery style, quality of life, and self-stigma.

Results: Retention at post-therapy was 90% (18/20 completed SELF; 18/20 remained on waitlist). Eleven waitlist participants then completed SELF (73% overall retention). Participants reported high satisfaction with the intervention, and participation was associated with reduced engulfment (ES = 0.48), more adaptive recovery style (ES = 0.37), improved self-esteem (ES = 0.35), and reduced self-stigma (ES = 0.25). The treatment group had lower engulfment (adjusted mean = 91.9) compared to waitlist (adjusted mean = 100.0) post-therapy, F (1,32) = 5.78, p = .02, partial η2 = 0.15.

Conclusions: The SELF intervention is highly acceptable to participants and can reduce engulfment and improve secondary outcomes. Future research should examine the efficacy of SELF in a larger randomized controlled trial.

Keywords: Cognitive-behaviour therapy; Narrative therapy; Psychosis; Recovery; Self-concept; Self-identity.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Pilot Projects
  • Psychosocial Intervention
  • Psychotic Disorders*
  • Quality of Life
  • Schizophrenia* / therapy
  • Self Concept

Grant support