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The mechanisms and processes of connection: developing a causal chain model capturing impacts of receiving recorded mental health recovery narratives

Ng, Fiona; Charles, Ashleigh; Pollock, Kristian; Rennick-Egglestone, Stefan; Cuijpers, Pim; Gillard, Steve; Van Der Krieke, Lian; Bongaardt, Rob; Pomberth, Scott; Hui, Ada; Repper, Julie; Roe, James; Llewellyn-Beardsley, Joy; Yeo, Caroline; Hui, Ada; Hare-Duke, Laurie; Manley, David; Slade, Mike


Ashleigh Charles

Pim Cuijpers

Steve Gillard

Lian Van Der Krieke

Rob Bongaardt

Scott Pomberth

Assistant Professor

Julie Repper

Caroline Yeo

Assistant Professor

Laurie Hare-Duke

David Manley

Professor of Mental Health Recovery and Social Inclusion


Background: Mental health recovery narratives are a core component of recovery-oriented interventions such as peer support and anti-stigma campaigns. A substantial number of recorded recovery narratives are now publicly available online in different modalities and in published books. Whilst the benefits of telling one's story have been investigated, much less is known about how recorded narratives of differing modalities impact on recipients. A previous qualitative study identified connection to the narrator and/or to events in the narrative to be a core mechanism of change. The factors that influence how individuals connect with a recorded narrative are unknown. The aim of the current study was to characterise the immediate effects of receiving recovery narratives presented in a range of modalities (text, video and audio), by establishing the mechanisms of connection and the processes by which connection leads to outcomes.
Method: A study involving 40 mental health service users in England was conducted. Participants were presented with up to 10 randomly-selected recovery narratives and were interviewed on the immediate impact of each narrative. Thematic analysis was used to identify the mechanisms of connection and how connection leads to outcome. Results: Receiving a recovery narrative led participants to reflect upon their own experiences or those of others, which then led to connection through three mechanisms: comparing oneself with the narrative and narrator; learning about other's experiences; and experiencing empathy. These mechanisms led to outcomes through three processes: the identification of change (through attending to narrative structure); the interpretation of change (through attending to narrative content); and the internalisation of interpretations. Conclusions: This is the first study to identify mechanisms and processes of connection with recorded recovery narratives. The empirically-based causal chain model developed in this study describes the immediate effects on recipients. This model can inform selection of narratives for use in interventions, and be used to support peer support workers in recounting their own recovery narratives in ways which are maximally beneficial to others.


Ng, F., Charles, A., Pollock, K., Rennick-Egglestone, S., Cuijpers, P., Gillard, S., …Slade, M. (2019). The mechanisms and processes of connection: developing a causal chain model capturing impacts of receiving recorded mental health recovery narratives. BMC Psychiatry, 19,

Journal Article Type Article
Acceptance Date Dec 10, 2019
Online Publication Date Dec 21, 2019
Publication Date Dec 21, 2019
Deposit Date Dec 12, 2019
Publicly Available Date Dec 12, 2019
Journal BMC Psychiatry
Electronic ISSN 1471-244X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 19
Article Number 413
Keywords Psychiatry and Mental health
Public URL
Publisher URL
Additional Information Received: 24 October 2019; Accepted: 11 December 2019; First Online: 21 December 2019; : Ethical Committee approval was obtained from a UK National Health Service (NHS) research ethics committee. Full name: London-West London REC and GTAC. The reference for the application was 18/LO/0991. All participants were informed of the aims and risks of the study and gave written informed consent.; : Not applicable.; : The authors declare that they have no competing interests.


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