Understanding personal recovery experiences in bipolar disorder
Creators: name: Mezes, Barbara
Publisher: name: Lancaster University
Year: 2018
Subjects: Bipolar Disorder
Recovery in Mental Health
personal recovery

description: Background: Personal recovery is a user-defined recovery concept, which
      has resulted from the recovery movement since the 1980s. This movement
      signifies a change in the conceptualisation of recovery, moving away from
      solely focusing on clinical recovery (symptomatic remission) to
      concentrating on the idiosyncratic experiences of service users with
      mental health problems. The concept of personal recovery has been
      recognised internationally and mental health policies foster the delivery
      of recovery-oriented services. There is increasing evidence for the role
      of bipolar-relevant psychological processes in influencing clinical
      outcomes; despite this research on potential psychological underpinning
      mechanisms of personal recovery in bipolar disorder (BD) is limited.
      
      Objective: To explore factors influencing personal recovery in BD, with
      special focus on BD-relevant psychological processes.
      
      Methods: A systematic review and narrative synthesis was undertaken, which
      included 26 quantitative studies, to explore the operational definition of
      recovery (excluding clinical recovery) and factors assessed for
      associations. A quantitative study was conducted examining a cohort of
      individuals with BD. Backward stepwise multiple linear regression was used
      to determine whether the examined psychological processes (dysfunctional
      attitudes, self-dispositional appraisals, impulsivity, response styles,
      and Behavioural Activation System [BAS] processes) contributed to the
      Bipolar Recovery Questionnaire (BRQ) scores at baseline, and to changes in
      BRQ scores (6 months follow-up), after allowing for adjustment for the
      effects of clinical and demographic factors. Backward stepwise ordinal
      regression was used to determine predictors of clinical outcomes
      (operationalised as factors created from the number of depressive and
      manic episodes) in order to compare the factors found to be associated
      with clinical and personal recovery outcomes in the baseline sample. A
      qualitative study and a thematic analysis were also conducted, using
      semi-structured interviews to explore 21 purposively selected (based upon
      self-reported recovery scores) participants’ views on personal recovery
      and experiences regarding factors influencing their day-to-day and
      longer-term recovery.
      
      Results: The concept of recovery is complex and operational definitions
      were often arbitrary and showed significant diversity. As a result of
      this, findings of previous research are controversial, with limited
      consensus on best predictors. Research on underpinning psychological
      mechanisms were limited and lacked prospective examinations. In the
      present cohort, depressive symptoms, negative selfdispositional appraisal
      and dysfunctional attitudes were negative predictors of baseline personal
      recovery, while adaptive coping, risk taking, being in a relationship, and
      being female positively predicted personal recovery at baseline.
      Rumination and being in employment positively predicted changes in
      personal recovery at 6 months. In comparison, depressive episodes were
      positively predicted by depressive symptoms and negative
      self-dispositional appraisals; whilst (hypo)manic episodes were negatively
      predicted by BAS processes, adaptive coping, and recent depression
      relevant experiences; and positively predicted by impulsivity, education
      level and dysfunctional attitudes and both types of episodes were
      predicted by the time since first episode. Participants’ recovery
      experiences seemed to be on a spectrum, with participants with lower
      self-rated personal recovery identifying more strongly with the clinical
      recovery concept, whilst participants with higher recovery scores, who
      found the personal recovery concept more applicable. Behavioural
      self-management strategies, emotion and problem-focused coping strategies,
      along with spirituality, normalisation and self-acceptance seem to be
      important factors supporting recovery, with the latter primarily appearing
      in the narratives of individuals who self-reported higher rates of
      personal recovery.
      
      Conclusion: Psychological processes seem to play an important role in both
      clinical and personal recovery outcomes; and the present study identified
      both overlaps and differences in the underpinning processes. Considering
      the diverse experiences of individuals, psychological interventions and
      mental health services should be flexible to address personal differences
      and concentrate on a broader spectrum of experiences when assessing
      outcomes in individuals with BD.