Recovery and serious mental illness: a review of current clinical and research paradigms and future directions

Introduction: Recovery from serious mental illness has historically not been considered a likely or even possible outcome. However, a range of evidence suggests the courses of SMI are heterogeneous with recovery being the most likely outcome. One barrier to studying recovery in SMI is that recovery has been operationalized in divergent and seemingly incompatible ways, as an objective outcome, versus a subjective process. Areas Covered: This paper offers a review of recovery as a subjective process and recovery as an objective outcome; contrasts methodologies utilized by each approach to assess recovery; reports rates and correlates of recovery; and explores the relationship between objective and subjective forms of recovery. Expert Commentary: There are two commonalities of approaching recovery as a subjective process and an objective outcome: (i) the need to make meaning out of one’s experiences to engage in either type of recovery and (ii) there exist many threats to engaging in meaning making that may impact the likelihood of moving toward recovery. We offer four clinical implications that stem from these two commonalities within a divided approach to the concept of recovery from SMI

A Bayesian test for the appropriateness of a model in the biomagnetic inverse problem

This paper extends the work of Clarke [1] on the Bayesian foundations of the biomagnetic inverse problem. It derives expressions for the expectation and variance of the a posteriori source current probability distribution given a prior source current probability distribution, a source space weight function and a data set. The calculation of the variance enables the construction of a Bayesian test for the appropriateness of any source model that is chosen as the a priori infomation. The test is illustrated using both simulated (multi-dipole) data and the results of a study of early latency processing of images of human faces. [1] C.J.S. Clarke. Error estimates in the biomagnetic inverse problem. Inverse Problems, 10:77--86, 1994.Comment: 13 pages, 16 figures. Submitted to Inverse Problem

Are We All in the Same Boat? The Role of Perceptual Distance in Organizational Health Interventions

The study investigates how agreement between leaders' and their team's perceptions influence intervention outcomes in a leadership-training intervention aimed at improving organizational learning. Agreement, i.e. perceptual distance was calculated for the organizational learning dimensions at baseline. Changes in the dimensions from pre-intervention to post-intervention were evaluated using polynomial regression analysis with response surface analysis. The general pattern of the results indicated that the organizational learning improved when leaders and their teams agreed on the level of organizational learning prior to the intervention. The improvement was greatest when the leader's and the team's perceptions at baseline were aligned and high rather than aligned and low. The least beneficial scenario was when the leader's perceptions were higher than the team's perceptions. These results give insights into the importance of comparing leaders' and their team's perceptions in intervention research. Polynomial regression analyses with response surface methodology allow three-dimensional examination of relationship between two predictor variables and an outcome. This contributes with knowledge on how combination of predictor variables may affect outcome and allows studies of potential non-linearity relating to the outcome. Future studies could use these methods in process evaluation of interventions

Using kaizen to improve employee well-being: Results from two organizational intervention studies

Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present paper, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee wellbeing in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which in turn predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which in turn predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions

Metacognition and intersubjectivity: reconsidering their relationship following advances from the study of persons with psychosis

As research on metacognition has progressed a significant array of definitions, methodologies and therapeutic applications have emerged. Some of this work has primarily framed metacognition as an activity carried out by one person in order to know, monitor and adjust their beliefs, memories and behaviors. Accordingly, problems with metacognition have often been characterized as issues related to cognition. This however risks neglecting how metacognition is also a fundamentally intersubjective act, one in which human beings know and reflect upon themselves and others primarily with and through connections with other people. In this paper we review research on metacognition in schizophrenia using the integrative model of metacognition and a research paradigm in which metacognition is assessed within personal narratives. Stimulated by this work we discuss how disturbances in intersubjective experience and metacognitive capacity mutually influence one another, with disruptions in metacognition perhaps more deeply understood as disruptions in relatedness with others. We then discuss how metacognition and intersubjectivity each affect mental health. We finally focus on the implications of this for treatments that target metacognition as well as future directions for research

No leader is an island : contextual antecedents to line managers’ constructive and destructive leadership during an organizational intervention

Purpose: Line managers can make or break organizational interventions, yet little is known about what makes them turn in either direction. As leadership does not occur in a vacuum it has been suggested that the organizational context plays an important role. Building on the intervention and leadership literature, we examine if span of control and employee readiness for change are related to line managers’ leadership during an organizational intervention. Design: Leadership is studied in terms of intervention-specific constructive, as well as passive and active forms of destructive, leadership behaviors. As a sample, we use employees (N = 172) from 37 groups working at a process industry plant. Multilevel analyses over two time points, with both survey and organizational register data were used to analyze the data. Findings: The results revealed that span of control was negatively related to constructive leadership and positively related to passive destructive leadership during the intervention. Employee readiness for change was positively related to constructive leadership, and negatively related to both passive and active destructive leadership. Practical implications: Our findings suggest that contextual factors need to be assessed and considered if we want line managers to engage in constructive rather than destructive leadership during interventions. Originality/value: The present study is the first to address line managers’ making or breaking of organizational interventions by examining the influence of context on both their destructive and constructive leadership