Psychological mechanisms and the ups and downs of personal recovery in bipolar disorder

Background Personal recovery is recognized as an important outcome for individuals with bipolar disorder (BD) and is distinct from symptomatic and functional recovery. Recovery-focused psychological therapies show promise. As with therapies aiming to delay relapse and improve symptoms, research on the psychological mechanisms underlying recovery is crucial to inform effective recovery-focused therapy. However, empirical work is limited. This study investigated whether negative beliefs about mood swings and self-referent appraisals of mood-related experiences were negatively associated with personal recovery. Design Cross-sectional online survey. Method People with a verified research diagnosis of BD (n = 87), recruited via relevant voluntary sector organizations and social media, completed online measures. Pearson's correlations and multiple regression analysed associations between appraisals, beliefs, and recovery. Results Normalizing appraisals of mood changes were positively associated with personal recovery. Depression, negative self-appraisals of depression-relevant experiences, extreme positive and negative appraisals of activated states, and negative beliefs about mood swings had negative relationships with recovery. After controlling for current mood symptoms, negative illness models (relating to how controllable, long-term, concerning, and treatable mood swings are; β = −.38), being employed (β = .39), and both current (β = −.53) and recent experience of depression (β = .30) predicted recovery. Limitations Due to the cross-sectional design, causality cannot be determined. Participants were a convenience sample primarily recruited online. Power was limited by the sample size. Conclusions Interventions aiming to empower people to feel able to manage mood and catastrophize less about mood swings could facilitate personal recovery in people with BD, which might be achieved in recovery-focused therapy. Practitioner points •Personal recovery is an important outcome for people living with bipolar disorder •More positive illness models are associated with better personal recovery in bipolar disorder, over and above mood symptoms •Recovery-focused therapy should focus on developing positive illness models •Recovery-focused therapy should address personally meaningful goals such as gaining employmen

A social pedagogical intervention to support children in care:Back on Track

This paper focuses on an intervention project, Back on Track (BoT), implemented as a part of the Resilience Revolution: HeadStart Blackpool (RR:HS) programme in the UK. Whilst it is a famous family holiday resort, Blackpool is also one of the most deprived towns in England. This makes life challenging for young people (YP) to maintain wellbeing and reach their potential. Blackpool also has an above average and growing proportion of children in care. They are at a higher risk of developing mental health difficulties and of being permanently excluded from school. BoT aimed to support fostered children who have been referred by schools or social workers to the project for having emotional and behavioural struggles. As a consequence of their difficulties, they were at risk of permanent exclusion from the school. The intervention was grounded in a social pedagogical approach and Resilient Therapy. Resilience Coaches (i.e., wellbeing practitioners) had the role of enhancing communication between YP, family, social care, and school, whilst working with YP to co-produce coping strategies. Between November 2016 and June 2021, 39 YP (61.5% male) aged 10 to 15 (M = 12.74, SD = 1.60) received BoT support over a period lasting between 4 months to 2.5 years (M = 14 months, SD = 6.8 months). Using a mixed-methods design, this paper explored the BoT implementation. YP completed questionnaires before and after BoT. Triangulation interviews were conducted with a randomly selected YP, foster parent and the Resilience Coach. Results showed the benefit of equipping YP with ‘resilient moves’ and joining up systems to work together and better support YP and families. YP reported reduced difficulties, improved strengths (i.e., prosocial behaviour) and educational outcomes. This helped build resilience and reduce the risk of permanent exclusions from school. Policy and practice implications for children in care are discussed

Bounce Forward:A School-Based Prevention Programme for Building Resilience in a Socioeconomically Disadvantaged Context

Socioeconomic status is a strong predictor of normative development and well-being in young people. It is well-known that growing up in a socioeconomically disadvantaged context may lead to negative outcomes, both in childhood and in adulthood. Early intervention and prevention programmes are crucial for building resilience and improving health, well-being and equity. Bounce Forward is a school-based prevention programme implemented in Blackpool, a town in the United Kingdom facing multiple challenges. It was part of a whole town resilience approach and nascent global social movement known as the "Resilience Revolution." Between 2017 and 2019, the programme was delivered in all Year 5 classes at every primary school in Blackpool (n school = 36), reaching out to 3,134 students (ages 9-10; 50.4% male). The programme aimed to increase resilience in young people by building knowledge and skills about mental health and resilience through 10 sessions. In the current study, we longitudinally examined a range of protective factors, which are relevant to young people's resilience, as well as their mental health outcomes at three time points: before they participated in Bounce Forward, at the end of the programme, and 3-5 months later, when they started Year 6. The current sample included 441 Year 5 students (54.2% male) from 11 primary schools in Blackpool. Nineteen teaching staff also participated in the study and provided qualitative data regarding the impact of the programme on their students. Results showed improvement in some areas of young people's resilience after taking part in Bounce Forward. We also identified gender differences in several protective factors, indicating that boys may need further support. Teaching staff highlighted improvements in various areas; and also observed that their students have been using the strategies that they learnt from the programme. Altogether, findings suggested that young people benefitted from Bounce Forward. The programme is sustainable, offering a free to download teacher resource pack that allows schools to self-deliver it

Beliefs about mood swings and the experience of recovery in bipolar disorder

Introduction: There is increasing evidence that cognitive and behavioural psychological processes are important in relation to bipolar disorder, particularly the ways in which people think about and respond to their experiences. This includes research on processes including positive and negative self appraisals (e.g. ‘When I feel good, I know that whatever I do, I could do no wrong’, or ‘I am a worthless person to have these type of thoughts’; Dodd et al, 2011; Jones & Day, 2008), and behavioural strategies such as risk-taking or rumination (Fisk, Dodd & Collins, 2015). Importantly, these are amenable to change in psychological interventions, and are key psychological processes targeted by Thinking Effectively About Mood Swings cognitive-behavioural therapy for bipolar disorder (Searson, Mansell, Lowens & Tai, 2012). There is also evidence that some people value some aspects of their BD (Lobban, Taylor, Murray & Jones, 2012), such as creativity and inspiration, which is linked to cognitive, behavioural and emotional processes relevant to bipolar disorder and mania risk in students (Jones, Dodd & Gruber, 2014). Additionally, there is increasing evidence that people with BD value improved quality of life and functional outcomes, as well as reduced relapse and symptoms, in relation to psychological interventions (Jones et al, 2013). With this in mind, the Bipolar Recovery Questionnaire (Jones et al, 2013) was developed to measure these experiences, in collaboration with service users. This is important so that novel interventions can be evaluated with respect to outcomes that are valued by individual service users. This research has evaluated associations between positive and negative cognitive styles, emotion regulation strategies, mood and recovery among individuals with a diagnosis of bipolar disorder. Method: Individuals with a diagnosis of bipolar disorder (n = 140) completed measures relating to appraisals of internal states, beliefs about mood swings, emotion regulation strategies, mood and recovery via a cross-sectional survey. Results: Data collection was completed as of March 2015. Hierarchical multiple regression will be used to explore associations between these cognitive and behavioural processes and outcomes (mood and recovery). Conclusions: Findings will be discussed in relation to existing theory and evidence about the psychological processes underlying the development and maintenance of bipolar disorder. The study has explored the role of cognitive styles not yet investigated in a diagnosed bipolar sample, such as inspiration and positive beliefs about mood swings. Another novel aspect of this research has been the investigation of associations between cognitive styles, emotion regulation strategies and personal recovery in bipolar disorder. This is important to assess clinical validity and aid the development of new psychological models and interventions. These measures have the potential for clinical use in formulation, assessing the process of change in interventions, and utilising outcome variables important for service users (such as recovery)