Promoting Personal Recovery in People with Persisting Psychotic Disorders: Development and Pilot Study of a Novel Digital Intervention

BACKGROUND For people with persisting psychotic disorders, personal recovery has become an important target of mental health services worldwide. Strongly influenced by mental health service consumer perspectives, personal recovery refers to being able to live a satisfying and contributing life irrespective of ongoing symptoms and disability. Contact with peers with shared lived experience is often cited as facilitative of recovery. We aimed to develop and pilot a novel recovery-based digitally supported intervention for people with a psychotic illness. METHODS We developed a website to be used on a tablet computer by mental health workers to structure therapeutic discussions about personal recovery. Central to the site was a series of video interviews of people with lived experience of psychosis discussing how they had navigated issues within their own recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment model of recovery. We examined the feasibility and acceptability of an 8-session low intensity intervention using this site in 10 participants with persisting psychotic disorders and conducted a proof-of-concept analysis of outcomes. RESULTS All 10 participants completed the full course of sessions, and it was possible to integrate use of the website into nearly all sessions. Participant feedback confirmed that use of the website was a feasible and acceptable way of working. All participants stated that they would recommend the intervention to others. Post-intervention, personal recovery measured by the Questionnaire for the Process of Recovery had improved by an average standardized effect of d = 0.46, 95% CI [0.07, 0.84], and 8 of the 10 participants reported that their mental health had improved since taking part in the intervention. CONCLUSION In-session use of digital resources featuring peer accounts of recovery is feasible and acceptable and shows promising outcomes. A randomized controlled trial is the next step in evaluating the efficacy of this low intensity intervention when delivered in conjunction with routine mental health care.This study was funded by the State Government of Victoria Department of Health Mental Illness Research Fund (MIRF33). The funder had no role in the design of the study or reporting of results

Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol

BACKGROUND: Psychosocial interventions have an important role in promoting recovery in people with persisting psychotic disorders such as schizophrenia. Readily available, digital technology provides a means of developing therapeutic resources for use together by practitioners and mental health service users. As part of the Self-Management and Recovery Technology (SMART) research program, we have developed an online resource providing materials on illness self-management and personal recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment (CHIME) framework. Content is communicated using videos featuring persons with lived experience of psychosis discussing how they have navigated issues in their own recovery. This was developed to be suitable for use on a tablet computer during sessions with a mental health worker to promote discussion about recovery. METHODS/DESIGN: This is a rater-blinded randomised controlled trial comparing a low intensity recovery intervention of eight one-to-one face-to-face sessions with a mental health worker using the SMART website alongside routine care, versus an eight-session comparison condition, befriending. The recruitment target is 148 participants with a schizophrenia-related disorder or mood disorder with a history of psychosis, recruited from mental health services in Victoria, Australia. Following baseline assessment, participants are randomised to intervention, and complete follow up assessments at 3, 6 and 9 months post-baseline. The primary outcome is personal recovery measured using the Process of Recovery Questionnaire (QPR). Secondary outcomes include positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, subjective experiences of psychosis, emotional symptoms, quality of life and resource use. Mechanisms of change via effects on self-stigma and self-efficacy will be examined. DISCUSSION: This protocol describes a novel intervention which tests new therapeutic methods including in-session tablet computer use and video-based peer modelling. It also informs a possible low intensity intervention model potentially viable for delivery across the mental health workforce

Surface Tension: a novel that plots recovery and narrative therapy devices to articulate the heroine’s developmental journey

Submission note: This novel and exegesis are submitted in total fulfilment of the requirements for a Doctor of Philosophy to the School of Humanities and Social Sciences, College of Arts, Social Sciences and Commerce, La Trobe University, Bundoora.This PhD project contains two parts. The first is a detective novel titled Surface Tension and the second is an exegesis that describes the methodologies I have utilised in writing the novel. I have written Surface Tension as a vehicle for social justice advocacy, with the objective to influence readers’ attitudes about people who experience serious mental health problems. Stigmatising and discriminatory discourses about mental illness are pervasive and often pose insurmountable challenges for people who are struggling to recover, and for whom such attitudes result in multiple human rights violations (Corrigan, 2005; Solomon, 2004). Surface Tension is intended to offer all the pleasures of a plot driven detective novel, while also taking readers on a moral journey. Surface Tension introduces readers to new ways of understanding forces that exclude people from being equal and participating citizens. The novel also provides alternative narratives about “recovery” to elicit reader identification and exposure to a new worldview. I have utilized the detective genre as a utility for representing social justice themes, because, as Cole argues, the genre’s very purpose is to examine moral and ethical terrains and the good/evil dyad (Cole, 2004, p. 86). She contends that the genre traditionally gives voice to society’s “less fortunate” and that this can function as a type of protest, offering new ways of seeing the sociopolitical world (Cole, p. 22)