Living well with bipolar disorder - Integrating positive psychology and personal recovery into the treatment of bipolar disorder
Due to the COVID-19 crisis the PhD defence of Jannis Kraiss will take place (partly) online.
The PhD defence can be followed by a live stream.
Jannis Kraiss is a PhD student in the research group Psychology, Health & Technology (PH&T). His supervisors are prof.dr. E.T. Bohlmeijer from the Faculty of Behavioural, Management and Social Science (BMS) and prof.dr. R. Kupka (VUMC).
Bipolar disorder (BD) is a recurrent mood disorder associated with substantial negative consequences for the individual and high societal burden. Current treatment guidelines for BD primarily focus on symptomatic and functional recovery. However, treatment outcomes related to mental well-being and personal recovery are increasingly seen as an important part of recovery from mental disorders. Despite the importance of mental well-being and personal recovery for BD, studies examining the effect of interventions focusing on personal recovery and mental well-being in BD remain scarce, as well as studies examining the effect of positive psychology treatments in BD.
Therefore, the overall goal of this thesis is to contribute to the integration of positive psychology and personal recovery into the treatment of BD. For this, four aims are addressed in this thesis. First, an overview of the research field of positive psychology interventions for serious mental illness (SMI) and of economic studies for BD is given, aiming to summarize the current state of the art of positive psychology interventions for SMI and cost-effectiveness of non-pharmacological interventions for BD. This is done by two systematic reviews of the literature and a meta-analysis. Second, two measurement instruments of personal recovery and positive emotion regulation are psychometrically evaluated, namely the Questionnaire about the Process of Recovery (QPR) and the Responses to Positive Affect questionnaire (RPA). These instruments assess the processes of personal recovery and positive emotion regulation, which both might constitute relevant outcomes in BD. Yet, these measurement instruments were not translated into Dutch before and/or have not been validated in people with BD. Third, this thesis aims to expand our knowledge of what contributes to personal recovery in BD, by exploring factors that are associated with personal recovery. Fourth, a novel positive psychology group treatment is developed aimed at improving personal recovery and mental well-being in euthymic BD patients and its effectiveness is evaluated in a pragmatic randomized controlled trial (RCT).
These four goals will be addressed in nine chapters.
Chapter 1 includes the general introduction and describes the importance of personal recovery and mental well-being for BD and the aim and outline of this thesis.
Chapter 2 describes a systematic review and meta-analysis on positive psychological interventions for people with SMI. A systematic literature search was conducted for quantitative studies examining the effect of positive psychology interventions on mental well-being and psychopathology in SMI. Data on population, study, and intervention characteristics were extracted from the studies and summarized. Effects of the interventions on mental well-being and psychopathology were synthesized using meta-analytical techniques.
Chapter 3 describes a systematic review on economic studies in BD. The literature was searched for both economic evaluations as well as cost-of-illness studies examining the cost-effectiveness of non-pharmacological interventions or costs associated with BD. Evidence on the cost-effectiveness of psychological treatments for BD was summarized. In addition, recent cost-of-illness studies were summarized to derive information on the direct and indirect costs associated with BD.
Chapter 4 describes a psychometric evaluation of a Dutch translation of the Questionnaire about the Process of Recovery (QPR) in a cross-sectional sample of people with BD. The QPR is a widely used measure of personal recovery. The factor structure, internal consistency and incremental validity of the QPR was examined. Furthermore, associations of personal recovery with social role participation and mental well-being were explored.
Chapter 5 describes a psychometric evaluation of the Dutch Responses to Positive Affect questionnaire (RPA) in a cross-sectional sample of people with BD. Associations of dampening and positive rumination with mental well-being, personal recovery and symptomatology were examined. In addition, the assumed underlying three-factor structure of the RPA was validated and the internal consistency and incremental validity of the questionnaire was evaluated.
Chapter 6 describes an exploration of factors associated with personal recovery in BD. Using a split-sample regression approach, a parsimonious multiple regression model was built with personal recovery as dependent variable. The ability of the model to explain personal recovery was examined. Potentially relevant independent variables included sociodemographic variables, social role participation, psychopathology and positive emotion regulation.
Chapter 7 describes the study protocol of the pragmatic randomized controlled trial. The protocol contains the rationale and design of the study, a description of the outcome and process measures and the intervention development and specific content of the intervention. Potential promises and limitations of the study and intervention were also discussed beforehand.
Chapter 8 describes the effectiveness of the multicomponent positive psychology group intervention in patients with BD. Effects of the intervention on outcomes of mental well-being, personal recovery, psychopathology, and social role participation as well as positive emotions, self-compassion and positive relationships were examined. The effects were examined until 6-month follow-up.
In chapter 9 the findings from the previous chapters are brought together in the general discussion and the main findings from these studies are discussed. Furthermore, implications and future directions are outlined and an overall conclusion is drawn.
In conclusion, we could show in a full RCT, that the positive psychology group treatment developed and evaluated in this thesis represents an effective treatment to enhance mental well-being and personal recovery in euthymic patients with BD. This intervention may therefore represent a valuable addition for TAU for BD, since it complements current treatment with an intervention that contributes to live a joyful, meaningful and engaged life, also in the presence of a severe mental illness. Furthermore, we found that a Dutch translation of the QPR represents a reliable and valid instrument to measure personal recovery in BD. The QPR is now available to be used in the Netherlands. We could also show that the RPA is a psychometrically sound instrument to assess positive emotion regulation in BD. The RPA can be used to assess positive emotion regulation strategies in BD, which may represent important facilitators or barriers for recovery. Furthermore, we found that positive rumination, anxiety symptoms and social participation are independently associated with personal recovery in BD and might therefore represent valuable treatment targets when aiming to improve personal recovery. Possible future directions for practice and research include the implementation of this intervention in the current treatment landscape, the integration of idiographic research and data science approaches in mental health research and the development of personalized treatments to advance the care we provide for patients with mental disorders.