Interventions addressing disabilities and recovery in schizophrenia 2nd ESR Conference March 20th 2015 Munich, Germany Institute of Psychiatry and Neurology, Sobieskiego 9, 02-957 Warsaw Interventions addressing disabilities and recovery in schizophrenia Izabela Nowak, Piotr Świtaj, Marta Anczewska BACKGROUND RESULTS Recovery process in schizophrenia goes beyond symptomatic remission and focuses on attainment of a valued and meaningful life despite the presence of disabilities imposed by illness.1,2 Nearly half of the patients diagnosed with schizophrenia suffer from chronic medical problems which in more than a half of cases lead to premature death.3 Existing evidence based knowledge learned from experts by experience indicates that personal recovery comprising of developing hope, empowerment, responsibility for self-management, developing a new identity, finding new life directions, and social connection is an important aspect of recovery in mental illness.4 Main research gaps: Cognitive Behavioural Therapy (CBT) as one of the interventions recommended for schizophrenia treatment5 typically focuses on specific functioning aspects, mostly symptoms. Information regarding which different CBT programmes impact the whole scope of disabilities that affect schizophrenia sufferers in needed. It is also unclear whether there are CBT interventions that focus on personal recovery. General objective To support schizophrenia sufferers in overcoming disabilities related to illness and personal recovery process through the development and implementation of a recovery oriented psychosocial intervention. Research plan The research leading to these results has received funding from the People Programme (Marie Curie Actions) of the European Union's Seventh Framework Programme FP7/2007-2013/ under REA grant agreement n°316795 Systematic review – disabilities and personal recovery in CBT interventions (step 1)* Research questions: What disability domains are being addressed by current CBT approaches? Are there CBT interventions that focus on personal recovery? *Preliminary findings Focus groups – personal recovery concept (step 2) Objective 1. To identify schizophrenia sufferers’ definition of recovery. 1. What does the term recovery mean to you? 2. Name the important elements of your recovery, please. Objective 2. To gain recommendations for a psychosocial intervention.* 1. Which of the recovery elements should be addressed in a psychosocial intervention? *Intervention recommendations referred to the all identifies themes. OBJECTIVES AND RESEARCH PLAN INTERVENTION Title Conclusions Step 1 1. To gain an overview to what extend CBT interventions address disability aspects of schizophrenia as defined in the ICF (WHO, 2001); 2. To examine whether there are interventions that focus on personal recovery. Methodology Systematic review on CBT interventions in schizophrenia. Hypotheses: The studies will mostly focus on mental functions (symptoms). There will be few interventions focusing on personal recovery. Step 2 To gain evidence-based knowledge from Polish experts by experience regarding the concept of personal recovery in schizophrenia and to gain recommendations regarding a recovery oriented - psychosocial intervention. Exploratory focus group study. Analyses Inductive Thematic Analysis. Step 3 To develop and implement a recovery oriented psychosocial intervention. 1. To integrate information obtained from the systematic review and focus groups regarding disability aspects and personal recovery in schizophrenia. 2. To design an intervention and seek feedback from experts in CBT and recovery paradigm. Step 4 1. To evaluate the intervention feasibility, acceptability and its initial effectiveness. Study design One group pre-post feasibility study 2. To evaluate psychometric properties of the PARADISE 24 measure in Polish patients diagnosed with schizophrenia Intervention (step 3)* Aim of the training: to support schizophrenia sufferers in overcoming illness related disabilities and foster personal recovery process. Length: 6 group sessions, 2 hours each Conceptual background: personal recovery, empowerment, life-long learning, CBT. * Design of the intervention in progress. Session 1 Moving beyond symptom reduction - biopsychosocial and personal recovery concept introduction Session 2 Value based goal setting Session 3 Empowerment and development of positive self-identity Session 4 Wellness strategies (mental health) Session 5 Wellness strategies (health promotion) Session 6 Connecting with others Title REFERENCES 1. Mueser, K. T., Deavers, F., Penn, D. L., & Cassisi, J. E. (2013). Psychosocial treatments for schizophrenia. Annual Review Of Clinical Psychology, 9, 465-497. 2. Świtaj, P., Anczewska, M., Chrostek, A., Sabariego, C., Cieza, A., Bickenbach, J., Chatterji, S. (2012). Disability and schizophrenia: a systematic review of experienced psychosocial difficulties. BMC Psychiatry, 12, 193. 3. Lambert, T. J., Velakoulis, D., & Pantelis, C. (2003). Medical comorbidity in schizophrenia. Medical Journal of Australia, 178, S67. 4. Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. The British Journal of Psychiatry, 199, 445-452. 5. NICE (2014). Psychosis and schizophrenia in adults. National Clinical Guideline Number 178. Retrieved from: http://www.nice.org.uk/nicemedia/live/14382/66529/66529.pdf