Psychological processes underlying personal recovery in bipolar disorder

Recovery is an important outcome among people with bipolar disorder – and highly variable over time and between people. To maximise recovery through psychological therapies, we need a better understanding of what factors determines this variation. As with psychological therapies aiming to delay relapse and improve symptoms, research on the psychological mechanisms underlying recovery is crucial to inform effective recovery-focused therapy. This talk presents findings from two studies on the psychological processes associated with personal recovery in bipolar disorder. Study 1 was a crosssectional investigation of whether negative beliefs about mood swings and self referent appraisals of mood-related experiences were negatively associated with personal recovery in people with bipolar disorder (n = 122). Normalising appraisals of mood changes were positively associated with personal recovery, while depressive symptoms, 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. Study 2 was a longitudinal investigation of whether negative beliefs about mood swings and early warning signs monitoring predicted change in personal recovery over time (48 week follow up) in bipolar disorder (n = 96). Both studies found that more negative illness models (relating to how controllable, long-term, concerning, and treatable mood swings are) are associated with diminished personal recovery in bipolar disorder, over and above mood symptoms. These types of cognitive representations of mood swings are potential mechanisms of change in psychological interventions. Psychological interventions aiming to empower people to feel better able to manage mood and catastrophise less about mood swings, and therefore develop less negative illness models, could facilitate personal recovery in people with BD, which might be achieved in recovery-focused therapy.