Development of the REFOCUS intervention to increase mental health team support for personal recovery.

BACKGROUND: There is an emerging evidence base about best practice in supporting recovery. This is usually framed in relation to general principles, and specific pro-recovery interventions are lacking. AIMS: To develop a theoretically based and empirically defensible new pro-recovery manualised intervention--called the REFOCUS intervention. METHOD: Seven systematic and two narrative reviews were undertaken. Identified evidence gaps were addressed in three qualitative studies. The findings were synthesised to produce the REFOCUS intervention, manual and model. RESULTS: The REFOCUS intervention comprises two components: recovery-promoting relationships and working practices. Approaches to supporting relationships comprise coaching skills training for staff, developing a shared team understanding of recovery, exploring staff values, a Partnership Project with people who use the service and raising patient expectations. Working practices comprise the following: understanding values and treatment preferences; assessing strengths; and supporting goal-striving. The REFOCUS model describes the causal pathway from the REFOCUS intervention to improved recovery. CONCLUSIONS: The REFOCUS intervention is an empirically supported pro-recovery intervention for use in mental health services. It will be evaluated in a multisite cluster randomised controlled trial (ISRCTN02507940).

Competing priorities: staff perspectives on supporting recovery.

Recovery has come to mean living a life beyond mental illness, and recovery orientation is policy in many countries. The aims of this study were to investigate what staff say they do to support recovery and to identify what they perceive as barriers and facilitators associated with providing recovery-oriented support. Data collection included ten focus groups with multidisciplinary clinicians (n = 34) and team leaders (n = 31), and individual interviews with clinicians (n = 18), team leaders (n = 6) and senior managers (n = 8). The identified core category was Competing Priorities, with staff identifying conflicting system priorities that influence how recovery-oriented practice is implemented. Three sub-categories were: Health Process Priorities, Business Priorities, and Staff Role Perception. Efforts to transform services towards a recovery orientation require a whole-systems approach.

A comparison of two coaching approaches to enhance implementation of a recovery-oriented service model.

Moving to recovery-oriented service provision in mental health may entail retraining existing staff, as well as training new staff. This represents a substantial burden on organisations, particularly since transfer of training into practice is often poor. Follow-up supervision and/or coaching have been found to improve the implementation and sustainment of new approaches. We compared the effect of two coaching conditions, skills-based and transformational coaching, on the implementation of a recovery-oriented model following training. Training followed by coaching led to significant sustained improvements in the quality of care planning in accordance with the new model over the 12-month study period. No interaction effect was observed between the two conditions. However, post hoc analyses suggest that transformational coaching warrants further exploration. The results support the provision of supervision in the form of coaching in the implementation of a recovery-oriented service model, and suggest the need to better elucidate the mechanisms within different coaching approaches that might contribute to improved care.

Strength-based cognitive-behavioural therapy and peer-to-peer support in the recovery process for people with schizophrenia: A randomised control trial.

BACKGROUND AND AIMS: Dysfunctional cognition and negative symptoms in schizophrenia are associated with persistently low social functioning and quality of life (QoL). Recovery interventions report only a modest effect in improving social functioning and QoL. This study examined the therapeutic effects and pathways of interventions using strength-based cognitive-behavioural therapy (SBCBT) and peer-to-peer support (PSP) approaches. METHODS: A randomised control trial compared SBCBT, PSP and TAU (treatment-as-usual) by recruiting 127 individuals with schizophrenia spectrum disorders and low social functioning. RESULTS: The three-group comparison found SBCBT produced improved social functioning and social support at post-intervention and 6-month follow-up while PSP reported improved social QoL and defeatist beliefs, but none remained at 6-month follow-up. Unsurprising, no improvement was found in any areas for TAU, both at post-test and 6-month follow-up. Regarding mechanisms of change, improvements in hope and personal recovery consistently and significantly accounted for improvements in social functioning and many aspects of QoL of participants, thus indicating the important contribution of hope and personal recovery in strength-based interventions for people with schizophrenia. CONCLUSION: This rigorously designed study provides the first few solid empirical evidence on the effectiveness of SBCBT and PSP in recovery from schizophrenia and provides initial evidence of the linkage between dysfunctional cognition, hope and recovery in schizophrenia.

Development of a short measure of psychological recovery in serious mental illness: the STORI-30.

OBJECTIVE: To develop a brief measure of stage of psychological recovery from mental illness by identifying the best-performing items of the 50-item Stages of Recovery Instrument (STORI). METHOD: Item response modelling was used to identify a short form of the full-length STORI. The resulting items were subjected to factor analysis to further refine the subscales. A second data set was used to confirm the construct validity of the new measure. A correlational analysis was conducted to examine relationships among the five subscale scores. RESULTS: Analyses identified 30 items that represented the five stages of the full STORI. The five stage subscale scores of the shorter measure, the STORI-30, showed a pattern of correlations that demonstrated an ordinal relationship between the stages. CONCLUSIONS: There is a need for recovery-oriented measures to augment established clinical assessment tools. The shorter version of the STORI, the STORI-30, shows promise as a brief measure of stage of recovery, more feasible for routine clinical use. Further psychometric and longitudinal testing is recommended. Qualitative research would be valuable in establishing acceptability to consumers and the clinical usefulness of the STORI-30.

Corrigendum: "A new hope" for positive psychology: a dynamic systems reconceptualization of hope theory.

[This corrects the article DOI: 10.3389/fpsyg.2022.809053.].

Impact of Cofacilitated, Collaborative, Recovery-Oriented Practice Training on Clinical Mental Health Workforce Competencies.

OBJECTIVE: The authors aimed to evaluate the impact of a staff development training program informed by the collaborative recovery model (CRM) on staff outcomes in the largest implementation of CRM undertaken by a public clinical mental health service. METHODS: Implementation spanned community, rehabilitation, inpatient, and crisis programs for children and youths, adults, and older persons in metropolitan Melbourne, 2017-2018. The CRM staff development program was cofacilitated and coproduced by trainers with clinical and lived experience of recovery (including caregivers) and delivered to the mental health workforce (N=729, including medical, nursing, allied health, lived experience, and leadership staff). The 3-day training program was supplemented by booster training and coaching in team-based reflective practice. Pre- and posttraining measures assessed changes in self-reported CRM-related knowledge, attitudes, skills, and confidence and in the perceived importance of CRM implementation. Staff definitions of recovery were analyzed to understand changes in language related to collaborative recovery. RESULTS: The staff development program significantly (p<0.001) improved self-rated knowledge, attitudes, and skills in applying CRM. At booster training, improvements in attitudes and self-confidence in implementing CRM were maintained. Ratings of the importance of CRM and confidence in the organization's implementation did not change. Definitions of recovery illustrated development of shared language throughout the large mental health program. CONCLUSIONS: The cofacilitated CRM staff development program achieved significant changes in staff knowledge, attitudes, skills, and confidence and changes in language related to recovery. These results suggest that implementing collaborative, recovery-oriented practice in a large public mental health program is feasible and can result in broad and sustainable change.

Recovery in Australia: marshalling strengths and living values.

Clear national policy now exists in Australia regarding recovery. Personal accounts of recovery often include reference to meaning, purpose and issues regarding identity. Personal strengths and expression of personal values are closely related to the development of meaning, purpose and a stable sense of self, resulting in a sense of wellbeing. These constructs fall under the research umbrella of positive psychology. By combining aspects of the recovery policy with evidence from the science of positive psychology there are increasing attempts to include strengths and values work with mental health staff and consumers. This paper describes how the collaborative recovery model (CRM) with its emphasis on strengths and values, draws on the emerging evidence based on positive psychology. CRM has now been implemented in non-government community services in each mainland state of Australia. Implementation issues of the CRM as one example of recovery-orientated service provision are then described. Potential barriers and facilitators of growth-based approaches such as CRM moving to government clinical services is then discussed. Recent national reviews of recovery measurement instruments are also summarized. Specific recommendations are then provided to further national implementation of recovery-orientated service provision in Australia.

Recovery in mental health: a movement towards well-being and meaning in contrast to an avoidance of symptoms.

OBJECTIVE: This paper examines the types of goals being set by individuals in the context of Australian mental health services and whether goal type differs across the stages of recovery. METHODS: Goal records of 144 individuals accessing services were reviewed to examine goal content, ratio of approach and avoidance oriented goals and changes across stages of psychological recovery. RESULTS: Individuals further along in their recovery set significantly more approach goals and types of goals set appeared to reflect broader life roles. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Setting approach goals and goals that reflect broader life roles tends to support the definition of psychological recovery as being "the movement towards" greater meaning and enhanced sense of self.

Chinese international students' conceptualizations of wellbeing: A prototype analysis.

Wellbeing can mean different things to different people, even in the same culture with the same language. People living at the intersection of two languages and cultures, such as Chinese students studying in an English-speaking nation, not only speak a different language than their host country, but also may have different conceptualizations of wellbeing itself. This study investigated Chinese international students' (aged 18-39, N = 123) conceptualizations of wellbeing using a modified prototype analysis, which provided insights on people's underlying structure of the construct as revealed through language. Chinese international students' conceptualizations of wellbeing were prototypically structured; key components of wellbeing included positive relationships, security, positivity/optimism, physical health, and self-strength. The findings broaden the understanding of layperson wellbeing conceptualizations, provide insights into the wellbeing related concepts and language that are most used by international Chinese students, and inform strategies that tertiary education institutions might adopt to effectively support Chinese international students' wellbeing.

"A New Hope" for Positive Psychology: A Dynamic Systems Reconceptualization of Hope Theory.

In this review of the central tenets of hope theory, we examine the meta-theoretical, theoretical, and methodological foundations of the literature base. Our analysis moves from a broad examination of the research landscape in hope theory across disciplines, to a deeper investigation of the empirical literature in university students. This review highlights the significant impact of this body of research in advancing our understanding of aspects of thriving characterized by hope. However, we also evidence several limitations that may impede the advancement of the next wave of growth in this field. To address these limitations, we argue for an interdisciplinary approach to expanding the meta-theoretical, theoretical, and methodological horizons, enabling a more dynamic systems approach to the study of hope. Drawing on the intersection of positive psychology with systems thinking, we describe a methodological approach that enables a deeper examination of the processes and interactions through which hope emerges, using an analysis of the lived experience of young people. It is proposed that this research agenda will bring to life an alternate story about the resourcefulness of our youth through their own voice, enabling us to leverage this in the design of more effective strategies to facilitate hope in the future. This research agenda provides a roadmap that will provide alternative methodologies that address the current limitations in the field of hope research and, importantly, can provide fuel to spur on the acceleration of the next wave of research and practice in the field of positive psychology more broadly.

Toward a Unified Framework for Positive Psychology Interventions: Evidence-Based Processes of Change in Coaching, Prevention, and Training.

Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly "negative" processes, and supports practitioners in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol.

Wellbeing Literacy: Conceptualization, Measurement, and Preliminary Empirical Findings from Students, Parents and School Staff.

AIMS: Wellbeing literacy is the intentional use of wellbeing relevant vocabulary, knowledge and language skills to maintain or improve the wellbeing of oneself, others and the world. In this study, we operationalize the human aspects of the concept of wellbeing literacy and empirically test its relationship with wellbeing and illbeing. We also assess its incremental variance in wellbeing and illbeing, after controlling for existing and well-established predictors of these constructs within education settings. METHODS: We developed and empirically tested the Wellbeing literacy 6-item (Well-Lit 6) scale to assess the concept of wellbeing literacy in the education context. The scale was developed based on a working definition of wellbeing literacy, in combination with the Australian Curriculum, Assessment and Reporting Authority (ACARA)'s definition of literacy. The Well-Lit 6 was administered via a cross-sectional survey to three Australian samples that comprise different elements of Australian education systems: students (N = 1392), parents (N = 584) and school staff (N = 317). RESULTS: Exploratory factor analysis (EFA) suggested the six items of the Well-Lit 6 form an independent construct, empirically distinguishable from other wellbeing-related constructs (e.g., general wellbeing, resilience, and emotion regulation). Convergent analyses showed wellbeing literacy was positively related to wellbeing and negatively related to illbeing. Incremental validity analyses showed wellbeing literacy predicted variance in wellbeing and illbeing after controlling for participant demographics, resilience, and emotion regulation, showing initial evidence of incremental validity. CONCLUSIONS: Our results provide preliminary evidence that wellbeing literacy is a distinct construct from wellbeing and illbeing, and it also demonstrates significant unique variance in these constructs over and above resilience and emotion regulation. The Well-Lit 6 is a useful provisional measure of wellbeing literacy, although we suggest a fruitful avenue for future research is to develop a more comprehensive scale of wellbeing literacy that denotes specific facets of communication, allowing a fuller exploration wellbeing literacy, its components, and their antecedents and consequences. We offer further recommendations for future research and discuss limitations with our approach.

Development and Assessment of the Personal Emotional Capital Questionnaire for Adults.

(1) Background: The present study developed and evaluated a personal emotional capital questionnaire (PECQ) for adults that assessed 10 domains of personal emotional capital. (2) Method: Initially, 100 items were created and then administered to students attending Semnan University and Semnan University of Medical Sciences in Iran. Of the 700 questionnaires distributed, 527 were completed in full. Students were sampledusing the multi-stage random cluster method. Exploratory factor analyses, Cronbach's alpha, and test-retest reliability were used to evaluate the scale. (3) Results: The ten components ofthe PECQ were confirmed. Test-retest correlations after 30 days were high, as was Cronbach's alpha (0.94). Thecomponents highly correlatedwith overall emotional capital. The PECQ displayed convergent validity as it positively correlated with the Keyes's Mental Health Continuum-Short Form and students'GPAs. The PECQ displayed divergent validity as it negatively correlated with measures of depression, anxiety and stress (Depression Anxiety and Stress Scale (DASS21)). Differences in overall PECQ scores and its components were examined for several variables including gender, age, marital and employment status, academic program, and field of study. PECQ scores were not sensitive to the order of administering questionnaires. (4) Conclusion: The results suggest that the PECQ is a valid and reliable measure of personal emotional capital and supports its use in adults.

Wellbeing Literacy: A Capability Model for Wellbeing Science and Practice.

Wellbeing science is the scientific investigation of wellbeing, its' antecedents and consequences. Alongside growth of wellbeing science is significant interest in wellbeing interventions at individual, organizational and population levels, including measurement of national accounts of wellbeing. In this concept paper, we propose the capability model of wellbeing literacy as a new model for wellbeing science and practice. Wellbeing literacy is defined as a capability to comprehend and compose wellbeing language, across contexts, with the intention of using such language to maintain or improve the wellbeing of oneself, others or the world. Wellbeing literacy is underpinned by a capability model (i.e., what someone is able to be and do), and is based on constructivist (i.e., language shapes reality) and contextualist (i.e., words have different meanings in different contexts) epistemologies. The proposed capability model of wellbeing literacy adds to wellbeing science by providing a tangible way to assess mechanisms learned from wellbeing interventions. Moreover, it provides a framework for practitioners to understand and plan wellbeing communications. Workplaces and families as examples are discussed as relevant contexts for application of wellbeing literacy, and future directions for wellbeing literacy research are outlined.

Do clinical outcome measures assess consumer-defined recovery?

There is an international call for mental health services to become recovery-oriented, and also to use evidence-based practices. Addressing this call requires recovery-oriented measurement of outcomes and service evaluation. Mental health consumers view recovery as leading as meaningful life, and have criticised traditional clinical measures for being too disability-oriented. This study compares three measures of consumer-defined recovery from enduring mental illness: the Recovery Assessment Scale, the Mental Health Recovery Measure and the Self-Identified Stage of Recovery, with four conventional clinical measures. Correlational analyses supported the convergent validity of the recovery measures, although certain subscales were unrelated to each other. More importantly, little relationship was found between consumer-defined recovery and the clinical measures. Analyses of variance revealed that scores on the recovery measures increased across self-identified stage of recovery, but scores on most clinical measures did not improve consistently across stage of recovery. The findings demonstrate the qualitative difference between the two types of measures, supporting the claim by consumers that clinical measures do not assess important aspects of recovery. There is a need for further research and refinement of recovery measurement, including assessment of stages of recovery, with the aim of including such measures as an adjunct in routine clinical assessment, service evaluation and research.

The use of metaphor for understanding and managing psychotic experiences: A systematic review.

BACKGROUND: Subjective experiences of psychotic disorders are often not communicated because of the difficulty in articulating them. Metaphor is a valuable way of describing these experiences to others. Recovery in psychotic disorders involves consolidation and transitioning processes. The ontological and orientational types of metaphor seem to form the linguistic basis of these processes. AIMS: The aim of this paper is to review and describe how metaphor may be used both as a strategy for people with psychotic disorders to articulate their subjective experiences of self, and also as an approach to support recovery. METHOD: A systematic review of 28 studies was conducted, to examine the nature and function of metaphor used in studies involving an intervention or therapeutic method for psychosis. RESULTS: Sixteen studies contained first-person experiences, 24 studies used metaphor to consolidate the self of the person with psychotic disorder, and 19 studies used metaphor to transition the self of the person, although applied use of metaphor in this way was limited. CONCLUSIONS: The use of metaphor as a strategy is a potentially valuable way for both people with psychotic disorders to express their experiences, and for promotion of recovery within this population.

Hope and improvements in mental health service providers' recovery attitudes following training.

BACKGROUND: Service providers' attitudes towards recovery can improve with formal training. However, it is unclear whether improvements depend on dispositional hope. AIMS: To determine whether attitudinal improvements following formal recovery training vary depending on participants' dispositional hope. METHOD: One hundred and three providers attended formal recovery training and completed measures of recovery knowledge, attitudes, hopefulness and optimism. RESULTS: Training improved providers' recovery knowledge, attitudes, hopefulness and optimism. Providers with both high and low dispositional hope achieved similar gains. CONCLUSIONS: Attitudinal improvements following formal recovery training were not dependent on baseline levels of dispositional hope. Institutions committed to recovery-oriented care should consider utilizing formal training.

Strengthening University Student Wellbeing: Language and Perceptions of Chinese International Students.

Students at the tertiary education level in Australia are at increased risk of experiencing high levels of psychological distress, with international students at particularly high risk for poor adjustment. As mental health and wellbeing strongly correlate with students' academic performance and general overseas experience, a growing number of studies focus on what universities can do to effectively support students' wellbeing. However, assumptions are made about what wellbeing is, strategies primarily focus on treating mental ill-health, and treatment approaches fail to account for cultural differences. This study aimed to explore how Chinese international students understand wellbeing, the language used about and for wellbeing, and activities that students believe strengthen their own and others' wellbeing. Eighty-four Chinese international students completed the online survey, and a subset of 30 students participated in semi-structured interviews. Data were analysed using thematic, phenomenographic, and language analyses. Physical health and mental health appeared as the key components that participants believed defined wellbeing, and intrapersonal activities were perceived as the primary approach used to strengthen wellbeing. Findings help broaden the understanding of wellbeing concept from the population of tertiary students, identify students' perspectives of activities that strengthen their wellbeing, offer a snapshot of the language used by Chinese students around wellbeing, and provide new data of population health through a wellbeing lens.

Do goal-setting interventions improve the quality of goals in mental health services?

OBJECTIVE: The use of evidence-based goal-setting principles is thought to improve goal attainment of people with psychiatric disability. Little is known about the frequency or quality of goal setting, and whether training and formalized goal-setting interventions improve goal setting practice. This study examines the impact of the Goal Instrument for Quality as related to the frequency and quality of goal setting. METHODS: The Goal Instrument for Quality (Goal-IQ) was used to review 122 goal records in several eastern Australian mental health services. RESULTS: Seventy-four percent of people in recovery had a documented goal record and these had 54% of the evidence-based goal-setting principles measured by the Goal-IQ. CONCLUSIONS: Staff trained in goal setting showed significant improvements in the frequency and quality of documenting goals.