Psychological mechanisms and the ups and downs of personal recovery in bipolar disorder

Background: Personal recovery is recognised as an important outcome for individuals with bipolar disorder (BD), and is distinct from symptomatic and functional recovery. Recovery-focused psychological therapies show promise. As with therapies aiming to delay relapse and improve symptoms, research on the psychological mechanisms underlying recovery is crucial to inform effective recovery-focused therapy. However, empirical work is limited. This study investigated whether negative beliefs about mood swings and self-referent appraisals of mood-related experiences were negatively associated with personal recovery. Design: Cross-sectional online survey. Method: People with a verified research diagnosis of BD (n = 87), recruited via relevant voluntary sector organisations and social media, completed online measures. Pearson’s correlations and multiple regression analysed associations between appraisals, beliefs and recovery. Results: Normalising appraisals of mood changes were positively associated with personal recovery. Depression, 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. After controlling for current mood symptoms, negative illness models (relating to how controllable, long-term, concerning, and treatable mood swings are; β = -.38), being employed (β = .39) and both current (β = -.53) and recent experience of depression (β = .30) predicted recovery. Limitations: Due to the cross-sectional design, causality cannot be determined. Participants were a convenience sample primarily recruited online. Power was limited by the sample size. Conclusions: Interventions aiming to empower people to feel able to manage mood and catastrophise less about mood swings could facilitate personal recovery in people with BD, which might be achieved in recovery-focused therapy.