BackgroundSchizophrenia is a disabling disease that impacts all major life areas. There is a growing need for meeting the challenge of disability from a perspective that extends symptomatic reduction. Therefore, this study aimed to systematically review the extent to which traditional and “third wave” cognitive – behavioral (CBT) interventions address the whole scope of disabilities experienced by people with lived experience of schizophrenia using the WHO’s International Classification of Functioning, Disability and Health (ICF) as a frame of reference. It also explores if current CBT interventions focus on recovery and what is their impact on disability domains.MethodsMedline and PsycINFO databases were searched for studies published in English between January 2009 and December 2015. Abstracts and full papers were screened against pre-defined selection criteria by two reviewers. Methodological quality of included studies was assessed by two independent raters using the Effective Public Health Practice Project Quality assessment tool for quantitative studies (EPHPP) guidelines.ResultsA total of 50 studies were included, 35 studies evaluating traditional CBT interventions and 15 evaluating “third wave” approaches. Overall, traditional CBT interventions addressed more disability domains than “third wave” approaches and mostly focused on mental functions reflecting schizophrenia psychopathology. Seven studies met the inclusion criteria of recovery-oriented interventions. The majority of studies evaluating these interventions had however a high risk of bias, therefore evidence on their effectiveness is inconclusive.ConclusionsTraditional CBT interventions address more disability domains than “third wave” therapies, however both approaches focus mostly on mental functions that reflect schizophrenia psychopathology. There are also few interventions that focus on recovery. These results indicate that CBT interventions going beyond symptom reduction are still needed. Recovery-focused CBT interventions seem to be a promising treatment approach as they target disability from a broader perspective including activity and participation domains. Although their effectiveness is inconclusive, they reflect users’ views of recovery and trends towards improvement of mood, negative symptoms and functioning are shown.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0912-8) contains supplementary material, which is available to authorized users.

PurposeTo elucidate the mechanism through which internalized stigma reduces the quality of life (QoL) of people with mental illness by exploring the mediating roles of self-esteem and sense of coherence (SOC).MethodsA cross-sectional analysis of 229 patients diagnosed with schizophrenia or affective disorders was undertaken to test a sequential mediation model assuming that more severe internalized stigma is related to lower self-esteem, which is associated with weaker SOC, which in turn relates to worse QoL.ResultsThe proposed model was supported by the data. A sequential indirect effect from internalized stigma to QoL via self-esteem and SOC turned out to be significant [beta = −0.06, SE = 0.02; 95% CI (−0.11, −0.03)]. Support was also found for simple mediation models with either self-esteem or SOC as single mediators between internalized stigma and QoL.ConclusionsSelf-esteem and SOC are personal resources that should be considered as potential targets of interventions aiming to prevent the harmful consequences of internalized stigma for the QoL of people receiving psychiatric treatment.

The objective of this study was to explore definitions of recovery among Polish service users with lived experience of schizophrenia and to hear their recommendations regarding elements that should be considered in the planning of a recovery oriented psychosocial intervention. Four semi-structured focus groups were conducted in the Institute of Psychiatry and Neurology in Warsaw, Poland. A total of 28 service users' narratives were examined using the inductive thematic analysis approach. Five main recovery themes emerged from the combined users accounts, listed in order of frequency: psychological dimension of recovery, relationships with others, wellness strategies, clinical understanding of recovery and support systems. Service user recommendations referred to the above identified recovery themes as well as indications that the intervention should be flexible, individualized, and facilitative of personal growth. The findings indicate that for service users with lived experience of schizophrenia in Poland it is culturally feasible to embrace the person-oriented approach to practice and develop a recovery-oriented psychosocial intervention emphasizing psychological domains of recovery such as positive identity, personal strengths, or meaning and purpose in life alongside the other relevant recovery dimensions. Actions regarding the system level of change are also required.

Objective: Hope is a key component of personal recovery. There is limited evidence regarding the association of hope with the level of functioning in individuals with psychosis. It is also not clear which dimensions of hope are most strongly related to clinical recovery. Thus, this study aims to explore the relationships of hope and its dimensions with various indicators of clinical recovery such as overall psychopathology, depression and global functioning among people with psychotic disorders. Method: The Integrative Hope Scale (IHS; Schrank, Woppmann, Sibitz, & Lauber, 2011) was administered to 110 people with psychotic disorders. Multiple regression analysis was used to investigate the associations of the IHS total score and its four subscales (i.e., Trust and Confidence, Lack of Perspective, Positive Future Orientation, and Social Relations and Personal Value) with overall psychiatric symptoms, depression, and general functioning. Results: A total level of Hope was not associated with overall psychopathology or global functioning; however, it showed a significant negative relationship with severity of depression. A stronger feeling of a Lack of Perspective turned out to be associated with more severe depression and a greater intensity of psychopathological symptoms. The relationships of the remaining dimensions of Hope with the indicators of clinical recovery were found to be nonsignificant. Conclusion and Implications for Practice:The findings suggest that combining Hope-enhancement strategies with interventions targeting symptoms may increase the effectiveness of rehabilitation programs for people with psychosis. They also point to the sense of a Lack of Perspective as the aspect of Hope most strongly related to clinical recovery. Impact and ImplicationsThis study suggests that Hope is a construct that is loosely and selectively related to objective measures of recovery. Clinicians should pay particular attention to counteracting the sense of a Lack of Perspective among their clients, which is the dimension of Hope most strongly associated with clinical recovery, through supporting patients in pursuing their personal goals. Hope-enhancement strategies may interact with interventions targeting psychiatric symptoms, particularly symptoms of depression, in improving the effectiveness of rehabilitation programs for people with psychotic disorders.

Background: There is a need to develop culturally adapted interventions that support the personal recovery and real-world functioning of people diagnosed with schizophrenia. Aims: This study reports on the development and evaluation of a culturally adapted, recovery-oriented, cognitive behavioural workshop for service users with schizophrenia. Method: The feasibility and acceptability were assessed, as were changes over time in personal recovery and psychosocial functioning (primary outcomes) along with psychopathology and health-related behaviours (secondary outcomes), using multi-level modelling. It was also assessed whether personal recovery predicts psychosocial functioning. Results: The workshop was feasible and was received favourably. Participants improved over time regarding confidence and hope, feeling less dominated by symptoms, psychosocial functioning, and psychopathology. Personal recovery predicted decreased psychosocial difficulties. Conclusions: The workshop is a promising intervention. It shows potential in terms of both improving personal recovery as well as real-life functioning of people diagnosed with schizophrenia. Further workshop evaluation in a randomized controlled study is required.