Is the Wellness Recovery Action Plan (WRAP) efficacious for improving personal and clinical recovery outcomes? A systematic review and meta-analysis.

Abstract

Objective:The Wellness Recovery Action Plan (WRAP) is a structured approach to illness self-management that is widely used within mental health services. This systematic review identifies, appraises, and metaanalyzes quantitative evidence from experimental or quasi-experimental comparison group designs for effects of WRAP on measures reflecting personal recovery and clinical symptomatology. Method: A systematic strategy was used to search 6 electronic reference databases (Medline, CINAHL, EMBASE, PsycINFO, PsycARTICLES, The Cochrane Library) using full-text, keywords, and Medical Subject Headings (MeSh)/ Thesaurus headings terms. Unpublished research was identified using the same strategy in the EThOS database. Controlled trials of WRAP were selected and assessed for quality. Meta-analyses were applied to quantitative data to establish the effects of WRAP on outcomes of interest. Results: Of 253 studies initially identified, 5 quantitative studies (reported in 6 papers) reporting controlled trials were included in the review. Meta-analyses revealed that, relative to inactive control conditions, WRAP was (a) superior for promoting self-perceived recovery outcomes (demonstrating a small-but-significant pooled effect), but (b) not superior for reducing clinical symptomatology-although restriction to randomized-controlled trials revealed 1 small effect favoring WRAP for reducing depression. Conclusions and Implications for Practice: Participation in WRAP has positive outcomes for participants, quantifiable using comprehensive measures of self-perceived recovery. Improvements were not sustained over time. Future research could explore this, as well as potential effects of follow-up WRAP sessions. The results support a move to broader measurement of outcomes within mental health, away from a reliance on clinical outcome measures. Recommendations for further research are made. Impact and ImplicationsThe current article pooled data from studies into the effectiveness of the Wellness Recovery Action Plan in adult mental health settings. The findings provide support for a broader conceptualization of outcomes than clinical symptom measurement: demonstrating significant growth in self-identified personal recovery in the absence of significant symptom reduction.

Effects of Illness Management and Recovery: A Multicenter Randomized Controlled Trial

“…Previous studies have confirmed the relevance of improvement in personal recovery by demonstrating the importance of the therapeutic benefits of managing mental illness, which facilitates personal well-being and self-perceived growth. Additionally, studies have highlighted the value of living a satisfying life despite the presence of enduring symptoms ( 13 , 19 , 65 , 66 ). Therefore, changes should be measured based on both symptomatology and consumer-defined recovery ( 5 , 20 , 65 , 67 ).…”

Perceptions of wellness recovery action plan (WRAP) training: a systematic review and metasynthesis

“…This allows investigation not only of the potentially broad 'outcomes' of WRAP training, but also the processes that may contribute to the achievement of any outcomes. A systematic review of quantitative evidence (Canacott et al, 2019) cannot sufficiently capture the breadth of evidence regarding 'effectiveness' of WRAP training as perceived by participants. Qualitative studies pertaining to WRAP training should therefore also be systematically reviewed to attain a broad understanding of potential outcomes of WRAP training -synthesising experiential accounts of WRAP and its subjective impact.…”

“…Quantitative research into WRAP outcomes has been conducted, with a focus on both clinical outcomes of "symptom reduction" and also measures of self-perceived recovery outcomes. A recent review of these studies (Canacott et al, 2019) indicated that WRAP was superior to active controls for promoting self-perceived recovery outcomes but not for reducing clinical symptomatology. However, a paradigm shift within mental health services from understandings of clinical to personal recovery (Slade, 2009) necessitates shifts within research also.…”

“…This evidence provides the context within which quantitative studies of the "outcomes" of WRAP training must be considered. A related review and meta-analysis of quantitatively measured recovery outcomes of WRAP training (Canacott et al, 2019) identified no significant pooled effect of WRAP on clinical symptomatology but a significant pooled effect on self-perceived recovery (relative to inactive control conditions). Qualitative analyses may provide some insight into mediating variables of positive outcomes, such as a greater sense of control, confidence and hope -i.e.…”

“…It is possible that acceptance may reduce the secondary psychological battle of living with chronic illness and enable individuals to live meaningful lives. It is of interest that quantitative studies of WRAP outcomes identified in a review (Canacott et al, 2019) did not use measures of "acceptance".…”