What influences recovery in the moment?

Posted on: 16 August 2023 by Dr Barbara Mezes in August 2023 Posts

Dr Barbara Mezes is a Lecturer in Clinical Psychology in the Department of Primary Care and Mental Health. Here she discusses the research support grant she received from the Wellcome ISSF to support her research focusing on personal recovery in bipolar disorder.

"I am passionate about research that focuses on improving mental health services, interventions, and outcomes for young people and adults with mental health problems. My primary research aims include improving the wellbeing of individuals with severe mental health problems and supporting communities facing systemic disadvantages to prevent the development of mental health problems in the first place. I work towards these aims by exploring the broader determinants of mental health and wellbeing and developing community-based approaches to tackle these determinants. 

Learning new methods

The Wellcome ISSF funding enabled me to learn new research data collection and analysis methods called Experience Sampling Methodology (ESM). In ESM, we ask participants to complete a short set of questions multiple times during a day for a period of one to two weeks. It allows us to get 'in-the-moment’ account of individuals' subjective experience and contextualise this in terms of psychological, social, and environmental factors. Analysis of complex ESM data requires expert training, and the funding meant I was able to attend a prestigious online course at Maastricht University designed and delivered by experts in this method. This course covered all aspects of the use of ESM in clinical practice and research, including data collection and analysis techniques.

Implementation into research

I analysed my previously collected ESM data to explore the fluctuation of personal recovery and underpinning factors, including mood, stress, social support, psychological processes and coping strategies in bipolar disorder. This is important because people with bipolar disorder often talk about their recovery as a fluctuating process and a journey with setbacks, so I wanted to learn more about how their recovery fluctuates during day-to-day life and what may influence this fluctuation to inform interventions and tailor community-based support.

My early results showed that, irrespective of other demographic and clinical variables, people with more hospital admissions struggled more with their day-to-day recovery. Mood fluctuation influenced recovery day-to-day. When people reported higher positive affect (positive emotions and expression), they also reported higher rates of personal recovery. Higher rates of negative affect (negative emotions and expression) were linked to lower personal recovery.

How people with bipolar disorder made sense of their moods was also important. People who viewed their positive affect as an internal, personal characteristic rather than an external, circumstantial factor reported better personal recovery. Whereas those who considered depressive mood as a personal characteristic linked to lower rates of personal recovery. This has implications for interventions, i.e., special attention should be paid on the interpretation of mood fluctuation for individuals with bipolar disorder and maladaptive appraisal processes should be targeted in therapy.

Next steps

In terms of future research, hospitalisation seems to make personal recovery more challenging on a day-to-day basis. This has implications for mental health care and highlight the negative impact of severe mood episodes and hospitalisation on the personal recovery journey. We will therefore next explore how people experience personal recovery during the post hospital discharge periods and how we can improve care and support in the community.

The grant also enabled me to present my research in a symposium at the Association for Behavioural and Cognitive Psychotherapies in Cardiff. I am now writing up my findings for a publication, which I hope to publish in the Journal of Psychopathology and Clinical Science. Follow me on Twitter @BarbaraMezes for up-to-date information on upcoming publications."