Self-management of Psychiatric Illness: Impact of Wellness Recovery Action Planning (WRAP) participation on symptomatology and recovery attitudes

Background: Self-management of psychiatric illnesses is a central tenet of consumer-directed mental health treatment. While several manualized self-management programs have been developed in recent years, the most widely disseminated is Wellness Recovery Action Planning, known as WRAP (Copeland, 1997). WRAP is a program in which participants identify internal and external resources for facilitating recovery, and then use these tools to create an individualized self-management plan. The goal of participation is health-related behavioral and attitudinal change, emphasizing the acquisition of new information and skills to better manage symptoms and maintain increased levels of health and functioning. In this study we describe the impact of WRAP participation on self-reported symptoms, hope, self-management, and recovery goals.

Methods: Participation involved 12 weekly sessions in groups of 4 to 12 facilitated by one staff person and one peer worker at 5 community mental health centers. Eligibility criteria included a documented diagnosis of severe mental illness, no previous experience with WRAP, and attendance of at least 75% of the meetings. Of the 90 WRAP participants, 58 met the criteria and consented to participate in the study. Comparison group participants were recruited by matching diagnosis, gender, and age using a statewide database. Previous WRAP experience was an exclusion criteria. Fifty-six of the 99 potential comparison group subjects consented to participate. The total sample (N=114) had a mean age of 43.5; 62% were female, 65% were white, and 30% were African-American. Thirty-four percent had a diagnosis of schizophrenia, 32% with major depression, 23% with bipolar disorder, while the remainder were diagnosed with other psychotic or affective disorders. Pre- and post-test measures included the Modified Colorado Symptom Scale (Conrad et al., 2001), the State Hope Scale (Snyder et al., 1996) and the self-management and recovery goals subscales of the Recovery Enhancing Environment Scale (Ridgway et al., 2003).

Results: Findings suggest significant improvements in symptomatology, hope, self-management and recovery goals after WRAP participation, relative to comparison group. Independent-samples t-tests were conducted to assess mean differences between the groups both before and after WRAP participation. There were no significant pre-test mean score differences between the treatment and comparison groups on demographic variables, diagnosis, symptoms, hope, self-management and recovery goals. At post-test the treatment and comparison groups differed significantly on hope (p<.05), self-management and recovery goals, (p<.01). Paired-samples t-tests were then conducted to evaluate the impact of WRAP participation on symptoms, hope, self-management and recovery goals. The experimental group experienced improvement in hope between pre-test and post-test (p<.01) as well as increased self-management and recovery goals (p<.01). Finally, post-test symptoms were lower than at pre-test (p<.01). Paired-samples t-tests showed no significant differences between pre-test and post-test scores for the comparison group for any of the measures.

Implications: These results offer promising evidence that WRAP participation has a positive effect on symptoms and recovery-related attitudes, thereby providing an effective complement to current mental health treatment. Implications for practice, programming and policy will be discussed.