Living well with bipolar disorder: Integrating positive psychology and personal recovery into the treatment of bipolar disorders

The overall goal of this dissertation is to contribute to the integration of positive psychology and personal recovery into the treatment of BD. First, an overview of the research field of positive psychology interventions for serious mental illness (SMI) and of economic studies for BD is provided. This aims to summarize the current state of the art of positive psychology interventions for SMI and cost-effectiveness of non-pharmacological interventions for BD. Second, two measurement instruments, the Questionnaire about the Process of Recovery (QPR) and the Responses to Positive Affect questionnaire (RPA), are psychometrically validated. Although these constructs constitute relevant outcomes for BD, the two measurement instruments were not translated into Dutch before and/or have not been validated in people with BD. Third, this thesis aims to widen our knowledge of what contributes to personal recovery in BD, by exploring factors that are associated with personal recovery in people with BD. Fourth, a novel positive psychology group treatment is developed aimed at improving personal recovery and mental well-being in euthymic BD patients. The effectiveness of this treatment is evaluated in a pragmatic randomized controlled trial (RCT). We could show in a full RCT, that the positive psychology group treatment developed and evaluated in this thesis represents an effective treatment to enhance mental well-being and personal recovery in euthymic patients with BD. This intervention may therefore represent a valuable addition for TAU for BD, since it complements current treatment with an intervention that contributes to live a joyful, meaningful and engaged life, also in the presence of a severe mental illness. Furthermore, we found that a Dutch translation of the QPR represents a reliable and valid instrument to measure personal recovery in BD. The QPR is now available to be used in the Netherlands. We could also show that the RPA is a psychometrically sound instrument to assess positive emotion regulation in BD. The RPA can be used to assess positive emotion regulation strategies in BD, which may represent important facilitators or barriers for recovery. Furthermore, we found that positive rumination, anxiety symptoms and social participation are independently associated with personal recovery in BD and might therefore represent valuable treatment targets when aiming to improve personal recovery. Possible future directions for practice and research include the implementation of this intervention in the current treatment landscape, the integration of idiographic research and data science approaches in mental health research and the development of personalized treatments to advance the care we provide for patients with mental disorders.