Artículo científico Living e-Motions

EMOTIONS IN OUR LIVES: THE EVALUATION OF A USERCENTERED TRAINING COURSE »LIVING E-MOTIONS« IN THE CONTEXT OF RECOVERY OF PEOPLE WITH MENTAL HEALTH

www.living-emotions.org

CHALLENGES Karin Bakračevič a, Saša Zorjan a, Sara Tement a, Louise Christie b, Bojan Musil a a

Department of Psychology, Faculty of Arts, University of Maribor, Slovenia

b

Scottish Recovery Network, United Kingdom

ABSTRACT Purpose. This paper aims to evaluate the feasibility and effectiveness of a training course »Living e-Motions« for people living with mental health challenges in the context of their recovery. The course was developed in the joint project of partners from Spain, Estonia, Slovenia, and the United Kingdom. The curriculum of the course is focused on emotional education. It uses a narrative

Emotions are the main part of us!

approach as a practical way for participants to explore and regulate their emotions and consequently take charge of their recovery.

Design/methodology/approach. Seventeen participants were included in the pilot training in Spain and Estonia. Impact of the training was assessed on measures of life satisfaction, emotion regulation, positive and negative affect, and recovery at baseline and directly after training.

Findings. The analysis revealed that participants reported of higher life satisfaction, emotion regulation skills, positive affect and recovery after the training. However, due to the small sample size, the mean differences did not reach statistical significance. Further studies on larger samples are needed to test the effectiveness of the training course.

Practical implications. Pilot study findings are encouraging and show that the developed training course has a potential for improving key competencies and abilities needed in daily life, concretely in emotion regulation, positive and negative affect, life satisfaction and recovery.

Originality/value. The paper presents a novel training course that uses a narrative approach and focuses on recovery and improvement of key competencies and abilities of individuals with mental health issues.

Keywords: Emotions, »Living e-Motions« project, Recovery Training, Mental Health, Evaluation Study.

1

1. Introduction

In recent years mental health has been globally addressed by WHO (2019), since it was recognized as a neglected part of global efforts to improve health (e.g., The Lancet

www.living-emotions.org

Commission on Global Mental Health and Sustainable Development, 2018). The systemic problem is related to the accessibility and quality of mental health care system and accompanying social services, but on a more concrete level people with mental health challenges more often have other physical health problems and widespread human rights violations, discrimination and stigma.

According to The Lancet Commission on Global Mental Health and Sustainable Development (2018), the primary goal of psychosocial interventions in the field of mental health is »to facilitate the acquisition of skills to address the risk factors, mediators, or consequences of mental health conditions and to enable social circumstances for the patient’s recovery« (p. 21). In this vein, this approach to mental health includes the third and fourth shift in the history of global mental health, where mental health promotion, prevention, treatment, and recovery are no longer exclusively focused on the work of a limited range of professions and related experts. In the

Emotions are the main part of us!

diversity of involved professions and groups, people with mental health challenges play a central and active role.

In the context of this more contextual approach to mental health with a more active role of the targeted group (i.e., people with mental health challenges), the partners from Spain (Fundacion INTRAS), Estonia (Astangu Vocational Rehabilitation Centre), Slovenia (University of Maribor), and United Kingdom (Scottish Recovery Network) collaborated in the EU funded project »Living e-Motions«. The project's focus was on recovery, and the central aim was to develop a training course designed to be used by people experiencing any type of mental health challenge and who want to improve their quality of life. The curriculum of the course is focused on emotional education and uses a narrative approach as a practical way for participants to explore and regulate their emotions and consequently take charge of their recovery.

The central goal of the »Living e-Motions« project for the participants was to achieve an experience of an improvement in key competencies and abilities needed in daily life, such as communication, empathy, self-management, organizational skills, problem solving, and selfesteem. In more concrete tasks, participants should learn to verbalize their emotions and gain benefit from this; increase social contact, inclusion and a sense of belonging; have a greater sense of self-control, personal safety and wellbeing; discuss and think more openly about their mental health experiences from a different perspective; show deeper understanding of their skills and strengths and a commitment to the recovery process.

2

1.1. The »Living e-Motions« training course: Key concepts and structure.

The key concept in the development of the »Living e-Motions« training course is recovery, central in connecting mental health with social context, emotional education, and narrative approach. The

www.living-emotions.org

Lancet Commission on Global Mental Health and Sustainable Development (2018) defines recovery as: From the perspective of the person with mental illness, recovery means gaining and retaining hope, understanding of one’s abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self. Importantly, recovery is defined by the person themself and not other people’s definition of what recovery means. (p. 10) Central in this definition of recovery is active (empowered) individuals with preferences and priorities embedded in a social context. Medical or psychiatric treatment is thus only one possible solution. Other solutions address the use of community and personal resources (The Lancet Commission on Global Mental Health and Sustainable Development, 2018, p. 13). Thus, in »Living e-Motions« project, we have adopted a recovery approach that emphasizes and supports

Emotions are the main part of us!

a person's recovery potential.

In the past years, the literature on recovery has also shifted from exploring what recovery is to understanding how recovery comes about. The process of recovery usually refers to one’s personal journey of living with mental illness and trauma (van Weeghel et al., 2019). One of the most cited definitions views recovery as: Deeply personal, unique process of changing one’s attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even within the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.

(Anthony, 1993, p. 17) The CHIME scheme best describes this process. It is a conceptual framework for personal recovery in mental health, combining categories of connectedness, hope and optimism about the future, identity, meaning in life, and empowerment (e.g., Brijnath; 2015, Leamy et al., 2011; Slade et al., 2012; van Weeghel et al., 2019). The CHIME scheme is not merely a framework of recovery domains but can also be used as a facilitator of recovery. Connectedness can, for instance, be fostered by organized activities where the participants engage in social sharing of emotions, traumatic experiences, and experiences related to their mental illness (e.g., storytelling exercise; Nurser, Rushworth, Shakespeare, & Williams, 2018). Hope can be instilled by exercises aimed at thinking about one’s life situation in a positive way. The “best possible self” activities where 3

individuals are asked to image that everything has gone as well as it possibly could and write it down can be utilized in that regard (King, 2001). Additionally, systematically thinking about one’s life goals and writing down the steps they can take to achieve these goals was found to be efficient (Feldman and Dreher, 2012). When rebuilding one’s positive sense of self a reflection

www.living-emotions.org

of the wide range of one’s role and activities that can still be pursued is necessary. Individuals need to broaden their thought repertoire by challenging the impression that they are “just their illness”. An exercise involving the 20 statement test where individuals simply answer the questions “Who I am” in 20 blank rows starting with “I am…” can be useful in that regard (Kuhn & McPartland, 1954). The same exercise may foster meaning in life by turning the participants’ attention to meaningful life roles. Finding meaning in different life role and activities as well as greater quality of life in general can also be encouraged by the classical positive psychology exercise “counting one’s blessings” where individuals are encouraged to think about things in their lives that you can be grateful for and how much they appreciate people, events, and situations that have been part of your life story (e.g., Emmons & McCullough, 2003). Finally, empowerment needs to be secured throughout the process as individuals recovering from mental illness need to experience control over their journeys. One way to achieve this is by involving participants in

Emotions are the main part of us!

decision-making regarding their recovery process and allowing them to participate in activities they consider helpful.

As a theoretical framework, we adopted the CHIME framework because it is a very useful way to explore personal recovery and because it is based on an analysis of people’s narratives about their own recovery. This means that it is rooted in the ‘lived experience’ of people living with mental health challenges and is particularly relevant to the »Living e-Motions« training course, which uses a narrative approach.

In the introduction we highlighted that mental health is related to social stigma attached to mental illness is still a very strong barrier influencing any recovery-oriented practice. Any training activities for empowerment of people, suffering difficulties in mental health, should thus include social interactions into account, from the context of interpersonal relations to broader, societal perspectives.

In the systematic review of social factors that influence the recovery process, Tew and colleagues (2012) identified underlying themes that contribute to mental health difficulties. According to the review of other studies, people with mental health problems often experience powerlessness, injustice, abuse or ‘social defeat’, often combined with the lack of positive relationships. Brijnath (2015) in the study of participants with depression, highlighted feelings of alienation and loneliness and fear of stigmatization.

4

Van Weeghel and colleagues (2019) in their review identified barriers to social inclusion such as stigma, low income, unemployment, and poor housing. Similarly, in a more societal manner, Wood and Alsawy (2018) highlighted stigma, social deprivation and

www.living-emotions.org

lack of opportunity, substance abuse, and the negative effects of mental health services and medication.

From different studies, stigma and stigmatization are central in influencing the recovery process. According to previous studies (see review in Tew et al., 2012), the stigma as a vital part of someone’s self-definition (identity) influences self-esteem and aspirations, self-efficacy and confidence in social interactions.

Social interaction in that manner addresses themes as communication and communication competencies, group processes and group dynamics, self and identity. The goals should be improvement of social skills and competencies for effective communication, stable and realistic self-definition and self-esteem, climate of support, inclusion and collaboration. To achieve these goals, training activities should include two interconnected objectives, first addressing the (social) context and second addressing adequate (socially oriented) procedures. Concretely, these objectives are establishing the atmosphere of social support and trust, and enhancing strategies

Emotions are the main part of us!

and activities of sharing emotions in social settings. According to Tew and colleagues (2012), these three CHIME categories are particularly social in the conceptual elaboration. From their review of social factors of recovery from mental health difficulties, each of these categories address special (subordinate) themes or processes in the recovery; connectedness is related to interpersonal relationships, family/systems approaches, social inclusion, occupation and employment, and community development; identity is related to social identities, discrimination (race, gender, etc.), mental illness stigma, and anti-stigma/anti-discriminatory interventions; and empowerment to self-efficacy, power together with others, strengths approach, self-directed support, and peer-organized services (p. 447). Taking together, these various recovery processes from the superordinate categories address both socially oriented and self-oriented strategies of possible recovery interventions.

Next, the challenge in the training course was to create a program, where people better understand and manage their emotions and as a result lead more fulfilling and satisfying lives.

This is idea of emotional education, the combination of the acquisition of basic knowledge about the emotions and skills of emotion regulation, both domains deeply relevant and widely neglected.

Emotions that would rate high on arousal often times feel very overwhelming and can sometimes be overpowering; in many situations, that can be disruptive and lead to poor performance. Therefore, it is important that we know how to manage or regulate our emotions.

5

This means that we influence what emotions we experience, when and how we experience and express them (Gross, 2002). Emotion regulation often involves “down-regulation”, which means that an individual purposefully reduces the intensity of the emotion they are experiencing. If someone is feeling very anxious before an exam, they might distract themselves from thinking

www.living-emotions.org

about the exam by focusing on other things. Emotion regulation also entails strategies such as reappraisal, which means that an individual re-assesses the situation they are in and tries to think of different explanations for what is happening (think of our example with a friend that is late).

Emotion regulation strategies are often times very simple and can be learned. Research has shown, that training these skills can help with coping in the long term (LeBlanc et al., 2017).

Putting recovery story and accompanying feelings into words has therapeutic effects.

From the perspective of the narrative (therapeutic) approach it is essential to understand how individuals attempt to interpret and understand their lives. Narrative therapy aims to help individuals elaborate and broaden their personal stories (Kondrat and Teater, 2009).

In the UK recovery movement, in so-called recovery colleges, Individual service users, professionals, and careers address mental health difficulties in the climate of sharing and

Emotions are the main part of us!

normalizing mental health difficulties with storytelling as central (Nurser et al., 2018).

Furthermore, users are encouraged to elaborate and share their own recovery story with others.

Story sharing is a powerful recovery tool for people living with mental health challenges, because it is a way for to explore someone’s experiences and inner worlds. Consequently, users develop and share their story and learn to ‘live’ their story by using their experiences and learning to support their own recovery journey and inspire others. In this way they recognize that they are ‘experts by experience’ and that they are the protagonist of their own story.

The »Living e-Motions« training course has been designed as a participative, group learning experience. Participants learn from each other and the role of the trainer is to facilitate this group learning experience.

The training course is composed of eight sessions (see Table I). The first session focuses on establishing the learning group in which the aim is that participants with a series of discussions and exercises create a safe and supportive environment. After that there are three sessions where the participants think about what recovery means to them, start to explore their own recovery story, and explore emotions and how they experience them. After this there are two sessions exploring key elements in both managing emotions and recovery – self-management and selfcare, and session about connections or social interactions and relationships. In seventh session, participants return to their recovery story and focus on the turning points, which has helped their 6

recovery and want to share. The final session focuses on bringing the learning together by providing a space for participants to share their story and capture their learning in a format of

------- Table I about here -------

Emotions are the main part of us!

www.living-emotions.org

»Living e-Motions« portfolio.

7

1.2. Aims of the evaluation study

The aim of the study was to evaluate the »Living e-Motions« training course. More specifically,

www.living-emotions.org

we followed two groups of pilot participants throughout training completion and measured several outcomes before and immediately after the training.

2. Methods 2.1. Participants Participants were recruited through two organizations that carried out the pilot test of the training course – the Astangu Vocational Rehabilitation Centre in Estonia and the Fundacion INTRAS in Spain. In total, 17 participants were enrolled in the pilot training. One participant dropped out of the training and for one additional participant there was no baseline data. Therefore, the data of 15 participants who completed the pilot version of the »Living e-Motions« training course (53.3% female) and had baseline and follow-up data were analyzed. Age ranged from 16 to 53, with the

Emotions are the main part of us!

mean age being 25.20 (SD = 10.90). Thirteen participants also indicated their current diagnosis – mood disorders (i.e., major depression) were most common (5 participants), followed by comorbid mood and anxiety disorders (3 participants), psychosis spectrum disorders (i.e., schizophrenia; 3 participants) and anxiety disorders (2 participants).

2.2. Questionnaires All questionnaires were completed by participants before the training (i.e., baseline) and after the completion of the training program (i.e., follow-up).

Satisfaction with life. Satisfaction with life was assessed using the Satisfaction with life scale (SWLS; Diener et al., 1985). SWLS is a short 5-item instrument designed to measure global cognitive judgements of satisfaction with one’s life. Participants completed the scale before and after completing the Living e-motions training course. They rated how much they agreed with each item using a 7-point scale (1 = strongly disagree; 7 = strongly agree).

Emotion regulation. Emotion regulation difficulties were assessed using the short form of the Difficulties in emotion regulation scale (DERS; Kaufman et al., 2015). The scale is a widely used self-report measure for assessing emotion regulation problems among adolescents and adults. It encompasses six subscales with three items each assessing several aspects of emotion dysregulation. Participants rate the items on a 5-point scale from 1 (almost never) to 5 (almost always) in terms of how often certain statements apply to them.

8

Recovery process. Recovery was assessed using the Questionnaire about the process of recovery (QRP; Neil et al., 2009). The QPR is a 15-item questionnaire which assesses different aspects of recovery, providing an indication of where the individuals feel they are in relation to their mental health and general well-being. Participants rate the items on a 5-point scale ranging

www.living-emotions.org

from 1 (disagree strongly) to 5 (agree strongly).

Positive and negative emotionality. Positive and negative affect were assessed using the Positive and Negative Affect Schedule (PANAS; Watson, 1988), a self-report questionnaire consisting of two 10-item scales to measure both positive and negative affect. Each item is rated on a 5-point scale (1 = not at all, 5 = very much). Participants completed the scale with regards to how they felt during the past week.

2.3. Procedure Two groups (one in Spain and one in Estonia) of participants were followed over the course of 8 weeks. Outcomes (listed in 2.2. Questionnaires) were assessed before the training and immediately after completing the training.

It is recommended that the learning group comprises up to 12 people. In Estonia, 10

Emotions are the main part of us!

participants were included into the pilot group. In Spain, 7 participants were included into the pilot group (with complete data for 5). Each session lasted for around two-and-a-half hours with a short break. It was noted, however, that some sessions were a bit too short to cover all the material, so this can also be adapted. Sessions took place once a week. We also suggest scheduling a follow-up session around two to three weeks after the final session.

3. Results and discussion Participants completed questionnaires assessing satisfaction with life, emotion dysregulation, recovery process and positive and negative affect before and after completing the »Living eMotions« training course. The results (means and standard deviations) are listed in Table II below.

------- Table II about here -------

As seen from Table II, they were changes in most of the overall scores over the course of the pilot study. Relative to results before completing the training program, the mean values after the completed training are slightly higher for satisfaction of life, positive affect, negative affect, and

9

recovery. Furthermore, participants reported of slightly lower difficulties in emotion regulation strategies after the training compared to before.

We also tested whether the differences between the scores before and after the training

www.living-emotions.org

are statistically significant. Due to the fact that all variables followed a normal distribution, we used a paired-samples t-test to compare mean values. The differences between the mean values before and after training were not statistically significant for satisfaction with life (t(13) = -1.02, p = .33), difficulties in emotion regulation (t(12) = 1.36, p = .20), recovery process (t(13) = -.59, p = .57) and negative affect (t(13) = -.54, p = .60). The difference was approaching statistical significance for positive affect (t(13) = -1.86, p = .08). However, it must be noted that this is not surprising given the small sample size included in the analyses.

From a descriptive point of view, the results of the pilot training seem to be promising.

More specifically, we see that participants, in general, reported an increase in outcomes such as satisfaction with life, positive affectivity, and recovery process. Although these outcomes are not directly related to the symptoms that people with mental health problems experience, they offer an insight into meaningful outcomes to service users (Trivedi and Wykes, 2002). Namely,

Emotions are the main part of us!

researchers have emphasized in the past that symptom-based measured may be incongruous with service user’s perspectives of recovery. Therefore, it is essential to measure recovery from the user’s perspective (Faulkner & Thomas, 2002). Thus, participants experienced increases in hope, empowerment, confidence, purpose, connectedness to others, and reliance on others – which have been key components of recovery (Neil et al., 2009).

The increases (albeit not reaching statistical significance due to a small sample size) in satisfaction with life and positive affect could indicate that the participants were happier, more satisfied with life and had higher levels of positive affect. This might be a promising result, as subjective well-being is associated with fewer emotional symptoms such as anxiety, depression, and stress (Chambel and Curral, 2004).

Perhaps most importantly, we found that there was a small (albeit not significant) reduction in reported difficulties in emotion regulation. With the training, we aimed to emphasize the functionality of emotions, which does not necessarily emphasize the reduction of negative emotions (as in reducing experiencing the full spectrum of emotions). Instead, the program focuses on emotion regulation as a multidimensional construct, which includes (1) awareness, understanding and acceptance of emotions, (2) ability to engage in goal directed behaviors, (3) flexible use of appropriate strategies to modulate the intensity of emotions, and (4) willingness to experience negative emotions (Gratz and Roemer, 2004). We can also interpret a slight increase

10

in negative affect with this in mind. It seems that the participants reported slight improvements in being able to manage their emotions in a more successful way.

Given the formative nature of this study, the results should be interpreted with some

www.living-emotions.org

limitations in mind. First, although we hypothesize that the training program will lead to improvement in several outcomes, related to recovery and positive emotion, the program should be tested further using larger samples. Furthermore, future work should examine which components of the training program are most effective and for whom. It could also be beneficial to test more homogenous groups in order to examine whether certain mental health issues are better suited for the program than others. Lastly, it would be important to conduct a follow-up assessment to establish whether the effects are present over a longer period of time.

4. Conclusions To conclude, the pilot study of the »Living e-Motions« training course has shown that the course is feasible and shows promise when it comes to increasing outcomes such as emotion regulation, satisfaction with life and positive emotionality. More data are needed, however, to fully explore

Emotions are the main part of us!

the effectiveness of the training course on larger samples.

11

Acknowledgements Conflict of interest: Authors claims no conflict of interest.

The »Living e-Motions« project was co-funded with financial support by the Erasmus+

www.living-emotions.org

Programme of the European Union. The research in the context of the project was carried out with the support of the University of Maribor (Slovenia); Scottish Recovery Network (UK); Fundación INTRAS (Spain); and Astangu Vocational Rehabilitation Centre (Estonia).

References Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health system in the 1990s. Innovations and Research 2, 17–24.

Brijnath, B. (2015). Applying the CHIME recovery framework in two culturally diverse Australian communities: Qualitative results. International Journal of Social Psychiatry, 61(7), 660–667.

Emotions are the main part of us!

Chambel, M. J., & Curral, L. (2005). Stress in Academic Life: Work Characteristics as Predictors of Student Well-being and Performance. Applied Psychology: An International Review, 54(1), 135–147.

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale.

Journal of Personality Assessment, 49(1), 71–75.

Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84, 377–389.

Faulkner, A., & Thomas, P. (2002). User-led research and evidence-based medicine. The British journal of psychiatry : the journal of mental science, 180, 1–3.

Feldman, D. B., & Dreher, D. E. (2012). Can hope be changed in 90 minutes? Testing the efficacy of a single-session goal-pursuit intervention for college students. Journal of Happiness Studies, 13, 745–759.

Gratz, K.L., Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment 26, 41–54.

12

Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences.

Psychophysiology, 39, 281–291.

Kaufman, E. A., Xia, M., Fosco, G., Yaptangco, M., Skidmore, C. R., & Crowell, S. E. (2016).

www.living-emotions.org

The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adult samples. Journal of Psychopathology and Behavioral Assessment, 38(3), 443–455.

King, L. (2001). The health benefits of writing about life goals. Personality and Social Psychology Bulletin, 27, 798–807.

Kondrat, D. C., & Teater, B. (2009). An anti-stigma approach to working with persons with severe mental disability: Seeking real change through narrative change. Journal of Social Work Practice, 23(1), 35–47.

Kuhn, M. H, & McPartland, T. S. (1954). An empirical investigation of self-attitudes. American Sociological Review, 19, 68–76.

Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework

Emotions are the main part of us!

for personal recovery in mental health: systematic review and narrative synthesis. The British Journal of Psychiatry, 199(6), 445–452.

LeBlanc, S., Uzun, B., Pourseied, K., & Mohiyeddini, C. (2017). Effect of an emotion regulation training program on mental well-being. International Journal of Group Psychotherapy, 67(1), 108–123.

Neil, S. T., Kilbride, M., Pittb, L., Nothard, S., Welford, M., Sellwood, W., & Morrison, A. P. (2010). The questionnaire about the process of recovery (QPR): A measurement tool developed in collaboration with service users. Psychosis: Psychological, Social and Integrative Approaches, 2(1), 88–91.

Nurser, K. P; Rushworth, I., Shakespeare, T., & Williams, D. (2018). Personal storytelling in mental health recovery. Mental Health Review Journal, 23, 25-36.

Slade, M., Leamy, M., Bacon, F., Janosik, M., Le Boutillier, C., Williams, J., & Bird, V. (2012).

International differences in understanding recovery: systematic review. Epidemiology and Psychiatric Sciences, 21(4), 353–364.

Tew, J., Ramon, S., Slade, M., Bird, V., Melton, J., & Le Boutillier, C. (2012). Social factors and recovery from mental health difficulties: a review of the evidence. The British Journal of Social Work, 42(3), 443–460.

13

The Lancet Commission on Global Mental Health and Sustainable Development. Lancet, 2018, 392: 1553–1598.

Trivedi, P., & Wykes, T. (2002). From passive subjects to equal partners: qualitative review of

www.living-emotions.org

user involvement in research. The British journal of psychiatry : the journal of mental science, 181, 468–472.

Van Weeghel, J., van Zelst, C., Boertien, D., & Hasson-Ohayon, I. (2019). Conceptualizations, assessments, and implications of personal recovery in mental illness: A scoping review of systematic reviews and meta-analyses. Psychiatric Rehabilitation Journal, 42(2), 169–181.

Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070.

Wood, L., & Alsawy, S. (2018). Recovery in psychosis from a service user perspective: A systematic review and thematic synthesis of current qualitative evidence. Community Mental Health Journal, 54(6), 793–804.

Emotions are the main part of us!

World Health Organization (WHO). (2019). The WHO special initiative for mental health (20192023):

universal

health

coverage

for

mental

health. World

Health

Organization. https://apps.who.int/iris/handle/10665/310981

14

APPENDICES:

Table I

www.living-emotions.org

The structure of »Living e-Motions« training course Sessions

Aims

1. Establishing the learning group

To introduce the course, and to create a positive group learning environment.

2. My recovery

To examine key concepts in recovery, and to identify what recovery means personally.

3. My recovery story

To introduce recovery story sharing and story living, and to begin the process of developing a personal recovery story.

4. Understanding my emotions

To provide an opportunity for participants to explore the range of emotions we experience and modes how we experience them.

5. Self-management and self-care

To introduce the concept of self-management and self-care, and

Emotions are the main part of us!

to explore how individuals can manage their own wellbeing.

6. Connections

To explore the role of social interactions or connections in mental health and emotional wellbeing.

7. Sharing my story

To provide an opportunity for participants to reflect on their learning, and to further develop their story and identify what they want to share with others.

8. Celebrating my journey

To share the stories of participants with the group and record their learning.

15

Table II Mean scores (and SDs) on satisfaction of life, emotion regulation difficulties, recovery process and positive and negative affect at baseline and after training

DERS

QRP

PA

NA

M

SD

M

SD

M

SD

M

SD

M

SD

Baseline

3,93

0,99

46,07

11,78

3,56

0,64

2,99

0,71

2,45

0,82

After training

4,24

0,92

42,31

11,26

3,76

0,75

3,40

0,88

2,57

0,90

Note. SWLS = satisfaction of life scale, DERS = difficulties in emotion regulation scale, QRP = questionnaire about the process of recovery, PA = positive affect, NA = negative affect.

Emotions are the main part of us!

www.living-emotions.org

SWLS

16