Wellness Recovery Action Plan (WRAP)

firesidechat

In my opinion , This is an excellent tool to helping one overcome psychological/emotional difficulties that they may be experiencing in their lives. It was developed by Mary Ellen Copeland who herself experienced difficulties in her life (as did her mother).
The programme works on self empowerment and belief working on 5 recovery concepts.
Hope.
Self Responsibility.
Education.
Self Advocacy
Support.
The Values & Ethics of WRAP support the view that we are experts on ourselves and that recovery is possable .

• There is hope. People get well, stay well for long periods of time, and do the things they want to do with their lives.
• Self-determination, personal responsibility, empowerment, and self-advocacy are expected outcomes of WRAP.
• Insist that you be treated as an equal with dignity, compassion, mutual respect, and unconditional high regard, a unique, special individual, including acceptance of diversity with relation to culture, ethnicity, language, religion, race, gender, age, disability, sexual preference, and “readiness” issues, and treat others the same way.
• WRAP is based on the premise that there are “no limits” to recovery.
• Every part of WRAP is totally voluntary. You, the person who is developing the WRAP, decide if you want to do it, when you want to do it, how long you will take, what it will include and who assists and supports you.
• It is understood that you as the person who is developing this WRAP, are the expert on yourself.
• Concentrate on your individual strengths and away from perceived deficits as determined by you or others.
• Keep the focus on things you do well, and avoid negative self-judgments or the findings of deficit-based assessments.
• Avoid the use of clinical, medical and diagnostic language.
• If possible, work together and learn with your peers to increase mutual understanding, knowledge and promote wellness.
• Emphasize strategies that are simple and safe.
• Difficult feelings and behaviors are normal responses to traumatic circumstances and what is happening in your life and need not be considered symptoms or a diagnosis.

I welcome all feedback from anyone who has used WRAP .

psycjay

To be honest this smells more like a money-making pseudoscience than a valid treatment. These are my reasons for taking this stance.

I cannot find any empirical evidence that this actually works. Look at any other treatment that is currently used [by mental health professionals] and you will find many studies which have shown that it effective.

It uses vague, non-specific language. When your claims are vague it's hard to say you are wrong. For example, "it helps overcome psychological or emotional difficulties", how could you possible test that?

The website mentions that WRAP "decrease the need for costly, invasive therapies". Statements such as these are loaded and harmful, good therapy has proved efficacy and the long term benefits far outweigh the costs.

Now people may come back and say I am being harsh and should give things a chance. But I would argue that people with a mental health problem are entitled to the most effective treatment. There is already far too much snake oil out there and I for one am sick of it. Come back to me when they have evidence.

firesidechat

Thanks for the response.
Evidence wise, Judith A cook, Ph.D. who is affiliated with the Department of Psychiatry, University of Illinois USA has done research which was funded by the US Dept. of Education, The National Institute on Disability and Rehabilitation research and the Centre for Mental Health Services USA.
CONCLUSIONS. “WRAP is now being offered across the country, with formal and informal WRAP initiatives on going in all 50 states and US territories. The widespread popularity of this model offers a wealth of opportunities for additional and more rigorous evaluations... Studies of the efficacy and effectiveness of this model in promoting recovery have the potential to advance our understanding of self-management interventions for people with mental disorders. The field stands to benefit from such research and individuals who participate in WRAP will have an opportunity to experience enhanced autonomy and greater self-determination.”
http://clinicaltrials.gov/ct2/show/NCT01024569
I think the language is self-explanatory, The NSUE has chosen to use the term “psychological / emotional difficulties. This is the term favoured by their members so that is why I choose to use it .After all it is they who have ownership of the title and difficulties can be overcome , which leaves to recovery.
What is so harmful about reducing the need for” invasive therapies”. The programme helps in empowerment, which leads the person to take responsibility for their recovery and to realise that they have so much to personally contribute to their recovery by taking control of their daily actions. The educational concept is all about the individual researching all therapies available and then making a responsible decision for themselves as to what is best for them. Yes people are entitled to the best care available, but it is also necessary to be aware that the individual involved is the expert on himself. That is why the Values & Ethics of WRAP are so important and must be respected by all parties involved in an individual’s care plan.

psycjay

I don't seem to be able to find the results from the study you provided a link to. I might just be navigating the site wrong. I can see the methodology alright and the hypothesis etc but no results. Also, where did the conclusion you pasted come from? Again, the may just be my failure to navigate that site.

Studies of the efficacy and effectiveness of this model in promoting recovery have the potential to advance our understanding of self-management interventions for people with mental disorders. The field stands to benefit from such research and individuals who participate in WRAP will have an opportunity to experience enhanced autonomy and greater self-determination.”

This conclusion is problematic. The language makes no logical sense. Efficacy studies determine how effective a treatment is, they do not increase our understanding of the treatment. That is the first error. The second sentence begins by stating the obvious - the field will benefit from efficacy studies. But this suggests that they haven't done any yet.. Have they? And finally the last section makes a statement regarding what individuals will experience with WRAP. Was this tested in the study?

Here is an example of a conclusion from a typical efficacy study

The results of the study show a consistent pattern of change supporting the superiority of CBT over BT for patients suffering from moderately severe GAD. Six months after the end of treatment, patients who
had received CBT differed significantly from those who had received BT on half the measures of anxiety, 1 out of 4 measures of depression, and 5 out of 6 measures of cognition. After treatment, patients who had received CBT differed significantly from those in the waiting list on all but 1 of the 16 main measures. In contrast, those who had received BT differed from waiting list patients on only 4 of these measures.

The difference is obvious, the results are discussed in a clear, logically sound manner.

I think the language is self-explanatory, The NSUE has chosen to use the term “psychological / emotional difficulties. This is the term favoured by their members so that is why I choose to use it .After all it is they who have ownership of the title and difficulties can be overcome , which leaves to recovery.

Fair enough, we do juggle around terminology a lot.

What is so harmful about reducing the need for” invasive therapies”. The programme helps in empowerment, which leads the person to take responsibility for their recovery and to realise that they have so much to personally contribute to their recovery by taking control of their daily actions. The educational concept is all about the individual researching all therapies available and then making a responsible decision for themselves as to what is best for them. Yes people are entitled to the best care available, but it is also necessary to be aware that the individual involved is the expert on himself. That is why the Values & Ethics of WRAP are so important and must be respected by all parties involved in an individual’s care plan.

I still don't think therapies should be portrayed as invasive. It is well established that one of the factors which promotes positive mental health is positive social relationships with others, which can include the therapist. This is often a key element in the therapeutic process.

firesidechat

psycjay wrote: »

I don't seem to be able to find the results from the study you provided a link to. I might just be navigating the site wrong. I can see the methodology alright and the hypothesis etc but no results. Also, where did the conclusion you pasted come from? Again, the may just be my failure to navigate that site.
http://www.montanapeernetwork.org/WRAP%20as%20and%20EBP%20-%20Cook.pdf





I still don't think therapies should be portrayed as invasive. It is well established that one of the factors which promotes positive mental health is positive social relationships with others, which can include the therapist. This is often a key element in the therapeutic process.

No one is saying that all therapies are invasive (far from it). what has to be considered is that what may seem as an acceptable therapy to one person may be completly invasive to someone else. A good relationship with any care worker is to be encouraged, But it must be a mutual relationship. One where the carer will validate and acknowledge the input from the client on how he/she wishes to proceed on the journey of recovery.

psycjay

It was mentioned as one of the goals of WRAP on the website.

"decrease the need for costly, invasive therapies"

It could be read in a negative way towards therapy in general, that was my point. Why not just say, reduce the need for therapy?

JuliusCaesar

Here's a study:

Cook et al, 2009, Initial Outcomes of a Mental Health Self-Management Program Based on WRAP, Psychiatric Services, 60,2, 246-249

OBJECTIVE: This study examined changes in psychosocial outcomes among participants in an eight-week, peer-led, mental illness self-management intervention called Wellness Recovery Action Planning (WRAP). METHODS: Eighty individuals with serious mental illness at five Ohio sites completed telephone interviews at baseline and one month after the intervention. RESULTS: Paired t tests of pre- and postintervention scores revealed significant improvement in self-reported symptoms, recovery, hopefulness, self-advocacy, and physical health; empowerment decreased significantly and no significant changes were observed in social support. Those attending six or more sessions showed greater improvement than those attending fewer sessions. CONCLUSIONS: These promising early results suggest that further research on this intervention is warranted. Confirmation of the efficacy and effectiveness of peer-led self-management has the potential to enhance self-determination and promote recovery for people with psychiatric disabilities

Seeing it's been popular all over the world for th last 10 years or so, I would have expected to see a great deal more research and more of an evidence base for it. I'd also expect to see better results than those above which seem to be in line with any old recovery model/approach. Maybe it just shows how bad the MH services are that don't work on a recovery model... imagine if physical medicine had been run in the same way!

Nice article here

firesidechat

SAMHSA (NREPP) National Registery of Evidence-based Progress and Practices have given the WRAP program recognition..

http://nrepp.samhsa.gov/ViewIntervention.aspx?id=208

psycjay

firesidechat wrote: »

SAMHSA (NREPP) National Registery of Evidence-based Progress and Practices have given the WRAP program recognition..

http://nrepp.samhsa.gov/ViewIntervention.aspx?id=208

From that site:

"Evaluated in comparative effectiveness research studies: No"

firesidechat

Psycjay.
I fail to see the reason why you are dismissing the positive outcomes of this programme.
Surely by now we are all aware of the benefit of one taking self responsibility for their difficulties, Been able to advocate for their needs and the ability to have the tools to maintain a good level of wellness.
WRAP helps to empower the person in difficulty which leads to them taking an active role in their recovery.
Actually WRAP is now been used by quiet a few HSE employees and there are now WRAP peer support groups opening up in many areas of the country.

WesternNight

firesidechat wrote: »

Psycjay.
I fail to see the reason why you are dismissing the positive outcomes of this programme.
Surely by now we are all aware of the benefit of one taking self responsibility for their difficulties, Been able to advocate for their needs and the ability to have the tools to maintain a good level of wellness.
WRAP helps to empower the person in difficulty which leads to them taking an active role in their recovery.
Actually WRAP is now been used by quiet a few HSE employees and there are now WRAP peer support groups opening up in many areas of the country.

The thing about programmes that aim to give people relief from clinical symptoms/conditions/disorders is that you have to be extremely vigilant about the quality and efficacy of the intervention you're planning to use.

The WRAP programme might work extremely well, but it can't be assumed so purely on the basis of its tagline, or how good the aims sound, or popularity or anything like that. Research. Proper research. And then research on the research. And then even more research. Just to make sure the previous research wasn't a fluke. That's how you establish whether an intervention or a treatment or a medicine is effective.

So when people question the research, or suggest that something seems to good to be true, they're oftentimes not doing so to be difficult, but because there are particular requirements that may not be being met to justify the claims that are being made.

firesidechat

Dr James Lucey, St Patricks hospital & Trinity College was on the Pat Kenny show this morning.
With him was a woman with a diagnosis of Bi-polar and who was introduced to the WRAP programme by Dr Lucey.
After years of turmoil ,which included several suicide attempts and experimentation with various prescribed medications ,she is now medication free and has a greater understanding of her wellness.
www.wrapireland.ie

she was great, describing how she was empowered to take control and responsibility for her recovery and how she can monitor her own wellness on a daily basis.
Great to hear a positive story like hers.
http://www.rte.ie/radio1/podcast/podcast_patkenny.xml