115 Personal recovery suits us all The link between resilience factors, specifically positive self-image and pro-active coping strategies, and personal recovery has been reported in earlier studies. İpçi et al. described that self-esteem, together with hopelessness, explained 52% of the variance of subjective recovery (35). Lecomte et al. found that 45% of the variance of optimism was explained by a model including high self-esteem, low depression, and high social support (36). Salzmann-Erikson wrote that ‘the inner process of recovery is about an ongoing and continuing fight, including setbacks (14). Song reported that resilience, family support and symptom severity were associated with personal recovery (19). Broyd et al. found that poorer coping was associated with reduced subjective well-being, which is closely related to personal recovery (37). Roosenschoon et al. also showed that coping is a determinant of recovery and mentioned the relevance of improving coping skills (38). Our findings that social interaction and functioning is associated with personal recovery is in line with previous research (8, 15). It is known that patients with severe mental illness unfortunately often lose important social relationships and have difficulties in developing new relationships (39). Also, carers of people with psychosis experience a high rate of social isolation (40). This may explain that differences in social functioning in siblings is associated with personal recovery, as it is in patients. Furthermore, it is probable that most healthy controls have social contacts, which means that other factors, such as coping strategies, are more important in their personal recovery than social interaction. Regarding (sub)clinical symptoms in patients and siblings, the more prominent impact of affective symptoms (compared to positive or negative symptoms) on personal recovery, has also been shown in previous research (16-18). Affective symptoms are obviously linked to hope and optimism about the future, which are vital for achieving personal recovery (41). A possible explanation of the impact of affective and positive symptoms on personal recovery in siblings is that they might perceive subclinical expressions as more alarming given the illness of their sibling. Implications Resilience factors as positive self-schema and pro-active coping strategies are robustly associated with personal recovery in patients, siblings and healthy controls. Irrespective of illness or vulnerability status, promoting positive schemas and coping strategies may result in better personal recovery. Changing a person’s attitudes and adopting more adaptive schemas have already been shown to have a positive impact on mental strength and well-being: treatments to increase self-esteem and improve functional coping show effect, such as a 24-session group module in which participants work on the sense of security, identity, belonging, purpose and competence (42-44). Treating dysfunctional beliefs by cognitive behavioral therapy can contribute to better functioning in patients with psychosis (45, 46). 6
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