160 Chapter 8 higher depression and anxiety symptom severity predicts higher personal recovery after three years, can mean that treatment of affective symptoms has more potential to make a change concerning personal recovery, than treating psychotic symptoms in this patient group with a long duration of illness. The impact of clinical treatment interventions on personal recovery Chapter 5 illustrates the heterogeneity of the perceived consequences of clinical treatment interventions for personal recovery of patients with severe mental illness, which is in line with the variety in the quantitative change of symptoms and personal recovery found earlier. It already starts with getting a diagnosis, that can lead to relief, but also to stigma. Accepting a diagnosis can be important for recovery (22). The impact of stigma on quality of life, well-being and personal recovery has already been reported frequently in literature (23-26). Furthermore, medication has positive effect on symptoms, but especially the side-effects can cause substantial impairment. An earlier study found that an emphasis on medication by mental health care workers seems to hinder personal recovery (27). Taking antipsychotics can have diverging consequences on identity and sense of self (28). The lived experience of recovery with antipsychotics differs greatly per patient (29). Studies are already undertaken to explore the effect of dose-reduction/discontinuation strategies on clinical and personal recovery (30). Hospitalization was in our study sometimes, in hindsight, perceived as a turning point in a positive way, but others mentioned that recovery-oriented care could lack in an acute clinical setting. This is in line with findings that acute hospitalization can bring tranquility (31), but does not quickly change personal recovery, although clinical symptoms improve (32). So, personal recovery might be more of a longitudinal process with ups and downs. Coercive measures were perceived as negatively influencing autonomy by some, but others mentioned feelings of safety and agreed they could not have decided by themselves. Existing literature stresses that professionals should be aware that leverages and coercion can lead to shame, self-contempt and stigma stress (33, 34). Slade argues that a focus on clinical recovery can lead to increasingly coercive approaches to reduce symptoms, such as medication compliance. But, if autonomy and self-determination are primary goals, compulsion can be more individualized, such as gradual transfer of control, based on re-obtaining decision-making capacity (13). Lastly, psychological interventions were perceived as beneficial by the participants of our qualitative study. Personal recovery suits us all Given the conceptual idea that personal recovery is transdiagnostic and even transcends illness and disability, it is informative to know whether common factors are associated with personal recovery in patients and non-patients (35, 36). Chapter 6 reports on the association between personal recovery on the one hand and
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