167 General discussion data of recovery narratives could not be classified in the five themes of the CHIME framework. Therefore, the authors advocate for adding a category of ‘difficulties’ to CHIME, because a too optimistic view of recovery might blame individuals rather than empower them (35, 143). Also, more longitudinal research with frequent measurements should be done to better grasp the process of recovery, for instance with experience sampling methods (144, 145). Intervention studies to investigate the efficacy of specific therapeutic approaches, for instance Acceptance and Commitment Therapy, on personal recovery outcomes are also needed (146). Continuing research on which (clinical) factors are associated with personal recovery nevertheless stays important to find out which treatment strategies help best to promote recovery (147, 148). Collecting and studying narratives is crucial to identify core struggles in recovery and answer specific questions, for instance about stigmatization (149-155). Constructing a narrative identity, i.e. a person’s internal life story, can help to better understand the course of an individual’s mental illness and personal recovery (156-158). Going back to the framework presented in the general introduction of this thesis, it would be interesting for future research to investigate whether it is possible (and desirable) to identify profiles of recovery, to study if there are specific differences between them (159). In conceptualizing the research described in chapter 5, we tried to incorporate this idea of profiles, but found it difficult how to define a cut off score between recovered versus not recovered and hesitated whether it is valid to compare quantitatively defined group differences in the context of qualitative research. The idea of different profiles has been used before in research of clinical staging and profiling in psychosis (160). However, it appears that achieving reliability and validity of this concept is also difficult (161). Based on the findings in chapter 6, future research can focus on exploring the process and determinants of personal recovery in the general population to see if there are common factors. Within the psychosis spectrum, it would be interesting to see whether there are differences in experiences of recovery or helping interventions in different stages of illness (high risk, first episode, longer-term) and setting of treatment (inpatient/outpatient, acute/longer admission) (42, 90, 162-165). Prospective research, also taking into account the influence of shifts from one stage or one setting to another, can help to understand the longitudinal process of personal recovery better (166). Furthermore, this research needs to be done in a broad range of diagnoses, especially also in mood disorders, in line with the finding in this thesis of the impact of affective symptoms on personal recovery (167-172). 8
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