New Study Finds WRAP Intervention Reduces Depression, Anxiety
Mental Health Weekly June 11, 2012
Researchers examining a widely recognized illness self-management intervention that promotes healthy living found that the program has helped reduce depression and anxiety for consumers with serious mental illness, according to a new study appearing in the June issue of Psychiatric Services.
The Wellness Recovery Action Plan (WRAP), an evidence-based, recovery-oriented intervention, helps participants identify personal wellness resources and how to use them in daily living, as well as deal with symptom triggers, early warning signs of illness exacerbation, and crisis periods. WRAP groups are facilitated by trained peers recovering from mental illness and certified as educators.
Though WRAP is widely disseminated around the country and its growth rapid since its 1997 implementation, the current study is the first randomized controlled trial demonstrating conclusively that the program has a positive and sustained impact on feelings of depression and anxiety, according to researchers.
In the current study, researchers studied the effectiveness of WRAP in reducing depression and anxiety and in increasing self-perceived recovery among individuals with a serious mental illness. “In this study we looked at various aspects of recovery,” Mary Ellen Copeland, Ph.D., founder of the Copeland Center for Wellness and Recovery, and considered the “architect” of the WRAP program, told MHW.
“It gives people a sense of hope and helps them with the ability to advocate for themselves, said Copeland.”
The WRAP program initially was coordinated by a group of individuals struggling with their own mental health challenges, said Copeland. “The WRAP program evolved from a grassroots effort,” said Copeland, coauthor of the study. “It doesn’t involve government or pharmaceutical funding.” Program facilitators charge for some services and accept donations, she said.
Many WRAP participants in general tend to exercise more and are in better health physically, said Copeland. “They can also educate themselves and make good decisions about Medicaid and about their treatment issues,” she added.
The positive outcomes of the WRAP program are no surprise to Copeland. “Over the years we’ve received a lot of anecdotal stories about [positive outcomes] but we needed research to show that,” she said.
The program has an international reach as well. The Wellness Recovery Action Plan and other WRAP implementation materials have been translated into many languages, including Chinese, French, Japanese, Polish, and Spanish.
Researchers conducted a singleblind, randomized controlled trial involving 519 individuals from outpatient community mental health settings in six Ohio communities. The participants were assigned to WRAP or to services as usual and assessed at baseline and at two-and eight-month follow-ups. The WRAP intervention consisted of eight weekly 2.5-hour sessions delivered. The mean number of WRAP sessions was five and fidelity ranged from 90 percent to 92 percent, the study stated.
Compared with the control group, intervention participants reported significantly greater improvement over time in Brief Symptom Inventory depression and anxiety subscales. The WRAP participants also showed significantly greater improvements in total Recovery Assessment Scale scores as well as the subscales measuring personal confidence and goal orientation.
According to the study, symptom severity continued to decrease among WRAP participants for six months after the intervention. The greater the participants’ exposure to WRAP the more they improved on depression and anxiety symptom severity and self-perceived recovery, said researchers.
The WRAP classes ranged in size from five to 12 participants and were taught in accessible community settings, free of charge. Content included lectures, individual and group exercises, discussions and person examples from the lives of participants and educators.
The participants participated in a number of WRAP components including:
- Creating a daily maintenance plan to stay emotionally and physically healthy.
- Learning about specific personal triggers for negative thoughts and feelings.
- Becoming aware of identifying early warning signs of sad or anxious feelings along with targeted coping strategies.
- Creating detailed plans for dealing with crises and postcrisis adjustment.
WRAP helps to extend, promote and maintain people’s recovery, Judith Cook, Ph.D., professor of psychiatry in the Department of Psychiatry at the University of Illinois at Chicago and lead author, told MHW. “Although the WRAP program has been around for some time, it’s taken awhile before researchers caught on,” said Cook. The program’s success is built on consumers being “put in touch with their own ability to be the source of their own wellness,” she said. “It’s helping them develop a daily plan.”
The study confirmed WRAP as part of a group of evidence-based, recovery-oriented interventions, said Cook. The program is part of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Registry of Evidence Based Programs and Practices (NREPP), she said.
“It’s great news to know that this is an evidence-based practice that can [help consumers with serious mental illness] increase hopefulness, increase the quality of their life, and help in their ability to talk to health care providers and negotiate and not be passive,” she said. “That’s the name of the game right now; that desire to engage people.”
For community mental health providers, the WRAP program provides a good addition to the services their clients are already receiving, said Cook. “There has to be a plan for them to stay well once they are emotionally well,” she said. The program can help support a consumer’s recovery once they’re no longer receiving formal services from a provider, when their problems are more under control, she said.
WRAP’s focus on enhancing competence, relatedness, and autonomy - processes that have been shown to improve health outcomes for chronic illnesses and conditions such as diabetes, obesity, and nicotine dependence - has much to offer the field of recovery as it expands and develops, wrote researchers.