Effects of IMR: a randomized controlled trial 115 Coping with Stress, Coping with Persistent Symptoms, Getting Your Needs Met in the Mental-Health System, and Healthy Lifestyles (56). The original American text was translated into Dutch and was adapted to the Dutch context as appropriate. Each group of patients who received IMR was guided by two trainers, who used a combination of motivation enhancement strategies (including conveying confidence and exploring the pros and cons of change), educational strategies (including interactive teaching, breaking down information, and checking for understanding), and cognitive-behavioral techniques (including shaping, modeling, and role-playing) (3). Peer-group support, coping, and social skills training are key IMR elements. Workbooks and homework assignments were accessible through an e-health module (6). During the first module—Recovery Strategies—the participants identified their personal goals during the program. For half of each session, some participants worked toward these goals. During the other half of each session, all participants worked on the module subjects with the help of the handouts. Our pilot study demonstrated that completing the modules required an average of three to four sessions (55). IMR was mostly provided by mental health nurses or social workers, recruited from among the group of case managers in the CMHC teams who were interested in providing the IMR intervention. All case managers were given the opportunity to provide IMR. Most case managers had years of professional experience and had previously been trained in psychiatric rehabilitation methodologies, including the Boston University Approach to Psychiatric Rehabilitation (57). As part of the institutes’ regular quality care program, all IMR trainers underwent two days of training in IMR and underwent additional four-hour training sessions twice annually. The IMR trainers underwent two hours of group supervision by a senior counselor at two-week intervals. Statistical Analysis Based on the effect sizes observed in the three RCTs on IMR published at the time of designing the current study (21–23), we anticipated a moderate effect size of 0.40 with respect to the primary outcome variable (i.e., the self-rated IMR scale) (41, 42). Based on power analyses with three measurement times (mixed models), equal allocation to the experimental and control groups, a power of 0.80, alpha set at 0.05, and an effect size of 0.40, we determined that it would be necessary to randomize 148 clients: 74 to the experimental condition and 74 to the CAU control group (6, 58, 59). Due to the planned 3:2 randomization we aimed for 111 participants (74 × 3:2) in the experimental condition.
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