Effects of IMR: a randomized controlled trial 125 insight, and addiction. Although the IMR scales capture the overall changes in these components, IMR training may have insufficient specificity for generating meaningful effects on individual measures within these separate domains. Additionally, as compared with the control group, the intervention group showed a greater improvement in self-esteem. This positive outcome is supported by the findings for the sensitivity analysis among IMR completers. Compared with the control group, IMR completers had superior outcomes with respect to self-esteem and the MHRM score, a composite measure of personal recovery. These combined results indicate the potential efficacy of IMR with respect to personal recovery. In contrast, the IMR intervention did not show a statistically significant effect on psychiatric symptoms. This is consistent with the findings of a recent meta-analysis that indicated a small to moderate association between clinical and personal recovery in patients with schizophrenia-spectrum disorders (15). Furthermore, clinical recovery does not appear to be necessary for personal recovery (11, 15). Previous studies have confirmed the relevance of improvement in personal recovery by demonstrating the importance of the therapeutic benefits of managing mental illness, which facilitates personal well-being and self-perceived growth. Additionally, studies have highlighted the value of living a satisfying life despite the presence of enduring symptoms (13, 19, 65, 66). Therefore, changes should be measured based on both symptomatology and consumer defined recovery (5, 20, 65, 67). Apart from symptoms (13), loss of self-esteem is considered to greatly affect the life and self-image of patients with schizophrenia (53, 57, 68). The concept of self-esteem corresponds with the concept of identity (i.e., a positive sense of self), which is one of the five processes within the CHIME conceptual framework of personal recovery (20). The impact of fidelity was analyzed within the two scales, revealing statistically significant outcomes in the intention-to-treat analysis. There was no effect of fidelity with respect to the client version of the IMR scale. However, the fidelity of IMR training affected SERS-SF scores. This suggests that fidelity is relevant to the effectiveness of IMR with respect to self-esteem. However, there is a need to further research the predictive validity of the IMR fidelity scale within high-powered gold-standard investigations.
RkJQdWJsaXNoZXIy MjY0ODMw