Chapter 4 88 One program for promoting recovery is Illness Management and Recovery (IMR), a curriculum-based psychosocial program for people with SMI that is intended to improve various aspects of illness management and self-management; and also by helping participants to set and achieve personal goals. Its overall purpose is to foster clinical recovery and to support personal and functional recovery. The development of IMR was based on an empirical review of the research literature on teaching illness self-management strategies to people with SMI. In this review, five empirically supported strategies were distinguished: psychoeducation on SMI and its treatment, cognitive-behavioral techniques to medication adherence, developing a relapse prevention plan, enhancing social support by social skills training, and coping skills training for controlling persistent symptoms. Those five illness management strategies were integrated into the IMR program (12, 23). The theoretical foundation of IMR rests on two models. The first, the trans-theoretical model, holds that people are more motivated to acquire new behavior if the types of intervention are adjusted to the stage of change, they are in (24–25). The second model is the stress-vulnerability model, which holds not only that mental health problems originate from the interaction between biological vulnerability and sources of stress in the environment, but also that people differ in their coping ability (12, 26–27). The aim of our main study, a randomized clinical trial (RCT) on IMR, is to determine the effectiveness of the IMR program in people with SMI as described in our protocol (28). The design is to compare the effects of “IMR + Care as Usual (CAU)” with those of “CAU only” on illness management constituents and on the three types of recovery mentioned. Measurement was planned to take place before randomization and at 12 and 18 months after randomization. Generalized linear mixed models (GLMM) are used to investigate group differences between the experimental and control conditions over an 18-month period, including a 12-month treatment period and a 6 month follow-up period. The working mechanisms of IMR are suggested in a conceptual framework in which better illness management leads to better clinical recovery, and better clinical recovery leads to more personal and functional recovery, see S1 Fig (12, 28). For the present cross-sectional study, we used the data of all 187 people who participated in the baseline measurement of our RCT on IMR. Aim of this analysis is to seek empirical support for any relationships between the concepts suggested in this conceptual framework, but without the input of the IMR-program. We used structural equation modeling (SEM) to develop a recovery-path model based on the direct and indirect associations proposed in this framework. This considers the associations between various components of illness management and the degree
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