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Table 1 Content of “Living well with bipolar disorder” and corresponding example exercises adapted for euthymic BD patients

From: B-positive: a randomized controlled trial of a multicomponent positive psychology intervention for euthymic patients with bipolar disorder - study protocol and intervention development

Module

Contents

Example (home) exercises

1. Introduction & compassion

▪ Participants are welcomed and become familiar with each other

▪ Psychoeducation about personal recovery and compassion

▪ Collective compassion exercise

▪ Homework: Fill in handout about personal goals and optimism

▪ Wish yourself something good: be mindful and identify needs and use your inner voice to repeat your compassionate wish [86].

▪ Common humanity: Realize that negative feelings and experiences are universal [87, 88].

2. Personal goals & optimism

▪ Based on the handouts, participants talk about personal goals and wishes and specify personal goals in the group

▪ Individually adjusting personal goals

▪ Collective optimism exercise

▪ Reading and discussing letter from an experienced person with BD

▪ Homework: Working on personal goals, writing a letter from the future

▪ Imagine your best possible self: Visualize yourself in a future where everything has turned out in the most optimal way [42, 89].

▪ Letter from the future: write yourself a letter from a future perspective

3. Positive emotions

▪ Read out letter from the future

▪ Psychoeducation about positive emotions

▪ Collective positive emotions exercises

▪ Homework: Taking a photo of a positive moment or experience, working on personal goals

▪ Three good things: Think about three good things that went well today and savor these moments [90].

▪ Expressing gratitude: identify what you are grateful for in the context of your illness and share those experiences [91].

4. Coping with fear of relapse

▪ Sharing photos of positive experiences and talking about the photos

▪ Talking about participant’s fears, how fear is experienced and internal barriers

▪ Psychoeducation about fear and (un)healthy emotion regulation strategies

▪ Collective exercises on how to efficiently cope with fear

▪ Homework: Do something you find exciting, perform personal strengths exercise, completing mid-treatment measurement

▪ Learn to tolerate and accept fear as important part of life and learn to regulate positive mood and gain a more open view towards them [43].

▪ Compassionate coping with inner fear: learn to be compassionate towards yourself, your emotions and your negative experiences [86].

5. Personal strengths

▪ Identifying strengths

▪ Psychoeducation about personal strengths

▪ Personal goals and strengths: which strengths can be used to achieve personal goals?

▪ Homework: Keep training with exercises, record possible benefits and barriers while performing the exercises

▪ Identifying strengths: Describe an activity you enjoy to someone else and he/she names strengths deriving from this activity.

▪ Top 5 strengths: Choose your top 5 strengths that give you energy and pleasure [92, 93].

6. Positive relationships

▪ Participants name skills they gathered in the course of the intervention so far and described one example from the last week

▪ Psychoeducation about positive relationships

▪ Participants describe a relationship they want to reinforce positively

▪ Collective positive relationship exercises

▪ Homework: Keep training with positive relationship exercises

▪ Acts of kindness: Performing unexpected acts of kindness for someone else [94].

▪ Active-constructive responding: Respond positively to good news shared by someone else. Use active communication skills [95, 96].

▪ Expressing gratitude [91].

7. Compassion

▪ Psychoeducation about emotional systems and evolutionary background

▪ Collective exercises mindfulness and compassion

▪ Coping with thoughts of inferiority and self-critique

▪ Homework: Writing a response to the letter from the second session, fill in questionnaires for post-measurement

▪ Develop a compassionate inner voice: Write about situation in the past week where you showed self-compassion [86].

▪ Grandma exercise: Imagine a person you feel comfortable with. Concentrate on how it feels to be together with this person and savor this moment [43].

8. Conclusion

▪ Talking about results of the questionnaires and figuring out which aspects are going well and which should receive some extra attention in the next weeks

▪ Read out response to the letter from the second sessions

▪ Participants thank each other

▪ Not applicable.