On the road to recovery: Addressing negative symptoms, cognitive deficits and environmental factors in residential patients with severe mental illness

Many patients with severe mental illness experience difficulties with adapting to the impact of their illness and with developing new meaning and purpose in life. This process of adapting to the consequences of the illness is called recovery. Patients in residential facilities often have stagnated recovery processes. This dissertation focusses on several aspects that hinder recovery processes in residential patients and the ability to follow a healthy lifestyle, namely negative symptoms (such as a lack of motivation or decreased engagement in social activities) and cognitive deficits (such as memory and the ability to plan). The research on negative symptoms confirms that negative symptoms can be divided into the negative symptom subdomains social amotivation and expressive deficits. Furthermore, it shows that the course of these domains fluctuates more than previously assumed and differentially relates to the course of functioning and quality of life. With regard to cognitive deficits, the pilot study on Cognitive Adaptation Training as a nursing intervention showed that everyday functioning can be improved by compensating for cognitive impairments. Finally, a lifestyle intervention, which primarily aims to reduce cardiometabolic risk factors by changing the obesogenic environment, was evaluated as to its effect on psychosocial well-being. In contrast to our expectations the intervention does not lead to improvements in psychosocial well-being, but the findings do give direction to future research. In conclusion, the studies presented in this thesis contribute to the development of the treatment of various aspects that stand in the way of recovery of residential patients.