Abstract

Objective
The Wellness Recovery Action Plan (WRAP) is a structured approach to illness self-management that is widely used within mental health services. This systematic review identifies, appraises, and meta-analyses quantitative evidence from experimental or quasi-experimental comparison group designs for effects of WRAP on measures reflecting personal recovery and clinical symptomatology.

Methods
A systematic strategy was used to search six electronic reference databases (Medline, CINAHL, EMBASE, PsycINFO, PsycArticles, The Cochrane Library) using full-text, keywords, and Medical Subject Headings (MeSh)/Thesaurus headings terms. Unpublished research was identified using the same strategy in the EThOS database. Controlled trials of WRAP were selected and assessed for quality. Meta-analyses were applied to quantitative data to establish the effects of WRAP on outcomes of interest.

Results
Of 253 studies initially identified, five quantitative studies (reported in six papers) reporting controlled trials were included in the review. Meta-analyses revealed that, relative to inactive control conditions, WRAP was (1) superior for promoting self-perceived recovery outcomes (demonstrating a small-but-significant pooled effect), but (2) not superior for reducing clinical symptomatology – although restriction to randomised-controlled trials revealed one small effect favoring WRAP for reducing depression.

Conclusions and Implications for Practice
Participation in WRAP has positive outcomes for participants, quantifiable using comprehensive measures of self-perceived recovery. Improvements were not sustained over time. Future research could explore this, as well as potential effects of follow-up WRAP sessions. The results support a move to broader measurement of outcomes within mental health, away from a reliance on clinical outcome measures. Recommendations for further research are made.