Wellness Recovery Action Plan® (WRAP®)
Wellness Recovery Action Plan® (WRAP®)
This is basically a personal journal where you keep information about yourself your disorder and your wishes so that you can learn from it and share from it if you need to when you are experiencing an episode. I am bipolar and I have created one but am not actively working in it now.
It helps to have a support group to work with and get feedback from.
I learned of this tool at the Training for the Future at the Center for Psychiatric Rehabilitation, Boston University. http://www.bu.edu/cpr/services/tftf/index.html
What follows are some links for other books and plans that are similar and a guide to develop your own WRAP
I found these resources independent of the BU program:
Pathways to Recovery: A Strengths Recovery Self-Help Workbook
By Priscilla Ridgeway, Diane McDiarmid, Lori Davidson, Julie Bayes and others,
The Recovery Workbook I: Practical Coping and Empowerment Strategies for People with Psychiatric Disabilities
By Leroy Spaniol, Martin Koehler and Dori Hutchinson
(with The Leader’s Guide: The Recovery Workbook and The Experience of Recovery),
Recovery and The Wellness Recovery Action Plan
By Mary Ellen Copeland,
The Recovery Workbook II: Connectedness
By LeRoy Spaniol, PhD, Richard Bellingham, EdD, Barry Cohen, PhD, and Susan Spaniol, EdD
(with The Leader’s Guide: The Recovery Workbook II and
Powerpoint® Presentation—The Recovery Workbook II: Connectedness) on this site:
This is the Self Advocacy and Empowerment Tool Kit:
Recovery Planner (English) FREE DOWNLOAD from South Carolina SHARE
This Recovery Planner is a quick and easy “workbook” that helps you think through some of your goals and areas you need help in. This booklet focuses on Change, Positive Self-Talk, Physical Health, Emotional/Mental Wellness, Stress, Substance Use, Living Space, Money, Down Time, Employment/Volunteer work, Education/Training, Relationships, Legal Issues, Spirituality, and Daily Routine.
As you begin this workbook we encourage you to work with a Mentor, case manager, doctor, or a trusted supporter. If you share it with the people who are helping you with your treatment plan, it will help you get the services and support you need to work on your recovery goals.
A wellness recovery action plan has six sections:
- A daily maintenance plan with three parts: a description of the person when they are well, the wellness tools to use every day to maintain wellness, and a list of regular daily activities.
- A list of events or triggers that might make the person feel worse—like an argument with a friend or getting a big bill—along with the wellness tools that can be used to deal with them.
- A list of the early warning signs, subtle signs that let a person know they are beginning to feel worse—like being unable to sleep or feelings of nervousness—along with an action plan for responding to these signs and to help the person feel better and avoid difficulties.
- A list of the signs that things are breaking down and the person is feeling much worse—like feeling sad all the time, or hearing voices—along with an action plan based on the wellness tools to help the person feel better and prevent an even more difficult time.
- Crisis plan or advance directive: A list of signs that let others know they need to take over responsibility for care and decision making including who takes over and supports through this time, health care information, a plan for staying at home through this time, things others can do that would help and things they might choose to do that would not be helpful. This kind of proactive advanced planning keeps the person in control even when it seems as though they are not.
- Post crisis plan: This part of the plan is thought out in advance of a crisis or as one begins to recover from the crisis—when there is a clearer picture of what needs to be done to get and stay well.
Guide to Developing a WRAP®: Wellness Recovery Action Plan®17
By Mary Ellen Copeland
The following is a list of supplies that are important to developing a WRAP®. While these items are suggested, only a writing utensil and paper is absolutely necessary.
1. A three-ring binder, one inch thick
2. A set of six dividers or tabs
3. A package of three ring filler paper; most people preferred lined
4. A writing instrument of some kind
5. A friend or other supporter to give you assistance and feedback (optional)
The three-ring binder should be divided into six sections; these sections or categories are listed below:
Section 1: Wellness Toolbox
• On the first tab, write “Wellness Toolbox.”
• On the first page, make a list of activities you do to stay well and feel better when you are not feeling well.
• Some common wellness tools are: taking a nap, exercising, eating three healthy meals per day and writing in a journal.
• Tools can be added and removed as you discover new activities you enjoy.
Section 2: Daily Maintenance List
• On the next tab, write “Daily Maintenance List” and insert it in the binder followed by several sheets of filler paper.
• On the first page, describe (in list form) yourself when you are feeling safe and healthy.
• On the next page, make a list of things you need to do for yourself every day to keep yourself feeling safe and well.
• On the next page, make a reminder list for things you might need to do to remain safe and healthy; reading through this list daily helps keep us on track.
Section 3: Triggers
Triggers are external events or circumstances that, if they occur, might produce serious symptoms that make you feel like you are in relapse. These are normal reactions to events in our lives, but if we do not respond to them and deal with them in some way, they might actually cause a worsening of our symptoms.
• On the next tab, write “Triggers” and put in several sheets of binder paper.
• On the first page, write down those things that, if they happened, might cause an increase in your symptoms. They may have triggered or increased symptoms in the past.
• On the next page, write an action plan to use if triggers come up, using the Wellness Toolbox at the end of this handout as a guide.
Section 4: Early Warning Signs
Early warning signs are internal and might be unrelated to reactions to stressful situations. In spite of our best efforts at reducing symptoms, we may begin to experience early warning signs, subtle signs of change that indicate we might need to take some further action.
• On the next tab write “Early Warning Signs”. On the first page of this section, make a list of early warning signs you have noticed.
• On the next page, write an action plan to use if early warning signs come up, using the Wellness Toolbox.
Section 5: Things Are Breaking Down
or Getting Worse
In spite of our best efforts, our symptoms might progress to the point where they are very uncomfortable, serious and even dangerous, but we are still able to take some action on our own behalf. This is a very important time. It is necessary to take immediate action to prevent a crisis.
• On the next tab write, “When Things are Breaking Down” and make a list of the symptoms which, for you, mean that things have worsened and are close to the crisis stage.
• On the next page, write an action plan to use “When Things are Breaking Down,” using the Wellness Toolbox.
Section 6: Crisis Planning
In spite of our best planning and assertive action, we may find ourselves in a crisis situation where others will need to take over responsibility for our care. We might feel like we are totally out of control.
Writing a crisis plan when you are well to instruct others about how to care for you when you are not well keeps you in control even when it seems like things are out of control. Others will know what to do, saving everyone time and frustration, while insuring that your needs will be met. Develop this plan slowly when you are feeling well. The crisis planning form includes space to write:
• Those symptoms that would indicate to others they need to take action in your behalf
• Who you would want to take this action.
• Medications you are currently taking, those that might help in a crisis and those that should be avoided.
• Treatments that you prefer and those that should be avoided.
• A workable plan for at home care.
• Acceptable and unacceptable treatment facilities.
• Actions that others can take that would be helpful.
• Actions that should be avoided.
• What my supporters should do if I am a danger to myself or separate instructions about when the plan no longer needs to be used.
Understanding Change Theory
Sometimes it is difficult for people to understand exactly where they are in their change process and what types of support and activities are most useful in helping them progress to the next stage. Prochaska and DiClemente developed the Stages of Change Theory Model to promote an understanding of the stages that a person goes through in moving from just thinking about something to taking action. They describe six stages of personal change and we adapt that model to help you understand what people may be feeling and why. Most importantly we identify things that you can do to help people empower themselves during their recovery journey.23
The term “relapse,” as used in the table below, includes any return to old behaviors that put people at risk for future involvement in the criminal justice system or that undermine their recovery. This includes failing to do the things that help them maintain recovery and personal wellness.
Regardless of what stage of change individuals are at in their recovery process, the Personal Narratives and this guide can help you identify strategies that may assist them in not just thinking about change, but actually taking action to successfully dealing with relapse.
If they are on parole, probation or participating in a jail diversion program, the consequences for these types of relapses are great. Therefore, it is important they fully understand the triggers that might lead them to relapse and to be proactive in taking responsibility for their overall wellness to reduce the likelihood of relapse and its negative consequences.
Although the speakers in the Personal Narratives emphasize that relapse is a natural part of the recovery process and can be a valuable learning experience, relapse is not inevitable.
Table 2. Adaptation of Prochaska and DiClemente’s Stages of Change Model
Stage of Change: Characteristics
Pre-contemplation: Not currently thinking about change
• Understand that the decision to change is yours
• Think carefully about your current behavior and its consequences
• Explore your life experiences and the impact they have on you and the decisions you make
Contemplation: Not really sure about change and what it means for you
• Understand that the decision to change is yours
• Think about the cost and benefits of not changing
• Set some new and positive goals for yourself
Preparation: You have made some changes and want to make more
• Identify and develop strategies for overcoming obstacles
• Identify and use supports
• Remember you have the skills to change
• Continue to take small steps
Action: Practicing new behavior
• Check in with supports about your progress
• Empower yourself to personally overcome obstacles and feelings of loss
Maintenance: Continued commitment to sustaining your new behavior
• Plan for follow-up support
• Reward yourself for your accomplishments
Relaspe: Resumption of old behaviors: “Fall from grace”
• Identify “triggers” for relapse
• Develop a plan for identifying stressors that lead to relapse and develop strategies for coping with them (WRAP® Plan is a good tool)
23 Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to addictive behavior. American Psychologist, 47(9): 1102-1114.
RECOVERY AS A JOURNEY OF THE HEART
Patricia Deegan, Ph.D., is a consultant with the National
Empowerment Center in Lawrence, MA. This article was originally
presented at a conference co-sponsored by the Alliance for
the Mentally Ill of Massachusetts& the Department of Mental
Health of Massachusetts Curriculum and Training Committee, and held at the Massachusetts State House on May 10, 1995.