Electronic supplementary material
Participants, eligibility and screening
Randomization and treatment allocation
Intervention adjustments for euthymic BD patients
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 .
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 .
▪ Expressing gratitude: identify what you are grateful for in the context of your illness and share those experiences .
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 .
▪ Compassionate coping with inner fear: learn to be compassionate towards yourself, your emotions and your negative experiences .
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.
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 .
▪ Active-constructive responding: Respond positively to good news shared by someone else. Use active communication skills [95, 96].
▪ Expressing gratitude .
▪ 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 .
▪ Grandma exercise: Imagine a person you feel comfortable with. Concentrate on how it feels to be together with this person and savor this moment .
▪ 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.
Therapists training and treatment manual
Global illness severity
Dampening of positive affect
Quality of Life
Costs associated with psychiatric illness
Gender, age, education, marital status, living situation, ethnicity