Understanding recovery in psychosis

This thesis explored conceptualisations of recovery, associated psychological factors and predictors, measurement of subjective recovery, and attitudes towards recovery. A multi-method approach was utilised, including reviewing evidence from the existing literature, cross-sectional, survey and longitudinal designs, and a computer based implicit association task. Chapter 1 provided a review of the literature, followed by an overview of the methodology employed throughout this thesis in chapter 2. Chapter 3 (study 1) included a user informed review of existing recovery measures. The Recovery Assessment Scale appeared to be the most valid and acceptable measure currently in use, although the Questionnaire about the Process of Recovery (QPR) received particularly positive feedback from service users, but lacked further psychometric validation. Consequently, chapter 4 (study 2, N=335) went on to explore the psychometric properties of the QPR. Exploratory factor analysis suggested a one factor model with high internal consistency, test re-test reliability and convergent validity. Recommendations for the use of the QPR in routine clinical practice was discussed. Chapter 5 (study 3, N=381) utilised the Delphi method to consult a large sample of service users about their views on recovery. A high level of consensus (>80%) was reached for a number of items on defining recovery, factors which help and hinder recovery and factors which show recovery. Implications for clinical practice and future research are discussed. Chapter 6 (study 4, N=110) examined longitudinal predictors of recovery. Negative emotion, positive self-esteem, hopelessness, and to a lesser extent symptoms and functioning predicted subjective recovery. Psychosocial factors and negative emotion appear to be the strongest longitudinal predictors of subjective recovery. Chapter 7 (study 5, N=146) used an online survey and computer task to explore attitudes towards recovery in health professionals and the general public. Explicit attitudes towards recovery were generally positive, with health professionals having significantly more positive attitudes than the general public group. Positive attitudes towards recovery were predicted by greater knowledge of recovery and a preference for psychosocial causal models of psychosis. Implications for focussing on psychosocial causal explanations in recovery training and awareness programmes for health professionals and the general public are discussed. This thesis has advanced our understanding of recovery by reaching consensus about what recovery means to individuals with experiences of psychosis, evaluating tools for measuring recovery and determining some of the key psychological processes and predictors of recovery, including causal beliefs, locus of control and negative emotion. These findings appear to fall into four main themes: conceptualising and defining recovery, measurement of recovery, relationships between psychological processes and recovery, and facilitating recovery. Further research is needed to explore recovery across the continuum of psychosis and investigate recovery focussed interventions which target the key psychological processes identified throughout this thesis.