A Naturalistic Study of Time to Recovery in Adults with Treatment-refractory Disorders

Abstract

Individuals with treatment-refractory disorders have high comorbidity. There is little information on whether recovery is possible and how long it might require. We focused on the individual's recovery using a broad measure of psychopathology, regardless of the variety of disorders present. Methods: We recruited 226 adults [mean age 31.0, SD = 10.3; 75.2% female] entering residential treatment for treatment-refractory disorders to delineate their course and outcome. Individuals received periodic Longitudinal Interval Follow-along Evaluation interviews for symptoms and functioning variables for up to 14 years. Periodic psychodynamic and relationship vignette interviews were rated with the Psychodynamic Conflict Rating Scales (PCRS) for a subgroup of 54 subjects. Outcome variables included modeled rates of change, final scores, time to recovery, and time to attaining healthy adaptive functioning, using Kaplan-Meier estimates from time-to-event analyses. Results: Recovery of PCRS Pathological Functioning occurred in 12 (22%) of 54 subjects rated: median time-to-recovery = 11.63 years (CI: 9.64-upper number not calculable). Eight (14.81%) subjects also developed healthy adaptive functioning, with the time-to-attainment for the first quartile at 10.95 years (CI: 7.87 -upper bound not calculable). Recovery from psychopathology was significantly associated with a median percentage recovered in the domains of symptoms (64.29%), functioning (87.50%), and psychodynamic functioning (50%). Although attaining healthy adaptive functioning was less common, it was highly associated with already achieving recovery from dynamic psychopathology, [OR = 57.40, CI 5.80 -567.83, p = .0001].

Do Patients With Treatment-resistant Disorders Recover?

“…Perry and Fowler studied change over time in terms of multiple familiar measures of symptoms, social adjustment, global functioning, and overall life satisfaction, but also measured psychodynamic change using the Psychodynamic Conflict Rating Scales as their main measure. 12,13 The larger 226-patient sample and the 54-patient subgroup with enough completed ratings to allow determination of progress over time did not differ on multiple relevant measures. The subgroup consisted primarily of young adults (average age ∼33 y), who were women (∼80%), and never married (∼57%), with 5 lifetime and 4 current psychiatric diagnoses at study intake, with mood, anxiety, and substance use disorders predominant, and 72% with 1 or more personality disorders.…”

“…Now, in a new paper, Perry and Fowler12 offer further evidence from a naturalistic prospective study that patients with previously treatment-resistant disorders can achieve full recovery. Their paper explores time to recovery in a subgroup of 54 of a total of 226 adults with treatment-refractory illness treated in the Austen Riggs Center continuum of care for an average of about 10 months, who then continued treatment after discharge and were followed for up to 14 years.…”

Harnessing the Synergy Between Mindfulness and Psychotherapy

“…The patients at Riggs generally present with complex disorders that include comorbid severe personality disorders. 25 All of the patients are in individual, 4 times weekly psychodynamic psychotherapy and live in a therapeutic community designed to support interpersonal learning and the acquisition of interpersonal skills and competencies. The therapeutic community is also designed as an antidote to passivity and over-identification with the "patient identity."…”

“…Recognizing the potential of mindfulness to support the work of intensive psychotherapy, clinicians at the psychodynamic Austen Riggs Center created a Mindful Approaches to Coping Skills Group. The patients at Riggs generally present with complex disorders that include comorbid severe personality disorders 25. All of the patients are in individual, 4 times weekly psychodynamic psychotherapy and live in a therapeutic community designed to support interpersonal learning and the acquisition of interpersonal skills and competencies.…”

Longitudinal stability of Social Cognition and Object Relations Scale—Global Rating Method dimensional ratings, score ranges and narrative ‘blandness’ in a clinical sample

“…Given the overall clinical severity of our sample, we hypothesized that participants would show greater consistency across dimensions compared to clinical samples with lower severity of psychopathology (e.g., Knekt et al, 2017; Rush et al, 2006). Moreover, a recent study on patients at this long‐term residential facility (Perry & Fowler, 2021) found that recovery can be a long and arduous process that takes years if not decades. As a result, we would expect that changes in mean dimensional scores would be modest over the course of an 18‐month period.…”