A qualitative phenomenological analysis of the subjective experience and understanding of the at risk mental state

Abstract

Over recent years there has been a growing interest in identifying the early stages of psychosis. The At Risk Mental State (ARMS) is characteristic of the prodromal stages of psychosis and its identification gives rise to a number of clinical and research opportunities including early intervention and prevention of psychosis. This study employs interpretative phenomenological analysis to gain insights into the subjective experience and individuals understanding of the development of their ARMS. Five participants took part and provided information on the experience of symptoms, life prior to onset of their ARMS and their understanding of symptoms and their development through a semi structured interview. From the analysis of transcripts eight themes emerged which were common across participants accounts. Three themes of experience (disturbed world/disturbed self, disconnection with the world, thunderstruck) and five themes of understanding (absence of understanding, use of others, identity, forming links, fragmented understanding) were identified. Themes are explored in detail and discussed in relation to existing literature and theory. Clinical implications, directions for future research, and limitations are discussed within.

A qualitative study on identity in individuals at clinical high risk for psychosis: “ … Why does it have to be one thing?”.

“…Although the majority of individuals did not define their self-concept in regard to their mental health, some participants discussed how mental health symptoms influenced their self-concept while other participants discussed how mental health experiences have changed them. These latter findings align with past research demonstrating the potential impact of mental health symptoms, stigma, and transitional events on one’s identity (Brew et al, 2017; Lally, 1989), and deserve further consideration in future research with individuals at CHR.…”

“…Given the emerging research in this area, no a priori hypotheses were made, and phenomenological procedures were used to develop themes. In our Conclusions section, we compare and contrast our findings to prior, formative phenomenological work with individuals at CHR (Ben-David et al, 2014;Brew et al, 2017). Data from similarly aged healthy controls (HCs) were also assessed for comparison.…”

“…In a recent narrative review of studies (Ben-David & Kealy, 2020), only 1 of 17 studies was identified that summarized findings related to personal identity among individuals at CHR. In this Irish study of five individuals at CHR (Brew et al, 2017), the authors used a semistructured interview to probe about experiences and understanding of symptoms, and life before the onset of the CHR state. The identity theme that emerged in this study related to participants’ struggles to differentiate between their symptoms and their identity, with participants incorporating various explanations for their symptoms, such as personality, genetics, and being an adolescent.…”

The duration of untreated psychosis: a phenomenological study

“…Within the TSD, psychotic experiences had the unique characteristics of being frightening and/or perplexing, as well as catalysts for further distressing events such as hospitalization and/or legal difficulties. These findings mirror recent phenomenological studies of both attenuated or prodromal symptoms (Brew, Shannon, Storey, Boyd, & Mulholland, 2017; Hu, 2017) and FEP (Cabassa et al, 2018; Hansen, Stige, Davidson, Moltu, & Veseth, 2018), which have indicated that young adults struggle to understand anomalous experiences that initially seem unfamiliar.…”

Recovery and self-identity development following a first episode of psychosis

“…Fowler et al , 2018; Ochoa et al , 2017), further attention has been paid to understanding the subjective experience of first episode psychosis (Boydell et al , 2010; Windell et al , 2015). Gaining an understanding of how adolescents make sense of their experiences of psychosis allows service providers to gain a deeper insight into how best to engage and support them (Brew et al , 2017). Researchers investigating the prodromal period using in-depth interviews with adolescents have identified a wide range of symptoms and behaviours including sleep difficulties, anxiety, problems with concentration, racing thoughts and social withdrawal (Corcoran et al , 2003; MacBeth et al , 2014; McCarthy-Jones et al , 2012).…”