Predicting engagement with services for psychosis: insight, symptoms and recovery style

Abstract

BackgroundTreatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.AimsWe examined whether insight, psychotic symptoms or individuals' recovery style (‘integration’ v. ‘sealing-over’) predicts service engagement.MethodFifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.ResultsSealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.ConclusionsRecovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.

The impact of thought disorder on therapeutic alliance and personal recovery in schizophrenia and schizoaffective disorder: An exploratory study

“…This interpretation is supported by evidence suggesting that patients who seal over are those who see greater loss and shame in their psychosis, motivating denial (Staring et al, 2014;Tait et al, 2003). In our study no significant association was found between thought disorder and patients' subjective experiences of recovery as measured by the RAS subscales.…”

Determinants of functioning and well-being among individuals with schizophrenia: An integrated model

“…Despite such findings, insight, as traditionally defined, has not always been related to either medication adherence (Trauer & Sacks, 2000), engagement in treatment (Tait, Birchwood, & Trower, 2003), or other beliefs about mental illness. In a cross-sectional study, Tait et al (2003) found that "recovery style, 1 " a construct that included the person's beliefs about the personal relevance of experiencing psychotic symptoms and whether the causes of symptoms are internal or external, predicted treatment engagement.…”

“…In a cross-sectional study, Tait et al (2003) found that "recovery style, 1 " a construct that included the person's beliefs about the personal relevance of experiencing psychotic symptoms and whether the causes of symptoms are internal or external, predicted treatment engagement. Individuals who took on a more "integrative" recovery style were more engaged in treatment; however, insight as traditionally defined was not associated with either recovery style or service engagement.…”

The Trauma and Life Events (TALE) checklist: development of a tool for improving routine screening in people with psychosis

“…However, trauma severity was not related to self-blame cognitions or negative symptom severity. The former may be explained by the self-blame items being less frequently endorsed compared to the negative self and world items, and the latter may be attributable to an avoidant or ‘sealed-over’ coping style, whereby people with negative symptoms may be less likely to disclose traumatic events (Tait, Birchwood, & Trower, 2003). This finding is also in line with a recent systematic review (Bailey, Alvarez-Jimenez, Garcia-Sanchez, Hulbert, Barlow & Bendall, 2018) that found only childhood neglect was associated with negative symptoms.…”