A scientific agenda for the concept of recovery as it applies to Schizophrenia

University Behavioral HealthCare and Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, United States.
Clinical psychology review (Impact Factor: 7.18). 04/2008; 28(7):1108-24. DOI: 10.1016/j.cpr.2008.03.004
Source: PubMed


Recovery is now a widely discussed concept in the field of research, treatment, and public policy regarding schizophrenia. As it has increasingly become a focus in mainstream psychiatry, however, it has also become clear both that the concept is often used in multiple ways, and that it lacks a strong scientific basis. In this review, we argue that such a scientific basis is necessary for the concept of recovery to have a significant long-term impact on the way that schizophrenia is understood and treated. The discussion focuses on key issues necessary to establish this scientific agenda, including: 1) differences in definitions of recovery and their implications for studying recovery processes and outcomes; 2) key research questions; 3) the implications of data from outcome studies for understanding what is possible for people diagnosed with schizophrenia; 4) factors that facilitate recovery processes and outcomes, and methods for studying these issues; and 5) recovery-oriented treatment, including issues raised by peer support. Additional conceptual issues that have not received sufficient attention in the literature are then noted, including the role of evidence-based practices in recovery-oriented care, recovery-oriented care for elderly people with schizophrenia, trauma treatment and trauma-informed care, and the role of hospitals in recovery-oriented treatment. Consideration of these issues may help to organize approaches to the study of recovery, and in doing so, improve the impact of recovery-based initiatives.

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Available from: Steven Silverstein, Jun 03, 2015
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    • "A further limitation to the study was the measure of recovery itself. There is ongoing debate about what constitutes recovery, especially in psychosis (Silverstein and Bellack, 2008), and trying to measure this quantitatively may lack validity. The recovery movement was initially developed by service users and it has been argued that professionals have adopted the term and misunderstood its original meaning. "
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    ABSTRACT: Low social rank and external shame have been found to be significantly associated with anxiety and depression. However, their relevance to experiences of psychosis has rarely been explored. Aims: This study aims to examine the relationship of social rank and external shame to personal recovery, depression and positive symptoms in psychosis. Method: A cross sectional correlational design was adopted to examine the relationship between all variables. Fifty-two service users, aged between 18 to 65 years, with experiences of psychosis were recruited for the study. Participants were administered outcome measures examining social rank, external shame, positive symptoms of psychosis, depression and personal recovery. Multiple regression analyses were conducted on the data. Results: Significant correlations were found between all variables. Low social rank was significantly associated with lower reported personal recovery, and higher levels of external shame and depression symptomology. The relationship between external shame and positive symptoms of psychosis and personal recovery was found to be mediated by participants’ level of depression. Conclusion: Findings suggest that social rank and external shame are relevant to those who experience psychosis. Therapeutic approaches may need to focus on perceptions of social rank and external shame in working with experiences of psychosis.
    Behavioural and Cognitive Psychotherapy 08/2015; DOI:10.1017/S1352465815000570 · 1.69 Impact Factor
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    • "Researchers have suggested that recovery might be parsed into different domains. Resnick et al. (2004) and Silverstein and Bellack (2008), have proposed that recovery may involve objective phenomena, including the absence or remission of symptoms and psychosocial deficits and subjective phenomena, which involve changes in how persons feel about themselves. While research suggests that individuals with schizophrenia value subjective and objective domains of recovery (Kuhnigk et al., 2012), research concerning the relationship of objective and subjective domains of recovery has been equivocal. "
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    ABSTRACT: Recovery from schizophrenia involves both subjective elements such as self-appraised wellness and objective elements such as symptom remission. Less is known about how they interact. To explore this issue, this study examined the relationship over the course of 1 year of four assessments of symptoms with four assessments of self-reports of subjective aspects of recovery. Participants were 101 outpatients with schizophrenia. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) while subjective recovery was assessed with the Recovery Assessment Scale (RAS). Separate Pearson׳s or Spearman׳s rank׳s correlation coefficients, calculated at all four measurement points, revealed the total symptom score was linked with lower levels of overall self-recovery at all four measurement points. The PANSS emotional discomfort subscale was linked with self-reported recovery at all four measurement points. RAS subscales linked to PANSS total symptoms at every time point were Personal confidence and hope, Goal and success orientation, and No domination by symptoms. Results are consistent with conceptualizations of recovery as a complex process and suggest that while there may be identifiably different domains, changes in subjective and objective domains may influence one another. Published by Elsevier Ireland Ltd.
    03/2015; 228(1). DOI:10.1016/j.psychres.2015.03.013
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    • "Currently, NICE guidelines for psychosis offer anti-psychotics as first-line treatment with individualized Cognitive Behavioural Therapy (CBT) being offered secondary to this (NICE 2014), which is clearly at odds to the Open Dialogue approach . Moreover, the traditional medical approach which underpins our current services views mental health recovery as an individualised approach dependent on symptom change which is quite contradictory to the Open Dialogue approach (Silverstein and Bellack 2008). Open Dialogue will require a whole-systems collaborative approach to ensure that it is integrated meaningfully which will involve taking a step back from medical treatment. "
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    ABSTRACT: Open Dialogue is a model of mental health services that originated in Finland and has since, been taken up in trial teams worldwide. As this is a relatively unknown approach in the UK, it is important to tentatively explore perspectives of NHS staff and service-users. Sixty-one Open Dialogue conference attendees, both staff and service-users, were recruited for this study. A feedback questionnaire was administered to determine the extent to which they believed the key tenets of Open Dialogue were important to service user care, and the extent to which they existed within current NHS services. Analysis of data demonstrated a strong consensus on the importance of the key principles of Open Dialogue for mental health care and also moderate disagreement that these principles exist within current NHS service provision. The Open Dialogue principles may offer a useful framework in order to develop services in a clinically meaningful way.
    Community Mental Health Journal 02/2015; 51(8). DOI:10.1007/s10597-015-9849-5 · 1.03 Impact Factor
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