Skip to main content Accessibility help

Longitudinal predictors of subjective recovery in psychosis

  • Heather Law (a1), Nick Shryane (a2), Richard P. Bentall (a3) and Anthony P. Morrison (a4)



Research has highlighted the importance of recovery as defined by the service user, and suggests a link to negative emotion, although little is known about the role of negative emotion in predicting subjective recovery.


To investigate longitudinal predictors of variability in recovery scores with a focus on the role of negative emotion.


Participants (n=110) with experience of psychosis completed measures of psychiatric symptoms, social functioning, subjective recovery, depression, hopelessness and self-esteem at baseline and 6 months later. Path analysis was used to examine predictive factors for recovery and negative emotion.


Subjective recovery scores were predicted by negative emotion, positive self-esteem and hopelessness, and to a lesser extent by symptoms and functioning. Current recovery score was not predicted by past recovery score after accounting for past symptoms, current hopelessness and current positive self-esteem.


Psychosocial factors and negative emotion appear to be the strongest longitudinal predictors of variation in subjective recovery, rather than psychiatric symptoms.


Corresponding author

Heather Law, Greater Manchester West Mental Health NHS Foundation Trust, Rico House c/o Harrop House, Bury New Road, Prestwich, Manchester M25 3BL, UK. Email:


Hide All

Declaration of interest




Hide All
1 National Institute for Health and Care Excellence. Psychosis and Schizophrenia in Adults: Treatment and Management (NICE clinical guideline CG178). NICE, 2014.
2 Torgalsboen, AK. Full recovery from schizophrenia: the prognostic role of premorbid adjustment, symptoms at first admission, precipitating events and gender. Psychiatr Res 1999; 88: 143–52.
3 Bellack, A. Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications. Schizophr Bull 2006; 32: 432–42.
4 Deegan, PE. Recovery: the lived experience of rehabilitation. Psychosoc Rehabil J 1988; 11: 11–9.
5 Pitt, L, Kilbride, M, Nothard, S, Welford, M, Morrison, AP. Researching recovery from psychosis: a user-led project. Psychiatr Bull 2007; 31: 5560.
6 Leete, E. How I perceive and manage my illness. Schizophr Bull 1989; 15: 197200.
7 Mead, S, Copeland, ME. What recovery means to us: consumers' perspectives. Community Ment Health J 2000; 36: 315–28.
8 Ridgeway, P. Restoring psychiatric disability: learning from first person recovery narratives. Psychiatr Rehab J 2001; 24: 335–43.
9 Morrison, AP, Shyrane, N, Beck, R, Heffernan, S, Law, H, McCusker, M, et al. Psychosocial and neuropsychiatric predictors of subjective recovery from psychosis. Psychiatr Res 2013; 208: 203–9.
10 Neil, ST, Kilbride, M, Pitt, L, Nothard, S, Welford, M, Sellwood, W, et al. The questionnaire about the process of recovery (QPR): a measurement tool developed in collaboration with service users. Psychosis 2009; 1: 145–55.
11 Law, H, Neil, ST, Dunn, G, Morrison, AP. Psychometric properties of the Questionnaire about the Process of Recovery (QPR). Schizophr Res 2014; 156: 184–9.
12 Kay, SR, Fiszbein, A, Opler, LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76.
13 Kay, SR, Opler, LA, Lindenmayer, JP. Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatr Res 1988; 23: 99110.
14 Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R. Development, reliability and acceptability of a new version of the DSM-IV Social Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 2000; 101: 323–9.
15 Kawata, AK, Revicki, DA. Psychometric properties of the Personal and Social Performance scale (PSP) among individuals with schizophrenia living in the community. Qual Life Res 2008; 17: 1247–56.
16 Hall, RCW. Global assessment of functioning: a modified scale. Psychosomatics 1995; 36: 267–75.
17 Addington, D, Addington, J, Schissel, B. A depression rating scale for schizophrenics. Schizophr Res 1990; 3: 247–51.
18 Beck, AT, Weissman, A, Lester, D, Trexler, L. The measurement of pessimism: the Hopelessness Scale. J Consult Clin Psychol 1974; 42: 861–5.
19 Nunn, KP, Lewin, TJ, Walton, M, Carr, VJ. The construction and characteristics of an instrument to measure personal hopefulness. Psychol Med 1996; 26: 531–45.
20 Dyce, JA. Factor structure of the Beck Hopelessness Scale. J Clin Psychol 1996; 52: 555–8.
21 Young, MA, Halper, IS, Clark, DC, Scheftner, W, Fawcett, J. An item-response theory evaluation of the Beck Hopelessness Scale. Cogn Ther Res 1992; 16: 579–87.
22 Lecomte, T, Corbiere, M, Laisne, F. Investigating self-esteem in individuals with schizophrenia: relevance of the self-esteem rating scale–short form. Psychiatr Res 2006; 143: 99108.
23 Juckel, G, Morosini, PL. The new approach: psychosocial functioning as a necessary outcome criterion for therapeutic success in schizophrenia. Curr Opin Psychiatry 2008; 21: 630–9.
24 Leamy, M, Bird, V, Le Boutillier, C, Williams, J, Slade, M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry 2011; 199: 445–52.
25 Oorschot, M, Lataster, T, Thewissen, V, Lardinois, M, van Os, J, Delespaul, PAEG, et al. Symptomatic remission in psychosis and real-life functioning. Br J Psychiatry 2012; 201: 215–20.
26 Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE. A cognitive model of the positive symptoms of psychosis. Psychol Med 2001; 31: 189–95.
27 Smith, B, Fowler, DG, Freeman, D, Bebbington, P, Bashforth, H, Garety, P, et al. Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophr Res 2006; 86: 181–8.
28 Freeman, D, Garety, PA. Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behav Res Ther 2003; 41: 923–47.
29 Barrowclough, C, Tarrier, N, Humphreys, L, Ward, J, Gregg, L, Andrews, B. Self-esteem in schizophrenia: relationships between self-evaluation, family attitudes, and symptomatology. J Abnorm Psychol 2003; 112: 92–9.
30 Krabbendam, L, Myin-Germeys, I, Hanssen, M, de Graaf, R, Vollebergh, W, Bak, M, et al. Development of depressed mood predicts onset of psychotic disorder in individuals who report hallucinatory experiences. Br J Clin Psychol 2005; 44: 113–25.
31 Hartley, S, Barrowclough, C, Haddock, G. Anxiety and depression in psychosis: a systematic review of associations with positive psychotic symptoms. Acta Psychiatr Scand 2013; 128: 327–46.
32 Goldstein, JM, Tsuang, MT, Faraone, SV. Gender and schizophrenia: implications for understanding the heterogeneity of the illness. Psychiatr Res 1989; 28: 243–53.
33 Nassar, EH, Walders, N, Jankins, JH. The experience of schizophrenia: what's gender got to do with it? A critical review of the current status of research on schizophrenia. Schizophr Bull 2002; 28: 351–62.
34 Rosen, K, Garety, P. Predicting recovery from schizophrenia: a retrospective comparison of characteristics at onset of people with single and multiple episodes. Schizophr Bull 2005; 31: 735–50.
35 Kim, CH, Jayathilake, K, Meltzer, HY. Hopelessness, neurocognitive function, and insight in schizophrenia: relationship to suicidal behavior. Schizophr Res 2003; 60: 7180.
36 Hall, PL, Tarrier, N. The cognitive–behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behav Res Ther 2003; 41: 317–32.
37 Lucksted, A, Drapalski, A, Calmes, C, Forbes, C, DeForge, B, Boyd, J. Ending self-stigma: pilot evaluation of a new intervention to reduce internalized stigma among people with mental illnesses. Psychiatr Rehab J 2011; 35: 51–4.
38 Birchwood, MJ, Trower, P. The future of cognitive–behavioural therapy for psychosis: not a quasi-neuroleptic. Br J Psychiatry 2006; 188: 107–8.
39 Foster, C, Startup, H, Potts, L, Freeman, D. A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. J Behav Ther Exp Psychiatry 2010; 41: 4551.
40 Hepworth, C, Startup, H, Freeman, D. Developing treatments of persistent persecutory delusions: the impact of an emotional processing and metacognitive awareness intervention. J Nerv Ment Dis 2011; 199: 653–8.
41 Freeman, D, Startup, H, Myers, E, Harvey, A, Geddes, J, Yu, LM, et al. The effects of using cognitive behavioural therapy to improve sleep for patients with delusions and hallucinations (the BEST study): study protocol for a randomized controlled trial. Trials 2013; 14: 214.
42 Myers, E, Startup, H, Freeman, D. Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions. J Behav Ther Exp Psychiatry 2011; 42: 330–6.
Type Description Title
Supplementary materials

Law et al. supplementary material
Supplementary Table S1-S3

 PDF (98 KB)
98 KB


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Longitudinal predictors of subjective recovery in psychosis

  • Heather Law (a1), Nick Shryane (a2), Richard P. Bentall (a3) and Anthony P. Morrison (a4)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *