Recovery style from mental illness and long-term outcome.
Abstract
Integration and sealing over have been identified as clinically distinct recovery styles from schizophrenia. Specific definitions and scales of these styles were applied reliably to 231 patients from the Chestnut Lodge follow-up study at long-term outcome (15 year average). Data were analyzed for the entire sample and for diagnostic subgroups: schizophrenia, schizoaffective and unipolar affective disorders, and schizotypal and borderline personality disorders. Results find that integration and sealing over are strongly correlated with functional outcome. While linked somewhat to type of psychopathology, these styles are best conceived as enduring personality trait characteristics in the nature of predictors.
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Meaning-making styles in psychosis are not static but can change over time.
“meaning-making styles in psychosis are not static but can change over time (58–61).”
From Making meaning of trauma in psychosis (2023) · cites this paper as [58]
A recovery style directed at turning toward and integrating experiences predicts better long-term functioning.
“a recovery style directed at turning toward and integrating experiences predicts better functioning on the long term”
From Making meaning of trauma in psychosis (2023) · cites this paper as [58]
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“High levels of systematic covariance (comorbidity) are seen not only within, but also across Axes I and II (Fabrega et al., 1992; McGlashan, 1987; Skodol et al., 1999).”
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“Furthermore, the conceptualisation of integration and sealing-over suggests that they represent enduring personality trait characteristics (McGlashan, 1987), which implies that they are more or less stable over time.”
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“In contrast to earlier views of recovery style as a stable trait characteristic (e.g. McGlashan, 1987), recent evidence suggests that recovery style can change over time; integration style changing to sealing over during adjustment to psychosis, and vice versa (Jackson et al, 1998; Tait et al,…”
BackgroundResultLack of Insight in Schizophrenia
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“Sealing-over of psychotic phenomena (178) is a challenge in a field, where assessment of pathology predominantly relies on the report of subjective experience.”
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“Although this sealing over may be initially adaptive, in the longer term, it may be associated with worse outcomes (McGlashan, 1987).”
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“The RSQ was developed as a brief self-report form of McGlashan’s [67] Integration Sealing Over Scale (ISOS).”
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“A recent literature review and empirical study found that several aspects of the health belief model 1The construct of “recovery style” was originated by McGlashan (1987), who distinguished between “integration” and “sealing over,” and characterized them as “coping styles.””
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“Different ways of coping with psychosis may represent strategies identified as ‘‘integrating’’ or ‘‘sealing over’’ (McGlashen, 1984, 1987; McGlashen & Carpenter, 1976; McGlashen et al., 1975).”
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McGorry, P. D., & Sb, M. (1999) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(99)90117-7 · Cited by 90 · see citing works
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“This finding was mediated by diagnosis, as patients with schizophrenia tended towards a sealing-over approach (McGlashan, 1987).”
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Jackson, C., Knott, C., Skeate, A., & Birchwood, M. J. (2004) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2004.01359.x · Cited by 77 · see citing works
“Recovery Style Questionnaire (RSQ) [25] is a 39 item self-report measure of McGlashan’s [26] ‘integration’ versus ‘sealing over’ styles of adaptation to psychotic illness.”
BackgroundLongden, E., Corstens, D., Escher, S., & Romme, M. (2012) · Psychosis · doi:10.1080/17522439.2011.596566 · Cited by 94 · see citing works
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“Individuals with a more integrated recovery style may have more positive clinical and functional outcomes (McGlashan, 1987; Staring et al., 2011).”
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“This recovery style has been associated with improved outcome and social functioning (McGlashan 1987; Tait et al. 2003).”
BackgroundDiagnosis and treatment of schizotypal personality disorder: evidence from a systematic review
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“, 2000), and integrating versus sealing over illness related experiences (McGlashan, 1987).”
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What do psychotic experiences mean for young men? A qualitative investigation
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“This might also reflect an attempt of patients to get rid of their illness by “sealing it over” (McGlashan, 1987).”
BackgroundReshaping an enduring sense of self: the process of recovery from a first episode of schizophrenia
Romano, D. M., McCay, E. A., Goering, P. N., Boydell, K., & Zipursky, R. B. (2010) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2010.00187.x · Cited by 53 · see citing works
“The study by McGlashan (1987) examined the recovery style from mental illness and long-term outcome, whereby there was some effort made to assess how patients viewed their illness experience.”
BackgroundInfluentialSUBJECTIVE ILLNESS THEORY AND ANTIPSYCHOTIC MEDICATION COMPLIANCE BY PATIENTS WITH SCHIZOPHRENIA
Holzinger, A., Löffler, W., MÜLLER, P., Priebe, S., & Angermeyer, M. C. (2002) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-200209000-00004 · Cited by 67 · see citing works
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“Integration Sealing-Over Scale (ISOS; McGlashan, 1987) was used by clinicians to evaluate their”
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“Research into recovery in psychosis has shown that people with a diagnosis of schizophrenia often use avoidance coping strategies rather than problem-focused ones [11, 16, 17, 49].”
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Gumley, A. I. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2011.09.025 · Cited by 37 · see citing works
“Sealing over is associated with poorer outcome over 15year follow-up (McGlashan, 1987).”
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“The RSQ has been evaluated as a valid measure of recovery style according to the original concept [49,69].”
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“There is evidence to suggest that individuals recovering from psychosis adopt either an integrative or a ‘sealing-over’ recovery style (McGlashan 1987; Tait 2003).”
BackgroundO'Donoghue, B. N., Lyne, J., Hill, M. B., O’Rourke, L., Daly, S., Larkin, C., Feeney, L., & O’Callaghan, E. (2011) · Journal of Mental Health · doi:10.3109/09638237.2011.562263 · Cited by 33 · see citing works
“On the other hand, individuals with an integrative recovery style have better outcomes and functioning at one year after a psychotic episode (McGlashan, 1987; Thompson et al., 2003).”
BackgroundGrief and Mourning in Schizophrenia
Wittmann, D. A., & Keshavan, M. S. (2007) · Psychiatry · doi:10.1521/psyc.2007.70.2.154 · Cited by 32 · see citing works
“They are also associated with a greater likelihood of depression, suggesting that patients are driven to unhappiness, perhaps despair, by recognizing the effect that the illness will have on their lives (McGlashan, 1987).”
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“approaches their psychotic experiences with curiosity and interest, to a sealing over style in which they are encapsulate their psychosis and see it as separate [70].”
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“The RSQ is based on and is a further development of the Integration/Sealing Over Scale (ISOS) [8].”
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““Integrators” are more likely to see their psychotic experience as something that is part of them, has arisen from their life context, which they are responsible for, and may be used as a source of information about themselves, conflicts, relationships and behaviour (McGlashan, 1987).”
BackgroundInfluentialHyperactivity of Associations in Psychosis
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“One theory closely related to such a conceptualization was developed by McGlashan and his colleagues (McGlashan et al., 1975; McGlashan, 1987), who suggested that patients vary in their ways of coping with psychotic episodes and the conse- quences of having developed serious mental disorders.”
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Corigliano, V., Comparelli, A., Mancinelli, I., Montalbani, B., Lamis, D. A., Carolis, A. D., Erbuto, D., Girardi, P., & Pompili, M. (2018) · Schizophrenia Research and Treatment · doi:10.1155/2018/4834135 · Cited by 23 · see citing works
COGNITIVE THERAPY FOR PREVENTING TRANSITION TO PSYCHOSIS IN HIGH RISK INDIVIDUALS: A CASE SERIES
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“He therefore displayed evidence of the sealing over coping style described by McGlashan (1987). John was eventually seen for 14 treatment sessions.”
BackgroundSilva, B., Bachelard, M., Bonsack, C., Golay, P., & Morandi, S. (2023) · Psychiatric Quarterly · doi:10.1007/s11126-023-10039-6 · Cited by 22 · see citing works
“On the contrary, when the experience is perceived as extraneous and meaningless, the associated feeling of coercion grow and foster a ‘sealing over’ recovery strategy characterised by avoidance and denial [53, 69].”
BackgroundCorrelates of Coping Styles in Psychotic Illness
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“Conversely, patients who seal over during the recovery process subjectively experience their illness as something external and beyond their control (McGlashan, 1987).”
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“This perspective has been supported by empirical evidence around the globe for decades (DeSisto, Harding, McCormick, Ashikaga, & Brooks, 1995; Fisher & Ahern, 1999; Harding, 2004, McGlashan, 1987).”
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“aims to facilitate the processing of thoughts and feelings that have previously been inhibited or avoided” (Pennebaker & Beall, 1986), which is a feature of psychosis, due to psychological (McGlashan, 1987) and social”
BackgroundTherapeutic factors and insight in group therapy for outpatients diagnosed with schizophrenia
García‐Cabeza, I., & de Chávez, M. G. (2009) · Psychosis · doi:10.1080/17522430902770058 · Cited by 13 · see citing works
“1984 ; McGlashan, 1987 , Strauss et al, 1980 ; Ugelstad, 1965 ).”
BackgroundRecovery style and stigma in psychosis: the healing power of integrating
Espinosa, R., Valiente, C., Rigabert, A., & Song, H. (2016) · Cognitive Neuropsychiatry · doi:10.1080/13546805.2016.1147427 · Cited by 12 · see citing works
“In addition, our findings are consistent with previous studies, which found that sealing-over recovery style tends to be associated with poorer social functioning, poorer quality of life and higher levels of depression (Drayton et al., 1998; McGlashan, 1987; Thompson, McGorry, & Harrigan, 2003).”
ResultGearing, R. E., DeVylder, J., Chen, F., Pogge, D. L., & Buccolo, M. (2014) · Psychiatry · doi:10.1521/psyc.2014.77.4.344 · Cited by 13 · see citing works
“According to McGlashan and colleagues (McGlashan, 1987; McGlashan, Levy, & Carpenter Jr., 1975), those who integrate their mental illness into their identity have better functional outcomes over time, consistent with pervasive integration among this highly adherent sample.”
Werbart, A., Forsström, D., & Jeanneau, M. (2012) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2012.654508 · Cited by 12 · see citing works
Roberts, L., Berrisford, G. S., Heron, J., Jones, L. A., Jones, I. R., Dolman, C., & Lane, D. A. (2018) · BJPsych Open · doi:10.1192/bjo.2018.9 · Cited by 11 · see citing works
“11,33,34 Although qualitative research does not seek statistical generalisabi-lity, 35 these potential systematic differences between the study sample and the overall postpartum psychosis population may limit the theoretical application of research findings, with integrative recovery…”
Cullberg, J., & Levander, S. (1991) · Nordic Journal of Psychiatry · doi:10.3109/08039489109103294 · Cited by 11 · see citing works
Carter, L., Read, J., Pyle, M., & Morrison, A. P. (2018) · Community Mental Health Journal · doi:10.1007/s10597-017-0219-3 · Cited by 10 · see citing works
“Conversely those who ‘seal over’, isolate the distressed part of themselves from other aspects of their lives and view it as an annoyance (McGlashan 1987).”
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First-episode psychosis: primary care experience and implications for service development
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Making meaning of trauma in psychosis
van Sambeek, N., Franssen, G., van Geelen, S., & Scheepers, F. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1272683 · Cited by 10 · see citing works
“Several studies suggest that a recovery style directed at turning toward and integrating experiences predicts better functioning on the long term and that meaning-making styles in psychosis are not static but can change over time (58–61).”
BackgroundToward Developing a Scale to Empirically Measure Psychotic Defense Mechanisms
Constantinides, P., & Beck, S. (2010) · Journal of the American Psychoanalytic Association · doi:10.1177/0003065110396875 · Cited by 9 · see citing works
“McGlashan (1987) has shown, for instance, that integration of the meaning and scope of the psychotic experience and a “sealing-over” of the experience are clinically distinct recovery styles correlated with functional outcome, and that these styles may correspond to enduring personality traits.”
BackgroundWragg, J. A., & Whitehead, R. E. (2004) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465804001389 · Cited by 9 · see citing works
“McGlashan (1987) showed that people who adopted an integrative recovery style had significantly better social functioning and less likelihood of relapse.”
BackgroundSubjective experience of diagnosis and treatment in two adolescents with first-episode schizophrenia
Abarzúa, M., Venegas, F., & Hidalgo, X. (2016) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2016.189 · Cited by 8 · see citing works
“Indeed, the way people process their psychotic experience or the recovery style has been linked to a long-term outcome (McGlashan, 1987) and, specifically in FESZ, to avoid the processing of the post-episode emotional impact has been linked to a worse symptomatic outcome and a reduced quality of…”
BackgroundEarly intervention in psychosis
FARMER, C. J. A. (1998) · Journal of Mental Health · doi:10.1080/09638239818201 · Cited by 9 · see citing works
Harris, O., Lawes, A., Andrews, C., & Jacobsen, P. C. (2021) · Early Intervention in Psychiatry · doi:10.1111/eip.13216 · Cited by 9 · see citing works
“This coheres with existing research and theories on recovery style, which have suggested that an integrating recovery style may predict better outcomes for those experiencing psychosis (McCarthy- Jones et al., 2013; Jose et al., 2015; Griffiths, Mansell, Edge & Tai, 2019; McGlashan, 1987).”
ResultKnaifel, E., & Mirsky, J. (2014) · Transcultural Psychiatry · doi:10.1177/1363461514552585 · Cited by 8 · see citing works
“There is evidence that this pattern of sealing-over is not unique to immigrants from the FSU and characterizes the strategies of many people who are coping with mental illness (McGlashan, 1987; Tait, Birchwood, & Trower, 2003).”
BackgroundPsychoéducation dans la schizophrénie
Petitjean, F., Bralet, M., Hodé, Y., & Tramier, V. (2014) · Time to knit · doi:10.1016/s0246-1072(14)58374-5 · Cited by 6 · see citing works
Cognitive‐behavioral therapy for individuals at high risk of developing psychosis
Addington, J., & Mancuso, E. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20609 · Cited by 7 · see citing works
“This indicated a sealing-over coping style (McGlashan, 1987).”
Do Patients With Psychosis Experience Loss and Grief As a Result of Their Illness?
Wittmann, D. A., Smith, P. F., Rajarethinam, R., Foley, S., VanBrussel, A., Philip, B., & Keshavan, M. S. (2010) · Psychoanalytic Social Work · doi:10.1080/15228871003676622 · Cited by 7 · see citing works
“…Birchwood & Jackson, 2005), Treatment Expectancy Scale (Smith, 2004), The Positive and Negative Symptoms Scale (PANSS; Opler, Stanley, Lindernmayer, & Fiszbein, 1992), The Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al., 1993), and The Coping Style measure (McGlashan, 1987).”
BackgroundMethodInfluentialGruber, M., Rumpold, T., Schrank, B., Sibitz, I., Otzelberger, B., Jahn, R., Amering, M., & Unger, A. (2018) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000471 · Cited by 7 · see citing works
Acosta, F. J., Navarro, S., Cabrera, B., Ramallo‐Fariña, Y., & Martínez, N. (2020) · Schizophrenia Research · doi:10.1016/j.schres.2020.03.042 · Cited by 7 · see citing works
Personal Recovery in Schizophrenia: A Narrative Review
Rossi, R., Socci, V., & Rossi, A. (2022) · Comprehensive approach to psychiatry · doi:10.1007/978-3-030-98301-7_3 · Cited by 7 · see citing works
Factors Related to Coping with Severe Mental Illness in the Latter Half of Life
Burton, E. G., Chaneb, B., & Meeks, S. (2007) · Clinical Gerontologist · doi:10.1300/j018v30n04_06 · Cited by 6 · see citing works
“Findings from a study by McGlashan (1987) suggest that individuals with more severe mental illness symptoms may focus on avoidant coping strategies.”
BackgroundResultFirst-episode psychosis: factors associated with delayed access to care in a rural Egyptian setting
El-Adl, M., Elmahdy, M., & Anis, M. (2008) · International Psychiatry · doi:10.1192/s1749367600002290 · Cited by 6 · see citing works
“FEP studies show that the average time between onset of symptoms and first effective treatment is often 1 year or more (McGlashan, 1987).”
BackgroundLes mécanismes d’adaptation des malades mentaux chroniques à la vie quotidienne
Lecomte, Y. (2007) · Santé mentale au Québec · doi:10.7202/032229ar · Cited by 6 · see citing works
LARSEN, J. A. (2002) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York) · doi:10.13140/rg.2.1.1608.8167 · Cited by 6 · see citing works
Service Engagement: Psychopathology, Recovery Style and Treatments
Vender, S., Poloni, N., Aletti, F. A., Bonalumi, C., & Callegari, C. (2014) · Psychiatry Journal · doi:10.1155/2014/249852 · Cited by 5 · see citing works
“Patients using modern health systems are more active in their own health care so that treatment regimes are modified or distorted by the consumer rather than being completely accepted or totally abandoned.”
BackgroundSupporting young people with psychosis in the community: An ICT enabled repalse prevention tool
Lederman, R., Wadley, G., Gleeson, J., Álvarez‐Jiménez, M., & Spiteri‐Staines, A. (2011) · Research Bank (Australian Catholic University) · Cited by 5 · see citing works
Negative Appraisal and Traumatic Stress Symptoms in Community Clients With Serious Mental Illness
Sherrer, M. V., Shen, C., & O’Hare, T. (2015) · Social Work in Mental Health · doi:10.1080/15332985.2014.916646 · Cited by 5 · see citing works
“The authors speculated that “sealers” might have greater difficulty accessing memories of their psychotic episodes as posited by McGlashan (1987).”
BackgroundThe trauma of first episode psychosis: the role of cognitive mediation
Jackson, C., Knott, C., Skeate, A., et al. (2004) · Australian & New Zealand Journal of Psychiatry · doi:10.1111/j.1440-1614.2004.01359.x · Cited by 5 · see citing works
“Recovery Style Questionnaire (RSQ) [25] is a 39 item self-report measure of McGlashan’s [26] ‘integration’ versus ‘sealing over’ styles of adaptation to psychotic illness.”
Background
- Authors
- McGLASHAN, T. H.
- Corresponding author
- McGLASHAN, THOMAS H.
- Venue
- The Journal of Nervous and Mental Disease
- Published
- 1987-11
- Volume
- 175
- Issue
- 11
- Pages
- 681-685
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2066056799
- Cited by
- 132
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 3 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 6 · 2017: 3 · 2016: 6 · 2015: 3 · 2014: 11 · 2013: 6 · 2012: 8
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Keywords
- schizophrenia, integration, long-term outcomes, functional outcome, schizoaffective disorder, unipolar affective disorder, schizotypal personality disorder, borderline personality disorder, personality traits, prognostic factors
- MeSH terms
- Adaptation, Psychological, Awareness, Mental Disorders, Borderline Personality Disorder, Depressive Disorder, Humans, Personality, Psychotic Disorders, Schizophrenic Psychology, Schizotypal Personality Disorder
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