Fear of recurrence: Results of a randomized trial of relapse detection in schizophrenia
Abstract
Objective: We aimed to develop and establish the reliability and validity of a measure of Fear of Recurrence, measuring cognitive appraisals of relapse rather than standard early signs of relapse. We also aimed to establish the sensitivity and specificity to relapse. Method: Participants diagnosed with schizophrenia or a related disorder were randomized to one of two early signs monitoring conditions, using either the Early Signs Scale or the Fear of Recurrence Scale (FoRSe). Participants were followed up for 6‐months or until relapse. Results: A total of 169 participants were randomized to Standard ( n = 86) or Fo RS e ( n = 83) monitoring. We found good evidence supporting reliability and validity of the Fo RS e. In addition, a cut‐off point of ≥5 was associated with an optimal sensitivity in both Standard ( n = 26:79%, 95% CI = 62–89) and Fo RS e ( n = 18:72%, 95% CI = 52–86) monitoring. However, this degree of sensitivity was associated with a lower specificity in Standard ( n = 30:35%, 96% CI = 23–50) and Fo RS e ( n = 25:46%, 95% CI = 32–60). Finally, Fear of Relapse was a significant predictor of time to relapse [Exp(β) = 1.20, 95% CI = 1.01–1.42, p < .05]. Conclusion: The study provides evidence that Fear of Recurrence may be an important clinical construct linked to increased risk of relapse and poorer emotional recovery in people diagnosed with schizophrenia. Practitioner points: Monitoring Fear of Recurrence is as sensitive to relapse detection as monitoring early signs alone. Greater Fear of Relapse was associated with shorter duration to actual relapse. Fear of recurrence may be an important clinical feature linked to poorer emotional recovery and increased risk of relapse. Fear of Recurrence may be an important focus of psychological therapy to promote emotional recovery and prevention of relapse.
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Studies of psychotic disorders have reported that FIR significantly predicted future relapse and was associated with increased positive psychotic symptoms, depression, anxiety, and greater use of maladaptive coping strategies.
“Studies of psychotic disorders have reported that FIR significantly predicted future relapse and was associated with increased positive psychotic symptoms, depression, anxiety, and greater use of maladaptive coping strategies (e.g., reassurance seeking) [21, 22].”
From Fear of depression recurrence among individuals with remitted depression: a qualitative interview study (2024) · cites this paper as [21]
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- Authors
- Gumley, A. I., MacBeth, A., Reilly, J. D., O'Grady, M., White, R. G., McLeod, H., Schwannauer, M., & Power, K. G.
- Affiliations
- University of Glasgow (GB)
- University of Aberdeen (GB)
- NHS Greater Glasgow and Clyde (GB)
- Institute of Health and Wellbeing University of Glasgow UK
- University of Edinburgh (GB)
- University of Stirling (GB)
- Corresponding author
- Gumley, Andrew I.
- ORCID
- Venue
- British Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2014-07-08
- Volume
- 54
- Issue
- 1
- Pages
- 49-62
- ISSN
- 0144-6657 (ISSN-L)
- 2044-8260
- OpenAlex
- W1964321112
- Cited by
- 46
- References
- 43
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 5 · 2019: 9 · 2018: 2 · 2017: 2 · 2016: 1 · 2013: 1
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Chief Scientist Office (CZG/4/8)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- fear of recurrence, schizophrenia, relapse detection, sensitivity and specificity, time to relapse, emotional recovery, psychotherapy, relapse prevention
- MeSH terms
- Adolescent, Adult, Fear, Female, Follow-Up Studies, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Surveys and Questionnaires, Recurrence, Schizophrenia, Schizophrenic Psychology, Sensitivity and Specificity, Reproducibility of Results, Cognitive Behavioral Therapy, Treatment Outcome
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