Fear of Recurrence: Results of a Randomized Trial of Relapse Detection in Schizophrenia

Andrew I. Gumley*, Angus Macbeth, James D. Reilly, Margaret O'Grady, Ross G. White, Hamish McLeod, Matthias Schwannauer, Kevin G. Power

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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 FoRSe (n = 83) monitoring. We found good evidence supporting reliability and validity of the FoRSe. 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 FoRSe (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 FoRSe (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.

Original languageEnglish
Pages (from-to)49-62
Number of pages14
JournalBritish Journal of Clinical Psychology
Issue number1
Early online date8 Jul 2014
Publication statusPublished - 1 Jan 2015


  • Fear of Recurrence
  • Randomized Controlled Trial
  • Relapse
  • Schizophrenia

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