A Transdiagnostic Approach to Fears of Recurrence and Progression in People with Mental Health Conditions

Abstract

Fears of recurrence and progression (FORP) are a common response to chronic illness, but they can become distressing and disabling. In cancer, FORP is well understood, yet little is known about FORP in mental health conditions, particularly as existing research is mostly limited to fear of psychosis relapse in schizophrenia. This thesis examines whether mental health-related FORP extends to non-psychotic conditions and whether it constitutes a distinct transdiagnostic construct. Chapter 2 reports a mixed-method systematic review and meta-synthesis. Qualitative synthesis produced a preliminary model of mental health-related FORP, relevant to those with and without psychosis, while narrative review of quantitative studies showed links between FORP, poorer psychological outcomes, reduced quality of life, and altered health behaviours, including increased medication adherence, across diagnoses. Chapter 3 extends this model using qualitative interviews of people with people with psychotic and non-psychotic conditions (n=18), further supporting transdiagnostic relevance, and a survey (n=269) offering preliminary quantitative support. To enable further research, Chapter 4 describes development and validation of a novel FORP questionnaire (n=905). This measure showed strong psychometrics, discriminant validity from mental health anxiety, and invariance across groups with and without histories of psychosis or mania, supporting its transdiagnostic use. Chapter 5 describes a 14-day ecological momentary assessment study (n=68), identifying intrusive memories, shame, and negative appraisals of mental state fluctuations as predictors of subsequent FORP, whereas attentional focus was not predictive. Together, these studies provide robust evidence that mental health-related FORP is a distinct, measurable, transdiagnostic construct. Chapter 6 considers clinical and theoretical implications and highlights the need for further research, given indications that FORP may predict relapse.