A transdiagnostic model of fears of recurrence and progression in people with mental health conditions.

Abstract

Fear of recurrence and progression (FORP) is a potentially adaptive response to living with a mental health condition. Nevertheless, it can be distressing and may increase vulnerability to mental health deterioration. Research on FORP has focused mainly on schizophrenia-spectrum conditions, leaving other conditions underexplored. This mixed-method study aimed to develop a transdiagnostic model of FORP from a grounded theory framework analysis of qualitative interviews and to test some model predictions using cross-sectional survey data. Between January and December 2023, adults with a mental health condition, in Australia were recruited from the University of Sydney Psychology Clinic or the community via social media. Analysis of 18 semistructured interviews found six themes and 10 subthemes expressed by people with a range of conditions: "In retrospect" participants described traumatic memories and an inability to trust themselves, which gave rise to FORP (fear of being harmed, fear of harming others, and fear of isolation). In response, participants adopted a better safe than sorry approach (vigilance-hypervigilance, reassurance seeking, and a low-risk, low-reward lifestyle). To cope with FORP, participants used avoidance, including suppression and distraction, and identified metacognitions that perpetuated fear. People who voiced prognostic pessimism also held more biological causal accounts of their conditions. Pervasive shame colored much of the participants' experience. Survey data from 269 participants (including 10 interviewees) confirmed that biological beliefs and intrusive thoughts of being unwell were uniquely associated with FORP, after controlling for psychopathology. Overall, qualitative and quantitative findings supported the notion that FORP is a clinically relevant transdiagnostic construct. (PsycInfo Database Record (c) 2025 APA, all rights reserved).