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Adapting to the challenge of psychosis: personal resilience and the use of sealing-over (avoidant) coping strategies

Background Avoidance coping (e.g. sealing over) is common in people recovering from psychosis, but it is not understood why some individuals ‘seal over’. Aims We examined the hypothesis that individuals who ‘seal over’ do not have the personal resilience to withstand this major life event. Method Fifty participants were interviewed during an acute episode of psychosis and reassessed at 3-month and 6-month follow-up. Measures included psychotic symptoms, recovery style, service engagement, parental and adult attachment and self-evaluative beliefs. Results Sealing-over recovery styles are associated with negative early childhood experience, insecure adult attachment, negative self-evaluative beliefs and insecure identity. Insecure adult attachment was associated with less engagement with services. Conclusions Sealing over was associated with multiple signs of low personal resilience in adapting to psychosis.