BRIEF REPORTS The Scale to Assess Narrative Development Association With Other Measures of Self and Readiness for Recovery in Schizophrenia Spectrum Disorders Paul H. Lysaker, PhD,*† Amanda Taylor, BS,‡ Amy Miller, BS,* Nicole Beattie, BA,* Amy Strasburger, MA,* and Louanne W. Davis, PsyD*† Abstract: While changes in self-experience have been suggested as an element of recovery from schizophrenia, little is known about how they are linked with other subjective indicators of recovery. To examine this, we have developed methods of eliciting narratives of self and illness in schizophrenia and quantitatively rating self- experience expressed within those narratives. In this study, we rated the narratives of 34 persons with schizophrenia spectrum disorder prior to entry into rehabilitation using the Scale to Assess Narrative Development (STAND). STAND scores were then correlated with concurrent assessments of self-esteem using the Rosenberg Self Esteem schedule and readiness for change using the Stages of Change Questionnaire. Results indicated that higher ratings on the STAND were associated with greater levels of self-esteem and greater overall readiness for change. This may suggest that qualities of self-experience within personal narratives of persons with schizo- phrenia are linked to objective and subjective assessments of recov- ery. Key Words: Schizophrenia, recovery, symptoms, narrative, remission. (J Nerv Ment Dis 2006;194: 223–225) W ith a view that schizophrenia is characterized by steady decline and dysfunction, the aim of many psychiatric interventions has been stability, or the prevention of deteri- oration (e.g., hospitalization symptom exacerbation). As ev- idence has suggested that a declining course is an exception rather than the rule, stability has been replaced as a treatment goal with recovery (Liberman and Kopelowicz, 2005). Sum- marized by Resnick et al. (2004), recovery can involve changes in any of a number of domains of function that can be grouped into at least two larger sets: objective assessments of the absence of illness (e.g., symptom remission and good psychosocial function) and subjective experiences related to attitudes and/or life orientation (e.g., hopefulness). We sug- gest that in addition to life attitudes and orientation, the subjective domain of recovery can be conceptualized as also including changes in qualities of self-experience. Schizophre- nia has in fact been observed to involve fundamental alter- ations in sense of self (Davidson, 2003; Stanghellini, 2004). It has been linked, for instance, with a diminished sense of life as a comprehensible ongoing story and difficulty perceiv- ing oneself as an active agent meaningfully connected to others (Lysaker et al., 2003; Roe and Ben-Yishai, 1999). To propose that changes in self-experience may be an element of recovery, however, raises the issue of how it should be measured. To address this issue, we have developed an interview based on a narrative theory of self (Gallagher, 2000), which offers participants an opportunity to share the story of their lives and psychiatric challenges in an open-ended man- ner (Lysaker et al., 2002). To measure quantitatively the qualities of self-experience contained in these narratives, we have also developed the Scale to Assessment Narrative De- velopment (STAND; Lysaker et al., 2003). While we have achieved good interrater reliability and internal consistency rating narrative interviews with the STAND (Lysaker et al., 2005), issues of validity have yet to be fully addressed. Accordingly, this study examines the concurrent validity of the STAND by comparing STAND ratings with two other conceptually similar measures: self-esteem and readiness for change. METHODS Participants Participants were 30 men and four women with DSM-IV diagnoses of schizophrenia (N = 20) or schizoaf- fective disorder (N = 14) enrolled in a larger study seeking to develop a cognitive behavioral therapy targeting working function in schizophrenia. All were recruited from the out- patient Psychiatry Service of a VA Medical Center and mental health center and were in a postacute phase of illness as defined by having no hospitalizations or changes in med- ication or housing in the prior month. Excluded from the study were participants with mental retardation or active *Roudebush VA Medical Center, Indianapolis, Indiana; †Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indi- ana; and ‡Indiana University Purdue University at Indianapolis, Depart- ment of Psychology, Indianapolis, Indiana. Send reprint requests to Paul H. Lysaker, PhD, Day Hospital 116H, 1481 West 10th St., Roudebush VA Medical Center, Indianapolis, IN 46202. Copyright © 2006 by Lippincott Williams & Wilkins ISSN: 0022-3018/06/19403-0223 DOI: 10.1097/01.nmd.0000202512.54587.34 The Journal of Nervous and Mental Disease • Volume 194, Number 3, March 2006 223