The Stages of Recovery Instrument (STORI)<\/strong> is a self-report psychometric measure designed to operationalize and assess the multidimensional process of psychological recovery<\/a> in individuals diagnosed with severe and enduring psychiatric conditions, most notably schizophrenia<\/a> and related affective psychoses. Developed by Retta Andresen, Peter Caputi, and Lindsay G. Oades in 2006 at the University of Wollongong, the instrument translates consumer-derived, qualitative narratives of recovery into an empirically verifiable stage model. The instrument comprises 50 items organized into 10 thematic groups representing five distinct, sequential stages: Moratorium<\/em>, Awareness<\/em>, Preparation<\/em>, Rebuilding<\/em>, and Growth<\/em>. Each stage is indexed by a dedicated 10-item subscale. Respondents rate each item on a 6-point Likert scale ranging from 0 (Not at all true now<\/em>) to 5 (Completely true now<\/em>), reflecting their current subjective psychological orientation toward their illness, self-concept, agency, and future outlook.<\/p>\n Extensive psychometric investigations substantiate the STORI\u2019s robust structural and measurement properties. Internal consistency estimates across diverse clinical cohorts demonstrate strong subscale reliability, with Cronbach\u2019s alpha<\/a> coefficients typically ranging from .74 to .88 for Moratorium, .76 to .86 for Awareness, .77 to .89 for Preparation, .83 to .91 for Rebuilding, and .86 to .92 for Growth. Construct validity has been rigorously demonstrated through convergent associations with standardized measures of hope, empowerment, resilience, and personal autonomy, alongside predictable inverse relationships with psychological distress, self-stigma, and hopelessness. Multidimensional scaling (MDS)<\/a> and cluster analytic procedures<\/a> confirm a simplex-like quasi-circumplex or ordered continuum that mirrors the theoretically postulated developmental progression. As a prominent tool within psychiatric rehabilitation, routine mental health outcome measurement, and consumer-centered intervention design, the STORI bridges clinical evaluation with the subjective paradigm of human transformation beyond illness.<\/p>\n Stages of Recovery Instrument, STORI, psychological recovery, psychiatric rehabilitation, serious mental illness, schizophrenia, hope, empowerment, stage model of recovery, psychometrics.<\/p>\n The Stages of Recovery Instrument was conceptualized, operationalized, and psychometrically validated by a specialized research team at the University of Wollongong<\/a> in New South Wales, Australia:<\/p>\n The primary purpose of the Stages of Recovery Instrument (STORI) is to systematically track and evaluate an individual\u2019s subjective journey through the transformative process of psychological recovery from serious mental illness (SMI). Historically, clinical psychiatry operationalized recovery strictly within a biomedical framework characterized by symptom remission, stabilization, neuroleptic compliance, relapse prevention, and functional restoration. However, the international mental health consumer movement demonstrated that recovery involves cultivating a deeply personal, hopeful, and self-directed existence despite the ongoing presence of mental health vulnerabilities or limitations. The STORI was constructed to translate this qualitative, experiential paradigm into an empirically robust, quantitative assessment architecture.<\/p>\n In clinical practice, the STORI serves several interrelated purposes:<\/p>\n In academic and clinical research, the STORI provides a validated metric for testing stage-based theoretical models, evaluating the comparative efficacy of recovery-oriented programs (e.g., peer-led interventions, Illness Management and Recovery [IMR], and Supported Employment), and clarifying the predictive associations between subjective recovery, neurocognitive functioning, and psychiatric symptom trajectories.<\/p>\n The STORI operationalizes psychological recovery as a self-directed, continuous process comprising five experiential stages spanning four overarching psychological processes: finding and maintaining hope<\/em>, re-establishment of a positive identity<\/em>, building a meaningful life<\/em>, and taking responsibility and control<\/em>. Each of the five stages encapsulates an integrated cognitive, emotional, and behavioral state:<\/p>\n The Moratorium<\/em> stage represents a period of pervasive withdrawal, hopelessness, identity dissolution, and profound crisis following the onset or catastrophic exacerbation of severe mental illness. Individuals in this phase often experience existential numbness, profound alienation, and a perceived loss of personhood, viewing themselves exclusively through the lens of pathology. Key manifestations include:<\/p>\n The Awareness<\/em> stage marks the fragile emergence of hope and the initial recognition that an individual\u2019s life is not entirely defined by their diagnosis. In this phase, consumers begin to perceive the possibility of recovery, often inspired by role models, supportive peers, or clinical staff. Key characteristics include:<\/p>\n The Preparation<\/em> stage represents an active internal appraisal and mobilization phase. Consumers engage in self-reflection, assess personal capabilities, identify personal values, and initiate foundational learning to cope with their illness. Key components include:<\/p>\n The Rebuilding<\/em> stage is characterized by behavioral execution, autonomous goal strivings, positive risk-taking, and active identity reconstruction. Consumers transition from internal contemplation to external self-actualization, pursuing vocational, educational, social, and creative goals. Characteristics include:<\/p>\n The Growth<\/em> stage represents an integrated culmination of the recovery journey characterized by wisdom, empowerment, emotional equilibrium, and continuous self-transcendence. Psychiatric challenges are integrated into the holistic fabric of life, functioning as catalysts for personal development. Hallmarks include:<\/p>\n The theoretical architecture of the STORI is grounded in the qualitative synthesis of mental health consumer narratives conducted by Andresen, Caputi, and Oades (2003). The authors conducted a comprehensive meta-synthesis of autobiographical accounts, published consumer testimonies, and grounded-theory qualitative investigations of recovery from schizophrenia and affective psychosis (e.g., Deegan, 1988; Anthony, 1993; Davidson & Strauss, 1992). This synthesis revealed recurring structural commonalities across diverse lived experiences, culminating in the development of a conceptual five-stage model of psychological recovery.<\/p>\n The model draws heavily upon established psychological paradigms:<\/p>\n The psychometric validity of the STORI has been rigorously demonstrated across diverse clinical populations and international health jurisdictions.<\/p>\n Construct validity was initially confirmed by Andresen, Caputi, and Oades (2006) using non-metric multidimensional scaling (MDS)<\/a>. The analysis demonstrated that the 50 items plotted in a distinct, circular or simplex pattern, supporting the developmental continuity of the five stages. Adjacent stages displayed higher statistical proximity than non-adjacent stages, validating the theoretical ordering (Moratorium \u2192 Awareness \u2192 Preparation \u2192 Rebuilding \u2192 Growth).<\/p>\n Extensive correlation analyses with established psychometric scales provide strong convergent and discriminant validity evidence:<\/p>\n Validation studies across global cohorts\u2014including the United Kingdom (Weeks et al., 2011), Australia (Burgess et al., 2011), and non-English adaptations across European and Asian contexts\u2014support the cross-cultural generalizability of these validity indices.<\/p>\n The STORI displays excellent internal consistency across both research and clinical samples. In the foundational validation study by Andresen, Caputi, and Oades (2006) involving 97 individuals diagnosed with psychotic disorders, the Cronbach\u2019s alpha<\/a> coefficients for the five 10-item subscales were:<\/p>\n Replication studies by Weeks, Slade, and Hayward (2011) in a UK mental health trust ($N = 104$<\/span>) corroborated these reliability parameters, reporting subscale alpha coefficients of .84 (Moratorium), .77 (Awareness), .82 (Preparation), .89 (Rebuilding), and .90 (Growth). Composite scale internal consistency regularly exceeds $\\alpha = .92$<\/span>.<\/p>\n Test-retest reliability evaluations over intervals ranging from two to four weeks demonstrate adequate temporal stability among clinically stable outpatients, with intra-class correlation coefficients (ICC) ranging between .72 and .86 across all subscales. These metrics confirm that the instrument captures enduring subjective orientations while retaining sensitivity to genuine longitudinal clinical and developmental change.<\/p>\n Investigating the internal structural properties of the STORI has generated nuanced psychometric dialogue regarding stage models versus continuous recovery dimensions.<\/p>\n Initial Exploratory Factor Analyses using principal axis factoring with oblique rotations (Promax) consistently reveal three to five substantive latent factors. However, high inter-factor correlations between adjacent stages (e.g., between Preparation and Rebuilding, and between Rebuilding and Growth, often exhibiting $r > .70$<\/span>) frequently result in factor collapses in unconstrained EFAs. Specifically, items from Stages 4 (Rebuilding) and 5 (Growth) routinely load onto a single higher-order factor representing “Active Flourishing and Resilience,” while Stage 1 (Moratorium) cleanly segregates into an independent “Hopelessness and Identity Loss” factor. Stage 2 (Awareness) and Stage 3 (Preparation) typically load onto a transitional “Awakening and Preparedness” latent construct.<\/p>\n Structural evaluations through Confirmatory Factor Analysis<\/a> reveal challenges when fitting standard, highly restrictive five-factor orthogonal models, driven by the theoretical continuum underlying the scale. When modeled as a five-factor correlated structure, fit indices achieve acceptable thresholds across empirical evaluations (e.g., Root Mean Square Error of Approximation [RMSEA] $\\approx .058$<\/span> to $.068$<\/span>; Comparative Fit Index [CFI] $\\approx .90$<\/span> to $.93$<\/span>; Standardized Root Mean Square Residual [SRMR] $\\approx .062$<\/span>).<\/p>\n Because the STORI conceptualizes recovery as a continuous developmental process, classical linear independent factor models do not fully capture its structural architecture. Researchers frequently employ multidimensional scaling (MDS) and Rasch analysis. MDS confirms a quasi-circumplex or simplex pattern where correlation coefficients decay monotonically as developmental distance between stages increases\u2014a diagnostic hallmark of true developmental continuum models. Rasch polytomous rating scale analyses further substantiate that individual item thresholds advance smoothly from low-recovery item endorsements in Moratorium to high-recovery endorsements in Growth.<\/p>\n2. Keywords<\/h2>\n
3. Authors<\/h2>\n
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4. Purpose<\/h2>\n
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5. Psychological Construct<\/h2>\n
Stage 1: Moratorium<\/h3>\n
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Stage 2: Awareness<\/h3>\n
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Stage 3: Preparation<\/h3>\n
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Stage 4: Rebuilding<\/h3>\n
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Stage 5: Growth<\/h3>\n
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6. Theoretical Framework<\/h2>\n
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7. Validity<\/h2>\n
Construct and Structural Validity<\/h3>\n
Convergent and Discriminant Validity<\/h3>\n
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8. Reliability<\/h2>\n
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9. Factor Analysis<\/h2>\n
Exploratory Factor Analysis (EFA)<\/h3>\n
Confirmatory Factor Analysis (CFA)<\/h3>\n
Multidimensional Scaling and Circumplex Modeling<\/h3>\n
10. Instrument \/ Measurement Tool<\/h2>\n
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11. Permissions, Fee, and Test Year<\/h2>\n
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12. References<\/h2>\n
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13. Items of the Scale (Questionnaire)<\/h2>\n