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Negative symptoms: associations with defeatist beliefs, self-efficacy, and maladaptive schemas in youth and young adults at-risk for psychosis

Published online by Cambridge University Press:  17 November 2021

Daniel J. Devoe Open the ORCID record for Daniel J. Devoe [Opens in a new window] ,
K.S. Cadenhead ,
Barbara Cornblatt ,
Eric Granholm  and
Jean Addington
Daniel J. Devoe
Affiliation:
Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
K.S. Cadenhead
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA
Barbara Cornblatt
Affiliation:
Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, USA
Eric Granholm
Affiliation:
Department of Psychiatry, University of California, San Diego, CA, USA Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
Jean Addington*
Affiliation:
Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
*
*Corresponding author. Email: jmadding@ucalgary.ca
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Abstract

Background:

Investigations into possible mechanisms that may contribute to the development, maintenance, and exacerbation of negative symptoms are needed. Defeatist beliefs, self-efficacy, and early maladaptive schemas have been shown to contribute to negative symptoms in schizophrenia. Likewise, negative symptoms occur in those at clinical high-risk (CHR) for psychosis.

Aims:

The aim of this study was to determine if negative symptoms were associated with defeatist beliefs, self-efficacy, and early maladaptive schemas in CHR participants of a group therapy intervention study.

Method:

All CHR participants (n = 203; 99 males, 104 females) were recruited as part of a three-site randomized control trial: Recovery through Group Study (ReGroup). Negative symptoms, defeatist beliefs, self-efficacy and early maladaptive schemas were assessed by trained clinical raters. Mediation analyses were conducted to examine the relationship between defeatist beliefs, self-efficacy, functioning, and negative symptoms.

Results:

The majority of CHR youth (72.9%) had at least one negative symptom of moderate to above moderate severity at baseline. In multiple mediation analyses, both asocial beliefs and social self-efficacy mediated the effects of social functioning on negative symptoms. Finally, defeatist performance attitudes significantly mediated the effects of role functioning on negative symptoms.

Conclusions:

These results highlight the importance of considering beliefs and attitudes in relation to functioning and severity of negative symptoms. Psychosocial interventions may wish to target beliefs and attitudes in effort to reduce negative symptoms and improve functioning in CHR youth.

Keywords

beliefsclinical high risk for psychosisnegative symptomspsychosisself-efficacy
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 50 , Issue 3 , May 2022 , pp. 298 - 311
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Addington, J., Liu, L., Santesteban-Echarri, O., Brummitt, K., Braun, A., Cadenhead, K. S., … & Granholm, E. (2021). Cognitive behavioural social skills training: methods of a randomized controlled trial for youth at risk of psychosis. Early Intervention in Psychiatry. doi: 10.1111/eip.13102CrossRefGoogle Scholar
Addington, J., & Tran, L. (2009). Using the brief core schema scales with individuals at clinical high risk of psychosis. Behavioural and Cognitive Psychotherapy, 37, 227–231. doi: 10.1017/s1352465809005116 CrossRefGoogle ScholarPubMed
Auther, A., Smith, C., & Cornblatt, B. (2006). Global Functioning: social scale (GF: social). Glen Oaks, NY, USA: Zucker-Hillside Hospital.Google Scholar
Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ, USA: Prentice-Hall, Inc.Google Scholar
Beck, A. T., Grant, P. M., Huh, G. A., Perivoliotis, D., & Chang, N. A. (2013). Dysfunctional attitudes and expectancies in deficit syndrome schizophrenia. Schizophrenia Bulletin, 39, 43–51. doi: 10.1093/schbul/sbr040 CrossRefGoogle ScholarPubMed
Beck, A. T., & Haigh, E. A. P. (2014). Advances in cognitive theory and therapy: the generic cognitive model. Annual Review of Clinical Psychology, 10, 1–24. doi: 10.1146/annurev-clinpsy-032813-153734 CrossRefGoogle ScholarPubMed
Beck, A. T., Himelstein, R., & Grant, P. M. (2019). In and out of schizophrenia: activation and deactivation of the negative and positive schemas. Schizophrenia Research, 203, 55–61. doi: https://doi.org/10.1016/j.schres.2017.10.046 CrossRefGoogle ScholarPubMed
Beck, A. T., & Rector, N. A. (2005). Cognitive approaches to schizophrenia: theory and therapy. Annual Review of Clincial Psychology, 1, 577–606. doi: 10.1146/annurev.clinpsy.1.102803.144205 CrossRefGoogle ScholarPubMed
Beck, A. T., Rector, N. A., Stolar, N., & Grant, P. (2009). Schizophrenia: Cognitive Theory, Research, and Therapy. New York, USA: Guilford Press.Google Scholar
Bentall, R. P., Simpson, P. W., Lee, D. A., Williams, S., Elves, S., Brabbins, C., & Morrison, A. P. (2010). Motivation and avolition in schizophrenia patients: the role of self-efficacy. Psychosis, 2, 12–22.10.1080/17522430903505966CrossRefGoogle Scholar
Bortolon, C., Capdevielle, D., Boulenger, J.-P., Gely-Nargeot, M.-C., & Raffard, S. (2013). Early maladaptive schemas predict positive symptomatology in schizophrenia: a cross-sectional study. Psychiatry Research, 209, 361–366.10.1016/j.psychres.2013.03.018CrossRefGoogle ScholarPubMed
Campellone, T. R., Sanchez, A. H., & Kring, A. M. (2016). Defeatist performance beliefs, negative symptoms, and functional outcome in schizophrenia: a meta-analytic review. Schizophrenia Bulletin, 42, 1343–1352. doi: 10.1093/schbul/sbw026 CrossRefGoogle ScholarPubMed
Corcoran, C., Kimhy, D., Parrilla-Escobar, M., Cressman, V., Stanford, A., Thompson, J., … & Malaspina, D. (2011). The relationship of social function to depressive and negative symptoms in individuals at clinical high risk for psychosis. Psychological Medicine, 41, 251–261. Retrieved from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=psyc8&AN=2011-02011-003 10.1017/S0033291710000802CrossRefGoogle ScholarPubMed
Cornblatt, B. A., Auther, A. M., Niendam, T., Smith, C. W., Zinberg, J., Bearden, C. E., & Cannon, T. D. (2007). Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia. Schizophrenia Bulletin, 33, 688–702.10.1093/schbul/sbm029CrossRefGoogle ScholarPubMed
Couture, S. M., Blanchard, J. J., & Bennett, M. E. (2011). Negative expectancy appraisals and defeatist performance beliefs and negative symptoms of schizophrenia. Psychiatry Research, 189, 43–48. doi: 10.1016/j.psychres.2011.05.032 CrossRefGoogle ScholarPubMed
Darlington, R. B., & Hayes, A. F. (2016). Regression Analysis and Linear Models: Concepts, Applications, and Implementation: Guilford Publications.Google Scholar
Devoe, D. J., Lu, L., Cannon, T. D., Cadenhead, K. S., Cornblatt, B. A., McGlashan, T. H., … & Addington, J. (2020). Persistent negative symptoms in youth at clinical high risk for psychosis: a longitudinal study. Schizophrenia Research. https://doi.org/10.1016/j.schres.2020.04.004 CrossRefGoogle Scholar
Eckblad, M., Chapman, L., Chapman, J., & Mishlove, M. (1982). The Revised Social Anhedonia Scale. Unpublished test.Google Scholar
Falkenberg, I., Valmaggia, L., Byrnes, M., Frascarelli, M., Jones, C., Rocchetti, M., … Fusar-Poli, P. (2015). Why are help-seeking subjects at ultra-high risk for psychosis help-seeking? Psychiatry Research, 228, 808–815. https://doi.org/10.1016/j.psychres.2015.05.018 CrossRefGoogle ScholarPubMed
Fowler, D., Freeman, D., Smith, B., Kuipers, E., Bebbington, P., Bashforth, H., … & Garety, P. (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36, 749–759. doi: 10.1017/s0033291706007355 CrossRefGoogle ScholarPubMed
Galderisi, S., Mucci, A., Buchanan, R. W., & Arango, C. (2018). Negative symptoms of schizophrenia: new developments and unanswered research questions. Lancet Psychiatry, 5, 664–677. doi: 10.1016/s2215-0366(18)30050-6 CrossRefGoogle ScholarPubMed
Galderisi, S., Rossi, A., Rocca, P., Bertolino, A., Mucci, A., & Bucci, P. (2014). The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry, 13, 275–287. doi: 10.1002/wps.20167 CrossRefGoogle ScholarPubMed
Granholm, E., Holden, J., Link, P. C., McQuaid, J. R., & Jeste, D. V. (2013). Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: defeatist performance attitudes and functional outcome. American Journal of Geriatric Psychiatry, 21, 251–262. doi: 10.1016/j.jagp.2012.10.014 CrossRefGoogle ScholarPubMed
Granholm, E., Holden, J., & Worley, M. (2017). Improvement in negative symptoms and functioning in cognitive-behavioral social skills training for schizophrenia: mediation by defeatist performance attitudes and asocial beliefs. Schizophrenia Bulletin, 44, 653–661. doi: 10.1093/schbul/sbx099 CrossRefGoogle Scholar
Granholm, E., Ruiz, I., Gallegos-Rodriguez, Y., Holden, J., & Link, P. C. (2016). Pupillary responses as a biomarker of diminished effort associated with defeatist attitudes and negative symptoms in schizophrenia. Biological Psychiatry, 80, 581–588. doi: 10.1016/j.biopsych.2015.08.037 CrossRefGoogle Scholar
Grant, P. M., & Beck, A. T. (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin, 35, 798–806. doi: 10.1093/schbul/sbn008 CrossRefGoogle Scholar
Grant, P. M., & Beck, A. T. (2010). Asocial beliefs as predictors of asocial behavior in schizophrenia. Psychiatry Research, 177, 65–70. doi: 10.1016/j.psychres.2010.01.005 CrossRefGoogle Scholar
Green, M. F., Hellemann, G., Horan, W. P., Lee, J., & Wynn, J. K. (2012). From perception to functional outcome in schizophrenia: modeling the role of ability and motivation. Archives of General Psychiatry, 69, 1216–1224. doi: 10.1001/archgenpsychiatry.2012.652 CrossRefGoogle ScholarPubMed
Harvey, P. D., & Strassing, M. (2012). Predicting the severity of everyday functional disability in people with schizophrenia: cognitive deficits, functional capacity, symptoms, and health status. World Psychiatry, 11, 73–79. doi: 10.1016/j.wpsyc.2012.05.004 CrossRefGoogle ScholarPubMed
Hayes, A. F. (2017). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Publications.Google Scholar
Kang, M., Bang, M., Lee, S. Y., Lee, E., Yoo, S. W., & An, S. K. (2018). Coping styles in individuals at ultra-high risk for psychosis: associations with cognitive appraisals. Psychiatry Research, 264, 162–168. https://doi.org/10.1016/j.psychres.2018.03.079 CrossRefGoogle ScholarPubMed
Khosravani, V., Mohammadzadeh, A., & Sheidaei Oskouyi, L. (2019). Early maladaptive schemas in patients with schizophrenia and non-patients with high and low schizotypal traits and their differences based on depression severity. Comprehensive Psychiatry, 88, 1–8. https://doi.org/10.1016/j.comppsych.2018.10.011 CrossRefGoogle ScholarPubMed
Kim, K. R., Song, Y. Y., Park, J. Y., Lee, E. H., Lee, M., Lee, S. Y., … & Kwon, J. S. (2013). The relationship between psychosocial functioning and resilience and negative symptoms in individuals at ultra-high risk for psychosis. Australian and New Zealand Journal of Psychiatry, 47, 762–771. doi: 10.1177/0004867413488218 CrossRefGoogle ScholarPubMed
Kimhy, D., Jobson-Ahmed, L., Ben-David, S., Ramadhar, L., Malaspina, D., & Corcoran, C. M. (2014). Cognitive insight in individuals at clinical high risk for psychosis. Early Intervention in Psychiatry, 8, 130–137. doi: 10.1111/eip.12023 CrossRefGoogle ScholarPubMed
Kirkpatrick, B., Fenton, W. S., Carpenter, W. T., & Marder, S. R. (2006). The NIMH-MATRICS consensus statement on negative symptom. Schizophrenia Bulletin, 32, 214–219.10.1093/schbul/sbj053CrossRefGoogle Scholar
Kiwanuka, J. N., Strauss, G. P., McMahon, R. P., & Gold, J. M. (2014). Psychological predictors of functional outcome in people with schizophrenia. Schizophrenia Research, 157, 299–304. doi: 10.1016/j.schres.2014.04.030 CrossRefGoogle ScholarPubMed
Lee, S. J., Kim, K. R., Lee, S. Y., & An, S. K. (2017). Impaired social and role function in ultra-high risk for psychosis and first-episode schizophrenia: its relations with negative symptoms. Psychiatry Investigation, 14, 186–192. doi: 10.4306/pi.2017.14.2.186 CrossRefGoogle ScholarPubMed
Luther, L., Coffin, G. M., Firmin, R. L., Bonfils, K. A., Minor, K. S., & Salyers, M. P. (2018). A test of the cognitive model of negative symptoms: associations between defeatist performance beliefs, self-efficacy beliefs, and negative symptoms in a non-clinical sample. Psychiatry Research, 269, 278–285. https://doi.org/10.1016/j.psychres.2018.08.016 CrossRefGoogle Scholar
McDermott, B. E. (1995). Development of an instrument for assessing self-efficacy in schizophrenic spectrum disorders. Journal of Clinical Psychology, 51, 320–331. doi: 10.1002/1097-4679(199505)51:3<320::Aid-jclp2270510302>3.0.Co;2-#3.0.CO;2-#>CrossRefGoogle ScholarPubMed
McGlashan, T., Walsh, B., & Woods, S. (2010). The Psychosis-Risk Syndrome: Handbook for Diagnosis and Follow-Up. Oxford University Press.Google Scholar
Meyer, E. C., Carrion, R. E., Cornblatt, B. A., Addington, J., Cadenhead, K. S., Cannon, T. D., … & Seidman, L. J. (2014). The relationship of neurocognition and negative symptoms to social and role functioning over time in individuals at clinical high risk in the first phase of the North American Prodrome Longitudinal Study. Schizophrenia Bulletin, 40, 1452–1461. doi: 10.1093/schbul/sbt235 CrossRefGoogle ScholarPubMed
Morrison, A. P., French, P., Lewis, S. W., Roberts, M., Raja, S., Neil, S. T., … & Bentall, R. P. (2006). Psychological factors in people at ultra-high risk of psychosis: comparisons with non-patients and associations with symptoms. Psychological Medicine, 36, 1395–1404. doi: 10.1017/S0033291706007768 CrossRefGoogle ScholarPubMed
Perivoliotis, D., Morrison, A. P., Grant, P. M., French, P., & Beck, A. T. (2009). Negative performance beliefs and negative symptoms in individuals at ultra-high risk of psychosis: a preliminary study. Psychopathology, 42, 375–379. doi: 10.1159/000236909 CrossRefGoogle ScholarPubMed
Piskulic, D., Addington, J., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., Heinssen, R., … & McGlashan, T. H. (2012). Negative symptoms in individuals at clinical high risk of psychosis. Psychiatry Research, 196, 220–224. https://doi.org/10.1016/j.psychres.2012.02.018 CrossRefGoogle ScholarPubMed
Pratt, S. I., Mueser, K. T., Smith, T. E., & Lu, W. (2005). Self-efficacy and psychosocial functioning in schizophrenia: a mediational analysis. Schizophrenia Research, 78, 187–197. doi: 10.1016/j.schres.2005.02.014 CrossRefGoogle ScholarPubMed
Quinlan, T., Roesch, S., & Granholm, E. (2014). The role of dysfunctional attitudes in models of negative symptoms and functioning in schizophrenia. Schizophrenia Research, 157, 182–189. doi: 10.1016/j.schres.2014.05.025 CrossRefGoogle Scholar
Schlosser, D. A., Campellone, T. R., Biagianti, B., Delucchi, K. L., Gard, D. E., Fulford, D., … & Vinogradov, S. (2015). Modeling the role of negative symptoms in determining social functioning in individuals at clinical high risk of psychosis. Schizophrenia Research, 169, 204–208. doi: 10.1016/j.schres.2015.10.036 CrossRefGoogle ScholarPubMed
Schmidt, S. J., Grunert, V.-M., Schimmelmann, B. G., Schultze-Lutter, F., & Michel, C. (2014). Differences in coping, self-efficacy, and external control beliefs between patients at-risk for psychosis and patients with first-episode psychosis. Psychiatry Research, 219, 95–102. https://doi.org/10.1016/j.psychres.2014.04.045 CrossRefGoogle ScholarPubMed
Staring, A. B., Ter Huurne, M. A., & van der Gaag, M. (2013). Cognitive behavioral therapy for negative symptoms (CBT-n) in psychotic disorders: a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 44, 300–306. doi: 10.1016/j.jbtep.2013.01.004 CrossRefGoogle ScholarPubMed
Stowkowy, J., Liu, L., Cadenhead, K. S., Cannon, T. D., Cornblatt, B. A., McGlashan, T. H., … & Addington, J. (2016). Core schemas in youth at clinical high risk for psychosis. Behavioural and Cognitive Psychotherapy, 44, 203–213. doi: 10.1017/s1352465815000144 CrossRefGoogle ScholarPubMed
Strauss, G. P., Morra, L. F., Sullivan, S. K., & Gold, J. M. (2015). The role of low cognitive effort and negative symptoms in neuropsychological impairment in schizophrenia. Neuropsychology, 29, 282–291. doi: 10.1037/neu0000113 CrossRefGoogle Scholar
Ventura, J., Subotnik, K. L., Ered, A., Gretchen-Doorly, D., Hellemann, G. S., Vaskinn, A., & Nuechterlein, K. H. (2014). The relationship of attitudinal beliefs to negative symptoms, neurocognition, and daily functioning in recent-onset schizophrenia. Schizophrenia Bulletin, 40, 1308–1318. doi: 10.1093/schbul/sbu002 CrossRefGoogle ScholarPubMed
Weissman, A. N., & Beck, A. T. (1978). Development and validation of the Dysfunctional Attitude Scale: a preliminary investigation. https://eric.ed.gov/?id=ED167619 Google Scholar
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2006). Schema Therapy: A Practitioner’s Guide. Guilford Press.Google Scholar
Yung, A. R., Nelson, B., McGorry, P. D., Wood, S. J., & Lin, A. (2018). Persistent negative symptoms in individuals at ultra high risk for psychosis. Schizophrenia Research. doi: 10.1016/j.schres.2018.10.019 CrossRefGoogle Scholar
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