Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T10:08:57.909Z Has data issue: false hasContentIssue false

Core Schemas across the Continuum of Psychosis: A Comparison of Clinical and Non-Clinical Groups

Published online by Cambridge University Press:  07 August 2013

Hannah E. Taylor*
Affiliation:
University of Manchester, UK
Suzanne L. K. Stewart
Affiliation:
University of Manchester, UK
Graham Dunn
Affiliation:
University of Manchester, UK
Sophie Parker
Affiliation:
Greater Manchester West Mental Health NHS Foundation Trust, UK
David Fowler
Affiliation:
University of East Anglia, Norwich, UK
Anthony P. Morrison
Affiliation:
University of Manchester, UK
*
Reprint requests to Hannah Taylor, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK. E-mail: hannahelizabeth.taylor@postgrad.manchester.ac.uk

Abstract

Background: Research suggests that core schemas are important in both the development and maintenance of psychosis. Aims: The aim of the study was to investigate and compare core schemas in four groups along the continuum of psychosis and examine the relationships between schemas and positive psychotic symptomatology. Method: A measure of core schemas was distributed to 20 individuals experiencing first-episode psychosis (FEP), 113 individuals with “at risk mental states” (ARMS), 28 participants forming a help-seeking clinical group (HSC), and 30 non-help-seeking individuals who endorse some psychotic-like experiences (NH). Results: The clinical groups scored significantly higher than the NH group for negative beliefs about self and about others. No significant effects of group on positive beliefs about others were found. For positive beliefs about the self, the NH group scored significantly higher than the clinical groups. Furthermore, negative beliefs about self and others were related to positive psychotic symptomatology and to distress related to those experiences. Conclusions: Negative evaluations of the self and others appear to be characteristic of the appraisals of people seeking help for psychosis and psychosis-like experiences. The results support the literature that suggests that self-esteem should be a target for intervention. Future research would benefit from including comparison groups of people experiencing chronic psychosis and people who do not have any psychotic-like experiences.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, J. and Tran, L. (2009). Using the Brief Core Schema Scales with individuals at clinical high risk of psychosis. Behavioural and Cognitive Psychotherapy, 37, 227231.Google Scholar
Beck, A. T. and Rector, N. A. (2003). A cognitive model of hallucinations. Cognitive Therapy and Research, 27, 1952.Google Scholar
Bentall, R. P. and Kaney, S. (1996). Abnormalities of self-representation and persecutory delusions. Psychological Medicine, 26, 12311237.Google Scholar
Bentall, R. P., Kinderman, P. and Kaney, S. (1994). The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research and Therapy, 32, 331341.Google Scholar
Bentall, R. P. and Morrison, A. P. (2002). More harm than good: the case against using antipsychotic drugs to prevent severe mental illness. Journal of Mental Health, 11, 351365.Google Scholar
Cartwright-Hatton, S. and Wells, A. (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behaviour Research and Therapy, 42, 385396.Google Scholar
Fowler, D. (2000). Psychological formulation of early episodes of psychosis: a cognitive model. In Birchwood, M. J., Jackson, C. and Fowler, D. (Eds.), Early Intervention in Psychosis: a guide to concepts, evidence and interventions. Chichester: Wiley.Google Scholar
Fowler, D., Freeman, D., Smith, B., Kuipers, E., Bebbington, P., Bashforth, H., et al. (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36, 749759.Google Scholar
Freeman, D., Garety, P., Fowler, D., Kuipers, E., Dunn, G., Bebbington, P., et al. (1998). The London-East Anglia randomized controlled trial of cognitive-behaviour therapy for psychosis. IV: self-esteem and persecutory delusions. British Journal of Clinical Psychology, 37, 415430.CrossRefGoogle ScholarPubMed
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D. and Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189195.Google Scholar
Gumley, A. I., Gillan, K., Morrison, A. P. and Schwannauer, M. (2011). The development and validation of the Beliefs about Paranoia Scale (Short Form). Behavioural and Cognitive Psychotherapy, 39, 3553.Google Scholar
Hall, P. L. and Tarrier, N. (2003). The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behaviour Research and Therapy, 41, 317332.CrossRefGoogle ScholarPubMed
Hall, P. L. and Tarrier, N. (2004). Short term durability of a cognitive behavioural intervention in psychosis: effects from a pilot study. Behavioural and Cognitive Psychotherapy, 32, 117121.Google Scholar
IBM Corporation (2010). IBM SPSS Statistics 19.0 [Computer software].Google Scholar
Jackson, C., Trower, P., Reid, L., Smith, J., Hall, M., Townend, M., et al. (2009). Improving psychological adjustment following a first episode of psychosis: a randomised controlled trial of cognitive therapy to reduce post psychotic trauma symptoms. Behaviour Research and Therapy, 47, 454462.CrossRefGoogle ScholarPubMed
Kampman, O., Kiviniemi, P., Koivisto, E., Väänänen, J., Kilkku, N., Leinonen, E., et al. (2004). Patient characteristics and diagnostic discrepancy in first-episode psychosis. Comprehensive Psychiatry, 45, 213218.Google Scholar
Keith, L. K. and Bracken, B. A. (1996). Self-concept instrumentation: a historical and evaluative review. In Bracken, B. A. (Ed.), Handbook of Self-Concept: developmental, social, and clinical considerations (pp. 91170). New York: Wiley.Google Scholar
Krabbendam, L., Janssen, I., Bak, M., Bijl, R. V., de Graaf, R. and van Os, J. (2002). Neuroticism and low self-esteem as risk factors for psychosis. Social Psychiatry and Psychiatric Epidemiology, 37, 16.CrossRefGoogle ScholarPubMed
Krabbendam, L., Myin-Germeys, I., Bak, M. and van Os, J. (2005). Explaining transitions over the hypothesized psychosis continuum. Australian and New Zealand Journal of Psychiatry, 39, 180186.Google Scholar
Krabbendam, L., Myin-Germeys, I., Hanssen, M., de Graaf, R., Vollebergh, W., Bak, M., et al. (2005). Development of depressed mood predicts onset of psychotic disorder in individuals who report hallucinatory experiences. British Journal of Clinical Psychology, 44, 113.Google Scholar
Laithwaite, H. M., Gumley, A., Benn, A., Scott, E., Downey, K., Black, K., et al. (2007). Self-esteem and psychosis: a pilot study investigating the effectiveness of a self-esteem programme on the self-esteem and positive symptomatology of mentally disordered offenders. Behavioural and Cognitive Psychotherapy, 35, 569577.CrossRefGoogle Scholar
Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S. and Phelan, J. C. (2001). Stigma as a barrier to recovery: the consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52, 16211626.Google Scholar
Mattick, R. P. and Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455470.Google Scholar
Miller, G. A. and Chapman, J. P. (2001). Misunderstanding analysis of covariance. Journal of Abnormal Psychology, 110, 4048.Google Scholar
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Research, 29, 257276.Google Scholar
Morrison, A. P., French, P., Stewart, S. L. K., Birchwood, M., Fowler, D., Gumley, A. I., et al. (2012). Early detection and intervention evaluation for people at risk of psychosis: a multisite randomised controlled trial. British Medical Journal, 344:e2233. doi:10.1136/bmj.e2233.CrossRefGoogle ScholarPubMed
Morrison, A. P., Nothard, S., Bowe, S. E. and Wells, A. (2004). Interpretations of voices in patients with hallucinations and non-patient controls: a comparison and predictors of distress in patients. Behaviour Research and Therapy, 42, 13151323.Google Scholar
Morrison, A. P., Stewart, S. L. K., French, P., Bentall, R. P., Birchwood, M., Byrne, R., et al. (2011). Early detection and intervention evaluation for people at high-risk of psychosis-2 (EDIE-2): trial rationale, design and baseline characteristics. Early Intervention in Psychiatry, 5, 2432. doi: 10.1111/j.1751-7893.2010.00254.x Google Scholar
Oliver, J. E., O’Connor, J. A., Jose, P. E., McLachlan, K. and Peters, E. (2011). The impact of negative schemas, mood and psychological flexibility on delusional ideation: mediating and moderating effects. Psychosis, 4, 618.Google Scholar
Robson, P. J. (1988). Self-esteem: a psychiatric view. British Journal of Psychiatry, 153, 615.CrossRefGoogle ScholarPubMed
Robson, P. J. (1989). Development of a new self-report questionnaire to measure self esteem. Psychological Medicine, 19, 513518.Google Scholar
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press.Google Scholar
Sartorius, N. (2007). Stigma and mental health. The Lancet, 370, 810811.Google Scholar
Silverstone, P. and Salsali, M. (2003). Low self-esteem and psychiatric patients: Part I - the relationship between low self-esteem and psychiatric diagnosis. Annals of General Hospital Psychiatry, 2, 2.Google Scholar
Stefanis, N. C., Hanssen, M., Smirnis, N. K., Avramopoulos, D. A., Evdokimidis, I. K., Stefanis, C. N., et al. (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine, 32, 347358.Google Scholar
Stowkowy, J. and Addington, J. (2012). Maladaptive schemas as a mediator between social defeat and positive symptoms in young people at clinical high risk for psychosis. Early Intervention in Psychiatry, 6, 8790. doi: 10.1111/j.1751-7893.2011.00297.x Google Scholar
Swartz, M. S. and Monahan, J. (2001). Special section on involuntary outpatient commitment: introduction. Psychiatric Services, 52, 323324.Google Scholar
Taylor, H. E., Gumley, A. I., Dunn, G., Stewart, S. L. K., Parker, S. and Morrison, A. P. (2012). Metacognitive beliefs and appraisals across the continuum of psychosis. Unpublished manuscript.Google Scholar
Taylor, H. E., Stewart, S. L. K., Dunn, G., Parker, S., Bentall, R. P., Birchwood, M., et al. (in press). Psychopathology and affect dysregulation across the continuum of psychosis: a multiple comparison group study. Early Intervention in Psychiatry. doi: 10.1111/eip.12064 Google Scholar
Trower, P. and Chadwick, P. (1995). Pathways to defense of the self: a theory of two types of paranoia. Clinical Psychology: Science and Practice, 2, 263278.Google Scholar
van ‘t Wout, M., Aleman, A., Kessels, R. P. C., Larøi, F. and Kahn, R. S. (2004). Emotional processing in a non-clinical psychosis-prone sample. Schizophrenia Research, 68, 271281.CrossRefGoogle Scholar
Vracotas, N., Iyer, S. N. and Malla, A. (2008). Outcome in first-episode psychosis: the role of self-esteem and insight. Schizophrenia Research, 98(Supplement 1), 8788.Google Scholar
Warner, R., Taylor, D., Powers, M. and Hyman, J. (1989). Acceptance of the mental illness label by psychotic patients: effects on functioning. American Journal of Orthopsychiatry, 59, 398409.CrossRefGoogle ScholarPubMed
Winter, L. B., Steer, R., Jones-Hicks, L. and Beck, A. T. (1999). Screening for major depressive disorder in adolescent medical outpatients with the Beck Depression Inventory for Primary Care. Journal of Adolescent Health, 24, 389394.Google Scholar
Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell’Olio, M., et al. (2005). Mapping the onset of psychosis: the Comprehensive Assessment of At Risk Mental States (CAARMS). Australian and New Zealand Journal of Psychiatry, 39, 964971.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.