Korean J Schizophr Res.  2020 Apr;23(1):29-37. 10.16946/kjsr.2020.23.1.29.

Characteristics of Early Maladaptive Schemas in Individuals with Schizophrenia: A Comparative Study Relative to Major Depressive Disorder

• Jang TY
• Lee SJ

• KMID: 2500473
• DOI: http://doi.org/10.16946/kjsr.2020.23.1.29

Abstract

Objectives
This study aimed to investigate the characteristics of early maladaptive schemas and their associations with clinical symptoms in patients with schizophrenia.
Methods
Forty-eight patients with schizophrenia, 49 patients with major depressive disorder, and 50 healthy controls completed the Young Schema Questionnaire and symptom measures including the Brief Psychiatric Rating Scale-Expanded (BPRS-E).
Results
The schizophrenia group had significantly higher scores than the healthy controls and lower scores than the depression group in most schemas. Compared with healthy controls, the schizophrenia group exhibited higher scores in 10 schemas, i.e., mistrust, social isolation, failure, dependence, vulnerability to harm, enmeshment, insufficient self-control, subjugation, emotional inhibition, and negativity schemas (all p<0.001). Moreover, vulnerability to harm, enmeshment, subjugation, and negativity schemas were correlated with total scores of the BPRS-E (0.37≤r≤0.43, all p<0.05). Regarding the five BPRS domains, emotional deprivation schema showed significant relationships with negative (r=0.50, p=0.005) and disorganization (r=0.39, p=0.033) symptoms, while no schemas showed correlations with positive symptoms.
Conclusion
These results suggest that most schemas in patients with schizophrenia pertain to impaired autonomy and performance as well as disconnection and rejection domains and may improve our understanding and the treatment of schizophrenia from a perspective of schema therapy focused on these domains.

Keyword

Early maladaptive schemas; Major depressive disorder; Schema therapy; Schizophrenia

Reference

1. Tandon R, Nasrallah HA, Keshavan MS. Schizophrenia, “just the facts” 4. Clinical features and conceptualization. Schizophr Res. 2009; 110:1–23.

2. Eack SM, Newhill CE. Psychiatric symptoms and quality of life in schizophrenia: a meta-analysis. Schizophr Bull. 2007; 33:1225–1237.

3. Taylor M, Perera U. NICE CG178 psychosis and schizophrenia in adults: treatment and management - an evidence-based guideline? Br J Psychiatry. 2015; 206:357–359.

4. Beck AT, Rector NA. Cognitive approaches to schizophrenia: theory and therapy. Annu Rev Clin Psychol. 2005; 1:577–606.

5. Tai S, Turkington D. The evolution of cognitive behavior therapy for schizophrenia: current practice and recent developments. Schizophr Bull. 2009; 35:865–873.

6. Young JE, Klosko JS, Weishaar ME. Schema therapy: a practitioner’s guide. New York: Guilford Press;2003.

7. Rafaeli E, Bernstein DP, Young J. Schema therapy. London: Routledge;2010.

8. Cannon M, Clarke MC. Risk for schizophrenia-broadening the concepts, pushing back the boundaries. Schizophr Res. 2005; 79:5–13.

9. Janssen I, Krabbendam L, Bak M, Hanssen M, Vollebergh W, de Graaf R, et al. Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand. 2004; 109:38–45.

10. Read J, van Os J, Morrison AP, Ross CA. Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand. 2005; 112:330–350.

11. Cohen CI, Palekar N, Barker J, Ramirez PM. The relationship between trauma and clinical outcome variables among older adults with schizophrenia spectrum disorders. Am J Geriatr Psychiatry. 2012; 20:408–415.

12. Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W, et al. Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophr Bull. 2012; 38:661–671.

13. Bentall RP, Wickham S, Shevlin M, Varese F. Do specific earlylife adversities lead to specific symptoms of psychosis? A study from the 2007 the adult psychiatric morbidity survey. Schizophr Bull. 2012; 38:734–740.

14. Kaufman J, Torbey S. Child maltreatment and psychosis. Neurobiol Dis. 2019; 131:104378.

15. Ucok A, Bikmaz S. The effects of childhood trauma in patients with first-episode schizophrenia. Acta Psychiatr Scand. 2007; 116:371–377.

16. Read J, Perry BD, Moskowitz A, Connolly J. The contribution of early traumatic events to schizophrenia in some patients: a traumagenic neurodevelopmental model. Psychiatry. 2001; 64:319–345.

17. van Winkel R, Stefanis NC, Myin-Germeys I. Psychosocial stress and psychosis. A review of the neurobiological mechanisms and the evidence for gene-stress interaction. Schizophr Bull. 2008; 34:1095–1105.

18. Birchwood M, Meaden A, Trower P, Gilbert P, Plaistow J. The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychol Med. 2000; 30:337–344.

19. Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE. A cognitive model of the positive symptoms of psychosis. Psychol Med. 2001; 31:189–195.

20. Turner DT, van der Gaag M, Karyotaki E, Cuijpers P. Psychological interventions for psychosis: a meta-analysis of comparative outcome studies. Am J Psychiatry. 2014; 171:523–538.

21. Wykes T, Steel C, Everitt B, Tarrier N. Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophr Bull. 2008; 34:523–537.

22. Renner F, Lobbestael J, Peeters F, Arntz A, Huibers M. Early maladaptive schemas in depressed patients: stability and relation with depressive symptoms over the course of treatment. J Affect Disord. 2012; 136:581–590.

23. Nilsson KK, Nielsen Straarup K, Halvorsen M. Early maladaptive schemas: a comparison between bipolar disorder and major depressive disorder. Clin Psychol Psychother. 2015; 22:387–391.

24. Kim JE, Lee SW, Lee SJ. Relationship between early maladaptive schemas and symptom dimensions in patients with obsessive-compulsive disorder. J Psychiatr Res. 2014; 215:134–140.

25. Bortolon C, Capdevielle D, Boulenger JP, Gely-Nargeot MC, Raffard S. Early maladaptive schemas predict positive symptomatology in schizophrenia: a cross-sectional study. Psychiatry Res. 2013; 209:361–366.

26. Sundag J, Ascone L, de Matos Marques A, Moritz S, Lincoln TM. Elucidating the role of early maladaptive schemas for psychotic symptomatology. Psychiatry Res. 2016; 238:53–59.

27. Stowkowy J, Liu L, Cadenhead KS, Cannon TD, Cornblatt BA, McGlashan TH, et al. Core schemas in youth at clinical high risk for psychosis. Behav Cogn Psychother. 2016; 44:203–213.

28. Taylor CDJ, Harper SF. Early maladaptive schema, social functioning and distress in psychosis: a preliminary investigation. Clin Psychol. 2017; 21:135–142.

29. Azadi S, Khosravani V, Naragon-Gainey K, Bastan FS, Mohammadzadeh A, Ghorbani F. Early maladaptive schemas are associated with increased suicidal risk among individuals with schizophrenia. Int J Cogn Ther. 2019; 12:274–291.

30. Cui Y, Kim SW, Lee BJ, Kim JJ, Yu JC, Lee KY, et al. Negative schema and rumination as mediators of the relationship between childhood trauma and recent suicidal ideation in patients with early ssychosis. J Clin Psychiatry. 2019; 80:3.

31. Boyda D, McFeeters D, Dhingra K, Rhoden L. Childhood maltreatment and psychotic experiences: exploring the specificity of early maladaptive schemas. J Clin Psychol. 2018; 74:2287–2301.

32. Young JE, Pascal B, Cousineau P. Young schema questionnaireshort form 3 (YSQ-S3). New York: Schema Therapy Institute;2005.

33. Lee SJ, Choi YH, Rim HD, Won SH, Lee DW. Reliability and validity of the Korean young schema questionnaire-short form-3 in medical students. Psychiatry Investig. 2015; 12:295–304.

34. Derogatis LR, Rickels K, Rock AF. The SCL-90 and the MMPI: a step in the validation of a new self-report scale. Br J Psychiatry. 1976; 128:280–289.

35. Kim KI, Kim JH, Won HT. Korean manual of symptom checklist90-revision. Seoul: Chungang Aptitude Publishing Co Ltd;1984.

36. Lukoff D, Nuechterlein K, Ventura J. Manual for the expanded brief psychiatric rating scale. Schizophr Bull. 1986; 12:594–602.

37. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962; 10:799–812.

38. Shafer A, Dazzi F, Ventura J. Factor structure of the brief psychiatric rating scale-expanded (BPRS-E) in a large hospitalized sample. J Psychiatr Res. 2017; 93:79–86.

39. Khosravani V, Mohammadzadeh A, Oskouyi LS. Early maladaptive schemas in patients with schizophrenia and non-patients with high and low schizotypal traits and their differences based on depression severity. Compr Psychiatry. 2019; 88:1–8.

40. Sundag J, Ascone L, Lincoln TM. The predictive value of early maladaptive schemas in paranoid responses to social stress. Clin Psychol Psychother. 2018; 25:65–75.

41. Khosravani V, Bastan FS, Mohammadzadeh A, Amirinezhad A, Ardestani SMS. Early maladaptive schemas in patients with obsessive-compulsive disorder, bipolar disorder, and schizophrenia: a comparative study. Curr Psychol. 2019; 1–11.

42. Shahravan N, Rezaei O, Hosseini R. The relationship between delusional beliefs and early maladaptive schemas in psychotic patients. GMP Rev. 2015; 18:3.

43. Fannon D, Hayward P, Thompson N, Green N, Surguladze S, Wykes T. The self or the voice? Relative contributions of self-esteem and voice appraisal in persistent auditory hallucinations. Schizophr Res. 2009; 112:174–180.

44. Kesting ML, Lincoln TM. The relevance of self-esteem and selfschemas to persecutory delusions: a systematic review. Compr Psychiatry. 2013; 54:766–789.

45. Garety P, Freeman D. The past and future of delusions research: from the inexplicable to the treatable. Br J Psychiatry. 2013; 203:327–333.

46. Salehi D, Abedin A, Tavakoli Hassan Abadi MR. Comparison of early maladaptive schema of adult children of schizophrenic parent with adult children of healthy parent. J Pract Clin Psychol. 2017; 5:3–10.

47. Bortolon C, Seille J, Raffard S. Exploration of trauma, dissociation, maladaptive schemas and auditory hallucinations in a french sample. Cogn Neuropsychiatry. 2017; 22:468–485.

48. Giesen-Bloo J, Van Dyck R, Spinhoven P, Van Tilburg W, Dirksen C, Van Asselt T, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry. 2006; 63:649–658.

49. Bamelis LL, Evers SM, Spinhoven P, Arntz A. Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. Am J Psychiatry. 2014; 171:305–322.

50. Pugh M. A narrative review of schemas and schema therapy outcomes in the eating disorders. Clin Psychol Rev. 2015; 39:30–41.