Schema functioning across the psychosis continuum: a systematic review

This review identifies, summarises, and critically evaluates quantitative studies examining schema functioning across the psychosis continuum. Negative and positive schema, as well as early maladaptive schema, were reviewed in clinical samples of people with or at risk of psychosis. Prospective cohort, case-control, cross-sectional, and longitudinal studies were eligible. Following a systematic search, 28 studies were identified. Overall, methodological quality was ‘fair’. Results indicated that people with psychosis and those at high-risk reported more negative-self and -other schema than those with sub-threshold symptoms and healthy controls. Associations between negative-self schema and psychosis when controlling for confounders were mixed. Further well-controlled longitudinal studies confirming direction of effects are required. Findings were mixed regarding schema stability, though only two studies examined this longitudinally. Evidence indicated specificity between certain schema and symptoms or overall dimensions. Childhood trauma was consistently linked with negative-other schema. Negative-self and -other schema partially mediated the relationship between certain adversities and psychosis. Findings offer broad support for theoretical proposals that early trauma influences the development of -self and -other schema. Positive-self and -other schema may play an important role in recovery. Negative schema should be integrated into psychological assessment and intervention, while positive schema may offer an alternative intervention target.