Skip to main content Accessibility help

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

  • Hannah E. Taylor (a1), Suzanne L. K. Stewart (a1), Graham Dunn (a1), Sophie Parker (a2), David Fowler (a3) and Anthony P. Morrison (a1)...


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.


Corresponding author

Reprint requests to Hannah Taylor, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK. E-mail:


Hide All
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.
Beck, A. T. and Rector, N. A. (2003). A cognitive model of hallucinations. Cognitive Therapy and Research, 27, 1952.
Bentall, R. P. and Kaney, S. (1996). Abnormalities of self-representation and persecutory delusions. Psychological Medicine, 26, 12311237.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
IBM Corporation (2010). IBM SPSS Statistics 19.0 [Computer software].
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.
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.
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.
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.
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.
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.
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.
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.
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.
Miller, G. A. and Chapman, J. P. (2001). Misunderstanding analysis of covariance. Journal of Abnormal Psychology, 110, 4048.
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Research, 29, 257276.
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.
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.
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
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.
Robson, P. J. (1988). Self-esteem: a psychiatric view. British Journal of Psychiatry, 153, 615.
Robson, P. J. (1989). Development of a new self-report questionnaire to measure self esteem. Psychological Medicine, 19, 513518.
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press.
Sartorius, N. (2007). Stigma and mental health. The Lancet, 370, 810811.
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.
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.
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
Swartz, M. S. and Monahan, J. (2001). Special section on involuntary outpatient commitment: introduction. Psychiatric Services, 52, 323324.
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.
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
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.
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.
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.
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.
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.
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.


Related content

Powered by UNSILO

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

  • Hannah E. Taylor (a1), Suzanne L. K. Stewart (a1), Graham Dunn (a1), Sophie Parker (a2), David Fowler (a3) and Anthony P. Morrison (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

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

  • Hannah E. Taylor (a1), Suzanne L. K. Stewart (a1), Graham Dunn (a1), Sophie Parker (a2), David Fowler (a3) and Anthony P. Morrison (a1)...
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *