Skip to main content Accessibility help

Core Schemas in Youth at Clinical High Risk for Psychosis

  • Jacqueline Stowkowy (a1), Lu Liu (a1), Kristin S. Cadenhead (a2), Tyrone D. Cannon (a3), Barbara A. Cornblatt (a4), Thomas H. McGlashan (a3), Diana O. Perkins (a5), Larry J. Seidman (a6), Ming T. Tsuang (a2), Elaine F. Walker (a7), Scott W. Woods (a3), Carrie E. Bearden (a8), Daniel H. Mathalon (a9), Robert Heinssen (a10) and Jean Addington (a1)...


Background: Schema Theory proposes that the development of maladaptive schemas are based on a combination of memories, emotions and cognitions regarding oneself and one's relationship to others. A cognitive model of psychosis suggests that schemas are crucial to the development and persistence of psychosis. Little is known about the impact that schemas may have on those considered to be at clinical high risk (CHR) of developing psychosis. Aims: To investigate schemas over time in a large sample of CHR individuals and healthy controls. Method: Sample included 765 CHR participants and 280 healthy controls. Schemas were assessed at baseline, 6 and 12 months using the Brief Core Schema Scale (BCSS). Baseline schemas were compared to 2-year clinical outcome. Results: CHR participants evidenced stable and more maladaptive schemas over time compared to controls. Schemas at initial contact did not vary amongst the different clinical outcome groups at 2 years although all CHR outcome groups evidenced significantly worse schemas than healthy controls. Although there were no differences on baseline schemas between those who later transitioned to psychosis compared to those who did not, those who transitioned to psychosis had more maladaptive negative self-schemas at the time of transition. Associations between negative schemas were positively correlated with earlier abuse and bullying. Conclusions: These findings demonstrate a need for interventions that aim to improve maladaptive schemas among the CHR population. Therapies targeting self-esteem, as well as schema therapy may be important work for future studies.


Corresponding author

Reprint requests to Jacqueline Stowkowy, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada. E-mail:


Hide All
Addington, D., Addington, J. and Maticka-Tyndale, E. (1993). Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry, 163, 3944.
Addington, J., Cadenhead, K. S., Cornblatt, B. A., Mathalon, D. H., McGlashan, T. H., Perkins, D. O., et al. (2012). North American Prodrome Longitudinal Study (NAPLS 2): overview and recruitment. Schizophrenia Research, 142, 7782.
Addington, J. and Heinssen, R. (2011). Prediction and prevention of psychosis in youth at clinical high risk. Annual Review of Clinical Psychology, 8, 269289.
Addington, J., Shah, H., Liu, L. and Addington, D. (2014). Reliability and validity of the Calgary Depression Scale for Schizophrenia (CDSS) in youth at clinical high risk for psychosis. Schizophrenia Research, 153 (1–3), 6467.
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.
Barrantes-Vidal, N., Gross, G. M., Sheinbaum, T., Mitjavila, M., Ballespi, S. and Kwapil, T. R. (2013). Positive and negative schizotypy are associated with prodromal and schizophrenia-spectrum symptoms. Schizophrenia Research, 145, 5055.
Bortolon, C., Capdevielle, D., Boulenger, J. P., Gely-Nargeot, M. C. and Raffard, S. (2013). Early maladaptive schemas predict positive symptomatology in schizophrenia: a cross-sectional study. Psychiatry Research, 209, 361366.
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, 739749.
Garety, P. A., Bebbington, P., Fowler, D., Freeman, D., and Kuipers, E. (2007). Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine, 37, 13771391.
Janssen, I., Krabbendam, L., Bak, M., Hanssen, M., Vollebergh, W., de Graaf, R., et al. (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavia, 109, 3845.
Masley, S. A., Gillanders, D. T., Simpson, S. G. and Taylor, M. A. (2012). A systematic review of the evidence base for Schema Therapy. Cognitive Behavior Therapy, 41, 185202.
McGlashan, T., Walsh, B. C. and Woods, S. W. (2010). The Psychosis Risk Syndrome: handbook for diagnosis and follow-up. New York: Oxford University Press.
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 Psychiatry, 6, 8790.
Taylor, H. E., Stewart, S. L., Dunn, G., Parker, S., Fowler, D. and Morrison, A. P. (2013). Core schemas across the continuum of psychosis: a comparison of clinical and non-clinical groups. Behavioural and Cognitive Psychotherapy, 42, 718730.
Young, J. E., Klosko, J. S. and Weishaar, M. E. (2003). Schema Therapy: a practitioner's guide. New York: Guilford Press.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Behavioural and Cognitive Psychotherapy
  • ISSN: 1352-4658
  • EISSN: 1469-1833
  • URL: /core/journals/behavioural-and-cognitive-psychotherapy
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

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 in Youth at Clinical High Risk for Psychosis

  • Jacqueline Stowkowy (a1), Lu Liu (a1), Kristin S. Cadenhead (a2), Tyrone D. Cannon (a3), Barbara A. Cornblatt (a4), Thomas H. McGlashan (a3), Diana O. Perkins (a5), Larry J. Seidman (a6), Ming T. Tsuang (a2), Elaine F. Walker (a7), Scott W. Woods (a3), Carrie E. Bearden (a8), Daniel H. Mathalon (a9), Robert Heinssen (a10) and Jean Addington (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? *