Prospective Bidirectional Associations Between Core Schemas, Attenuated Psychotic Symptoms, and Functioning in Youth at Clinical High Risk for Psychosis
Year: 2026
Type: preprint
Abstract: Objective Cognitive models of psychosis implicate maladaptive core schemas in the development and emergence of psychotic symptoms, but no study has tested temporal dynamics between schemas and psychotic symptoms in a large sample of clinical high-risk (CHR) youth. Given their sizable role in cognitive behavioral therapies, the first-line treatment for CHR youth, core schemas may be key to both symptom development and treatment in this population. Methods Participants were 578 CHR individuals from the second North American Prodrome Longitudinal Study (NAPLS-2) assessed across five timepoints. Time-lagged mixed-effects models tested forward (schema→outcome) and reverse (outcome→schema) paths for each Brief Core Schema Scales subscale with both psychotic symptom and functioning changes, controlling for autoregressive effects, time-varying depression, and linear time. Results Twenty of 36 schema–outcome pairs showed significant prospective associations. Negative-other schemas were prospectively associated with worsening across nearly all psychosis symptom and functioning domains. Suspiciousness exhibited bidirectional associations with all four schema subscales. Grandiose ideas were uniquely prospectively associated with positive-self and negative-other schemas. Positive schemas were prospectively associated with decreases in suspiciousness, negative symptoms, and improvements in functioning. Effects were largely independent of depressive symptoms and robust across sensitivity analyses, with partial attenuation of self-schema effects on suspiciousness. Conclusions Core schemas were prospectively associated with psychosis symptom and functioning change in CHR youth, with symptom-domain specificity and bidirectionality. These findings extend cognitive models of psychosis into CHR syndromes and highlight schemas as potentially modifiable treatment targets to improve outcomes in this population. Highlights Schema changes preceded shifts in functioning and psychosis symptoms among CHR youth Negative-other schemas preceded worsening across nearly all outcome domains Suspiciousness was the only outcome with bidirectional schema associations Positive schemas preceded fewer negative symptoms and better global functioning
Source: medRxiv
Institutions: Yale University, Connecticut Mental Health Center, University of Calgary, Hotchkiss Brain Institute, University of California, Los Angeles, University of California San Diego, San Francisco VA Medical Center, University of California, San Francisco, University of North Carolina at Chapel Hill, Emory University
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7216323679