Further support for the role of dysfunctional attitudes in models of real-life functioning in schizophrenia

VA Greater Los Angeles Healthcare System, University of California, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90073, USA.
Journal of Psychiatric Research (Impact Factor: 3.96). 12/2009; 44(8):499-505. DOI: 10.1016/j.jpsychires.2009.11.001
Source: PubMed


According to A.T. Beck and colleagues' cognitive formulation of poor functioning in schizophrenia, maladaptive cognitive appraisals play a key role in the expression and persistence of negative symptoms and associated real-world functioning deficits. They provided initial support for this model by showing that dysfunctional attitudes are elevated in schizophrenia and account for significant variance in negative symptoms and subjective quality of life. The current study used structural equation modeling to further evaluate the contribution of dysfunctional attitudes to outcome in schizophrenia. One hundred eleven outpatients and 67 healthy controls completed a Dysfunctional Attitudes Scale, and patients completed a competence measure of functional capacity, clinical ratings of negative symptoms, and interview-based ratings of real-world functioning. Patients reported higher defeatist performance beliefs than controls and these were significantly related to lower functional capacity, higher negative symptoms, and worse community functioning. Consistent with Beck and colleagues' formulation, modeling analyses indicated a significant indirect pathway from functional capacity-->dysfunctional attitudes-->negative symptoms-->real-world functioning. These findings support the value of dysfunctional attitudes for understanding the determinants of outcome in schizophrenia and suggest that therapeutic interventions targeting these attitudes may facilitate functional recovery.

Full-text preview

Available from:
  • Source
    • "), even when depression is controlled (Rector, 2004). Moreover, defeatist performance beliefs have been found to mediate the relationship between cognitive performance and both negative symptoms and functioning (Grant and Beck, 2009), as well as mediate the relationship between the capacity to perform everyday functional behaviors and negative symptoms (Horan et al., 2010). Longitudinal investigations of defeatist performance beliefs in individuals with schizophrenia have largely been conducted in the context of cognitive therapy clinical trials, which have found some support for an association between a reduction in defeatist performance beliefs and improved negative symptoms and functioning over time (Granholm et al., 2013, 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Negative symptoms are often enduring and lead to poor functional outcomes in individuals with schizophrenia. The cognitive model of negative symptoms proposes that low expectancies of success contribute to the development and maintenance of negative symptoms; however, longitudinal investigations assessing these beliefs and negative symptoms are needed. The current study examined whether an individual's baseline expectancies of success - one's beliefs about future success and goal attainment - predicted negative symptoms reduction over 18 months in individuals with schizophrenia-spectrum disorders (n=118). Data were collected at baseline, 9 months, and 18 months as part of a randomized controlled trial of Illness Management and Recovery. A mixed effects regression analysis revealed a significant reduction in negative symptoms over time, with a significant interaction effect between time and baseline expectancies of success. After controlling for baseline negative symptoms, demographic variables, and treatment conditions, those with high and moderate baseline expectancies of success evidenced a significant reduction in negative symptoms at 18 months, while those with low baseline expectancies of success did not evidence reduced negative symptoms. Findings support the cognitive model of negative symptoms and suggest that expectancies of success may be a useful treatment target for interventions aimed at reducing negative symptoms. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Jun 2015
  • Source
    • "used to compute the EI , there was some evidence for larger effect sizes on more cognitively demanding than less demanding tests . These findings are consistent with evidence indicating that psychological processes ( e . g . , low expectancies for success ) may play a significant role in both neuropsychological impairment and insufficient effort ( Horan et al . , 2010 ; Couture et al . , 2011 ; Strauss et al . , 2014 ) . Although only a minority of our schizophrenia sample failed the EI , findings have important implications for clinical trials examining the efficacy of cognitive enhancing drugs or cognitive retraining programs . Specifically , it may be useful to screen for insufficient effort to id"
    [Show abstract] [Hide abstract]
    ABSTRACT: There is some evidence that insufficient effort may be common in schizophrenia, posing significant threats to the validity of neuropsychological test results. Low effort may account for a significant proportion of variance in neuropsychological test scores and the generalized cognitive deficit that characterizes the disorder. The current study evaluated clinical predictors of insufficient effort in schizophrenia using an embedded effort measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI). Participants were 330 patients meeting DSM-IV-TR criteria for schizophrenia, schizoaffective disorder, or another psychotic disorder who received a battery of neuropsychological tests, including: Wechsler Test of Adult Reading (WTAR), Wechsler Abbreviated Scale of Intelligence (WASI), and RBANS. Clinical assessments designed to measure functional outcome and symptoms were also obtained. Results indicated that 9.4% of patients failed the EI. Patients who failed had lower full-scale, verbal, and performance IQ, as well as poorer performance on RBANS domains not included in the EI (immediate memory, language, and visuospatial/construction). Patients who failed the EI also displayed poorer community-based vocational outcome, greater likelihood of having “deficit schizophrenia” (i.e., primary and enduring negative symptoms), and increased severity of positive symptoms. Regression analyses revealed that insufficient effort was most significantly predicted by a combination of low IQ, negative symptoms, and positive symptoms. Findings suggest that although insufficient effort may be relatively uncommon in schizophrenia, it is associated with important clinical outcomes. The RBANS EI may be a useful tool in evaluating insufficient effort in schizophrenia.
    Full-text · Article · Jan 2015 · Schizophrenia Research
  • Source
    • "These include defeatist performance beliefs (i.e., overly generalized negative conclusions regarding task performance ) and negative expectancy appraisals, such as perceptions of limited cognitive resources, negative beliefs related to one's ability to persist in difficult tasks, and reduced expectations for success (Couture, Blanchard, & Bennett, 2011; Grant & Beck, 2009; Horan et al., 2010). Several studies have reported an association between neurocognitive deficits and dysfunctional beliefs in SZ, including defeatist performance beliefs and negative expectancy appraisals (Couture et al., 2011; Grant & Beck, 2009; Horan et al., 2010). There is also a significant association between neurocognitive impairment and anhedonia in SZ. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Two experiments were conducted to examine whether insufficient effort, negative symptoms (e.g., avolition, anhedonia), and psychological variables (e.g., anhedonia and perception of low cognitive resources) predict generalized neurocognitive impairment in individuals with schizophrenia (SZ). Method: In Experiment 1, participants included 97 individuals with SZ and 63 healthy controls (CN) who completed the Victoria Symptom Validity Test (VSVT), the MATRICS Consensus Cognitive Battery (MCCB), and self-report anhedonia questionnaires. In Experiment 2, participants included 46 individuals with SZ and 33 CN who completed Green's Word Memory Test (WMT), the MCCB, and self-reports of anhedonia, defeatist performance beliefs, and negative expectancy appraisals. Results: RESULTS indicated that a low proportion of individuals with SZ failed effort testing (1.0% Experiment 1; 15.2% Experiment 2); however, global neurocognitive impairment was significantly predicted by low effort and negative symptoms. Conclusions: Findings indicate that low effort does not threaten the validity of neuropsychological test results in the majority of individuals with schizophrenia; however, effort testing may be useful in SZ patients with severe negative symptoms who may be more likely to put forth insufficient effort due to motivational problems. Although the base rate of failure is relatively low, it may be beneficial to screen for insufficient effort in SZ and exclude individuals who fail effort testing from pharmacological or cognitive remediation trials.
    Full-text · Article · Jul 2014 · Neuropsychology
Show more