The cognitive model of negative symptoms: a systematic review and meta-analysis of the dysfunctional belief systems associated with negative symptoms in schizophrenia spectrum disorders.

Abstract

Background: The hypothesized cognitive model of negative symptoms, proposed nearly twenty years ago, is the most prevalent psychological framework for conceptualizing negative symptoms in schizophrenia spectrum disorders (SSDs). The aim of this study was to comprehensively validate the model for the first time, specifically by quantifying the relationships between negative symptom severity and all related dysfunctional beliefs.

Methods: A systematic search was conducted using MEDLINE and PsychINFO, supplemented by manual reviews of reference lists and Google Scholar. Eligible studies were peer-reviewed with data on the direct cross-sectional association between negative symptoms and at least one relevant dysfunctional belief in SSD patients. Screening and data extraction were completed by independent reviewers. Random-effects meta-analyses were performed to pool effect size estimates of z-transformed Pearson's r correlations. Moderators of these relationships, as well as subset analyses for negative symptom domains and measurement instruments, were also assessed.

Results: Significant effects emerged for the relationships between negative symptoms and defeatist performance beliefs (k = 38, n = 2808), r = 0.23 (95% CI, 0.18-0.27), asocial beliefs (k = 8, n = 578), r = 0.21 (95% CI, 0.12-0.28), low expectancies for success (k = 55, n = 5664), r = -0.21 (95% CI, -0.15 - -0.26), low expectancies for pleasure (k = 5, n = 249), r = -0.19 (95% CI, -0.06 - -0.31), and internalized stigma (k = 81, n = 9766), r = 0.17 (95% CI, 0.12-0.22), but not perception of limited resources (k = 10, n = 463), r = 0.08 (95% CI, -0.13 - 0.27).

Conclusions: This meta-analysis provides support for the cognitive model of negative symptoms. The identification of specific dysfunctional beliefs associated with negative symptoms is essential for the development of precision-based cognitive-behavioral interventions.