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

Abstract

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.

Functional capacity: a new framework for the assessment of everyday functioning in schizophrenia

“…As expected, negative symptoms contribute to the gap between competence and performance, 56 especially through subtle traits such as defeatist beliefs and lack of motivation. 57 It appears that the dysfunctional attitudes 56 described in cognitive theory, as well as low selfefficacy 58 and depressive symptoms, 7 also contribute negatively to the conversion of capacity into functioning.…”

Additional support for the cognitive model of schizophrenia: evidence of elevated defeatist beliefs in schizotypy

“…Cross-sectional studies have also found that increased defeatist performance beliefs are associated with elevated overall and domain-specific cognitive impairments [13,16] including, for example, deficits in working memory and verbal learning [17]. Increased defeatist performance beliefs have also shown associations with increased negative symptoms, but not positive symptoms, as well as reduced functioning in individuals with schizophrenia [11,13,14,16]. Moreover, some [13,18] but not all [11] studies have found that increased defeatist performance beliefs are associated with greater depressive symptoms; however, importantly, the relationship between defeatist performance beliefs and negative symptoms remains significant even after controlling for depressive symptoms [13,18].…”

“…To date, defeatist performance beliefs -a specific subtype of defeatist beliefs that focuses on overgeneralized negative beliefs about one's ability to successfully perform tasks-have received the most empirical support. Indeed, individuals with schizophrenia have been found to report increased defeatist performance beliefs compared to healthy controls [13][14][15]. Cross-sectional studies have also found that increased defeatist performance beliefs are associated with elevated overall and domain-specific cognitive impairments [13,16] including, for example, deficits in working memory and verbal learning [17].…”

“…Defeatist performance beliefs have been assessed in inpatients and outpatients with schizophrenia [13,16], older adults with schizophrenia [19], individuals with deficit syndrome schizophrenia [20], those with recent on-set schizophrenia [15], and veterans with schizophrenia [14]. Despite considerable research in schizophrenia samples, there is a dearth of research investigating defeatist performance beliefs in individuals with schizotypy.…”

Understanding and treating amotivation in people with psychosis: An experimental study of the role of guided imagery

“…Negative beliefs about future performance in a particular activity (or defeatist performance beliefs) are thought to result from past experiences of failure (Rector et al, 2005;Rector, 2004;Grant and Beck, 2009;Horan et al, 2010;Avery et al, 2009). Low expectancy of pleasure is considered to arise through difficulties with anticipatory pleasure (predicting and pre-experiencing future pleasure), which is both impaired relative to non-clinical controls, and associated with ANS (Gard et al, 2007;Oorschot et al, 2013).…”