Prospective Bidirectional Associations Between Core Schemas, Attenuated Psychotic Symptoms, and Functioning in Youth at Clinical High Risk for Psychosis
- 1Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
Abstract
ObjectiveCognitive 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.
MethodsParticipants 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.
ResultsTwenty 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.
ConclusionsCore 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.
HighlightsO_LISchema changes preceded shifts in functioning and psychosis symptoms among CHR youth C_LIO_LINegative-other schemas preceded worsening across nearly all outcome domains C_LIO_LISuspiciousness was the only outcome with bidirectional schema associations C_LIO_LIPositive schemas preceded fewer negative symptoms and better global functioning C_LI
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BibTeX
@misc{broekhuijse2026prospective,
title = {{Prospective Bidirectional Associations Between Core Schemas, Attenuated Psychotic Symptoms, and Functioning in Youth at Clinical High Risk for Psychosis}},
author = {A. Broekhuijse and A. Saxena and C. Mourgues-Codern and H. Mukhtar and J. Addington and C. E. Bearden and K. S. Cadenhead and D. H. Mathalon and T. H. McGlashan and D. O. Perkins and E. F. Walker and T. D. Cannon and S. W. Woods and A. R. Powers and E. A. Farina},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.30.26364206},
url = {https://www.medrxiv.org/content/10.64898/2026.09.30.26364206v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Prospective Bidirectional Associations Between Core Schemas, Attenuated Psychotic Symptoms, and Functioning in Youth at Clinical High Risk for Psychosis
AU - A. Broekhuijse
AU - A. Saxena
AU - C. Mourgues-Codern
AU - H. Mukhtar
AU - J. Addington
AU - C. E. Bearden
AU - K. S. Cadenhead
AU - D. H. Mathalon
AU - T. H. McGlashan
AU - D. O. Perkins
AU - E. F. Walker
AU - T. D. Cannon
AU - S. W. Woods
AU - A. R. Powers
AU - E. A. Farina
PY - 2026
DA - 2026/09/30
PB - medRxiv
DO - 10.64898/2026.09.30.26364206
UR - https://www.medrxiv.org/content/10.64898/2026.09.30.26364206v1
AB - ObjectiveCognitive 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. MethodsParticipants 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. ResultsTwenty 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. ConclusionsCore 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. HighlightsO_LISchema changes preceded shifts in functioning and psychosis symptoms among CHR youth C_LIO_LINegative-other schemas preceded worsening across nearly all outcome domains C_LIO_LISuspiciousness was the only outcome with bidirectional schema associations C_LIO_LIPositive schemas preceded fewer negative symptoms and better global functioning C_LI
ER -