Do cognitive schema mediate the association between childhood trauma and being at ultra-high risk for psychosis?

Abstract

Exposure to childhood trauma has been associated with psychotic symptoms, being at ultra-high risk for psychosis (UHR), and psychotic disorders such as schizophrenia. Negative self-beliefs have been shown to partially mediate the relationship between childhood trauma and paranoia and have been shown to be characteristic of patients with psychosis. However, whether the association between childhood trauma and being at high risk of developing psychosis (e.g., UHR) and paranoia symptoms is mediated by altered cognitive schema is unknown and warrants investigation to inform preventive interventions. Data was collected on 30 UHR patients from Outreach and Support in South London about exposure to childhood trauma, cognitive schema, paranoia and cannabis use. Relative to healthy controls (n = 38), UHR patients were significantly more likely to report exposure to various types of childhood trauma (emotional and sexual abuse, and emotional and physical neglect), had more negative schema and less positive schema about themselves and others, and were more likely to use cannabis more than once a month. Emotional neglect was found to be significantly associated with UHR status even after controlling for the effects of previous exposure to cannabis use (b = 0.262, 95% CI: 0.115-0.408), and this association was partially mediated by negative self-schema (b = 0.045, 95% CI: 0.004-0.159). Similarly, emotional neglect was significantly associated with paranoia (b = 1.354, 95% CI: 0.246-2.462), and this association was partially mediated by negative self-schema (b = 0.988, 95% CI: 0.323-1.895). These findings provide preliminary evidence about the cognitive mechanisms that may underlie the association between childhood trauma and later risk for psychosis.

In the eye of the beholder: Perceptions of neighborhood adversity and psychotic experiences in adolescence

“…That is, the association between adverse neighborhood conditions and early expressions of psychosis is detectable at the level of the eye of the beholder. This is consistent with psychological theories and empirical studies of psychosis aetiology which emphasize the key role played by negative beliefs about the world and other people, hostile attributions of the intentions of others, and threat anticipation (An et al, 2010; Appiah-Kusi et al, 2017; Fowler et al, 2006; Freeman, 2016; Garety et al, 2007; Noone et al, 2015) in the development of psychotic experiences, such as paranoia; together with a broader literature suggesting that subjective perceptions of early-life adversity are associated with mental health problems over and above more objective reports of adversity exposure (Brown et al, 2005; Reuben et al, 2016; Widom & Morris, 1997; Widom et al, 1999). …”

Childhood maltreatment and psychotic experiences: Exploring the specificity of early maladaptive schemas

“…When serious forms of abuse take place, it is likely to convey the message that the child's core self is a disappointment because he or she has not lived up to expectations, or is simply not worthy of love and attention (Cecil et al, 2017). This notion aligns with research from cognitive models of psychosis used within clinical and nonclinical samples (Appiah-Kusi et al, 2017). Evidence suggests that childhood maltreatment may create an enduring cognitive vulnerability, characterized by negative schematic models of the self and the world that facilitates appraisal biases and low self-esteem, particularly if criticism stems directly from family members (Barrowclough et al, 2003;Garety, Bebbington, Fowler, Freeman, & Kuipers, 2007;Garety et al, 2001;Tiernan, Tracey, & Shannon, 2014).…”

Mediating role of cognitive biases, resilience and depressive symptoms in the relationship between childhood trauma and psychotic‐like experiences in young adults

“…As of yet, research has focused inter alia on dissociative factors (Kilcommons & Morrison, 2005), external locus of control (Bentall & Fernyhough, 2008), attachment styles Korver-Nieberg, Berry, Meijer, de Haan, & Ponizovsky, 2015), basic self-disturbances (Gawęda, Pionke, et al, 2018), anxiety (Freeman & Fowler, 2009), cognitive affect regulation strategies (Hardy et al, 2016) and cognitive biases (Gawęda, Pionke, et al, 2018;Kilcommons & Morrison, 2005) with special emphasis put to negative self-schemas, that are often observed in people suffering from psychosis. In their study, Appiah-Kusi et al (2017) found that negative self-schemas partially mediate the relationship of emotional neglect with UHR state of psychosis and paranoia. Similar results were obtained by Fisher, Appiah-Kusi, and Grant (2012), who demonstrated that recent anxiety and negative self-beliefs partially accounted for the association between emotional or physical abuse in childhood and paranoia.…”