Saperia Sarah, Plahouras Joanne, Best Michael, Kidd Sean, Zakzanis Konstantine, Foussias George
Schizophrenia Division and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada.
Psychol Med. 2025 Feb 5;55:e11. doi: 10.1017/S0033291724003325.
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.
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 -transformed Pearson's correlations. Moderators of these relationships, as well as subset analyses for negative symptom domains and measurement instruments, were also assessed.
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).
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.
近二十年前提出的阴性症状假设认知模型，是精神分裂症谱系障碍（SSDs）中概念化阴性症状最普遍的心理学框架。本研究的目的是首次全面验证该模型，具体方法是量化阴性症状严重程度与所有相关功能失调信念之间的关系。
使用MEDLINE和PsychINFO进行系统检索，并辅以对参考文献列表和谷歌学术的人工检索。符合条件的研究需经过同行评审，包含关于SSD患者阴性症状与至少一种相关功能失调信念之间直接横断面关联的数据。筛选和数据提取由独立评审员完成。进行随机效应荟萃分析，以汇总 - 转换后的皮尔逊相关系数的效应量估计值。还评估了这些关系的调节因素，以及阴性症状领域和测量工具的亚组分析。
阴性症状与失败主义表现信念（k = 38，n = 2808）之间的关系出现显著效应，r = 0.23（95% CI，0.18 - 0.27）；与社交障碍信念（k = 8，n = 578）之间的关系出现显著效应，r = 0.21（95% CI，0.12 - 0.28）；与低成功期望（k = 55，n = 5664）之间的关系出现显著效应，r = -0.21（95% CI，-0.15 - -0.26）；与低愉悦期望（k = 5，n = 249）之间的关系出现显著效应，r = -0.19（95% CI，-0.06 - -0.31）；与内化耻辱感（k = 81，n = 9766）之间的关系出现显著效应，r = 0.17（95% CI，0.12 - 0.22），但与资源有限感知（k = 10，n = 463）之间的关系未出现显著效应，r = 0.08（95% CI，-0.13 - 0.27）。
这项荟萃分析为阴性症状的认知模型提供了支持。识别与阴性症状相关的特定功能失调信念对于开发基于精准的认知行为干预措施至关重要。
