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A longitudinal mediation analysis of the effect of negative-self-schemas on positive symptoms via negative affect

  • E. S. Jaya (a1) (a2), L. Ascone (a2) and T. M. Lincoln (a2)

Cognitive models postulate that negative-self-schemas (NSS) cause and maintain positive symptoms and that negative affect mediates this link. However, only few studies have tested the temporal mediation claim systematically using an appropriate design.


A longitudinal cohort design in an online community sample (N = 962) from Germany, Indonesia, and the USA was used. NSS, negative affect and positive symptoms were measured at four time-points (T0–T3) over a 1-year period. Cross-lagged panel and longitudinal mediation analyses with structural equation modeling were used to test the temporal mediation.


Independent cross-lagged panel models showed a significant unidirectional longitudinal path from NSS to positive symptoms (T2–T3, β = 0.18, p < 0.01) and bidirectional longitudinal associations from NSS to negative affect (T0–T1, γ = 0.14, p < 0.01) and vice versa (T0–T1, γ = 0.19, p < 0.01). There was also a significant indirect pathway from NSS at baseline via negative affect at T1 and T2 to positive symptoms at T3 (unstandardized indirect effect coefficient = 0.020, p < 0.05, BCa CI 0.004–0.035), indicating mediation.


Our findings support the postulated affective pathway from NSS to positive symptoms via negative affect. Specifically, our data indicate that NSS and negative affect influence each other and build up over the course of several months before leading on to positive symptoms. We conclude that interrupting this process by targeting NSS and negative affect early in the process could be a promising strategy to prevent the exacerbation of positive symptoms.

Corresponding author
*Address for correspondence: Edo S. Jaya, Faculty of Psychology, Universitas Indonesia, 16426 Depok, Indonesia. (Email:
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Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.
Beck, AT, Rector, NA (2002). Delusions: a cognitive perspective. Journal of Cognitive Psychotherapy 16, 455468.
Beck, AT, Rector, NA (2003). A cognitive model of hallucinations. Cognitive Therapy and Research 27, 1952.
Bentall, RP, de Sousa, P, Varese, F, Wickham, S, Sitko, K, Haarmans, M, Read, J (2014). From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology 49, 10111022.
Bentler, PM, Bonett, DG (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin 88, 588.
Ben-Zeev, D, Ellington, K, Swendsen, J, Granholm, E (2011). Examining a cognitive model of persecutory ideation in the daily life of people with schizophrenia: a computerized experience sampling study. Schizophrenia Bulletin 37, 12481256.
Brenner, K, Schmitz, N, Pawliuk, N, Fathalli, F, Joober, R, Ciampi, A, King, S (2007). Validation of the English and French versions of the Community Assessment of Psychic Experiences (CAPE) with a Montreal community sample. Schizophrenia Research 95, 8695.
Buhrmester, M, Kwang, T, Gosling, SD (2011). Amazon's mechanical Turk: a new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science 6, 35.
Cheung, GW, Lau, RS (2008). Testing mediation and suppression effects of latent variables bootstrapping with structural equation models. Organizational Research Methods 11, 296325.
Cole, DA, Maxwell, SE (2003). Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology 112, 558577.
Fergusson, DM, McLeod, GFH, Horwood, LJ (2013). Childhood sexual abuse and adult developmental outcomes: findings from a 30-year longitudinal study in New Zealand. Child Abuse & Neglect 37, 664674.
Fowler, D, Freeman, D, Smith, B, Kuipers, E, Bebbington, P, Bashforth, H, Coker, S, Hodgekins, J, Gracie, A, Dunn, G, Garety, PA (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine 36, 749759.
Fowler, D, Hodgekins, J, Garety, PA, Freeman, D, Kuipers, E, Dunn, G, Smith, B, Bebbington, P (2012). Negative cognition, depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling. Schizophrenia Bulletin 38, 10631073.
Freeman, D, Dunn, G, Startup, H, Pugh, K, Cordwell, J, Mander, H, Černis, E, Wingham, G, Shirvell, K, Kingdon, D (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): a parallel, single-blind, randomised controlled trial with a mediation analysis. The Lancet Psychiatry 2, 305313.
Freeman, D, Pugh, K, Dunn, G, Evans, N, Sheaves, B, Waite, F, Černis, E, Lister, R, Fowler, D (2014). An early Phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: the potential benefits of enhancing self confidence. Schizophrenia Research 160, 186192.
Fusar-Poli, P, Nelson, B, Valmaggia, L, Yung, AR, McGuire, PK (2014). Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophrenia Bulletin 40, 120131.
Fusar-Poli, P, Rutigliano, G, Stahl, D, Davies, C, Bonoldi, I, Reilly, T, McGuire, P (2017). Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis. JAMA Psychiatry 74, 493500.
Garety, PA, Bebbington, P, Fowler, D, Freeman, D, Kuipers, E (2007). Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine 37, 13771391.
Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, P (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189195.
Gevonden, MJ, Myin-Germeys, I, van den Brink, W, van Os, J, Selten, JP, Booij, J (2015). Psychotic reactions to daily life stress and dopamine function in people with severe hearing impairment. Psychological Medicine 45, 16651674.
Häfner, H, Maurer, K, an der Heiden, W (2013). ABC schizophrenia study: an overview of results since 1996. Social Psychiatry and Psychiatric Epidemiology 48, 10211031.
Henrich, J, Heine, SJ, Norenzayan, A (2010). The weirdest people in the world? Behavioral and Brain Sciences 33, 6183.
Howes, OD, Murray, RM (2014). Schizophrenia: an integrated sociodevelopmental-cognitive model. The Lancet 383, 16771687.
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal 6, 155.
Jaspers, K (1963). General Psychopathology. 7th edn (trans. Hoenig, J. & Hamilton, M.W.). Manchester University Press: Manchester.
Jaya, ES, Ascone, L, Lincoln, TM (2017). Social adversity and psychosis: the mediating role of cognitive vulnerability. Schizophrenia Bulletin 43, 557565.
Johnson, JA (2005). Ascertaining the validity of individual protocols from Web-based personality inventories. Journal of Research in Personality 39, 103129.
Kapur, S, Mizrahi, R, Li, M (2005). From dopamine to salience to psychosis-linking biology, pharmacology and phenomenology of psychosis. Schizophrenia Research 79, 5968.
Kessler, RC, Demler, O, Frank, RG, Olfson, M, Pincus, HA, Walters, EE, Wang, P, Wells, KB, Zaslavsky, AM (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine 352, 25152523.
Kesting, M-L, Bredenpohl, M, Klenke, J, Westermann, S, Lincoln, TM (2013). The impact of social stress on self-esteem and paranoid ideation. Journal of Behavior Therapy and Experimental Psychiatry 44, 122128.
Kesting, M-L, Lincoln, TM (2013). The relevance of self-esteem and self-schemas to persecutory delusions: a systematic review. Comprehensive Psychiatry 54, 766789.
Kramer, I, Simons, CJP, Wigman, JTW, Collip, D, Jacobs, N, Derom, C, Thiery, E, van Os, J, Myin-Germeys, I, Wichers, M (2014). Time-lagged moment-to-moment interplay between negative affect and paranoia: new insights in the affective pathway to psychosis. Schizophrenia Bulletin 40, 278286.
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9. Journal of General Internal Medicine 16, 606613.
Lincoln, TM, Lange, J, Burau, J, Exner, C, Moritz, S (2009). The effect of state anxiety on paranoid ideation and jumping to conclusions. An experimental investigation. Schizophrenia Bulletin 36, 11401148.
Lincoln, TM, Marin, N, Jaya, ES (2017). Childhood trauma and psychotic experiences in a general population sample: a prospective study on the mediating role of emotion regulation. European Psychiatry 42, 111119.
Löwe, B, Decker, O, Müller, S, Brähler, E, Schellberg, D, Herzog, W, Herzberg, PY (2008). Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Medical Care 46, 266274.
Luhrmann, TM, Padmavati, R, Tharoor, H, Osei, A (2015). Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study. The British Journal of Psychiatry: The Journal of Mental Science 206, 4144.
Martin, A, Rief, W, Klaiberg, A, Braehler, E (2006). Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population. General Hospital Psychiatry 28, 7177.
Mayer, A, Thoemmes, F, Rose, N, Steyer, R, West, SG (2014). Theory and analysis of total, direct, and indirect causal effects. Multivariate Behavioral Research 49, 425442.
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655664.
Morgan, C, Reininghaus, U, Fearon, P, Hutchinson, G, Morgan, K, Dazzan, P, Boydell, J, Kirkbride, J, Doody, GA, Jones, PB, Murray, RM, Craig, T (2014). Modelling the interplay between childhood and adult adversity in pathways to psychosis. Psychological Medicine 44, 407419.
Moritz, S, Schröder, J, Klein, JP, Lincoln, TM, Andreou, C, Fischer, A, Arlt, S (2016). Effects of online intervention for depression on mood and positive symptoms in schizophrenia. Schizophrenia Research 175, 216222.
Morrison, AP (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29, 257276.
National Institute for Health and Clinical Excellence (2009). Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care (Update) . National Institute for Health and Clinical Excellence: Guidance. British Psychological Society: Leicester, UK.
Oliver, JE, O'Connor, JA, Jose, PE, McLachlan, K, Peters, E (2012). The impact of negative schemas, mood and psychological flexibility on delusional ideation – mediating and moderating effects. Psychosis 4, 618.
Preacher, KJ (2015). Advances in mediation analysis: a survey and synthesis of new developments. Annual Review of Psychology 66, 825852.
Reininghaus, U, Depp, CA, Myin-Germeys, I (2016). Ecological interventionist causal models in psychosis: targeting psychological mechanisms in daily life. Schizophrenia Bulletin 42, 264269.
Rosseel, Y (2012). Lavaan: an R package for structural equation modeling. Journal of Statistical Software 48, 136.
Schlier, B, Jaya, ES, Moritz, S, Lincoln, TM (2015). The community assessment of psychic experience measures nine clusters of psychosis-like experiences: a validation of the German version of CAPE. Schizophrenia Research 169, 274279.
Schmitt, M, Eid, M (2007). Richtlinien für die Übersetzung fremdsprachlicher Messinstrumente. Diagnostica 53, 12.
Spitzer, RL, Kroenke, K, Williams, JW, Löwe, B (2006). A brief measure for assessing generalized anxiety disorder: The gad-7. Archives of Internal Medicine 166, 10921097.
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, IK, Stefanis, CN, Verdoux, H, van Os, J (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347358.
Thewissen, V, Bentall, RP, Oorschot, M, à Campo, J, van Lierop, T, van Os, J, Myin-Germeys, I (2011). Emotions, self-esteem, and paranoid episodes: an experience sampling study. British Journal of Clinical Psychology 50, 178195.
Vandenbroucke, JP, Elm, E von, Altman, DG, Gøtzsche, PC, Mulrow, CD, Pocock, SJ, Poole, C, Schlesselman, JJ, Egger, M, STROBE Initiative (2007). Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Medicine 4, e297.
van der Gaag, M, Nieman, DH, Rietdijk, J, Dragt, S, Ising, HK, Klaassen, RMC, Koeter, M, Cuijpers, P, Wunderink, L, Linszen, DH (2012a). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophrenia Bulletin 38, 11801188.
van der Gaag, M, van Oosterhout, B, Daalman, K, Sommer, IE, Korrelboom, K (2012b). Initial evaluation of the effects of competitive memory training (COMET) on depression in schizophrenia-spectrum patients with persistent auditory verbal hallucinations: a randomized controlled trial. British Journal of Clinical Psychology 51, 158171.
van Os, J, Kenis, G, Rutten, BPF (2010). The environment and schizophrenia. Nature 468, 203212.
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