Recent reports of improvement in the negative symptoms of schizophrenia following targeted cognitive interventions have prompted interest in the cognitive underpinnings of these symptoms. This review integrates current experimental research with the phenomenological accounts of patients participating in cognitive therapy for these specific symptoms. We propose that, in addition to the well-established role of neurobiological factors in their development and maintenance, specific cognitive appraisals and beliefs play a role in the expression and persistence of negative symptoms. This cognitive model of negative symptoms is based on a diathesis–stress formulation: a continuum of predispositional traits from the premorbid personality to the full-blown negative symptomatology, the incorporation of negative social and performance attitudes within these traits, and low expectancies for pleasure or success in goal-oriented activities. We suggest that negative symptoms represent, in part, a compensatory pattern of disengagement in response to threatening delusional beliefs, perceived social threat, and anticipated failure in tasks and social activities. A psychological aspect of this motivational and behavioural inertia appears to be the patient's perception of limited psychological resources—a perception that motivates patients to conserve energy by minimizing investment in activities requiring effort.
RectorNABeckAT. Cognitive behavioral therapy for schizophrenia: An empirical review. J Nerv Ment Dis2001;189:278–87.
2.
TarrierNWykesT.Is there evidence that cognitive behaviour therapy is an effective treatment of schizophrenia?A cautious or cautionary tale? Behav Res Ther2004;42:1377–401.
3.
GouldRAMueserKTBoltonEMaysVGoffD.Cognitive therapy for psychosis in schizophrenia: An effect size analysis. Schizophr Res2001;48:335–42.
4.
RectorNASeemanMVSegalZV. Cognitive therapy of schizophrenia: A preliminary randomized controlled trial. Schizophr Res2003;63:1–11.
5.
KraepelinE.“Dementia praecox.” Barclay RM, translator (1919). Psychiatrica. 8th ed.Melbourne (FL): Robert E Krieger; 1913.
6.
BleulerE.Dementia praecox or the group of schizophrenics. Kinkin J, translator. New York: International Universities Press Inc; 1950.
7.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Text revision. Washington (DC): American Psychiatric Association; 2000.
8.
BerriosGE. Positive and negative symptoms and Jackson: A conceptual history. Arch Gen Psychiatry1985;42:95–7.
9.
AndreasenNC. Negative symptoms in schizophrenia: Definition and reliability. Arch Gen Psychiatry1982;39:784–8.
10.
CrowTJ. Positive and negative schizophrenic symptoms and the role of dopamine: II. Br J Psychiatry1980;137:383–6.
11.
CrowTJ. The two-syndrome concept: Origins and current status. Schizophr Bull1985;11:471–86.
12.
StraussJSCarpenterWTBartkoJJ. Speculations on the processes that underlie schizophrenic symptoms and signs: III. Schizophr Bull1975;11:61–9.
13.
EarnstKSKringAM. Construct validity of negative symptoms: An empirical and conceptual review. Clin Psychol Rev1997;17:167–90.
14.
KaySROplerLALindenmayerJP. The Positive and Negative Syndrome Scale (PANSS): Rationale and standardisation. Br J Psychiatry1989;155:59–65.
15.
ZubinJSpringB.Vulnerability—a new view of schizophrenia. J Abnorm Psychol1997;86:103–26.
16.
DworkinRHLenzenwengerMF. Symptoms and the genetics of schizophrenia: Implications for diagnosis. Am J Psychiatry1984;141:1541–6.
17.
DworkinRHLenzenwengerMFMoldinSO. Genetics and the phenomenology of schizophrenia. In: HarveyPDWalkerEF, editors. Positive and negative symptoms of psychosis. Hillsdale (NJ): Erlbaum; 1987.
18.
CannonTDMednickSAParnasJ.Antecedents of predominantly negative and predominantly positive symptom schizophrenia in a high-risk population. Arch Gen Psychiatry1990;47:622–32.
19.
PahlJJSwayzeVWAndreasenNC. Diagnostic advances in anatomical and functional brain imaging in schizophrenia. In: KalesAStefanisCNTalbottJA, editors. Recent advances in schizophrenia. New York: Springer-Verlag; 1990. p 163–89.
20.
AndreasenNCOlsenSADennertJWSmithMR. Ventricular enlargement in schizophrenia: Relationship to positive and negative symptoms. Am J Psychiatry1982;139:297–302.
21.
FoersterALewisSWMurrayRM. Genetic and environmental correlates of the positive and negative syndromes. In: GredenJFTandonR, editors. Negative schizophrenic symptoms: Pathophysiology and clinical implicationsWashington (DC): American Psychiatric Press; 1991. p 187–202.
22.
WalkerELewineRJNeumannC.Childhood behavioral characteristics and adult brain morphology in schizophrenia. Schizophr Res1996;22:93–101.
23.
BunneyWEBunneyBG. Neurodevelopmental hypothesis of schizophrenia. In: CharneyDSNestlerEBunneyBS, editors. Neurobiology of mental illness. New York: Oxford University Press; 1999. p 225–35.
24.
FeinbergI.Schizophrenia: Caused by a fault in programmed synaptic elimination during adolescence. J Psychiatr Res1983;17:319–34.
25.
McGlashanTHHoffmanRE. Schizophrenia as a disorder of developmentally reduced synaptic connectivity. Arch Gen Psychiatry2000;57:637–48.
26.
NuechterleinKHDawsonME. Information processing and attentional functioning in the developmental course of schizophrenic disorders. Schizophr Bull1984;10:160–203.
27.
LenczTSmithCWAutherACorrellCUCornblattB.Nonspecific and attenuated negative symptoms in patients at clinical high-risk for schizophrenia. Schizophr Res2004;68:37–48.
28.
CarpenterWTHeinrichsDWWagmanAMI. Deficit and nondeficit forms of schizophrenia: The concept. Am J Psychiatry1988;145:578–83.
29.
KirkpatrickBBuchananRWMcKennyPDAlphsLDCarpenterWTJr., The schedule for the deficit syndrome: An instrument for research in schizophrenia. Psychiatr Res1989;30:119–23.
30.
SubtonikKLNuechterleinKHVenturaJGreenMFHwangSS. Prediction of the deficit syndrome from initial deficit symptoms in the early course of schizophrenia. Psychiatr Res1998;80:53–9.
31.
VenturaJNuechterleinKHGreenMFHoranWPSubotnikKLMintzJ.The timing of negative symptom exacerbations in relationship to positive symptom exacerbations in the early course of schizophrenia. Schizophr Res2004;69:333–42.
32.
HochA.On some of the mental mechanisms in dementia praecox. J Abnorm Psychol1910;5:255–73.
33.
KretschmerE.Physique and character. London: Kegan Paul, Trench, Trubner and Co; 1925.
34.
SolanoJJRDe ChavezGM. Premorbid personality disorders in schizophrenia. Schizophr Res2000;44:137–44.
35.
PeraltaACuestaMJde LeonJ.Premorbid personality and positive and negative symptoms in schizophrenia. Acta Psychiatr Scand1991;84:336–9.
36.
LindstroemEvon KnorringLEkseliusL.Self-reported personality disorders in patients with schizophrenia and the relationship to symptoms, side effects, and social functioning. Nord J Psychiatr2000;54:341–6.
37.
BattagliaMBernardeschiLFranchiniLBellodiLSmeraldiE.A family study of schizotypal disorder. Schizophr Bull1995;21:33–45.
38.
RadoS.Dynamics and classification of disordered behaviour. Am J Psychiatry1953;110:406–16.
39.
MeehlPE. Schizotaxia, schizotypy and schizophrenia. Am Psychol1962;17:827–38.
40.
ClaridgeG.Theoretical background and issues. In: ClaridgeG.Schizotypy: Implications for illness and health. Oxford: Oxford University Press; 1997. p 3–18.
41.
MataIShamPCGilvarryCMJonesPBLewisSWMurrayRM. Childhood schizotypy and positive symptoms in schizophrenic patients predict schizotypy in relatives. Schizophr Res2000;44:129–36.
42.
ChapmanLJChapmanJPRaulinML. Scales for physical and social anhedonia. J Abnorm Psychol1976;85:374–82.
43.
ChapmanLJChapmanJPMillerEN. Reliabilities and intercorrelations of 8 measure of proneness to psychosis. J Consult Clin Psychol1982;50:187–95.
44.
ChapmanLJChapmanJPKwapilTREckbladMZinserMC. Putatively psychosis-prone subjects 10 years later. J Abnorm Psychol1994;103:171–83.
45.
MillerPByrneMHodgesANLawrieSMOwensDGCJohnstonEC. Schizotypal components in people at high risk of developing schizophrenia: Early findings from the Edinburgh high-risk study. Br J Psychiatry2002;180:179–84.
46.
KendlerKSThackerLWalshD.Self-report measures of schizotypy as indices of familial vulnerability to schizophrenia. Schizophr Bull1996;22:511–20.
47.
BlanchardJJMueserKTBellackAS. Anhedonia, positive and negative affect, and social functioning in schizophrenia. Schizophr Bull1998;24:413–24.
48.
BlanchardJJHoranWPBrownSA. Diagnostic differences in social anhedonia: A longitudinal study of schizophrenia and major depressive disorder. J Abnorm Psychol2001;11:363–71.
49.
SirisSG. Diagnosis of secondary depression in schizophrenia: Implications for DSM-IV. Schizophr Bull1991;17:75–98.
50.
SirisSG. Depression in schizophrenia. In: ShriquiCLNasrallahHA, editors. Contemporary issues in the treatment of schizophrenia. Washington (DC): American Psychiatric Press; 1995.
51.
RectorNA. Dysfunctional attitudes and symptom expression in schizophrenia: Differential associations with paranoid delusions and negative symptoms. J Cog Psychother: Int Q2004;18:163–73.
52.
RectorNABeckAT. Dysfunctional attitudes and symptom expression in schizophrenia: Associations with behavioural and social withdrawal. Paper presented at the meeting of the Society for Psychopathology Research; October2003; Toronto (ON).
53.
WeissmanANBeckAT. Development and validation of the Dysfunctional Attitude Scale: A preliminary investigation. Paper presented at the meeting of the American Psychological Association;1978; Toronto (ON).
54.
BarrlowcloughCTarrierNHumphreysLWardJGreggLAndrewsB.Self-esteem in schizophrenia: Relationships between self-evaluation, family attitudes, and symptomatology. J Abnorm Psychol2003;112:92–9.
55.
BirchwoodMChadwickP.The omnipotence of voices: Testing the validity of a cognitive model. Psychol Med1997;27:1345–53.
56.
ChadwickPBirchwoodM.The omnipotence of voices: I. A cognitive approach to auditory hallucinations. Br J Psychiatry1994;164:190–201.
57.
BeckATRectorNA. A cognitive model of hallucinations. Cognitive Ther Res2003;27:19–52.
58.
DeVriesMWDelespaulPA. Time, context, and subjective experiences in schizophrenia. Schizophr Bull1989;15:233–44.
59.
BerenbaumHOltmansTF. Emotional experience and expression in schizophrenia and depression. J Abnorm Psychol1992;101:37–44.
60.
KringAMNealeJM. So schizophrenic patients show a disjunction amount expressive, experiential, and psychophysiological components of emotion?J Abnorm Psychol1996;105:249–57.
61.
EarnstKSKringAM. Emotional responding in deficit and non-deficit schizophrenia. Psychiatr Res1999;88:191–207.
62.
GermansMJKringAM. Hedonic deficit in anhedonia: Support for the role of approach motivation. Pers Indiv Differ2000;28:659–72.
63.
GardDEGermans GardMKHoranWPKringAMJohnOPGreenMF. Anticipatory and consummatory pleasure in schizophrenia: A scale development study. Paper presented at the Annual Meeting of the Society for Research in Psychopathology; October2003; Toronto (ON).
64.
van ReelJMGerritsMAFMVanderschurenLJMJ. Opioids, reward and addiction: An encounter of biology, psychology, and medicine. Pharmacol Rev1999;51:341–96.
65.
BermanIViegnerBMersonAAllanEPappasDGreenAI. Differential relationships between positive and negative symptoms and neuropsychological deficits in schizophrenia. Schizophr Res1997;25:1–10.
66.
StolarNBerenbaumHBanichMTBarchD.Neuropsychological correlates of alogia and affective flattening in schizophrenia. Biol Psychiatry1994;35:164–72.
67.
EstroffSE. Self, identity, and subjective experiences of schizophrenia: In search of the subject. Schizophr Bull1989;15:189–96.
68.
KingdomDTurkingtonD.Cognitive behavioural therapy of schizophrenia. New York: Guilford; 1994.
69.
BeckATRectorNA. Delusions: A cognitive perspective. J Cogn Psychother2002;16:455–68.
70.
NuechterleinKHEdellWSNorriesMDawsonME. Attentional vulnerability indicators, thought disorder, and negative symptoms. Schizophr Bull1986;12:408–26.
71.
LiddlePF. Disordered mind and brain: The neural basis of mental symptoms. London (UK): Gaskell; 2001.
72.
WeinbergerDREganMFBertolinoACallicotJHMattayVSLipskaBK, and others. Prefrontal neurons and the genetics of schizophrenia. Biol Psychiatry2001;50:825–44.
73.
McGlashanTHFentonWS. Subtype progression and pathophysiologic deterioration in early schizophrenia. Schizophr Bull1993;19:71–84.
