Do cognitive behavioural therapy interventions lead to schema change in people with psychosis? A systematic literature review

Background: Negative schemas have been highlighted as important factors in the development and maintenance of psychosis. However, evidence for schema therapy in people with experiences of psychosis and for schema specific interventions is lacking for these disabling core beliefs. Cognitive behavioural therapy (CBT) interventions remain a first line recommended psychological treatment for psychosis, alongside psychotropic medication. The current review aimed for the first time to investigate if CBT interventions led to schema change in this population. Method: A systematic search of five databases (PsycINFO, MEDLINE, Embase, CINAHL and Web of Science) identified 19 eligible studies, of which 10 were eligible for inclusion in the meta-analyses. Results: A narrative synthesis highlighted variety in CBT intervention length and focus. A small proportion of studies highlighted schema theory within their therapy rationale and within their subsequent CBT intervention. Meta-analytic findings demonstrated that participants receiving a CBT intervention experienced a significant reduction in their negative-self schemas at the end of therapy, compared to control participants. Conclusion: The findings provide evidence that CBT for Psychosis can reduce negative schemas in people with psychosis. The review also offers a rationale for considering schema more explicitly within CBT for Psychosis intervention studies and clinical practice.
Key Practitioner Messages:

1. There are limited CBT intervention studies for psychosis that include a measure of schema.
2. CBT significantly reduces negative schemas in people with psychosis compared to controls.
3. Negative schemas may play a crucial role in the development and experience of psychosis.
4. Future CBT intervention research would benefit from inclusion of schema measures.