Assuming defeat, thwarting the feat: Defeatist beliefs, negative symptoms, and everyday functioning in people with schizophrenia

Imagine wanting to invite a friend for coffee. You might be thinking about what coffee shop to go to or what outfit to wear. But what if instead of planning the details of the coffee date you immediately thought that your friend would say no because he probably thinks you are boring company. In this scenario, thinking that your friend would reject your invitation because you are a dull companion would likely mean that you never invite them in the first place. This style of thinking, also called defeatist performance beliefs, were first identified by Aaron Beck and colleagues as part of their cognitive model of depression. In their model, defeatist performance beliefs were thought to contribute to the decrease in motivation commonly reported by people with depression. More recently, Beck and colleagues proposed another model linking defeatist performance beliefs and motivational impairment, but this time for people with schizophrenia.

Decreased motivation is part of what are called the negative symptoms of schizophrenia. While medications and therapy have been shown to help reduce the positive symptoms, such as hallucinations and delusional thinking, attempts to treat the negative symptoms of schizophrenia have not been as successful. As such, negative symptoms tend to be persistent, and over the course of the illness are an important contributor to difficulties in everyday functioning commonly found among people with schizophrenia. Therefore, a critical and currently unmet need is targets for treating the negative symptoms of schizophrenia.

In our paper and in line with the cognitive model of schizophrenia, we examined whether defeatist performance beliefs might be a viable target for treating negative symptoms and improving functioning in people with schizophrenia. To do this, we performed a meta-analysis, a method that allowed us to look at the all of the studies that had examined the association between defeatist performance beliefs and either negative symptoms or functioning among people with schizophrenia. In total, our analysis included 10 studies and 858 people with schizophrenia.

Are defeatist performance beliefs a potential treatment target for improving negative symptoms and functioning in schizophrenia? We found that across all of the studies included in our meta-analysis, greater defeatist performance beliefs were associated with more severe negative symptoms and poorer functioning among people with schizophrenia. Our findings suggest that treatments that target  defeatist performance beliefs may help improve both motivation and everyday functioning in people with schizophrenia.  The good news is that treatments that effectively reduce defeatist performance beliefs already exist.  Our analyses showing that defeatist performance beliefs, a treatable mechanism, are associated with a persistent, intractable, and debilitating symptom of schizophrenia provides promise and hope to both providers and people with schizophrenia.

Timothy R. Campellone and Amy H. Sanchez
Department of Psychology, University of California, Berkeley, USA

 

Publication

Defeatist Performance Beliefs, Negative Symptoms, and Functional Outcome in Schizophrenia: A Meta-analytic Review.
Campellone TR 1, Sanchez AH 1, Kring AM
Schizophr Bull. 2016 Mar 15
1First authorship is shared between these 2 authors

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