The role of cognitive schemas in personal recovery, symptom severity, and functioning in schizophrenia-spectrum disorders

Hanna V Hamzai; Jessica D'Arcey; Shreya Jagtap; Talia Leibovitz; Felicia Martins; Robert Aidelbaum; Aqsa Zahid Ibrahim; Sylvia Romanowska; Michael W Best

doi:10.1016/j.schres.2026.03.029

The role of cognitive schemas in personal recovery, symptom severity, and functioning in schizophrenia-spectrum disorders

Schizophr Res. 2026 Jul:293:91-98. doi: 10.1016/j.schres.2026.03.029. Epub 2026 Apr 9.

Authors

Hanna V Hamzai¹, Jessica D'Arcey², Shreya Jagtap³, Talia Leibovitz², Felicia Martins⁴, Robert Aidelbaum², Aqsa Zahid Ibrahim², Sylvia Romanowska², Michael W Best⁵

Affiliations

¹ Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada. Electronic address: hanna.hamzai@mail.utoronto.ca.
² Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada.
³ Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada; Forensic Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
⁴ Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada.
⁵ Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada; Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada; Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.

PMID: 41962430
DOI: 10.1016/j.schres.2026.03.029

Abstract

Background: Negative cognitive schemas about the self and others are prevalent in schizophrenia-spectrum disorders (SSDs) and are associated with symptom severity. Recent conceptualizations of recovery emphasize functional and personal outcomes in addition to symptoms. The current study examined the effects of schemas on domains of symptoms, functioning, and personal recovery.

Methods: 71 individuals diagnosed with SSDs were included in the present study. Data presented in this study were collected as part of the baseline assessment for a clinical trial evaluating remotely delivered cognitive behavioural therapy for psychosis. Participants completed measures of core schemas, symptom severity, psychosocial functioning, and personal recovery.

Results: Cognitive schemas accounted for significant variance in personal recovery (65%), symptom severity (27%), and psychosocial functioning (18%). Negative-self schemas were associated with poorer social functioning, lower personal recovery, and greater overall symptom severity (ps = 0.034-0.036; BH-adjusted ps = 0.073). Positive-other schemas were associated with greater social functioning (p = .018; BH-adjusted p = .072) and personal recovery (p and BH-adjusted p < .001). Positive-self schemas were associated with greater personal recovery (p and BH-adjusted p < .001). Associations between schemas and personal recovery largely persisted after the influence of the other recovery domains was accounted for (ps < 0.001-0.062).

Conclusion: Cognitive schemas demonstrated associations with symptoms, psychosocial functioning, and personal recovery in individuals with SSDs, with negative-self evaluations in particular showing trend-level associations across all three domains. Greater personal recovery was associated with higher positive self- and other-evaluations, independent of symptom severity and functioning, underscoring their relevance for recovery-oriented interventions.

Keywords: Functioning; Personal recovery; Schema; Schizophrenia; Symptom.

MeSH terms

Adult
Cognitive Behavioral Therapy
Female
Humans
Male
Middle Aged
Psychosocial Functioning*
Psychotic Disorders* / physiopathology
Psychotic Disorders* / psychology
Psychotic Disorders* / therapy
Schizophrenia* / physiopathology
Schizophrenia* / therapy
Schizophrenic Psychology*
Self Concept*
Severity of Illness Index
Young Adult