A cognitive model of the positive symptoms of psychosis
Open accessAbstract
In the last 10 years a consensus has developed that the symptoms of psychosis may be better understood by linking the steps between the phenomenological experiences and social, psychological and neurobiological levels of explanation. Cognitive models of psychosis are an important link in this chain. They provide a psychological description of the phenomena from which hypotheses concerning causal processes can be derived and tested; social, individual, and neurobiological factors can then be integrated via their impact on these cognitive processes. In this paper, we set out the cognitive processes that we think lead to the formation and maintenance of the positive symptoms of psychosis and we attempt to integrate into our model research in social factors. If this model proves useful, a fuller integration with the findings of biological research will be required (Frith, 1992).
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Stress-vulnerability and integrated cognitive models posit a role for social, environmental and psychological factors in the aetiology of psychosis, in addition to genetic and neurodevelopmental features such as a family history of psychosis and low IQ.
“Stress-vulnerability and integrated cognitive models 21,22 posit a role for social, environmental and psychological factors in the aetiology of psychosis, in addition to genetic and neurodevelopmental features such as a family history of psychosis and low intelligence quotient (IQ).”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [21]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe study's results support biopsychosocial models that emphasize the importance of environmental and psychological factors in the aetiology of psychosis and need for care.
“These results support biopsychosocial models 21,22,37 that emphasize the importance of environmental and psychological factors in the aetiology of psychosis and need for care.”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [21]
The Introduction (page unavailable) integrates social, psychological and neurobiological explanations of psychotic symptoms, and ‘A cognitive model of psychosis’ describes how adverse experiences may create cognitive vulnerability. The paper also discusses treatment outcomes, but the cited passages do not establish a role for these factors in the need for care. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPersistent psychotic experiences only become problematic in the context of pre-existent vulnerabilities.
“it is likely that persistent PEs only become problematic in the context of pre-existent vulnerabilities, as suggested by contemporary aetiological models of psychosis 21,22,37”
From Clinical, socio‐demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a “need for care” (2016) · cites this paper as [21]
In “A cognitive model of psychosis” (page not available), the paper says psychosis occurs in people with a vulnerable predisposition and suggests that earlier adversity can create enduring cognitive vulnerability. It does not establish that persistent psychotic experiences become problematic only in the presence of pre-existing vulnerabilities; it also discusses appraisal, emotion and social isolation as influences on symptoms and their maintenance. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAccording to the cognitive model of positive symptoms of psychosis and the Bio-Psychosocial Model of Transition to Psychosis, avoidance and social withdrawal, as well as psychosocial stress and interpersonal sensitivity, contribute to the onset and maintenance of psychosis symptoms.
“According to the cognitive model of positive symptoms of psychosis (Garety et al. 2001) and the Bio‐Psychosocial Model of Transition to Psychosis (Georgiades et al. 2023), avoidance and social withdrawal, as well as psychosocial stress and interpersonal sensitivity, contribute to the onset and maintenance of psychosis symptoms.”
From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Garety et al. 2001
In “A cognitive model of psychosis” (page unavailable), the paper links onset to periods of isolation and suggests that social isolation can maintain reasoning biases associated with symptoms. In “Dysfunctional schemas and adverse social environments” (page unavailable), it also links chronic stress to vulnerability and relapse, and safety behaviours to the maintenance of psychotic beliefs. It does not clearly identify interpersonal sensitivity as a contributor to symptom onset or maintenance, so that part of the joint claim is not supported by this source. (LLM, conf=0.83)
Experimental — accuracy not yet measuredCognitive models of psychosis emphasise the role of emotional processes, particularly anxiety, in the onset and maintenance cycle of psychotic symptoms.
“Likewise, cognitive models of psychosis [23] emphasise the role of emotional processes, particularly anxiety, in the onset and maintenance cycle of psychotic symptoms [5, 24].”
From A brief CBT intervention for depersonalisation/derealisation in psychosis: Study protocol for a feasibility randomised controlled trial (2016) · cites this paper as [23]
The jumping-to-conclusions bias is invoked in models as a mechanism that explains delusions.
“the jumping to conclusions (JTC) bias is invoked as an explanatory mechanism in models of delusions.4”
From Computational psychiatry: a Rosetta Stone linking the brain to mental illness (2014) · cites this paper as [4]
In uncertain decision settings, people with schizophrenia and delusions (or proneness to them) tend to rely on less information than people without schizophrenia.
“When people with schizophrenia (who have or are prone to delusions) make decisions in an uncertain setting, they tend to draw on less information in reaching that decision than does a person without schizophrenia.”
From Computational psychiatry: a Rosetta Stone linking the brain to mental illness (2014) · cites this paper as [4]
People with schizophrenia may also disregard evidence that contradicts their decision.
“They might also ignore pieces of evidence that contradict that decision.”
From Computational psychiatry: a Rosetta Stone linking the brain to mental illness (2014) · cites this paper as [4]
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Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions
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Modafinil Improves Cognition and Attentional Set Shifting in Patients with Chronic Schizophrenia
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Fluctuations in self-esteem and paranoia in the context of daily life.
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Loneliness in psychosis: a systematic review
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Data Gathering: Biased in Psychosis?
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- Authors
- GARETY, P. A., KUIPERS, E., FOWLER, D., FREEMAN, D., & BEBBINGTON, P. E.
- Affiliations
- University of East Anglia (GB)
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2001-02
- Volume
- 31
- Issue
- 2
- Pages
- 189-195
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2162176680
- Cited by
- 1,546
- References
- 46
- Citations by year
- 2026: 62 · 2025: 68 · 2024: 48 · 2023: 66 · 2022: 62 · 2021: 77 · 2020: 72 · 2019: 77 · 2018: 76 · 2017: 87 · 2016: 67 · 2015: 74 · 2014: 86 · 2013: 90 · 2012: 65
- FWCI
- 16.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Keywords
- psychosis, positive symptoms, cognitive models, cognitive processes, symptom maintenance, social factors, neurobiological factors, levels of explanation, phenomenology
- MeSH terms
- Cognition Disorders, Humans, Psychological Theory, Psychotic Disorders, Self Concept, Social Environment
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