Keys to their Kingdom: Preliminary Evidence to Support the Role of Positive Beliefs in Recovery-Oriented Cognitive Therapy for Negative Symptoms and Community Participation

Background and Hypothesis Review studies find negative beliefs account for a small amount of the variance in negative symptoms and functioning. Recovery-Oriented Cognitive Therapy (CT-R) theory postulates positive beliefs as an additional causal factor. Study Design Two convenience datasets—including indices of beliefs, negative symptoms, positive symptoms, and community functioning—were utilized: a test-retest database (Study 1 and Study 2, n = 285); the CT-R condition of an RCT (Study 3, n = 31). Study Results Study 1 finds that positive and negative beliefs are independent and not highly correlated with each other at baseline (r = −0.4); an exploratory factor analysis also suggests this 2 factor solution. Study 2 finds significant prediction of positive beliefs at baseline with negative symptoms (β = −0.21; P = .001), and community functioning (β = 0.29; P = .002) 6 months later. Study 3 finds a significant correlation between increase in positive belief endorsement and improvement in community functioning in the CT-R condition across 24-months (r = 0.39, P < .05). The correlation between positive belief endorsement and negative symptom improvement was not statistically significant but showed a medium effect size (r = −0.26; P > .05). Change in positive beliefs were not significantly associated with positive symptom improvement. Negative beliefs were not significantly associated with change in any of the RCT outcomes. Conclusions The hypothesis that positive beliefs are related in the predicted direction to negative symptoms and functioning is supported, adding to an emerging literature. We point out the treatment implications of this result, utilizing CT-R theory, and discuss future research directions.