Purpose
Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are ...Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear.
Methods
We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non‐clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder.
Results
Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders.
Conclusions
The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders.
ABSTRACT
Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images ...typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta‐analysis aimed to evaluate the possibilities and effects of imagery‐based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta‐analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = −0.50, k = 10) and imagery distress (d = −0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.
Background
A central construct in Schema Therapy (ST) is that of a schema mode, describing the current emotional-cognitive-behavioral state. Initially, 10 modes were described. Over time, with the ...world-wide increasing and broader application of ST to various disorders, additional schema modes were identified, mainly based on clinical impressions. Thus, the need for a new, theoretically based, cross-cultural taxonomy of modes emerged.
Methods
An international workgroup started from scratch to identify an extensive taxonomy of modes, based on (a) extending the theory underlying ST with new insights on needs, and (b) recent research on ST theory supporting that modes represent combinations of activated schemas and coping.
Results
We propose to add two emotional needs to the original five core needs that theoretically underpin the development of early maladaptive schemas (EMSs), i.e., the need for Self-Coherence, and the need for Fairness, leading to three new EMSs, i.e. Lack of a Coherent Identity, Lack of a Meaningful World, and Unfairness. When rethinking the purpose behind the different ways of coping with EMS-activation, we came up with new labels for two of those: Resignation instead of Surrender, and Inversion instead of Overcompensation. By systematically combining EMSs and ways of coping we derived a set of schema modes that can be empirically tested.
Conclusions
With this project, we hope to contribute to the further development of ST and its application across the world.
: A category of disorders frequently associated with a history of trauma are the dissociative disorders, of which Dissociative Identity Disorder (DID) is the most severe and chronic form. DID is ...associated with high levels of impairment, treatment utilization, and treatment costs, yet systematic research into treatment effects is scarce. Practice-based clinical guidelines advise a phase-based approach which is lengthy and has rather high reported dropout rates. Therefore, in the current proposal the efficacy of an alternative treatment for DID (i.e. schema therapy) is tested.
: The aim of this study is to critically test the effectiveness of schema therapy for DID patients, for whom at present no evidence-based treatment is available.
: In light of the low prevalence of DID, and the proposed treatment length of three years, a case series experimental approach is used (non-concurrent multiple baseline design). Ten outpatients are included, who are diagnosed with DID by an independent rater using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), which is double-checked by another independent expert. Primary outcomes are a (bi)weekly assessed state measure of dissociative symptoms, a pre-, post- and follow-up measure of the presence of the DID diagnosis, and drop-out rate. Secondary outcomes include various measures of trait dissociative symptoms, comorbid symptomatology, and global symptomatic distress.
: Netherlands Trial Register (NTR): NTR4496.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
After a concussion, 1 in 3 patients report persistent symptoms and experience long-term consequences interfering with daily functioning, known as persistent concussion symptoms (PCS). Evidence ...suggests PCS is (partly) maintained by anxious thoughts about brain functioning, recovery, and experienced symptoms, leading to avoidance behaviors, which may prevent patients from meeting life demands. We aimed to investigate the efficacy of a newly developed intensive exposure intervention for individuals with PCS after concussion aimed to tackle avoidance behavior.
Participants took part in the intervention at the Maastricht University faculty.
Four participants who experienced PCS after concussion partook in the exploratory study. Participants' age ranged between 20 and 32 (mean = 26.5, SD = 5.9) years, with an average length of time after the concussion of 9.8 months.
A concurrent multiple-baseline single-case design was conducted. The baseline period (A phase) length was randomly determined across participants (3, 4, 5, or 6 weeks). The exposure intervention (B phase) was conducted by psychologists over a 4-week period and consisted of 3 stages: exploration (2 sessions), active exposure (12 sessions conducted over 1 week), and 2 booster sessions.
Participants answered daily questions on a visual analog scale related to symptom experience, satisfaction with daily functioning, and degree of avoidance of feared activities. Additional outcomes included symptom severity, catastrophizing, fear of mental activity, anxiety, depression, and societal participation.
Tau-U yielded significant effects (P < .05) for all participants on all measures when comparing baseline and intervention phases. The pooled standardized mean difference was high for all measures (symptom experience = 0.93, satisfaction of daily functioning = 1.86, and activity avoidance = -2.05).
The results show efficacy of the newly developed intensive exposure treatment for PCS after concussion, which is based on the fear avoidance model. Replication in a larger heterogeneous sample is warranted and needed.
Abstract Gilles de la Tourette's syndrome (GTS) is a disorder in which obsessive-compulsive (OC), Attention Deficit Hyperactivity Disorder (ADHD) and autism symptoms occur in up to 60% of patients, ...suggesting shared etiology. We explored the phenotypic structure of tic, OC, ADHD, and autism symptoms as measured by the YGTSS,Y-BOCS,CAARS and AQ, in 225 GTS patients and 371 family members. First, Confirmatory Factor Analyses (CFA) were performed on the symptom structure of each separate symptom scale. Second, the symptom dimensions derived from each scale were combined in one model, and correlations between them were calculated. Using the correlation matrix, Exploratory Factor Analyses (EFA) were performed on the symptom dimensions across the scales. EFA revealed a five factor structure: tic/aggression/symmetry; OC symptoms/compulsive tics/ numbers and patterns; ADHD symptoms; autism symptoms; and hoarding/inattention symptoms. The results are partly in line with the traditional categorical boundaries of the symptom scales used, and partly reveal a symptom structure that cuts through the diagnostic categories. This phenotypic structure might more closely reflect underlying etiologies than a structure that classically describes GTS patients according to absence or presence of comorbid OCD, ADHD and autism, and might inform both future genetic and treatment studies.
Treatment for Dissociative Identity Disorder (DID) often follows a practice-based psychodynamic psychotherapy approach that is conducted in three phases: symptom stabilization, trauma processing, and ...identity integration and rehabilitation. The percentage of patients that reach the third phase is relatively low, treatment duration is long, and the effects of this treatment on the core DID symptoms have been found to be small or absent, leaving room for improvement in the treatment of DID. Schema Therapy (ST) is an integrative psychotherapy that has been proposed as a treatment for DID. This approach is currently being investigated in several studies and has the potential to become an evidence-based treatment for DID. This case report presents an overview of the protocol adaptations for DID ST treatment. The presented case concerns a 43-year-old female patient with DID, depressive disorder (recurrent type), PTSD, cannabis use disorder, and BPD. Functioning was very low. She received 220 sessions of ST, which included direct trauma processing through Imagery Rescripting (ImRs). The patient improved in several domains: she experienced a reduction of PTSD symptoms, as well as dissociative symptoms, there were structural changes in the beliefs about the self, and loss of suicidal behaviors. After treatment she was able to stop her punitive mode, to express her feelings and needs to others, and to participate adequately in social interaction. This case report indicates that ST might be a viable treatment for DID, adding to a broader scope of treatment options for this patient group.
Speech anxiety (SA) is a highly prevalent social fear. Prospective ‘flashforward’ (FF) imagery of an upcoming social catastrophe may be a particularly important cognitive factor in SA persistence via ...eliciting anxiety and avoidance behaviors. Since earlier research on imagery and social anxiety has not strictly differentiated between types of negative imagery, the occurrence, precise features, and impact of FF imagery remain unclear. We therefore examined the phenomenological characteristics of FF imagery in SA and mapped the relationship between FF imagery features and anxiety and avoidance. Female participants who approached clinical levels of SA (
N
= 60) completed questionnaires on SA and avoidance behaviors, and rated anxiety and avoidance in anticipation of an actual speech. FF imagery and emotionally linked autobiographical memories were assessed with semi-structured interviews. All participants reported recurring FF images, which were experienced as vivid, distressing, field perspective images with accompanying negative feelings. Image distress and feelings of threat showed most consistent associations with SA and avoidance measures. Findings add to the conceptualization of SA, and support the clinical relevance of assessing FF imagery. Future experimental studies on FF imagery characteristics are necessary to test the proposed causal impact in SA persistence and to inform additional treatment targets.
Objective: Psychometrically sound measures of catastrophizing about symptoms and fear avoidance behavior are needed to further applications of the fear-avoidance model in mild traumatic brain injury ...(mTBI) for research and clinical purposes. To this end, two questionnaires were adapted (minor), the Postconcussion Symptom Catastrophizing Scale (PCS-CS) and the Fear of Mental Activity Scale (FMA). This study aimed to investigate the factor structure, internal consistency, test-retest reliability, and concurrent and construct validity of two adapted questionnaires in a sample of participants with mTBI compared to participants with orthopedic injury and healthy adults. Method: One hundred eighty-five mTBI participants (40% female), 180 participants with orthopedic injury (55% female), and 116 healthy adults (55% female) participated in the study. All participants were assessed at two time points (2 weeks postinjury and 3 months) using self-reported questionnaires. Data were collected using online questionnaires. Results: Findings indicated a three-factor model (magnification, rumination, helplessness) with a higher order factor (catastrophizing) for the PCS-CS and a two-factor model (activity avoidance and somatic focus) for the FMA. The results showed strong internal consistency, good test-retest reliability, and good concurrent and convergent validity for the PCS-CS and FMA across all samples. Conclusions: This study has shown that the PCS-CS and FMA are psychometrically sound instruments and can be considered for valid and reliable assessment of catastrophizing about postconcussion like symptoms and fear-avoidance beliefs about mental activities. These instruments can be used in research and clinical practice applications of the fear-avoidance model and add to explanations of prolonged recovery after mTBI.
Key Points
Question: What are the psychometric properties (factor structure, reliability, validity) of two adapted questionnaires measuring catastrophizing (Postconcussion Symptom Catastrophizing Scale; PCS-CS) and fear-avoidance behavior (Fear of Mental Activity Scale; FMA) related to postconcussion symptoms after mild traumatic brain injury. Findings: The PCS-CS and FMA have good internal consistency, test-retest reliability, and concurrent and convergent validity. Importance: This study suggests that the PCS-CS and FMA are reliable and valid measures of catastrophizing about symptoms and fear-avoidance of mental activity after injury in participants with mild traumatic brain injury. Clinicians and researchers can consider these questionnaires to further understanding of prolonged symptoms in this patient population. Next Steps: Future research should cross-validate these findings and develop reference data for these measures in these populations.
PDF
