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Tecuta L, Tomei G, DiGiuseppe R, Schumann R, Ballardini D, Tomba E. Mapping the Path to Cognitive Balance: Applying the States of Mind Model and Network Analysis to Eating Disorder Patients. J Clin Med 2023; 12:5790. [PMID: 37762731 PMCID: PMC10531813 DOI: 10.3390/jcm12185790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Background: In eating disorders (EDs), cognitive-behavioral therapy (CBT) represents one of the first-line treatment options albeit with sub-optimal results. The assessment of cognitive balance through an index measuring increased adaptive thinking and reduced maladaptive thinking, the desired outcomes, and the ultimate goal of CBT treatments warrants attention. The states of mind model (SOM) provides a framework through which a cognitive balance index can be defined. The current cross-sectional controlled study tested the clinical utility of the SOM model in a sample of ED outpatients. Methods: ED outpatients (n = 199) were assessed at baseline with the attitudes and beliefs scale-2 (ABS-2) for rational beliefs (RBs) and irrational beliefs (IBs), from which a SOM ratio score index (RBs/(RBs + IBs)) was calculated, the eating disorder inventory-3 (EDI-3) for ED symptoms and ED-related psychopathological features, the psychological well-being scales (PWB) for positive psychological functioning. A matched control sample (n = 95) was also assessed with the ABS-2. Results: ED patients exhibited significantly lower SOM and RB scores compared to controls. Network analysis results highlighted the centrality of the SOM-cognitive balance index, PWB-self-acceptance, and EDI-3-general psychological maladjustment, as well as the importance of the influence that cognitive balance and general psychological maladjustment exert on each other. Conclusions: The findings support the clinical utility of the SOM ratio applied to cognitions in EDs. This demonstrates its ability to differentiate such patients from controls and in capturing worse ED-related general psychopathology as well as compromised aspects of psychological well-being, in particular self-acceptance and environmental mastery. It thus might be considered in CBT treatment of EDs a potential cognitive clinimetric and clinical index of ED severity indicating key difficulties in counteracting maladaptive thinking with adaptive thinking.
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Affiliation(s)
- Lucia Tecuta
- Department of Psychology, University of Bologna, 40127 Bologna, Italy; (L.T.); (G.T.)
| | - Giuliano Tomei
- Department of Psychology, University of Bologna, 40127 Bologna, Italy; (L.T.); (G.T.)
| | - Raymond DiGiuseppe
- Department of Psychology, St. John’s University, New York, NY 11439, USA;
| | - Romana Schumann
- Eating Disorder Clinic “Centro Gruber”, 40125 Bologna, Italy; (R.S.); (D.B.)
| | | | - Elena Tomba
- Department of Psychology, University of Bologna, 40127 Bologna, Italy; (L.T.); (G.T.)
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Maher A, Cason L, Huckstepp T, Stallman H, Kannis-Dymand L, Millear P, Mason J, Wood A, Allen A. Early maladaptive schemas in eating disorders: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2021; 30:3-22. [PMID: 34636456 DOI: 10.1002/erv.2866] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/24/2021] [Accepted: 09/25/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Research and theory suggest the aetiological nature and symptomatic profile of eating disorders (EDs) can be explained by multiple factors, including the development of early maladaptive schemas (EMS). Yet, there is lack of consensus regarding the evidence supporting the relationship between EMS and EDs. Therefore, this systematic review aimed to examine existing literature concerning the relationship between different ED diagnoses and EMS to provide a synthesis and evaluation of relevant research. METHOD A comprehensive literature search of four electronic databases was conducted and studies were included that examined the association between EMS and EDs. Studies were required to use a variant of Young Schema Questionnaire and establish ED diagnosis or symptomology using self-report questionnaires or clinical interview. RESULTS A total of 29 studies were included in the review. Compared to healthy controls and varying clinical populations, individuals with EDs generally reported significantly higher scores across all EMS except for Entitlement. Furthermore, Unrelenting Standards consistently appeared as a significant EMS across all ED diagnoses whilst Insufficient Self-Control was significantly lower in ED diagnoses with restrictive behaviour compared to diagnoses with binge eating or purging behaviour. DISCUSSION Research supports significant associations between EMS and EDs, which may contribute to our understanding of ED aetiology, including different diagnostic categories. This review underscores the need for studies to explore more gender and age diverse samples and highlights important implications for practitioners.
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Affiliation(s)
- Anthea Maher
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Liana Cason
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Tyrone Huckstepp
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Helen Stallman
- Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Lee Kannis-Dymand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Prudence Millear
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Jonathan Mason
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Andrew Wood
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Andrew Allen
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
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Aloi M, Verrastro V, Rania M, Sacco R, Fernández-Aranda F, Jiménez-Murcia S, De Fazio P, Segura-Garcia C. The Potential Role of the Early Maladaptive Schema in Behavioral Addictions Among Late Adolescents and Young Adults. Front Psychol 2020; 10:3022. [PMID: 32038394 PMCID: PMC6985770 DOI: 10.3389/fpsyg.2019.03022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/20/2019] [Indexed: 12/22/2022] Open
Abstract
Background Behavioral addiction (BA) is a recent concept in psychiatry. Few studies have investigated the relationship between BA and early maladaptive schemas (EMSs). EMS is the core of Schema Therapy (ST). According to the ST model, psychiatric disorders result from the development of EMSs in response to unmet emotional needs in childhood. Bach et al. (2018) grouped the 18 EMSs into four domains: (1) disconnection and rejection; (2) impaired autonomy and performance; (3) excessive responsibility and standards; and (4) impaired limits. This study aims to assess the possible association of the most frequent BAs with EMSs in a large group of late adolescents and young adults and to evaluate their self-perceived quality of life (QoL). Methods A battery of psychological tests assessing food addiction (FA), gambling disorder (GD), internet addiction (IA), and QoL was administered to 1,075 late adolescents and young adults (N = 637; 59.3% women). A forward-stepwise logistic regression model was run to identify which variables were associated with BAs. Results Food addiction was more frequent among women and GD among men, while IA was equally distributed. Regarding the EMSs, participants with FA or IA showed significantly higher scores on all four-schema domains, whereas those with GD exhibited higher scores on impaired autonomy and performance and impaired limits. Besides, average scores of all domains increased with the association of two or more comorbid BAs. Self-perceived QoL was lower for participants with FA and IA, but not for those with GD; the presence of comorbid BAs was associated with lower Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Finally, specific EMS domains and demographic variables were associated with each BA. Conclusion Late adolescents and young adults with FA or IA have a lower perception of their mental and physical health. The most striking result is that FA appears to be associated with the disconnection and rejection schema domain, IA with all the schema domains (except for impaired autonomy and performance), and GD with impaired autonomy and performance schema domain. In conclusion, our findings suggest that EMS should be systematically assessed during psychotherapy of patients with BAs.
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Affiliation(s)
- Matteo Aloi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Valeria Verrastro
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Raffaella Sacco
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, Barcelona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital, IDIBELL, Barcelona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pasquale De Fazio
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Early maladaptive schemas in overweight and obesity: A schema mode model. Heliyon 2019; 5:e02361. [PMID: 31687536 PMCID: PMC6819863 DOI: 10.1016/j.heliyon.2019.e02361] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/02/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022] Open
Abstract
Obesity is a growing burden in our societies and, although different kinds of treatments are effective in the short time, weight gain often reoccurs in the longer period. One possible explanation might rely on the little comprehension of obese maladaptive schemas, as developed from early life experiences, which might interfere with treatment enduring efficacy. The aim of this study was to investigate early maladaptive schemas, their associated current schema-modes and dysfunctional coping strategies in overweight and obese individuals (N = 48). Results showed that overweight and obese subjects reported more severe insufficient self-control, abandonment, dependence and subjugation schemas, and actual schema-modes (i.e., impulsive and vulnerable child, detached protector), compared against normal-weight controls (N = 37). As well, the former displayed higher dysfunctional eating habits (i.e., bingeing and bulimic symptoms) and more emotional-avoidant coping strategies. Above all schemas, insufficient self-control predicted higher BMI, binge frequency and bulimic symptoms' severity. Furthermore, avoidant coping mediated between specific maladaptive schemas and frequency of bingeing and bulimic symptoms. Our findings illustrate that overweight and obese display more dysfunctional early maladaptive schemas and schema-modes, compared against normal-weight individuals, exhibiting more emotion-avoidant strategies such as over-eating and bingeing, which might stand for a detached self-soother coping mode. The insufficient self-control schema develops from a lack in self-discipline and an inability to tolerate frustration and might be embodied by the impulsive child mode. A deeper comprehension of schemas and modes, as addressed within the Schema Therapy model, might help to understand dysfunctional personality features that might interfere with the long-lasting efficacy of treatment interventions in obesity.
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