1
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Vuijk R, Turner W, Zimmerman D, Walker H, Dandachi-FitzGerald B. Schema therapy in adults with autism spectrum disorder: A scoping review. Clin Psychol Psychother 2024. [PMID: 38214936 DOI: 10.1002/cpp.2949] [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: 10/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Schema therapy (ST) in adults with autism spectrum disorder (ASD) have gained increasing interest in clinical practice and research. However, to date, there has been no synthesis of the literature on ST as treatment for adults with ASD. Through a scoping review, we aim to summarize the emerging research and literature on ST for adults with ASD. METHODS A comprehensive literature search of three electronic databases was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications were included that examined ST in adults with ASD and non-clinical adults with autistic traits. RESULTS Systematic searches identified a total of 11 publications, all published since 2014, with the majority being conducted by Dutch and Japanese researchers. Of the 11 publications, 1 described an ST-informed social interaction training, 1 was an ST protocol, 2 described conceptual ST models, 2 were case examples, 2 examined early maladaptive schemas (EMSs) and 3 investigated the effectiveness of ST interventions. In summary, the theoretical exploration, practical examples of the application of ST and research findings with preliminary evidence of ST, EMSs and schema modes (SMs) in adults with ASD point towards the potential of ST for the treatment of adults with ASD. DISCUSSION The current scoping review highlights preliminary research findings and offers valuable suggestions for clinicians treating adults with ASD. This review underscores the need for development of and research in specialized ST protocols and programmes tailored to adults with ASD with chronic mental conditions, such as personality disorders (PDs).
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Rotterdam, The Netherlands
| | - Wesley Turner
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - David Zimmerman
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Hugh Walker
- Minds & Hearts, Stones Corner, Queensland, Australia
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2
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Broglia G, Nisticò V, Di Paolo B, Faggioli R, Bertani A, Gambini O, Demartini B. Traits of narcissistic vulnerability in adults with autism spectrum disorders without intellectual disabilities. Autism Res 2024; 17:138-147. [PMID: 37983956 DOI: 10.1002/aur.3065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
The relationship between Autism Spectrum Disorders (ASD) and Narcissistic Personality Disorder (NPD), considering the dimensions of narcissistic grandiosity and vulnerability, represents an important differential diagnosis and potential ground of comorbidity, since both conditions show high grades of pervasiveness, a life-long course, ego-syntonic traits, and difficulties in building up and sustaining interpersonal relationships Although the co-diagnosis rates, according to the categorical criteria in use, are limited (0%-6.4%), it is common to encounter diagnostic doubts in clinical practice. Here we investigated the dimensions of narcissistic vulnerability and grandiosity in a sample of 87 adults diagnosed with ASD without intellectual disabilities through the administration of the Pathological Narcissism Inventory-52 Items (PNI-52). The mean scores of our sample were compared with the normative distribution available in the literature, and we found that individuals with ASD scored significantly higher than neurotypical controls at the Total Score and at the Vulnerable Narcissism subscale, but not at the Grandiose Narcissism subscales. Demographic features did not influence these results. Vulnerable narcissism was significantly associated with the "Ritvo Autism and Asperger Diagnostic Scale - Revised" subscale Social Relatedness. These findings could potentially be indicative of a greater comorbidity rate between the two disorders with respect to the one reported to date, possibly because DSM-5 criteria are mainly focused on the grandiose dimension. Potential explanatory links between ASD phenomenology and vulnerable narcissism, such as the personality dimension of neuroticism, are discussed, together with the possible role of narcissistic vulnerability in mediating internalizing symptoms (e.g., anxiety, depression) in individuals with ASD.
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Affiliation(s)
- Giovanni Broglia
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Dipartimento di Psicologia, Università degli Studi di Milano-Bicocca, Milan, Italy
| | - Bianca Di Paolo
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Raffaella Faggioli
- Unità di Psichiatria 52, Dipartimento Salute Mentale e Dipendenze, Presidio San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Angelo Bertani
- Centro Giovani "Ettore Ponti", Dipartimento Salute Mentale e Dipendenze, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Unità di Psichiatria 52, Dipartimento Salute Mentale e Dipendenze, Presidio San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
| | - Benedetta Demartini
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- Unità di Psichiatria 52, Dipartimento Salute Mentale e Dipendenze, Presidio San Paolo, ASST Santi Paolo e Carlo, Milan, Italy
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3
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Bach B, Vestergaard M. Differential Diagnosis of ICD-11 Personality Disorder and Autism Spectrum Disorder in Adolescents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:992. [PMID: 37371224 PMCID: PMC10297099 DOI: 10.3390/children10060992] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/17/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023]
Abstract
The International Classification of Diseases 11th Revision (ICD-11) introduces fundamentally new diagnostic descriptions for personality disorder and autism spectrum disorder. Instead of the traditional categorical taxonomies, both personality disorder and autism spectrum disorder are described as being on a continuum. Accumulating research has pointed out that, in some cases, adolescents with autism spectrum disorder are at risk of being confused with having a personality disorder, which particularly applies to female adolescents. Case reports describe how adult autistic women struggled with social and identity roles as children and adolescents, using compensatory strategies such as social imitation and other types of camouflaging. Furthermore, some adolescents with autism display emotion dysregulation and self-injury. The ICD-11 recognizes that features of autism spectrum disorder may resemble features of personality disorder, but the two diagnoses have not yet been formally compared to one another. The present article therefore sought to outline and discuss the overlap and boundaries between the ICD-11 definitions of personality disorder and autism spectrum disorder and propose guiding principles that may assist practitioners in differential diagnosis with female adolescents. We specifically highlight how aspects of the self and interpersonal functioning along with emotional, cognitive, and behavioral manifestations may overlap across the two diagnoses. Restricted, repetitive, and inflexible patterns of behavior, interests, and activities are core features of autism spectrum disorder, which may be masked or less pronounced in female adolescents. Collecting a developmental history of the early presence or absence of autistic features is vital for a conclusive diagnosis, including features that are typically camouflaged in females. A number of future directions for research and clinical practice are proposed.
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Affiliation(s)
- Bo Bach
- Psychiatric Research Unit, Center for Personality Disorder Research, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, 5230 Odense, Denmark
| | - Martin Vestergaard
- Psychiatric Research Unit, Center for Personality Disorder Research, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark
- Department of Child and Adolescence Psychiatry (Copenhagen University Hospital), Mental Health Services, Region Zealand, 4000 Roskilde, Denmark
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4
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van Dijk SDM, Veenstra MS, van den Brink RHS, van Alphen SPJ, Oude Voshaar RC. A Systematic Review of the Heterogeneity of Schema Therapy. J Pers Disord 2023; 37:233-262. [PMID: 37002933 DOI: 10.1521/pedi.2023.37.2.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
We aimed to explore the heterogeneity of schema therapy regarding (a) patient characteristics, (b) content, and (c) way of delivering schema therapy. A search was conducted of the electronic databases EMBASE, PsycINFO, Web of Science, MEDLINE, and COCHRANE up to June 15, 2022. Treatment studies were eligible if they (a) used schema therapy as (component of) the intervention examined, and (b) reported an outcome measure quantitatively. A total of 101 studies met the inclusion criteria, including randomized controlled trials (n = 30), non-randomized controlled trials (n = 8), pre-post designs (n = 22), cases series (n = 13), and case reports (n = 28), including 4006 patients. Good feasibility was consistently reported irrespective of format (group versus individual), setting (outpatient, day-treatment, inpatient), intensity of treatment, and the specific therapeutic components included. Schema therapy was applied to various (psychiatric) disorders. All studies presented promising results. Effectiveness of the different models of schema therapy as well as application beyond personality disorders should be examined more rigorously.
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Affiliation(s)
- Silvia D M van Dijk
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Martine S Veenstra
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Rob H S van den Brink
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Sebastiaan P J van Alphen
- Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Medical & Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Richard C Oude Voshaar
- University Centre of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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5
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Vuijk R, Deen M, Geurts HM, Arntz A. Schema therapy for personality disorders in autistic adults: Results of a multiple case series study. Clin Psychol Psychother 2022; 30:458-472. [PMID: 36522138 DOI: 10.1002/cpp.2817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND To our knowledge, treatment of personality disorder (PD) comorbidity in autistic adults is understudied and is still in its infancy. We investigated the effectiveness of schema therapy (ST) for autistic adults with PD. METHOD A multiple case series design with 12 adults (aged 19-62 years) was used with baseline, exploration, ST (with cognitive behavioural and experiential techniques) and follow-up conditions. Participants rated dysfunctional core beliefs (primary outcome) weekly during baseline and treatment and monthly during follow-up. Schema modes, general mental health symptoms, social responsiveness, PD traits and common Axis-I mental disorders were assessed. RESULTS Mixed model analyses indicated significant effects of ST with medium to large effect sizes for dysfunctional core beliefs, functional schema modes, PD traits, general mental health symptoms and social responsiveness. Results remained stable during follow-up. CONCLUSION The results of this study indicate that ST might be effective in decreasing dysfunctional core beliefs, PD traits and general mental health symptoms and in increasing functional schema modes and social responsiveness. Improvements persisted over time. ST seems effective in treating PD in autistic individuals.
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Rotterdam, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Institute of Psychology, Methodology and Statistics Unit, Leiden University, Leiden, The Netherlands
| | - Hilde M Geurts
- University of Amsterdam, Amsterdam, The Netherlands.,Leo Kanner Huis (Youz; Parnassia Psychiatric Institute), Amsterdam, The Netherlands
| | - Arnoud Arntz
- University of Amsterdam, Amsterdam, The Netherlands
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6
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- Department of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands
- Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- PsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | | | - Arita Schaling
- Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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7
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Rinaldi C, Attanasio M, Valenti M, Mazza M, Keller R. Autism spectrum disorder and personality disorders: Comorbidity and differential diagnosis. World J Psychiatry 2021; 11:1366-1386. [PMID: 35070783 PMCID: PMC8717043 DOI: 10.5498/wjp.v11.i12.1366] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/26/2021] [Accepted: 11/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Differential diagnosis, comorbidities and overlaps with other psychiatric disorders are common among adults with autism spectrum disorder (ASD), but clinical assessments often omit screening for personality disorders (PD), which are especially common in individuals with high-functioning ASD where there is less need for support. AIM To summarize the research findings on PD in adults with ASD and without intellectual disability, focusing on comorbidity and differential diagnosis. METHODS PubMed searches were performed using the key words "Asperger's Syndrome", "Autism", "Personality", "Personality disorder" and "comorbidity" in order to identify relevant articles published in English. Grey literature was identified through searching Google Scholar. The literature reviews and reference sections of selected papers were also examined for additional potential studies. The search was restricted to studies published up to April 2020. This review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. RESULTS The search found 22 studies carried out on ASD adults without intellectual disability that met the inclusion criteria: 16 evaluated personality profiles or PD in ASD (comorbidity), five compared ASD and PD (differential diagnosis) and one performed both tasks. There were significant differences in the methodological approaches, including the ASD diagnostic instruments and personality measures. Cluster A and cluster C PD are the most frequent co-occurring PD, but overlapping features should be considered. Data on differential diagnosis were only found with cluster A and cluster B PD. CONCLUSION ASD in high-functioning adults is associated with a distinct personality profile even if variability exists. Further studies are needed to explore the complex relationship between ASD and PD.
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Affiliation(s)
- Camilla Rinaldi
- Adult Autism Center, Department of Mental Health, ASL Città di Torino, Turin 10138, Italy
| | - Margherita Attanasio
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Marco Valenti
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Monica Mazza
- Department of Applied Clinical Sciences and Biotechnology, University of L’Aquila, L’Aquila 67100, Italy
- Regional Centre for Autism, Abruzzo Region Health System, L’Aquila 67100, Italy
| | - Roberto Keller
- Adult Autism Center, Department of Mental Health, ASL Città di Torino, Turin 10138, Italy
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May T, Pilkington PD, Younan R, Williams K. Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis. Autism Res 2021; 14:2688-2710. [PMID: 34608760 DOI: 10.1002/aur.2619] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022]
Abstract
Autism spectrum disorder (ASD) and borderline personality Disorder (BPD) share features, including social and emotion regulation difficulties. The evidence for the overlap in prevalence and clinical characteristics was systematically reviewed. Ovid Medline, PsycInfo, and PubMed were searched until November 30, 2020 using keywords relating to BPD and ASD. Studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort, or case-controlled design were included. Of 1633 screened studies, 19 were included, of which 12 reported data suitable for meta-analysis. Most samples were of small, clinically ascertained groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across clinical areas. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was within population prevalence estimates of each disorder. Based on this data we were not able to assess whether there is misdiagnosis of one in favor of the other. Neurocognitive differences may underlie similar behavioral symptoms, but further research using larger, well-validated samples is needed. LAY SUMMARY: Autism spectrum disorder (ASD) and borderline personality disorder (BPD) have overlaps in their symptoms. The overlap in how frequently they co-occur and their presentation was systematically reviewed. We searched the key databases and including all studies that reported on the overlap of ASD and BPD diagnoses or traits and used a case, cohort or case-controlled design. Of 1633 studies, 19 were included, of which 12 reported data suitable for pooling. Most samples were of small, clinical groups, with 11 having high risk of bias. The pooled prevalence of BPD in ASD was 4% [95% CI 0%-9%] and of ASD in BPD, 3% [95% CI 1%-8%]. There were inconsistent findings across studies comparing ASD and BPD related symptoms and problems. The prevalence of a dual diagnosis of BPD in ASD cohorts and of ASD in BPD cohorts was similar to the population prevalence of each disorder. Further research using larger, well-validated samples is needed.
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Affiliation(s)
- Tamara May
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Pamela D Pilkington
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Rita Younan
- Schema Therapy Institute of Australia, Carlton, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Murdoch Childrens Research Centre, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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9
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Oshima F, Murata T, Ohtani T, Seto M, Shimizu E. A preliminary study of schema therapy for young adults with high-functioning autism spectrum disorder: a single-arm, uncontrolled trial. BMC Res Notes 2021; 14:158. [PMID: 33926531 PMCID: PMC8082897 DOI: 10.1186/s13104-021-05556-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Psychological problems associated with isolation and mistrust are common among young adults with autism spectrum disorder (ASD). Schema therapy (ST) has recently been shown to be effective against chronic personality problems of various mental disorders, including personality disorders. This pilot clinical trial aimed to explore the feasibility and acceptability of ST in young adults with high-functioning ASD. RESULTS Following the intervention, a significant reduction in early maladaptive schemas and improvements in quality of life and social adjustment were observed. ST may be feasible and is applicable to young adults with HF-ASD. Trial registration UMIN000014535; registered on July 11, 2014.
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Affiliation(s)
- Fumiyo Oshima
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan.
| | - Tomokazu Murata
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
| | - Toshiyuki Ohtani
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan.,Safety and Health Organization, Chiba University, Chiba, Japan
| | - Mikuko Seto
- Research Center for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuouku, Chiba, 260-8670, Japan
| | - Eiji Shimizu
- Safety and Health Organization, Chiba University, Chiba, Japan
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10
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Aalbers G, Engels T, Haslbeck JMB, Borsboom D, Arntz A. The network structure of schema modes. Clin Psychol Psychother 2021; 28:1065-1078. [PMID: 33606318 PMCID: PMC8596577 DOI: 10.1002/cpp.2577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/16/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022]
Abstract
A fundamental question in psychotherapy is whether interventions should target client problems (i.e., problem-focused approaches) or client strengths (i.e., strength-focused approaches). In this study, we first propose to address this question from a network perspective on schema modes (i.e., healthy or dysfunctional patterns of co-occurring emotions, cognitions, and behaviours). From this perspective, schema modes mutually influence each other (e.g., healthy modes reduce dysfunctional modes). Recent evidence suggests that changes in modes that are strongly associated to other modes (i.e., central modes) could be associated with greater treatment effects. We therefore suggest research should investigate the relative centrality of healthy and dysfunctional modes. To make an exploratory start, we investigated the cross-sectional network structure of schema modes in a clinical (comprising individuals diagnosed with paranoid, narcissistic, histrionic, and Cluster C personality disorders) and non-clinical sample. Results showed that, in both samples, the Healthy Adult was significantly less central than several dysfunctional modes (e.g., Undisciplined Child and Abandoned and Abused Child). Although our study cannot draw causal conclusions, this finding could suggest that weakening dysfunctional modes (compared to strengthening the Healthy Adult) might be more effective in decreasing other dysfunctional modes. Our study further indicates that several schema modes are negatively associated, which could suggest that decreasing one might increase another. Finally, the Healthy Adult was among the modes that most strongly discriminated between clinical and non-clinical individuals. Longitudinal and experimental research into the network structure of schema modes is required to further clarify the relative influence of schema modes.
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Affiliation(s)
- George Aalbers
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, Netherlands
| | - Tiarah Engels
- Department of Social Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Jonas M B Haslbeck
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Denny Borsboom
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
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11
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Kopf-Beck J, Zimmermann P, Egli S, Rein M, Kappelmann N, Fietz J, Tamm J, Rek K, Lucae S, Brem AK, Sämann P, Schilbach L, Keck ME. Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT. BMC Psychiatry 2020; 20:506. [PMID: 33054737 PMCID: PMC7557007 DOI: 10.1186/s12888-020-02880-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. METHODS In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. DISCUSSION To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. TRIAL REGISTRATION Identifier on clinicaltrials.gov : NCT03287362 ; September, 12, 2017.
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Affiliation(s)
- Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
| | - Petra Zimmermann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Martin Rein
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Nils Kappelmann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Julia Fietz
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Jeanette Tamm
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Katharina Rek
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- University of Kassel, Kassel, Germany
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
- Department of Neuropsychology, Lucerne Psychiatry, Lucerne, Switzerland
| | - Philipp Sämann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Leonhard Schilbach
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Independent Max Planck Research Group for Social Neuroscience, München, Germany
- Ludwig-Maximilians-Universität, Munich, Germany
| | - Martin E Keck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Schmieder Hospital in Gailingen, Gailingen, Germany
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Vuijk R, de Nijs PF, Deen M, Vitale S, Simons-Sprong M, Hengeveld MW. Temperament and character in men with autism spectrum disorder: A reanalysis of scores on the Temperament and Character Inventory by individual case matching. Contemp Clin Trials Commun 2018; 12:55-59. [PMID: 30259003 PMCID: PMC6151855 DOI: 10.1016/j.conctc.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/12/2018] [Accepted: 09/17/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Interest in autism spectrum disorders (ASD) in adulthood is increasing. Although a person may be diagnosed with ASD, the diagnosis reveals little about the individual's temperament, character, and personality. Also, relatively little is known about the personality of adults with ASD. METHOD A reanalysis of scores on the Temperament and Character Inventory (TCI) administered to a group of 66 normally intelligent men aged 18-63 years, diagnosed with ASD, by individual case matching to a comparison group of 66 men from the general population drawn from the TCI manual. RESULTS Compared to the comparison group, men with ASD scored significantly higher on the scale for Harm Avoidance, and lower on Novelty Seeking, Reward Dependence, Self-Directedness, and Cooperativeness. CONCLUSIONS In this study the score pattern for temperament and character found in men with ASD by individual case matching confirms and strengthens earlier general group matching findings emerging from our 2012 study and from studies from Sweden and the Netherlands.
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Affiliation(s)
- Richard Vuijk
- Sarr Expertise Center for Autism, Parnassia Groep, Bavo Europoort, Oudedijk 76, 3062 AG, Rotterdam, the Netherlands
| | - Pieter F.A. de Nijs
- Erasmus MC, Sophia Children's Hospital, Department of Child and Adolescent Psychiatry/Psychology, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, Kiwistraat 32, 2552 DH, The Hague, the Netherlands
- Institute of Psychology, Methodology and Statistics Unit, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands
| | - Salvatore Vitale
- Erasmus MC, Department of Psychiatry, 's Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands
| | - Mirjam Simons-Sprong
- Sarr Expertise Center for Autism, Parnassia Groep, Bavo Europoort, Oudedijk 76, 3062 AG, Rotterdam, the Netherlands
| | - Michiel W. Hengeveld
- Erasmus MC, Department of Psychiatry, 's Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands
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Vuijk R, Deen M, Sizoo B, Arntz A. Temperament, Character, and Personality Disorders in Adults with Autism Spectrum Disorder: a Systematic Literature Review and Meta-analysis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2018. [DOI: 10.1007/s40489-018-0131-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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