Elucidating the role of Early Maladaptive Schemas for psychotic symptomatology

Prediction of insomnia severity based on early maladaptive schemas: a logistic regression analysis

BACKGROUND

In spite of the major role of early maladaptive schemas in vulnerability to various psychological disorders, studies about the relationship between early maladaptive schemas and insomnia disorder are scarce. Hence, the aim of the current study was to explore the contribution of early maladaptive schemas in insomnia severity by comparing a sample of patients with chronic insomnia and good sleepers.

METHODS

Patients with chronic insomnia and good sleepers were evaluated using Young Schema Questionnaire-Short Form (YSQ-SF), Depression Anxiety and Stress Scale (DASS-21), and Insomnia Severity Index (ISI).

RESULTS

The study enrolled 117 patients with chronic insomnia and 76 good sleepers. All early maladaptive schemas (EMSs) except for enmeshment showed significant correlations with insomnia severity. After controlling for depression/anxiety symptoms, logistic regression analysis showed that the EMSs including emotional deprivation, vulnerability to harm, and subjugation schemas were significantly associated with insomnia severity.

CONCLUSIONS

These preliminary findings suggest that EMSs may constitute a vulnerability factor for developing insomnia. Early maladaptive schemas may require attention in the existing treatments of insomnia.

The relationship between childhood trauma, psychotic symptoms, and cognitive schemas in patients with schizophrenia, their siblings, and healthy controls: results from the EU-GEI study

BACKGROUND

The relationship between childhood trauma (CT) and psychotic symptoms in patients with schizophrenia (SCZ), and subthreshold psychotic experiences in non-clinical populations is well-established. However, little is known about the relationship between subtypes of trauma and specific symptoms in patients, their siblings, and controls. It is also not clear which variables mediate the relationship between trauma and psychotic symptoms.

METHODS

Seven hundred and forty-two patients with SCZ, 718 of their unaffected siblings and 1039 controls from three EU-GEI sites were assessed for CT, symptom severity, and cognitive schemas about self/others. CT was assessed with the Childhood Trauma Questionnaire, and cognitive schemas were assessed by The Brief Core Schema Scale.

RESULTS

Patients with psychosis were affected by CT more than their siblings and controls in all domains. Childhood emotional abuse and neglect were more common in siblings than controls. CT was related to negative cognitive schemas toward self/others in patients, siblings, and controls. We found that negative schemas about self-mediated the relationship between emotional abuse and thought withdrawal and thought broadcasting. Approximately 33.9% of the variance in these symptoms was explained by the mediator. It also mediated the relationship between sexual abuse and persecutory delusions in SCZ.

CONCLUSIONS

Our findings suggest that childhood abuse and neglect are more common in patients with schizophrenia than their siblings and healthy controls, and have different impacts on clinical domains which we searched. The relationship between CT and positive symptoms seems to be mediated by negative cognitive schemas about self in schizophrenia.

Aberrant adapting of beliefs under stress: a mechanism relevant to the formation of paranoia?

BACKGROUND

Difficulties in the ability to adapt beliefs in the face of new information are associated with psychosis and its central symptom - paranoia. As cognitive processes and psychotic symptoms are both known to be sensitive to stress, the present study investigated the exact associations between stress, adapting of beliefs [reversal learning (RL), bias against disconfirmatory evidence (BADE), and jumping to conclusions (JTC)] and paranoia. We hypothesized that paranoia would increase under stress and that difficulties in adapting of beliefs would mediate or moderate the link between stress and paranoia. Furthermore, we hypothesized that the investigated effects would be strongest in the group of individuals diagnosed with a psychotic disorder.

METHODS

We exposed 155 participants (38 diagnosed with a psychotic disorder, 40 individuals with attenuated psychotic symptoms, 39 clinical controls diagnosed with an obsessive-compulsive disorder, and 38 healthy controls) to a control condition and a stress condition, in which we assessed their levels of paranoia and their ability to adapt beliefs. We applied multilevel models to analyze the data.

RESULTS

Paranoia was higher in the stress condition than in the control condition, b = 1.142, s.e. = 0.338, t(150) = 3.381, p < 0.001. RL, BADE, and JTC did not differ between conditions and did not mediate or moderate the association between stress and paranoia (all p_s > 0.05).

CONCLUSIONS

The results support the assumption that stress triggers paranoia. However, the link between stress and paranoia does not seem to be affected by the ability to adapt beliefs.

Effects of a Cognitive Schema Account on the Stigma of Schizophrenia: A Study in a French University Student Sample

Among people with psychiatric disorders, those with schizophrenia are subject to high levels of stigmatization. Research is necessary to identify new strategies that may help reduce the stigma of schizophrenia. Educational strategies using cognitive accounts, particularly early maladaptive schemas (EMSs), have shown promising results in the context of depression, but they have not been evaluated in the context of schizophrenia. The present study compared the effect on the stigma of three different educational strategies, based on cognitive distortions, biogenetics, and EMSs. A total of 378 students were randomly assigned to 1 of 4 groups. Three experimental groups were presented with a vignette that introduced 1 of 3 different etiological accounts of schizophrenia (cognitive distortions, EMSs, or biogenetics). The fourth group was presented with a text unrelated to schizophrenia. The participants completed questionnaires that measured their attitudes, empathic concern, and social distance toward people with schizophrenia, before and after reading the text. The intervention using the EMS etiology account for schizophrenia was the only one that led to a significant decrease in stigma. The latter effect was driven mainly by an increase in the level of empathic concern toward people with schizophrenia. Given that similar results have been observed for depression and that the role of EMSs in many psychiatric disorders has been demonstrated, studying the effects of EMS explanations for other stigmatized disorders may be promising for reducing the stigma of psychiatric disorders.

Early maladaptive schemas and depression in adulthood: A systematic review and meta-analysis

BACKGROUND

Improved understanding of the specific cognitive risk factors associated with depression is needed to inform prevention and treatment approaches. Recent research has examined the relationship between early maladaptive schemas (EMSs) and depression, but the findings were yet to be integrated using meta-analytic methods. The aim of this review was to synthesize the evidence on the relationship between depression and EMS.

METHOD

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, by searching the PsycINFO, PubMed and CINAHL databases. Included studies were peer-reviewed journal articles that examined the relationship between one or more EMS and depression in adulthood in participants aged 18 years or older.

RESULTS

A total of 51 studies were included (k = 743; pooled N = 17,830). All 18 EMSs were positively correlated with depression, with effect sizes ranging from small (r = .23 [.17, .29]; Entitlement) to large (r = .53 [.46, .60]; Social Isolation; r = .50, 95% CI [.45, .54]; Defectiveness/Shame).

CONCLUSION

The evidence suggests that individuals who feel like they do not belong, or that they are flawed, bad or unlovable, report higher levels of depression. However, most studies used cross-sectional designs, and further longitudinal research is needed to establish the direction of the relationship between EMS and depression. These findings can guide preventative and treatment approaches. Focusing treatment on the Social Isolation and Defectiveness/Shame EMS may aid in relieving depressive symptoms.

Early maladaptive schemas in patients with schizophrenia and non-patients with high and low schizotypal traits and their differences based on depression severity

BACKGROUND

The aims of this study were to predict positive and negative symptoms of psychosis via early maladaptive schemas (EMSs) in patients with schizophrenia (SZ); to compare EMSs among SZ patients, non-patients with high schizotypal traits, and non-patients with low schizotypal traits; and to compare EMSs among subgroups concerning depression severity.

METHODS

We applied three groups of participants including SZ patients (n = 105), non-patients with low schizotypal traits (n = 90), and non-patients with high schizotypal traits (n = 90). Participants completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Positive and Negative Syndrome Scale (PANSS), the Schizotypal Personality Scale (STA), and the Beck Depression Inventory-II (BDI-II).

RESULTS

The results indicated that the mistrust/abuse and social isolation schemas were significant predictors of positive and negative symptoms in SZ patients respectively. SZ patients and non-patients with high schizotypal traits exceeded non-patients with low schizotypal traits on all EMSs. There were no differences between SZ patients and non-patients with high schizotypal traits regarding EMSs. In the subgroups with high depression, SZ patients showed higher levels of EMSs than non-patients with low and high schizotypal traits. In the subgroups with low depression, both SZ patients and non-patients with high schizotypal traits had higher scores on EMSs than non-patients with low schizotypal traits.

CONCLUSION

The findings suggest that mistrust/abuse and social isolation may be specific to psychosis symptoms. Also, SZ and schizotypal traits may overlap in relation to EMSs. In addition, the activated EMSs may contribute to high depression in SZ.

An experience sampling study on the nature of the interaction between traumatic experiences, negative affect in everyday life, and threat beliefs

Research suggests that trauma is associated with the development of psychotic experiences, such as paranoia, via affective processes. However, the empirical evidence on the exact mechanism is limited and it is unclear which aspects of trauma are relevant. Here we tested whether self-reported frequency of trauma, recurring trauma, age, and type of trauma are predictive of later threat beliefs in daily life and which role affective processes (self-reported negative affect and autonomic arousal) play in this association. We tested two often postulated mechanisms: mediation, with affective processes in everyday life explaining the association between trauma and threat beliefs; and moderation, with trauma strengthening the association between affective processes and threat beliefs in everyday life. Trauma was assessed at baseline with the Trauma-History-Questionnaire in 67 individuals with attenuated symptoms of psychosis. We then applied the experience-sampling-method during 24 h to assess negative affect, heart rate and threat beliefs. Multilevel analysis showed that negative affect (p < 0.001) and heart rate (p < 0.05) were predictive of subsequent threat beliefs. There was no significant mediation effect from any trauma characteristic to threat beliefs via negative affect and heart rate. Trauma frequency (p < 0.001), age at first trauma (p < 0.001), as well as the presence of physical trauma (p < 0.001) moderated the path from negative affect to subsequent threat beliefs. Our findings indicate that more frequent trauma, trauma at young age and physical trauma strengthen the association from negative affect to threat beliefs and could be relevant to determining the extent of vulnerability to psychosis.

Schemas and modes in borderline personality disorder: The mistrustful, shameful, angry, impulsive, and unhappy child

In this study we investigated how early maladaptive schemas and schema modes uniquely characterize Borderline Personality Disorder (BPD) patients versus comparison groups. BPD patients (n = 101) were systematically matched with personality disordered patients without BPD (n = 101) and healthy controls (n = 101). Differences were investigated using one-way ANOVA and multinomial logistic regression analyses. Results indicated that schemas of Mistrust/Abuse and Defectiveness/Shame along with modes of Angry Child, Impulsive Child, and (low) Happy Child uniquely differentiated BPD patients from patients with other personality disorders. Likewise, schemas of Mistrust/Abuse, Defectiveness/Shame, and Insufficient Self-Control along with modes of Vulnerable Child, Enraged Child, and (low) Happy Child, uniquely differentiated BPD patients from healthy controls. The results are overall consistent with propositions in the schema therapy literature as well as previous findings, and suggest that underlying schemas of Mistrust/Abuse and Defectiveness/Shame as well as manifest modes of Angry/Enraged Child, Impulsive Child, and (low) Happy Child comprise key features of BPD. Consequently, these features may be important foci in the conceptualization and treatment of BPD.