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Popolo R, Dimaggio G, MacBeth A, Ottavi P, Centonze A. Management of the therapeutic relationship in a patient with Complex PTSD and Personality Disorder. J Clin Psychol 2024. [PMID: 39169871 DOI: 10.1002/jclp.23737] [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: 01/30/2023] [Revised: 06/01/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
Individuals diagnosed with Complex PTSD (C-PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within-session, challenges with patient-therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom-focused work. We describe a case study involving a 38-year-old woman presenting with C-PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C-PTSD (with or without comorbidity).
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Affiliation(s)
- Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
- DSM ASL Roma 1, Rome, Italy
| | | | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
| | - Paolo Ottavi
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
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Haeyen S, Dimaggio G. Arts and psychomotor therapies in the treatment of personality disorders. J Clin Psychol 2024; 80:1717-1725. [PMID: 38662958 DOI: 10.1002/jclp.23693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 07/05/2024]
Affiliation(s)
- Suzanne Haeyen
- Department Health & Vitality, Research Group Arts & Psychomotor Therapies in Health Care, HAN University of Applied Sciences, Nijmegen, GL, The Netherlands
- GGNet, Centre for Mental Health, Scelta, Expert Centre for Personality Disorders Apeldoorn, Warnsveld, The Netherlands
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Passarella T, Galasso V, Dimaggio G. Working through the body in metacognitive interpersonal therapy to change relational patterns in dependent personality disorder: The case of Lia. J Clin Psychol 2024; 80:1568-1581. [PMID: 38509753 DOI: 10.1002/jclp.23680] [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: 11/10/2023] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.
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Marconi E, Monti L, Fredda G, Kotzalidis GD, Janiri D, Zani V, Vitaletti D, Simone MV, Piciollo S, Moriconi F, Di Pietro E, Popolo R, Dimaggio G, Veredice C, Sani G, Chieffo DPR. Outpatient care for adolescents' and young adults' mental health: promoting self- and others' understanding through a metacognitive interpersonal therapy-informed psychological intervention. Front Psychiatry 2023; 14:1221158. [PMID: 38025443 PMCID: PMC10651761 DOI: 10.3389/fpsyt.2023.1221158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies. Methods We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment. Results Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (χ2 = 6.61, p < 0.001), BPRS (χ2 = 6.77, p < 0.001), and CGI (χ2 = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05). Conclusion The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication.
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Affiliation(s)
- Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Fredda
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), University of Rome “La Sapienza”, Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Zani
- Catholic University of the Sacred Heart–Rome, Rome, Italy
| | | | | | | | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
- Department of Mental Health, Rome, Italy
| | | | - Chiara Veredice
- Pediatric Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart–Rome, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Life Sciences and Public Health Department, Catholic University of Sacred Heart, Rome, Italy
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Fioravanti G, Nicolis M, MacBeth A, Dimaggio G, Popolo R. Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:690. [PMID: 37667887 PMCID: PMC10519278 DOI: 10.4081/ripppo.2023.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
Eating disorders (ED) are serious disorders characterized by an alteration of eating habits and excessive concern about weight and body shapes (Fairburn, 2002), accompanied by significant impairment inequality of life, high mortality rates and serious organic consequences (Jenkins et al., 2011; Treasure et al., 2015; 2020). Although evidence-based psychological therapies for nonunderweight ED presentations such as cognitive behavioral therapy for eating disorders (CBT-ED) are widely available, there is substantial scope for improvements, particularly in terms of efficacy and adherence. One option is to develop interventions to address elements of pathology not fully addressed by existing empirical supported treatments, such as incorporating techniques aimed at addressing interpersonal problems and personality disorder features into existing treatment delivery. We adapted Metacognitive Interpersonal Therapy, a psychological intervention supported by evidence for treating personality disorders and integrated it with existing CBT techniques for eating disorders (MIT-ED). MIT-ED targets aspects of ED that are not included in the transdiagnostic CBT-E model such as poor metacognition, or maladaptive interpersonal schemas. This is a pre-registered (Protocol number: 0000781) pilot randomized clinical trial aimed at assessing acceptability and feasibility of MIT-ED and establishing preliminary evidence of effectiveness for future larger studies. Twenty patients (10 in each arm) will be randomized to 20 sessions of individual psychotherapy, either MIT-ED or CBTE. Repeated follow-ups will be collected up to 24 months. Participants are recruited at a private outpatient clinic for ED treatment. Acceptability will be assessed via session attendance, completion rates and preliminary outcomes. The primary outcome is ED pathology assessed with the Eating Disorder Examination Questionnaire-6. Other ED outcomes assessed will be eating disorder attitudes, clinical impairment and binge eating pathology. Secondary treatment outcomes are anxiety, depression, and global symptomatology. We will also assess emotional awareness, emotion regulation and therapeutic alliance. Based on previous studies of MIT for personality disorders we hypothesize that MIT-ED will be acceptable to patients, evidenced by high treatment adherence and retention. We hypothesize that MIT-ED will be associated with reductions in eating disorder pathology, at least equivalent to CBT-E. Results will be used to inform the study design, sampling, likely effect sizes and choice of outcome measures for future larger trials of MIT-ED in ED samples.
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Affiliation(s)
- Gloria Fioravanti
- Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Martina Nicolis
- 1Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Edinburgh.
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Katakis P, Schlief M, Barnett P, Rains LS, Rowe S, Pilling S, Johnson S. Effectiveness of outpatient and community treatments for people with a diagnosis of 'personality disorder': systematic review and meta-analysis. BMC Psychiatry 2023; 23:57. [PMID: 36681805 PMCID: PMC9862782 DOI: 10.1186/s12888-022-04483-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Quality of care and access to effective interventions have been widely criticised as limited for people diagnosed with 'personality disorder' or who have comparable needs (described in some recent papers as "Complex Emotional Needs" (CEN). It is important to identify effective interventions and the optimal context and mode of delivery for people with CEN. We aimed to investigate the effectiveness of psychosocial interventions delivered in community and outpatient settings in treating symptoms associated with 'personality disorder', and the moderating effects of treatment-related variables. METHODS We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, HMIC, ASSIA for articles published in English, from inception to November 23, 2020. We included randomized controlled trials examining interventions provided in community or outpatient settings for CEN. The primary outcome was 'personality disorder' symptoms, while secondary outcomes included anxiety symptoms, depressive symptoms, and global psychiatric symptoms. Random-effects meta-analysis was conducted for each outcome, and meta-regression analysis was performed to assess the moderating effects of treatment characteristics. The quality of the studies and the degree of publication bias was assessed. RESULTS We included 54 trials (n = 3716 participants) in the meta-analysis. We found a large effect size (g = 0.78, 95% CI: 0.56 to 1.01, p < 0.0001) favoring interventions for 'borderline personality disorder' (BPD) symptoms over Treatment as Usual or Waitlist (TAU/WL), and the efficacy was maintained at follow-up (g = 1.01, 95% CI: 0.37 to 1.65, p = 0.002). Interventions effectively reduced anxiety symptoms (g = 0.58, 95% CI: 0.21 to 0.95, p = 0.002), depressive symptoms (g = 0.57, 95% CI: 0.32 to 0.83, p < 0.0001), and global psychiatric symptoms (g = 0.50, 95% CI: 0.35 to 0.66, p < 0.0001) compared to TAU/WL. The intervention types were equally effective in treating all symptom categories assessed. Treatment duration and treatment intensity did not moderate the effectiveness of the interventions for any outcome. CONCLUSIONS People with a 'personality disorder' diagnosis benefited from psychological and psychosocial interventions delivered in community or outpatient settings, with all therapeutic approaches showing similar effectiveness. Mental health services should provide people with CEN with specialised treatments in accordance with the availability and the patients' preferences.
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Affiliation(s)
- Panos Katakis
- Division of Psychiatry, University College London, London, UK.
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sarah Rowe
- Division of Psychiatry, University College London, London, UK
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Ledden S, Rains LS, Schlief M, Barnett P, Ching BCF, Hallam B, Günak MM, Steare T, Parker J, Labovitch S, Oram S, Pilling S, Johnson S. Current state of the evidence on community treatments for people with complex emotional needs: a scoping review. BMC Psychiatry 2022; 22:589. [PMID: 36064337 PMCID: PMC9442944 DOI: 10.1186/s12888-022-04171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.
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Affiliation(s)
- Sarah Ledden
- Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Brian Chi Fung Ching
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Brendan Hallam
- Division of Psychiatry, University College London, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Mia Maria Günak
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
| | - Sarah Labovitch
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
- West London NHS Trust, London, UK
| | - Sian Oram
- NIHR Mental Health Policy Research Unit, Department of Health Service and Population Research, King's College London, London, UK
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Faith LA, Lecomte T, Corbière M, Lysaker PH. Metacognitive mastery moderates the relationship between positive symptoms and distress in adults with serious mental illness. J Ment Health 2022:1-8. [PMID: 35766302 DOI: 10.1080/09638237.2022.2091758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Research supports the possibility that a person's metacognitive ability may influence the impact of positive symptoms. This connection is important because understanding how metacognitive capacity relates to positive symptoms and distress can guide treatment and bolster recovery. AIMS To explore this, we assessed the moderating role of Metacognitive Mastery on the relationship of positive symptoms to affective symptoms, or markers of distress, measured both concurrently and at a later time point (to assess durability of metacognition) with persons with serious mental illness. To rule out the possibility that any findings were the result of cognitive impairments or general psychopathology we included measures of neurocognition and symptoms as potential covariates. METHODS Participants were 67 individuals with the majority diagnosed with either schizophrenia spectrum disorder, major depressive disorder, or bipolar disorder. Metacognition was measured with the Metacognitive Assessment Scale-Abbreviated, symptoms were measured using the Brief Psychiatric Rating Scale and verbal memory was measured using the California Verbal Learning Test. RESULTS Metacognitive Mastery moderated the relationship between positive symptoms and affective symptoms at both time points with differential patterns at each point. CONCLUSIONS Metacognitive Mastery may exert a complex influence upon the effects of positive symptoms on distress.
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Affiliation(s)
- Laura A Faith
- Richard L Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Psychology, University of Missouri, Kansas City, MO, USA
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, QC, USA
| | - Marc Corbière
- Department of Psychology, University of Montreal, Montreal, QC, USA
| | - Paul H Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Misso D, Velotti P, Pasetto A, Dimaggio G. Treating intimate partner violence with metacognitive interpersonal therapy: The case of Aaron. J Clin Psychol 2021; 78:50-66. [PMID: 34927730 DOI: 10.1002/jclp.23294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/20/2021] [Accepted: 11/26/2021] [Indexed: 11/07/2022]
Abstract
Intimate partner violence (IPV) is responsible for loss of lives and significant psychological, financial, and social costs. Research into therapeutic effectiveness show inconsistent results irrespective of therapeutic orientation. The capacity to understand one's own mental states as subjective and distinct from others is an important factor in the regulation of mental states and physiological arousal associated with the perpetration of IPV. Metacognitive Interpersonal Therapy (MIT) offers an innovative approach in working with male perpetrators of IPV. The current paper outlines 14 sessions of MIT with a 45-year-old male perpetrator. A core aspect was helping the client resolve how his view of self and others were subjective experiences that were distinct from relational objectivity. The emergence of healthy self-narratives was fostered through experiential processes, involving guided imagery, rescripting and body focused interventions. Qualitative outcomes are summarized and implications for the use of MIT in treatment of perpetrators of IPV is discussed.
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Affiliation(s)
- Dave Misso
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patrizia Velotti
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Roma, Italy
| | - Andrea Pasetto
- Spazio di Ascolto NAV "Non agire Violenza" Centro Petra, Verona, Italy
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Bora E. A meta-analysis of theory of mind and 'mentalization' in borderline personality disorder: a true neuro-social-cognitive or meta-social-cognitive impairment? Psychol Med 2021; 51:2541-2551. [PMID: 34530941 DOI: 10.1017/s0033291721003718] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients. METHODS The current systematic review aimed to conduct separate meta-analyses of 'mentalization' [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls. RESULTS A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17-2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24-0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32-0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41-0.79) and faux pas recognition (d = 0.62, CI = 0.35-0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis. CONCLUSIONS BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir35340, Turkey
- Department of Neurosciences, Insitiute of Health, Dokuz Eylul University, Izmir, Turkey
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria3053, Australia
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Cheli S, Cavalletti V, Popolo R, Dimaggio G. A case study on a severe paranoid personality disorder client treated with metacognitive interpersonal therapy. J Clin Psychol 2021; 77:1807-1820. [PMID: 34263957 DOI: 10.1002/jclp.23201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
Paranoid personality disorder (PPD) is a severe condition, lacking specialized and empirically supported treatment. To provide the clinician with insights into how to treat this condition, we present a case study of a 61-year-old man with severe PPD who presented with ideas of persecution, emotionally charged hostility, and comorbid antisocial personality disorder. The client was treated with 6 months of Metacognitive Interpersonal Therapy, which included: creating a shared formulation of his paranoid attitudes; trying to change his inner self-image of self-as-inadequate and his interpersonal schemas where he saw the others as threatening. Guided imagery and rescripting techniques, coupled with behavioral experiments, were used to promote a change. At the end of the therapy the client reported a reliable change in general symptomatology and, specifically, in interpersonal sensitivity, hostility, and paranoid ideation; he could no longer be diagnosed as PPD and only some paranoid and antisocial characteristics remained.
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Affiliation(s)
- Simone Cheli
- Center for Psychology and Health, Tages Charity, Florence, Italy.,School of Human Health Sciences, University of Florence, Florence, Italy
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12
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Centonze A, Popolo R, MacBeth A, Dimaggio G. Building the alliance and using experiential techniques in the early phases of psychotherapy for avoidant personality disorder. J Clin Psychol 2021; 77:1219-1232. [DOI: 10.1002/jclp.23143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, Center for Applied Developmental Psychology University of Edimburgh Edimburgh Scotland UK
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13
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Borderline personality disorder, metacognition and psychotherapy. J Affect Disord 2020; 276:1095-1101. [PMID: 32777647 DOI: 10.1016/j.jad.2020.07.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Deficits in the ability to think about own mental states and that of others (mindreading) are seen as key aspects of borderline personality disorder (BPD), which could sustain BPD symptoms. Interestingly, some studies showed that in BPD patients metacognition is selectively compromised and could improve during treatments. However, empirical findings are inconsistent, and it is debatable whether BPD presents a specific profile of mindreading impairments that could improve during treatments. METHODS We performed a bibliographic research on PubMed , Google Scholar and Scopus of all studies investigating a) the metacognitive functioning in the BPD patients and b) the link between psychotherapy, metacognition improvement and BPD symptomatology. A total of 11 studies met our inclusion criteria and considered metacognition following the definition proposed by Semerari. RESULTS Overall, the results suggest that BPD metacognitive profile mainly includes difficulties in metacognitive sub-domains of integration, differentiation and mastery. The type of treatment most appropriate to improve metacognitive abilities and reduce symptoms seemed to be a long term treatment and specifically focused on metacognitive deficits. LIMITATIONS Lack of a control group, small sample sizes and heterogeneity in terms of gender, age, comorbidities and other ongoing treatments are the key limits of the original studies reviewed. CONCLUSIONS The results sustain the hypothesis of a selective and specific metacognitive impairment in BPD patients that could improve during treatments together with their symptomatology. However, more studies are needed to further investigate the role of metacognition in the effectiveness of treatments.
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Metacognition Is Uniquely Related to Concurrent and Prospective Assessments of Negative Symptoms Independent of Verbal Memory in Serious Mental Illness. J Nerv Ment Dis 2020; 208:837-842. [PMID: 32740145 DOI: 10.1097/nmd.0000000000001219] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The inability to synthesize information into experience of self and others could be one significant cause of negative symptoms. To explore this possibility, we examined the relationships between baseline metacognition and concurrent and prospective negative symptoms controlling for verbal memory. The participants were 62 adults diagnosed with serious mental illness enrolled in outpatient treatment. Metacognition was measured with the Metacognitive Assessment Scale-Abbreviated, symptoms were assessed using the Brief Psychiatric Rating Scale, and verbal memory was assessed using the California Verbal Learning Test. Significant correlations were found, indicating that poorer overall metacognition was associated with greater levels of negative symptoms assessed concurrently (r = 0.39) and 1 month later (r = 0.36). A significant relationship persisted after controlling for verbal memory and education. These findings support the idea that metacognitive deficits are related to negative symptoms and point to the potential of metacognitive interventions to positively influence negative symptoms.
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Giannone F, Guarnaccia C, Gullo S, Di Blasi M, Giordano C, Lo Coco G, Burlingame G. Italian adaptation of the Group Questionnaire: validity and factorial structure. RESEARCH IN PSYCHOTHERAPY (MILANO) 2020; 23:443. [PMID: 33024720 PMCID: PMC7513611 DOI: 10.4081/ripppo.2020.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/21/2020] [Indexed: 11/22/2022]
Abstract
The Group Questionnaire (GQ) is a measure recently developed by Krogel et al. (2013) for the evaluation of the therapeutic relationship in group. The GQ identifies a three-factor model of the relationship that allows to measure quality (Positive Bonding, Positive Working and Negative Relationship) and structure (member-member, member-leader and member-group), dimensions in group. This work shows the results of a first study on the Italian validation of the GQ. In this study the GQ was administered to 536 subjects from 32 non-clinical groups of undergraduate students. The cross-cultural validity of the GQ in the Italian population has been examined by comparing the psychometric properties and equivalence in factor structure and scores of the Italian GQ with the original American version. Multilevel confirmatory factor analysis was used to examine both the between- and within-group structures. Data concerning reliability and validity of GQ and the results for different SEM in Multilevel CFA confirm the three factors structure of the GQ. Data from the Italian population have a good fit with the original proposed model. Finally, we discuss the importance of an instrument like GQ, short but consistent, for the evaluation of the therapeutic relationship in clinical and training group.
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Affiliation(s)
- Francesca Giannone
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Cinzia Guarnaccia
- Université Rennes 2, LP3C, Laboratoire de Psychologie: Cognition, Comportement, Communication, Rennes, France
| | - Salvatore Gullo
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Maria Di Blasi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Cecilia Giordano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Gary Burlingame
- Department of Psychology, Brigham Young University, Provo, USA
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Colle L, Dimaggio G, Carcione A, Nicolò G, Semerari A, Chiavarino C. Do Competitive Contexts Affect Mindreading Performance? Front Psychol 2020; 11:1284. [PMID: 32655451 PMCID: PMC7324785 DOI: 10.3389/fpsyg.2020.01284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
Mindreading is contingent upon interpersonal context. Little is known about how competitive contexts influence mindreading skills. The idea was that the capacity to think about mental states would decline when individuals experiencing failure in competition. This study aims to assess effects of a competitive experience (a computer competitive PC game) on a sample of healthy subjects (119 participants). The sample was divided into two sub-samples. The experimental group underwent an experience of failure, consisting in a PC game of logic against a hypothetical opponent. The control group was required instead only to discuss past personal experiences of competitive interactions. The Metacognitive Assessment Interview was administered to each sub-sample for evaluating mindreading capacities. Self-report tests were additionally provided for evaluation of trait-based dispositions: self-esteem, perfectionism, narcissism. Results supported our hypothesis: induction of sense of failure compromises ability to describe one’s own mental states and mental states of others. This effect was more pronounced in the domain of self-reflection. Results remained significant after controlling for self-esteem, perfectionism, and narcissism. We discuss possible clinical implications of these findings and the importance of evaluating mindreading capacities under the pressure of social rank as well as of other social motive.
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Affiliation(s)
- Livia Colle
- Department of Psychology, University of Turin, Turin, Italy.,III Centro Psicoterapia Cognitiva, Rome, Italy
| | | | | | | | | | - Claudia Chiavarino
- Istituto Universitario Salesiano Torino Rebaudengo (IUSTO), Turin, Italy
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Metakognitive und mentalisierungsbasierte Konzepte und Behandlungsmodelle: Implikationen für die Kinder- und Jugendpsychiatrie. Prax Kinderpsychol Kinderpsychiatr 2020; 69:252-271. [DOI: 10.13109/prkk.2020.69.3.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ke T, Barlas J. Thinking about feeling: Using trait emotional intelligence in understanding the associations between early maladaptive schemas and coping styles. Psychol Psychother 2020; 93:1-20. [PMID: 30369013 PMCID: PMC7028072 DOI: 10.1111/papt.12202] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 09/03/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Maladaptive interpersonal schemas can trigger distressing emotions and drive dysfunctional behaviour that leads to difficulties in interpersonal relationships and perpetuates the original maladaptive schemas. This study sought to identify patterns of association between trait emotional intelligence (TEI), early maladaptive schemas (EMS), and coping styles in a non-clinical sample. Emotionality profiles were hypothesized to be associated with EMS severity and poorer coping, as early experiences can shape an individual's self-perceptions through reinforcement by maladaptive responses. DESIGN Cross-sectional study with 142 undergraduate students. METHODS We obtained self-reports of TEI, coping styles, and EMS. RESULTS Disengagement coping was strongly correlated with EMS severity (r = .565, p < .01). TEI was negatively correlated with EMS (r = -.660, p < .01) and Disengagement (r = -.405, p < .01). Emotionality, Impaired Autonomy, and Overvigilance partially mediated the relationship between Disconnection and Emotion-Focused Disengagement. Self-Control fully mediated the relationship between Impaired Limits and Problem-Focused Disengagement. CONCLUSIONS The findings suggest that lower TEI is associated with the likelihood for maladaptive coping in response to EMS. The preference for certain coping styles associated with a particular domain of EMS may be explained by an individual's perceived metacognitive ability to regulate their stress and emotions. When individuals' needs for love, safety, and acceptance from others are not met, there might be poorer perceived self-efficacies in Emotionality and the tendency to cope through emotional avoidance. Individuals with difficulties establishing internal limits are more likely to respond with problem avoidance, possibly due to deficient distress tolerance. Longitudinal studies with a clinical population are warranted to replicate these findings. PRACTITIONER POINTS Clinicians will likely find it helpful to consider their clients' TEI to facilitate more individualized formulation and treatment planning, by considering whether related emotional regulation problems might be innate or a deficit in skills Implies the need to do more basic emotional regulation work to supplement and strengthen the established imagery work in schema therapy (ST).
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Affiliation(s)
- Tianyuan Ke
- The Institute of Psychiatry, Psychology & Neuroscience (IoPPN)King's College LondonUK
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Metacognitive Interpersonal Therapy in Group for Personality Disorders: Preliminary Results from a Pilot Study in a Public Mental Health Setting. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09453-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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20
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Bröcker AL, Bayer S, Stuke F, Just S, Bertram G, Funcke J, Grimm I, Lempa G, von Haebler D, Montag C. Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach. Front Psychol 2020; 11:269. [PMID: 32153475 PMCID: PMC7047329 DOI: 10.3389/fpsyg.2020.00269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures specific for psychoses may promote and challenge a patient's metacognitive capacities, but should equally take the need for maturing structural skills into account. Modern psychodynamic approaches to psychosis are shortly presented, providing concepts and techniques for the implicit regulation of interpersonal experience and aiming at structural integration in this patient group.
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Affiliation(s)
- Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Bayer
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jakob Funcke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Imke Grimm
- International Psychoanalytic University Berlin, Berlin, Germany
| | | | - Dorothea von Haebler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
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Kealy D, Aafjes‐van Doorn K, Ehrenthal JC, Weber R, Ogrodniczuk JS, Joyce AS. Improving social functioning and life satisfaction among patients with personality dysfunction: Connectedness and engagement in integrative group treatment. Clin Psychol Psychother 2020; 27:288-299. [DOI: 10.1002/cpp.2427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- David Kealy
- Department of PsychiatryUniversity of British Columbia Vancouver Canada
| | | | | | - Rainer Weber
- Clinic for Psychosomatics and PsychotherapyUniversity of Cologne Cologne Germany
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Natalini E, Dimaggio G, Varakliotis T, Fioretti A, Eibenstein A. Misophonia, Maladaptive Schemas and Personality Disorders: A Report of Three Cases. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2019. [DOI: 10.1007/s10879-019-09438-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Cheli S, Lysaker PH, Dimaggio G. Metacognitively oriented psychotherapy for schizotypal personality disorder: A two-case series. Personal Ment Health 2019; 13:155-167. [PMID: 31169366 DOI: 10.1002/pmh.1447] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/31/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
Schizotypal personality disorder represents a broad range of maladaptive behaviour, which has been linked to both personality disorder and schizophrenia spectrum disorders; however, to date, little effort has been devoted to developing psychosocial treatment approaches to address it. In response, we conducted two case studies exploring the effects of two metacognitively oriented forms of psychotherapy: metacognitive interpersonal therapy and metacognitive reflection and insight therapy for patients with schizotypal personality disorder. We chose these two forms of therapy as they have been successfully delivered, respectively, to persons with other personality disorders and schizophrenia spectrum disorders. Both treatments consisted of weekly individual psychotherapy sessions over a period of 6 months. General symptoms were assessed during the first week of treatment, at treatment end and at 1 month following treatment using the Symptom Check List-90-Revised, while schizotypal traits were assessed with the Structured Clinical Interview for DSM-5. Both patients completed all sessions, and there were no reports of any adverse outcomes. Both patients achieved reliable change in symptoms (ranging from 4.98 to 9.81) and a significant reduction in schizotypal features. Results provide preliminary evidence of the feasibility of metacognitively oriented interventions for schizotypal personality disorder. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Simone Cheli
- School of Human Health Sciences, University of Florence, Florence, Italy.,Center for Psychology and Health, Tages Charity, Florence, Italy
| | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Fernández-Navarro P, Ribeiro AP, Soylemez KK, Gonçalves MM. Innovative Moments as Developmental Change Levels: A Case Study on Meaning Integration in the Treatment of Depression. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2019. [DOI: 10.1080/10720537.2019.1592037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Pablo Fernández-Navarro
- CIPsi - Psychology Research Center, Psychotherapy and Psychopathology Research Unit, School of Psychology, University of Minho, Braga, Portugal
| | - António P. Ribeiro
- CIPsi - Psychology Research Center, Psychotherapy and Psychopathology Research Unit, School of Psychology, University of Minho, Braga, Portugal
| | - Kerem K. Soylemez
- CIPsi - Psychology Research Center, Psychotherapy and Psychopathology Research Unit, School of Psychology, University of Minho, Braga, Portugal
| | - Miguel M. Gonçalves
- CIPsi - Psychology Research Center, Psychotherapy and Psychopathology Research Unit, School of Psychology, University of Minho, Braga, Portugal
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Metacognitive Interpersonal Therapy in Groups for Over-Regulated Personality Disorders: A Single Case Study. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2019. [DOI: 10.1007/s10879-018-9401-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Treatment of Clients with Anxious and Over-controlled Personality Disorders: An International Accord. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2019. [DOI: 10.1007/s10879-018-9403-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Popolo R, MacBeth A, Brunello S, Canfora F, Ozdemir E, Rebecchi D, Toselli C, Venturelli G, Salvatore G, Dimaggio G. Metacognitive interpersonal therapy in group: a feasibility study. RESEARCH IN PSYCHOTHERAPY (MILANO) 2018; 21:338. [PMID: 32913773 PMCID: PMC7451332 DOI: 10.4081/ripppo.2018.338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
Abstract
Patients with personality disorders (PDs) other than borderline, with prominent features of social inhibition and over-regulation of emotions, are in need of specialized treatments. Individuals present with poor metacognition, that is the capacity to understand mental states and use psychological knowledge for the sake of purposeful problem solving; and are guided by maladaptive interpersonal schemas. We developed a short-term group intervention, Metacognitive Interpersonal Therapy in Groups (MIT-G), incorporating psychoeducational and experiential elements, to help these individuals become more aware of their drives when interacting with others; and to help them adopt more flexible behaviors via improvements in metacognition. We present results of an effectiveness study, evaluating whether we could replicate the initial positive results of our first pilot randomized controlled trial. Seventeen young adults outpatients with personality disorders were included in the 16 session program. Effect sizes were calculated for change from baseline to treatment end for the primary outcome, symptoms and functioning (Clinical Outcomes in Routine Evaluation Outcome Measure) and then for one putative mechanism of change - metacognition. Emotional dysregulation and alexithymia were also assessed. Qualitative evaluations of the acceptability and subjective impact of the treatment were also performed. MIT-G was acceptable to participants. There were medium to large magnitude changes from pre- to post- treatment on wellbeing, emotion dysregulation, alexithymia and metacognition. These gains were maintained at follow-up. There was evidence of clinically significant change on key variables. MITG appears acceptable to patients, as evidenced by the absence of drop-out from treatment. In light of the positive outcomes of this study and the expanding evidence base, MIT-G is a candidate for dissemination and investigations in larger trials as a possible effective intervention for PDs characterized by tendencies to overcontrol.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Giampaolo Salvatore
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
- Scuola di Specializzazione “Humanitas”, Rome, Italy
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Lysaker PH, Gagen E, Moritz S, Schweitzer RD. Metacognitive approaches to the treatment of psychosis: a comparison of four approaches. Psychol Res Behav Manag 2018; 11:341-351. [PMID: 30233262 PMCID: PMC6130286 DOI: 10.2147/prbm.s146446] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual's response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person's relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA,
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,
| | - Emily Gagen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert D Schweitzer
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
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Specialized Treatment for Patients with Severe Avoidant Personality Disorder: Experiences from Scandinavia. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2018. [DOI: 10.1007/s10879-018-9395-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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El trastorno de personalidad por evitación: una propuesta de tratamiento especializado en la sanidad pública española. ANSIEDAD Y ESTRÉS 2018. [DOI: 10.1016/j.anyes.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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