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Fasolato R, De Felice M, Barbui C, Bertani M, Bonora F, Castellazzi M, Castelli S, Cristofalo D, Dall'Agnola RB, Ruggeri M, Signoretto B, Bonetto C. Early maladaptive schemas mediate the relationship between severe childhood trauma and eating disorder symptoms: evidence from an exploratory study. J Eat Disord 2024; 12:138. [PMID: 39261959 PMCID: PMC11389446 DOI: 10.1186/s40337-024-01103-y] [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] [Received: 06/21/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Childhood trauma history has frequently been linked to eating disorders (EDs); nevertheless, the scientific literature calls for extending knowledge regarding mediators between EDs and childhood trauma. This study explored whether ED symptoms and early maladaptive schemas were more severe in ED patients with severe childhood trauma than in ED patients with no/mild childhood trauma and whether early maladaptive schemas mediated the relationship between childhood trauma and ED symptom severity. METHODS Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona. The extracted data included self-reported data, including the Eating Disorder Inventory-3 score, Young Schema Questionnaire score, Childhood Experience and Experience of Care and Abuse Questionnaire score, and sociodemographic and clinical information on the ED outpatients seeking care. A mediation analysis using the structural equation modeling procedure was conducted. RESULTS Forty-two outpatients, 31% of whom exhibited severe childhood trauma, satisfied the criteria for registry data extraction. The severity of ED symptoms, as well as the early maladaptive schemas' scores for emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity, were greater in ED outpatients with severe childhood trauma. Furthermore, early maladaptive schemas related to defectiveness, failure, and negativity had a mediating role in the relationship between severe childhood trauma and ED symptom severity. CONCLUSIONS This exploratory study provides preliminary evidence about the importance of early maladaptive schemas in the relationship between trauma history and ED psychopathology. In addition, ED symptoms may represent a dysfunctional attempt to avoid unpleasant emotions associated with schema activation. The results support the need to consider early maladaptive schemas in the treatment of traumatized patients with ED symptoms. Study limitations, research and clinical implications are discussed.
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Affiliation(s)
- Rachele Fasolato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
| | - Mariangela De Felice
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Corrado Barbui
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariaelena Bertani
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Federica Bonora
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mariasole Castellazzi
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Silvia Castelli
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rosa Bruna Dall'Agnola
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Benedetta Signoretto
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Moroń M, Niedbała D, Mendrok M, Pach J. How complex are the associations between early maladaptive schemas and obsessive-compulsive symptoms? Commentary on Dostal and Pilkington (2023) meta-analysis. J Affect Disord 2024; 360:1-4. [PMID: 38810777 DOI: 10.1016/j.jad.2024.05.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/26/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Marcin Moroń
- Institute of Psychology, University of Silesia in Katowice, Poland.
| | - Dariusz Niedbała
- Department of Social Sciences, University of Silesia in Katowice, Poland.
| | - Mateusz Mendrok
- Department of Social Sciences, University of Silesia in Katowice, Poland.
| | - Janusz Pach
- Department of Social Sciences, University of Silesia in Katowice, Poland.
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Bardakçı MR, Şahin Can M. Early maladaptive schemas in autogenous and reactive subtypes of obsessive-compulsive disorder. Nord J Psychiatry 2024; 78:541-547. [PMID: 39002145 DOI: 10.1080/08039488.2024.2374416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/21/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
AIMS The aim of this study is to identify early maladaptive schemas in patients with obsessive-compulsive disorder (OCD) and to determine the use of these schemas in OCD autogenous and reactive subtypes. METHODS The study population included 40 healthy volunteers, and 90 patients diagnosed with OCD. The Yale-Brown Obsession-Compulsion Scale (Y-BOCS) was administered to the OCD group to determine the severity of the disorder, and the Y-BOCS Symptom Checklist was applied to determine the patients with autogenous (n = 37) and reactive (n = 53) subtypes of OCD. Young Schema Questionnaire-Short Form 3 (YSQ-SF3) scales were applied to all participants. RESULTS When autogenous and reactive subtype groups of OCD were compared with each other, the schema domains of disconnection (p = 0.004), high standards (p = 0.008), other-directedness (p < 0.001) and the schema dimensions of failure (p < 0.001), emotional deprivation (p < 0.001), defectiveness (p = 0.007), approval seeking (p = 0.007) and punishment (p = 0.001) were found to be more dominant in the autogenous group. CONCLUSIONS The findings of the study support that there are differences between autogenous and reactive subtypes of OCD in terms of dominant schemas. Therefore, its thought that the use of Schema Therapy methods in which schemas appropriate for subtypes are investigated in the treatment of OCD patients will contribute favorably to the treatment response.
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Affiliation(s)
| | - Merve Şahin Can
- Department of Psychiatry, Balıkesir University Faculty of Medicine, Balıkesir, Türkey
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Boecking B, Brueggemann P, Mazurek B. "I feel [so alone] nothing" - emotional vulnerability and detachment as transdiagnostic key characteristics of patients with chronic tinnitus: a schema mode model approach. Front Psychiatry 2024; 15:1375813. [PMID: 38979500 PMCID: PMC11229517 DOI: 10.3389/fpsyt.2024.1375813] [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: 01/24/2024] [Accepted: 04/26/2024] [Indexed: 07/10/2024] Open
Abstract
Background Gold-standard approaches for chronic tinnitus involve hearing amplification measures and psychological therapy, where applicable. Whilst schema therapy is accumulating evidence as a transdiagnostically useful treatment framework, its applicability for patients with chronic tinnitus has not yet been examined. The present study (a) explores latent dimensions of psychological distress in a sample of chronic tinnitus patients, and (b) examines whether the schema mode model might explain these dimensions - thus constituting a potentially helpful conceptualization and treatment framework. Methods N = 696 patients with chronic tinnitus completed the Tinnitus Questionnaire, Tinnitus Handicap Inventory, Hospital Anxiety and Depression Scale, Perceived Stress Questionnaire and ICD-10 Symptom Rating. As criterion, patients further completed the Schema Mode Inventory (SMI-r) - which assesses psychological constructs linked to negative self-beliefs ("parent modes"), primary emotions resulting from unmet psychological needs ("child modes"), and secondary emotional or behavioral attempts to reinstate or maintain psychological equilibrium ("coping modes"). A varimax-rotated principal axis factor analysis grouped the primary item pool. Factor scale scores were then correlated with the SMI-r. Results A three-factor solution explained 37.4% of variance and represented 78% of the included items. Following item content examination, the factors represented (1) General emotional distress, (2) Tinnitus-attributed emotional distress, and (3) Socio-audiological impairment. Factors 1|2 correlated highly (r = 0.70), Factors 2|3 moderately (r = 0.62). Linked to the schema mode model, Factor 1 correlated highly with the "vulnerable child" (r = 0.78), and moderately with the "parent", "angry child", and "detached protector" modes (0.53 < r < 0.65). Factor 2 correlated moderately with the "vulnerable child" (r = 0.53). Factor 3 was largely uncorrelated with SMI-r scores - although a low correlation with the "detached protector" warrants further examination. Conclusion "General" and "tinnitus-attributed" emotional distress correlate highly - warranting holistic (not symptom-specific) psychological case conceptualization and treatment planning. Viewed from a schema mode perspective, the "vulnerable child" explains substantial variance across both dimensions. Consequently, autobiographically anchored, unmet emotional needs and emotional detachment constitute key treatment targets. Social-audiological impairment should be multimodally conceptualised and treated with hearing aids and psychological support measures, as applicable.
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Affiliation(s)
- Benjamin Boecking
- Charité - Universitatsmedizin-Berlin - Tinnitus Center, Berlin, Germany
| | - Petra Brueggemann
- Charité - Universitatsmedizin-Berlin - Tinnitus Center, Berlin, Germany
| | - Birgit Mazurek
- Charité - Universitatsmedizin-Berlin - Tinnitus Center, Berlin, Germany
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Boecking B, Stoettner E, Brueggemann P, Mazurek B. Emotional self-states and coping responses in patients with chronic tinnitus: a schema mode model approach. Front Psychiatry 2024; 15:1257299. [PMID: 38449502 PMCID: PMC10916791 DOI: 10.3389/fpsyt.2024.1257299] [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: 09/15/2023] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
Background Amongst "third-wave" cognitive behavioural therapies, schema therapy demonstrates encouraging efficacy across various mental health conditions. Within this field, clinical interest has begun to converge on the "schema-mode-model" - a conceptualization framework for affective, cognitive and behavioral states that guide individuals' perceptions and behaviours at a given point in time. Schema mode expressions in patients with chronic tinnitus are as-yet unexamined. Methods The present study reports self-report data from N = 696 patients with chronic tinnitus who completed the Schema Mode- and Tinnitus Handicap Inventories alongside measures of perceived stress, anxiety and depression. The Schema Mode Inventory assesses so-called maladaptive "parent", "child" and "coping" modes. Parent modes can be understood as self-states which are characterized by self-critical and hostile beliefs; child modes are characterized by biographically unmet emotional needs; and coping modes by inflexible attempts to regulate emotion and stabilize one's sense of self. Descriptive, correlational and mediation analyses investigated schema mode expressions (1) in patients with chronic tinnitus, (2) as compared to published reference values from a healthy control sample, (3) in their relation to other psychological constructs, and (4) regarding their potential role in driving tinnitus-related distress. Results Patients reported mild-to-moderate levels of emotional distress. Compared to healthy controls, patients showed (1) high relative expressions of child-, detachment and compliant coping modes and (2) a conspicuously low relative expression of the 'punitive parent' mode. Correlational patterns suggested strong associations of (1) parent as well as angry child modes with perceived stress and anxiety, (2) the vulnerable child mode with all measured constructs and (3) emotional distress with - intrapersonally - emotional detachment as well as - interpersonally - alleged compliance. Mediation analyses demonstrated that tinnitus-related distress was driven by significant interactions between child and coping modes. Conclusions The study provides initial clinical evidence for the relevance and applicability of schema-mode based formulation and treatment planning in patients with chronic tinnitus.
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Affiliation(s)
- Benjamin Boecking
- Tinnitus Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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Sajadian M, Younesi SJ, Jafari P, Azkhosh M, Yarandi RB, Kordbagheri M. Shame, fear of compassion, self-criticism, and self-reassurance mediate the effect of early life events on emotional disorders among male prisoners: A structural equation modeling analysis. Acta Psychol (Amst) 2024; 242:104116. [PMID: 38113609 DOI: 10.1016/j.actpsy.2023.104116] [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: 10/06/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Early negative experiences in childhood are potent predictors of criminal behavior in youth and adulthood. This study aimed to identify the mediation effects of Shame, Fear of Compassion, Self-criticism, and Self-reassurance on the effect of Early Life Events on Emotional Disorders. METHOD This cross-sectional study was conducted among 368 male prisoners (Mean age: 33.26 ± 8.41 years) with convenient sampling method, from Ilam, Iran. A set of self-reported instruments were used for data collection. The ultimate model was constructed using structural equation modeling after confirming the construct validity of the measures via confirmatory factor analysis. RESULTS Shame, fear of compassion, self-criticism, and self-reassurance significantly mediated the relationship between Early Life Events and emotional disorders. The mediating effect accounted for 77 % of the total effect in the mediating model. According to Pearson's correlation, a positive and significant relationship existed between early life events and self-criticism, shame, fear of compassion and emotional disorders (P < .001). In conclusion, the presented model has an appropriate and acceptable fit, as evidenced by the results of the chi-square test (χ2 = 48.067, p < .001) and other relevant fit indices. However, self-reassurance's mediating role was insignificant (P > .05). CONCLUSIONS The present results showed that shame, fear of compassion, and self-criticism are important mediators in the relationship between early life events and emotional disorders among male prisoners. So, it is necessary to develop related protocols to increase the mental health of prisoners.
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Affiliation(s)
- Maryam Sajadian
- Department of Counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Jalal Younesi
- Department of Counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Parvin Jafari
- Department of Counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Manouchehr Azkhosh
- Department of Counselling, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Razieh Bidhendi Yarandi
- Epidemiology and Biostatistics Department, University of social welfare and rehabilitation sciences, Tehran, Iran
| | - Mohammadreza Kordbagheri
- Department of Statistics, Faculty of Mathematical Sciences, Shahid Beheshti University, Tehran, Iran
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Grażka A, Królewiak K, Sójta K, Strzelecki D. Suicidality in the Light of Schema Therapy Constructs, i.e., Early Maladaptive Schema and Schema Modes: A Longitudinal Study. J Clin Med 2023; 12:6755. [PMID: 37959221 PMCID: PMC10648388 DOI: 10.3390/jcm12216755] [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: 09/13/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: The search for new strategies to diagnose people at risk of suicide and to help them is highly significant in view of the still high rate of suicidality. Schema therapy and its core constructs, i.e., early maladaptive schemas (EMSs) and schema modes, correspond to both directions. (2) Methods: This study compared the severity of EMSs and schema modes in a clinical group of suicide risk, a clinical non-suicidal group, and a control group. Intragroup comparisons were also conducted between times of crisis and psychological stability. The evaluation was supported by controlling for the psychopathological symptoms presented, following the dimensional concept. (3) Results: The unquestionable relevance of the disconnection/rejection domain in suicidality has been proven. The importance of EMSs from other domains, especially during psychiatric crises, was confirmed. Among the schema modes, child and Punitive Parent modes proved to be the most significant. There were changes in coping modes but of a lesser effect size. The protective importance of the Healthy Adult and Happy Child modes was also proven. (4) Conclusions: The results provide an indication for practitioners about the EMSs and schema modes most associated with suicide risk. They can also serve as a framework for deepening the issue of identifying and preventing suicidality in schema therapy.
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Affiliation(s)
- Anna Grażka
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland; (A.G.); (K.S.)
| | - Klara Królewiak
- Faculty of Psychology, SWPS University, 03-815 Warszawa, Poland;
| | - Klaudia Sójta
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland; (A.G.); (K.S.)
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland; (A.G.); (K.S.)
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Sójta K, Juraś-Darowny M, Margulska A, Jóźwiak-Majchrzak W, Grażka A, Strzelecki D. Resilience and Strategic Emotional Intelligence as Mediators between the Disconnection and Rejection Domain and Negative Parenting among Female Intimate Partner Violence Victims. Brain Sci 2023; 13:1290. [PMID: 37759891 PMCID: PMC10526309 DOI: 10.3390/brainsci13091290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The exposure of children to intimate partner violence (IPV) is associated with a wide range of negative effects on children's development, where as parenting practice is considered to be one of the key factors mediating and mitigating this. Studies have found mixed results regarding the impact of female IPV victimization on maternal parenting practice; however, the most frequently tested hypothesis suggests that the cumulative stress of the IPV experience may emotionally deregulate the mother, contributing to an increased risk of neglected and abusive parenting practices. Little is still known about the factors determining the observed differences in maternal parenting practices among IPV victims. Thus, in our study, we use mediation models to provide preliminary results exploring the role of resilience and strategic emotional intelligence in the relationship between women's disconnection and rejection (D/R) schema domain and maternal parenting practice among IPV victims. (2) Methods: A total of 48 female survivors of IPV and 48 age-matched women with no prior experience of IPV completed a set of tests examining parenting practices, the D/R domain, resilience and emotional intelligence. (3) Results: IPV victimization was associated with significantly higher rates of negative parenting practices. The D/R domain was found to be a significant predictor of parental autonomy attitude and level of parental competence, and these relationships were fully mediated by resilience with strategic emotional intelligence and resilience, respectively. (4) Conclusions: The results shed light on the under-researched relationship between early maladaptive schemas and parenting behavior in the context of IPV. The implications for clinical practice and further research can be drawn based on the study findings.
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Affiliation(s)
- Klaudia Sójta
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechoslowacka Street 8/10, 92-216 Lodz, Poland; (K.S.); (A.G.)
| | - Małgorzata Juraś-Darowny
- Institute of Psychology, Faculty of Educational Sciences, University of Lodz, Rodziny Scheiblerów 2, 90-128 Lodz, Poland;
| | - Aleksandra Margulska
- Department of Adolescent Psychiatry, Medical University of Lodz, Czechoslowacka Street 8/10, 92-216 Lodz, Poland;
| | - Wioletta Jóźwiak-Majchrzak
- Department of Applied Sociology and Social Work, University of Lodz, Rewolucji 1905 41/43, 90-214 Lodz, Poland;
| | - Anna Grażka
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechoslowacka Street 8/10, 92-216 Lodz, Poland; (K.S.); (A.G.)
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Czechoslowacka Street 8/10, 92-216 Lodz, Poland; (K.S.); (A.G.)
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Grażka A, Strzelecki D. Early Maladaptive Schemas and Schema Modes among People with Histories of Suicidality and the Possibility of a Universal Pattern: A Systematic Review. Brain Sci 2023; 13:1216. [PMID: 37626572 PMCID: PMC10452338 DOI: 10.3390/brainsci13081216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The identification of variables affecting suicidality and the search for interventions to reduce suicide risk are priorities among mental health researchers. A promising direction for such research is schema therapy and its two main constructs, i.e., early maladaptive schemas (EMSs) and schema modes. METHODS This systematic review was designed in accordance with the PRISMA guidelines. It summarizes the studies conducted to date that describe the relationship between EMSs and schema modes and measures of suicidality in individuals over the age of 16. RESULTS The review confirmed that there are many significant associations between EMSs (especially from the Disconnection/Rejection domain) and suicide risk. Although only one study was found that explores the association between schema modes and suicidality, the correlations it identified are also confirmed here. DISCUSSION The results show the unquestionable importance of EMSs and schema modes in assessing suicide risk. The co-occurrence of these variables represents the first step in further assessing causality and introducing schema therapy techniques into work with patients who are at risk of suicide. This issue requires more extensive experimental research.
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Affiliation(s)
| | - Dominik Strzelecki
- Department of Affective and Psychotic Disorders, Medical University of Lodz, 92-216 Lodz, Poland;
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