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Tracy M, Penney E, Norton AR. Group schema therapy for personality disorders: Systematic review, research agenda and treatment implications. Psychother Res 2024:1-20. [PMID: 38862126 DOI: 10.1080/10503307.2024.2361451] [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: 11/08/2023] [Accepted: 05/22/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE There are significant temporal and financial barriers for individuals with personality disorders (PD) receiving evidence-based psychological treatments. Emerging research indicates Group Schema Therapy (GST) may be an accessible, efficient, and cost-effective PD intervention, however, there has been no synthesis of the available evidence to date. This review therefore aimed to investigate the efficacy of GST for PDs by systematically synthesizing available literature. METHOD Five electronic databases were screened with resulting studies subjected to a specific eligibility criteria, which yielded fourteen relevant studies. Characteristics were extracted and methodological quality rigorously assessed. RESULTS Strong support was evidenced for GST's ability to reduce Cluster B and C symptomology, particularly for Borderline and Avoidant PD. GST appeared to improve global symptom severity, quality of life and functional capacity, as well as treatment targets such as schemas and modes. CONCLUSION Although not without limitations and a moderate risk of bias, the current body of evidence supports GST as a potential solution to current service deficits in economical and evidence-based care for individuals with PD. Implications for treatment and future research are discussed.
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Affiliation(s)
- Mikaela Tracy
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia
| | - Erika Penney
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Alice R Norton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia
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Zhang K, Hu X, Ma L, Xie Q, Wang Z, Fan C, Li X. The efficacy of schema therapy for personality disorders: a systematic review and meta-analysis. Nord J Psychiatry 2023; 77:641-650. [PMID: 37402124 DOI: 10.1080/08039488.2023.2228304] [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: 02/27/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE Personality disorders (PDs) are prevalent and associated with functional impairment and psychological disability. Studies suggest that schema therapy (ST) may be an effective treatment for PDs. This review aimed to evaluate the efficacy of ST in treating PDs. METHOD We conducted a comprehensive literature search using PubMed, Embase, Web of Science, CENTRAL, PsycInfo, and Ovid Medline. We identified eight randomized controlled trials (587 participants) and seven single-group trials (163 participants). RESULTS Meta-analyses revealed that ST had a moderate effect size (g = 0.359) compared to control conditions in reducing symptoms of PDs. Subgroup analysis indicated that the effect of ST on different types of PDs varied slightly, and that group ST (g = 0.859) was more effective than individual ST (g = 0.163) in treating PDs. Secondary outcome analysis revealed a moderate effect size (g = 0.256) for ST compared to control conditions in improving quality of life, and ST was found to reduce early maladaptive schema (g = 0.590). Single-group trials analysis showed that ST had a positive effect on PDs (OR = 0.241). CONCLUSION ST appears to be an effective treatment for PDs, as it reduces symptoms and improves quality of life. This review provides support for the use of ST in the treatment of PDs.
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Affiliation(s)
- Kaiyuan Zhang
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinyang Hu
- Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, Anhui, China
| | - Lijun Ma
- Research Centre for Translational Medicine, the Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
| | - Qihang Xie
- Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, Anhui, China
| | - Zhipeng Wang
- Department of Clinical Medical, First Clinical Medical College, Anhui Medical University, Hefei, Anhui, China
| | - Chuan Fan
- Department of Psychiatry, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoming Li
- Research Centre for Translational Medicine, the Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
- Department of Medical Psychology, School of Mental Health and Psychological Science, Anhui Medical University, Hefei, Anhui, China
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Tracy M, Sharpe L, Bach B, Tiliopoulos N. Connecting DSM-5 and ICD-11 trait domains with schema therapy and dialectical behavior therapy constructs. Personal Ment Health 2023; 17:208-219. [PMID: 36575608 DOI: 10.1002/pmh.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 10/23/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022]
Abstract
The DSM-5 Section III alternative model of personality disorder (AMPD) and the International Classification of Diseases - 11th Edition's (ICD-11) personality disorder classification allow clinicians to identify individual trait domains in which people score highly. However, how these domains relate to constructs associated with efficacious treatment approaches is unclear. The current study aimed to determine whether constructs from two evidence-based treatments (schema therapy [ST] and dialectical behavior therapy [DBT]) were associated with maladaptive personality traits in a way consistent with underlying theories. We examined associations between ST constructs, DBT skill use and maladaptive coping styles, and personality traits in a sample of 525 adults. Bivariate intercorrelations and a series of multiple regression analyses were conducted to investigate the associations. As hypothesized, maladaptive coping was strongly associated with all trait domains. Surprisingly, poor DBT-skill use was only associated with negative affectivity, detachment, and disinhibition trait domains. Specific schema domains were associated with each personality trait domain, supporting trait domain-schema domain specificity. The current study highlights the potential clinical utility of the AMPD and ICD-11 trait models and ultimately contributes to the dearth of evidence on their likely usefulness for treatment selection, planning, and applications.
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Affiliation(s)
- Mikaela Tracy
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Bo Bach
- Center for Personality Disorder Research (CPDR), Psychiatric Research Unit, Mental Health Services, Region Zealand, Denmark
| | - Niko Tiliopoulos
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
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Safarzadeh A, Bakhtiari M, Shaeiri MR, Kheradmand A, Saberihaji M. Effectiveness of dialectic-behavioral skills training based on Soler model alone and along with family education in reduction of borderline personality disorder symptoms with three months follow up. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2023. [DOI: 10.14412/2074-2711-2023-1-50-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- A. Safarzadeh
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences
| | - M. Bakhtiari
- Department of Clinical Psychology, Shahid Beheshti University of Medical Sciences
| | | | - A. Kheradmand
- Department of Psychiatry, Shahid Beheshti University of Medical Sciences
| | - M. Saberihaji
- Department of Social Medicine, Baqiyatallah University of Medical Sciences
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Affective Neuroscience Personality Scales and Early Maladaptive Schemas in Depressive Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138062. [PMID: 35805734 PMCID: PMC9265663 DOI: 10.3390/ijerph19138062] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023]
Abstract
Aim: The aim of this study was to assess the interrelationships of Young’s early maladaptive schemas with indicators of specific neural emotional systems conceptualized in Panksepp’s theory in a group of people suffering from depressive disorders. Materials and methods: The Affective Neuroscience Personality Scales (ANPS) v. 2.4. and J. Young’s Early Maladaptive Schema Questionnaire (YSQ-S3-PL) were used. Ninety (90) individuals aged 18–58, including 45 people treated for depression (DD group), were qualified to participate in the experiment. Results: The subjects in the DD group scored statistically significantly lower than the subjects from the control group (CG group) on the three ANPS scale domains, namely SEEKING, PLAY, and ANGER. The subjects with depressive symptoms scored significantly higher in the YSQ-S3-PL questionnaire on two domains of early maladaptive schemas, i.e., “Impaired autonomy and performance” and “Other-directedness”. Regression analysis results indicate that impairment of the emotional SEEKING system explains most of the variability in the following typical domains of depression: “Disconnection and rejection”, “Impaired autonomy and performance”, and “Other-directedness”. For score variability in the domain area of “Impaired limits”, the ANGER system was found to be most significant, and the FEAR system proved the same for “Overvigilance and Inhibition”. Conclusions: 1. Two domains of early maladaptive schemas are significant for the onset of depressive symptoms, namely “Impaired autonomy and performance” and “Other-directedness”, linked to difficulties in engaging in behaviors to meet one’s own needs. 2. Impairment of the neural emotional SEEKING system most significantly explains the variability in depression-typical areas of early maladaptive schemas.
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Chodkiewicz J, Wydrzyński M, Talarowska M. J. Young's Early Maladaptive Schemas and Symptoms of Male Depression. Life (Basel) 2022; 12:167. [PMID: 35207455 PMCID: PMC8876682 DOI: 10.3390/life12020167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Aim: There are more non-specific, hence harder to diagnose, symptoms in the picture of male depression. These symptoms are strongly linked to social norms and roles traditionally assigned to men. The aim of this study was to assess the interrelationship of early maladaptive schemas that affect the formation of self-image as a man with indicators of male depression. Materials and methods: The Gender-Sensitive Depression Screening (GSDS-26) by A.M. Möller-Leimkühler and the Early Maladaptive Schema Questionnaire by J. Young (YSQ-S3-PL) were used. A group of 75 men (aged 18 to 50) were qualified to take part in the research. Results: The total score of the GSDS-26 scale and individual indicators of male depression are strongly positively correlated with the severity of all five domains of the YSQ-S3-PL questionnaire. The highest correlation coefficient value was obtained in the following areas: "Disconnection and rejection" (0.741), "Other-directedness" (0.711), and "Overvigilance and inhibition" (0.711). In case of the GSDS-26 total score and the following indicators-Elevated stress, Aggressiveness, Emotional control, Risky behavior, and Classic symptoms of depression-positive statistically significant associations were confirmed with each of the 18 schemas from the YSQ-S3-PL questionnaire. Multiple regression results revealed that the following domains were significant for symptoms typical of male depression: "Disconnection and rejection" and "Impaired autonomy and performance". The "Impaired limits" area was found to be statistically significant only for symptoms of classic depression. Conclusions: (1) The GSDS-26 scale scores show positive associations with each domain of the YSQ-S3-PL questionnaire. (2) The following areas seem to be more important for atypical depressive symptoms in men: "Disconnection and rejection" and "Impaired autonomy and performance", while for classic depression: "Impaired limits" was more important. (3) In therapeutic work with male depressive symptoms, it is useful to focus on dominant maladaptive schemas alongside beliefs about stereotypical male roles.
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Affiliation(s)
| | | | - Monika Talarowska
- Institute of Psychology, University of Lodz, 91-433 Lodz, Poland; (J.C.); (M.W.)
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Flink N, Honkalampi K, Lehto SM, Leppänen V, Viinamäki H, Lindeman S. Comparison of early maladaptive schemas between borderline personality disorder and chronic depression. Clin Psychol Psychother 2018; 25:532-539. [PMID: 29542265 DOI: 10.1002/cpp.2188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 11/06/2022]
Abstract
Borderline personality disorder (BPD) and chronic depression (CD) are common and challenging mental disorders. Maladaptive cognitive schemas have been proposed to increase vulnerability to both disorders. In order to elucidate the role of maladaptive cognitive schemas in BPD and CD, this study compared psychiatric outpatients with BPD (N = 30) and CD (N = 30) in terms of early maladaptive schemas (EMSs). The groups were compared using the Young Schema Questionnaire short form-extended (YSQ-S2-extended) and the 15D health status questionnaire. BPD patients showed higher endorsement on the majority of EMSs, poorer social functioning, and greater concurrent distress than CD patients. However, after controlling for concurrent effects of psychological distress, the groups did not differ in 14 out of the 18 EMSs. These findings point to significant similarities in maladaptive beliefs between the 2 disorders and do not support broad, specific patterns of EMSs associated with either disorder. The results highlight the need for further study of the role of maladaptive schemas in the development and treatment of chronic mental disorders.
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Affiliation(s)
- Niko Flink
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Virpi Leppänen
- City of Oulu, Social and Health Services, Mental Health Services, Oulu, Finland
| | - Heimo Viinamäki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Sari Lindeman
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Central Finland Health Care District, Jyväskylä Central Hospital, Jyväskylä, Finland
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Leppänen V, Vuorenmaa E, Lindeman S, Tuulari J, Hakko H. Association of parasuicidal behaviour to early maladaptive schemas and schema modes in patients with BPD: The Oulu BPD study. Personal Ment Health 2016; 10:58-71. [PMID: 26333517 DOI: 10.1002/pmh.1304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The present study aimed to examine which early maladaptive schemas (EMSs) and schema modes emerged in parasuicidal and non-parasuicidal patients with BPD participating in the Oulu BPD study. The patients' EMSs were assessed using the Young Schema Questionnaire, and schema modes using the Young Atkinson Mode Inventory. Sixty patients with BPD responded to both the schema and schema mode questionnaires; of these, 46 (76.7%) fulfilled the criteria for parasuicidality. In BPD patients with parasuicidality, the EMSs of emotional deprivation, abandonment/instability, mistrust/abuse and social isolation were the most prevalent, and the schema modes of vulnerable child, angry child, detached protector and compliant surrender were prominent. In patients without parasuicidality, the schema modes of healthy adult and happy child were the most prevalent. Significant correlations were observed between the schema modes of detached protector, vulnerable child, punitive parent and angry child and almost every EMS in BPD patients with parasuicidality. Our preliminary findings suggest that associations between certain EMSs and schema modes to parasuicidality in BPD patients may provide valuable information when planning and implementing their treatment.
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Affiliation(s)
- Virpi Leppänen
- City of Oulu, Social and Health Services, Mental Health Services, PO Box 13, 90015, Oulu, Finland.,University of Oulu, Institute of Clinical Medicine, Psychiatry, PO Box 5000, 90014, Oulu, Finland
| | - Elina Vuorenmaa
- University of Oulu, Institute of Clinical Medicine, Psychiatry, PO Box 5000, 90014, Oulu, Finland
| | - Sari Lindeman
- University of Eastern Finland, Department of Clinical Medicine, PO Box 100, 70029 KYS, Kuopio, Finland.,Central Finland Health Care District, Jyväskylä Central Hospital, Matarankatu 6 B, 40100, Jyväskylä, Finland
| | - Jyrki Tuulari
- Southern Ostrobothnia Hospital District, Huhtalantie 53, 60220, Seinäjoki, Finland
| | - Helinä Hakko
- Oulu University Hospital, Department of Psychiatry, PO Box 26, 90029, Oulu, Finland
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