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Pol SM, de Jong A, Trompetter H, Bohlmeijer ET, Chakhssi F. Effectiveness of compassion-focused therapy for self-criticism in patients with personality disorders: a multiple baseline case series study. Personal Ment Health 2024; 18:69-79. [PMID: 37942561 DOI: 10.1002/pmh.1597] [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: 07/23/2023] [Revised: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Targeting self-criticism, the tendency to negatively evaluate and judge aspects of oneself, may improve treatment efficacy for personality disorders (PDs). This study aimed to test whether adding 12-week group compassion-focused therapy (CFT) that explicitly targets self-criticism to treatment as usual (TAU) would reduce self-criticism in patients with PDs. METHOD Twelve patients with PDs participated in a multiple baseline study, randomly allocated to different baseline lengths. The primary outcome was twice-weekly assessed self-critical beliefs during baseline, treatment, and follow-up phases. Secondary outcomes were self-criticism, self-compassion, and PD severity at the end of CFT and follow-up (trial registered: NL8131). Nine participants completed the intervention. No significant changes were observed during CFT, but at follow-up significant decrease in self-critical beliefs (Cohen's d = -0.43; 95% CI = -0.73 to -0.12) was reported compared to baseline. On secondary outcomes, most participants showed reliable improvement on self-reported criticism (66.7%) and self-compassion (55.6%), and a minority of patients showed reliable improvement in PD severity (33.3%). CONCLUSIONS This study seems to provide preliminary evidence for the effectiveness of 12-week CFT for self-critical beliefs in patients with PDs compared to TAU. CFT for self-criticism in PDs may complement treatment offerings and warrant further research.
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Affiliation(s)
- Silvia M Pol
- GGNet Group for Mental Health Care in East-Gelderland and Zutphen, Scelta, Zutphen, The Netherlands
| | - Audrey de Jong
- GGNet Group for Mental Health Care in East-Gelderland and Zutphen, Scelta, Zutphen, The Netherlands
| | - Hester Trompetter
- Department of Medical and Clinical Psychology, Tilburg University Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | - Ernst T Bohlmeijer
- Psychology, Health & Technology, University of Twente Faculty of Behaviourial, Management and Social sciences, Enschede, The Netherlands
| | - Farid Chakhssi
- GGNet Group for Mental Health Care in East-Gelderland and Zutphen, Scelta, Zutphen, The Netherlands
- Dimence Groep, Deventer, The Netherlands
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Liu J, Li JT, Zhou M, Liu HF, Fan YY, Mi S, Tang YL. Non-suicidal self-injury in adolescents with mood disorders and the roles of self-compassion and emotional regulation. Front Psychiatry 2023; 14:1214192. [PMID: 38179248 PMCID: PMC10764550 DOI: 10.3389/fpsyt.2023.1214192] [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: 04/29/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Objective We aimed to investigate the characteristics and psychological mechanism of non-suicidal self-injury (NSSI) in adolescents with mood disorders. We examined how self-compassion and emotional regulation affected NSSI and tested the mediating role of self-compassion in the link between emotional regulation and NSSI. Method We recruited outpatient and inpatient adolescent patients with bipolar and related disorders or depressive disorders (DSM-5), with a focus on NSSI. We also recruited healthy controls from the community. We collected demographic and clinical data. The Adolescent Self-injury Questionnaire, Self-compassion Scale (SCS), and Emotion Regulation Questionnaire (ERQ) were used to assess the frequency and severity of NSSI, level of self-compassion, and emotional regulation. Results In total, we recruited 248 adolescent patients with mood disorders (N = 196 with NSSI, and 52 without NSSI) and 212 healthy controls. NSSI was significantly associated with the female sex, lower levels of education and less use of cognitive reappraisal strategies, lower levels of self-warmth, and higher levels of self-coldness. Multivariate analysis of variance showed that there were significant differences in the scores of ERQ, cognitive reassessment score, and the scores of SCS among the three groups, but no statistical differences in expressive suppression score among the three groups. Self-warmth had a mediating effect between cognitive reappraisal and NSSI behavior. Conclusion NSSI is prevalent among adolescent patients with mood disorders in clinical settings, especially among girls and those with lower levels of education and less cognitive reappraisal strategies. More clinical attention is needed. Self-compassion and its factors may mediate the association between emotional regulation and NSSI. Clinical implications and future research directions were discussed.
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Affiliation(s)
- Jing Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Jia-ting Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Man Zhou
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Hui-feng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yang-yang Fan
- Faculty of Economics and Management, East China Normal University, Shanghai, China
| | - Si Mi
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yi-lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
- Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States
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Krause JT, Brown SM. Mindfulness Intervention Improves Coping and Perceptions of Children's Behavior among Families with Elevated Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7092. [PMID: 38063522 PMCID: PMC10706069 DOI: 10.3390/ijerph20237092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
Mindfulness-informed interventions (MIIs) are increasingly common but have not been extensively studied among families with elevated levels of risk (e.g., those involved in child protective services and/or receiving financial assistance). These families often experience high rates of stressors that can impact coping strategies, interpersonal dynamics, and relationships. Given that mindfulness has been shown to promote health and wellbeing, this study used a sample from two pilot randomized controlled trials to test the extent to which a mindfulness-informed intervention improved coping strategies and perceptions of children's behavior among 53 families with elevated risk. A principal components analysis with a direct oblimin rotation revealed that cognitive-emotion coping strategies could be characterized by three factors: positive adaptation, negative adaptation, and positive refocusing. Intention-to-treat analysis indicated significant group by time differences, with intervention participants demonstrating improvements in positive refocusing coping, positive adaptation coping, and perceptions of children's behavior problems compared to participants in the waitlist control group. No significant differences were found for negative adaptation coping strategies. Findings provide preliminary support for the benefits of mindfulness training in a sample generally underrepresented in the mindfulness intervention literature.
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Affiliation(s)
- Jill T. Krause
- Department of Human Development & Family Studies, Colorado State University, 1570 Campus Delivery, Fort Collins, CO 80523-1570, USA
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Shaker NM, Azzam LA, Zahran RM, Hashem RE. Frequency of binge eating behavior in patients with borderline personality disorder and its relation to emotional regulation and impulsivity. Eat Weight Disord 2022; 27:2497-2506. [PMID: 35301691 DOI: 10.1007/s40519-022-01358-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Eating disorders are common among patients with borderline personality disorder (BPD), contributing to their lack of treatment response and bad prognosis. In this context, it is helpful to examine the relevance of eating behavior and to understand whether borderline traits are higher in those individuals. In this study, a sample of patients with BPD screened to determine the frequency of binge eating (BE) behaviors and its relation to impulsivity and emotional dysregulation. METHOD Seventy participants aged 25.81 ± 6.34 years were recruited from Okasha Institute of psychiatry, Cairo, Egypt. Diagnosed by the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), assessed for impulsivity, emotion regulation using the Barratt Impulsiveness Scale and the Trait Meta Mood Scale (TMMS), respectively, and screened for BE behaviors by Binge Eating Scale. RESULTS All of the participants had medium emotional regulation propensity 82.63 ± 10.81 and showed variable degrees of impulsivity, mainly moderate 42 (60%). More than half of the participants had BE behavior 37 (~ 53%), with a significant negative correlation with clarity of feeling, total score of TMMS, and age. Similarly, on comparing the participant with binging versus no binging group, a significant relation between BE behavior, fear of abandonment (p value 0.02), clarity of feeling, and total score of TMMS was found. However, no significant relation between BE behavior & impulsivity demonstrated. CONCLUSION A substantial number of patients with BPD suffering from BE, showing relation between binging, emotion dysregulation, and fear of abandonment. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Nermin Mahmoud Shaker
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Lobna AbuBakr Azzam
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Randa Mohamad Zahran
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Reem Elsayed Hashem
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt.
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Nester MS, Brand BL, Schielke HJ, Kumar S. An examination of the relations between emotion dysregulation, dissociation, and self-injury among dissociative disorder patients. Eur J Psychotraumatol 2022; 13:2031592. [PMID: 35145611 PMCID: PMC8823688 DOI: 10.1080/20008198.2022.2031592] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Dissociative disorder (DD) patients report high rates of self-injury. Previous studies have found dissociation and self-injury to be related to emotional distress. To the best of our knowledge, however, the link between emotion dysregulation and self-injury has not yet been examined within a DD population. OBJECTIVE The present study investigated relations between emotion dysregulation, dissociation, and self-injury in DD patients, and explored patterns of emotion dysregulation difficulties among DD patients with and without recent histories of self-injury. METHOD We utilized linear and logistic regressions and t-test statistical methods to examine data from 235 patient-clinician dyads enrolled in the TOP DD Network Study. RESULTS Analyses revealed emotion dysregulation was associated with heightened dissociative symptoms and greater endorsement of self-injury in the past six months. Further, patients with a history of self-injury in the past six months reported more severe emotion dysregulation and dissociation than those without recent self-injury. As a group, DD patients reported the greatest difficulty engaging in goal-directed activities when distressed, followed by lack of emotional awareness and nonacceptance of emotional experiences. DD patients demonstrated similar patterns of emotion dysregulation difficulties irrespective of recent self-injury status. CONCLUSIONS Results support recommendations to strengthen emotion regulation skills as a means to decrease symptoms of dissociation and self-injury in DD patients.
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Affiliation(s)
- M Shae Nester
- Department of Psychology, Towson University, Towson, MD, USA
| | - Bethany L Brand
- Department of Psychology, Towson University, Towson, MD, USA
| | - Hugo J Schielke
- Traumatic Stress Injury & Concurrent Program, Homewood Health Centre, Guelph, Ontario, Canada
| | - Shaina Kumar
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Salgó E, Bajzát B, Unoka Z. Schema modes and their associations with emotion regulation, mindfulness, and self-compassion among patients with personality disorders. Borderline Personal Disord Emot Dysregul 2021; 8:19. [PMID: 34112254 PMCID: PMC8194201 DOI: 10.1186/s40479-021-00160-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The current study's goal was to examine the multivariate patterns of associations between schema modes and emotion regulation mechanisms in personality disorders. Schema modes are either integrated or dissociative states of mind, including intense emotional states, efforts to regulate emotions, or self-reflective evaluative thought processes. Exploring the multivariate patterns of a shared relationship between schema modes and emotion regulation strategies may lead to a better understanding of their associations and a deeper understanding of the latent personality profiles that organize their associations in a mixed personality disorder sample. METHODS Patients who have personality disorders (N = 263) filled out five different self-report questionnaires, out of which four measured adaptive and maladaptive emotion-regulation strategies (Cognitive Emotion Regulation Questionnaire, Difficulty of Emotion Regulation Scale, Five Factor Mindfulness Questionnaire, Self-Compassion Scale), and the fifth one assessed schema modes (Schema Mode Inventory). We conducted canonical correlation analysis in order to measure the multivariate patterns of associations between the 26 emotion regulation and the 14 schema mode subscales. RESULTS We found strong multivariate associations between schema modes and emotion regulation strategies. Collectively, the full model based on all canonical variate pairs was statistically significant using the Wilks's Λ = .01 criterion, F (364,2804.4) = 3.5, p < .001. The first two canonical variate pairs yielded interpretable squared canonical correlation (Rc2) effect sizes of 74.7% and 55.8%, respectively. The first canonical variate pair represents a general personality pathology variable with a stronger weight on internalization than externalization, and bipolarity in terms of adaptive vs. non-adaptive characteristics. We labeled this variate pair "Adaptive/Non-Adaptive." The second canonical variate pair, labeled "Externalizing", represents externalizing schema modes and emotion regulation strategies. CONCLUSION Using a multivariate approach (CCA), we identified two independent patterns of multivariate associations between maladaptive schema modes and emotion regulation strategies. The Adaptive/Non-Adaptive general personality pathology profile and the Externalizing personality pathology profile may lead to a deeper understanding of personality disorders and help psychotherapists in their conceptualization in order to design the most appropriate interventions.
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Affiliation(s)
- Ella Salgó
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Bettina Bajzát
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Zsolt Unoka
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
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