Pathogenic beliefs among patients with depressive disorders

The Revised Pathogenic Beliefs Scale: A Transtheoretical Measure of Maladaptive Beliefs That Are Associated with Psychological Distress

Pathogenic beliefs are maladaptive cognitive schema that may obstruct a person's ability to achieve meaningful goals in their life. This study sought to revise a previously existing measure of pathogenic beliefs (the Pathogenic Beliefs Scale) by improving the quality of items and separating the ratings of the presence of a pathogenic belief from the distress associated with it. In Study 1 (n = 272), we used item-response theory to identify 21 items from an initial pool of 44 items. In Study 2 (n = 422), we tested the items from Study 1 using confirmatory factor analysis. Study 3 used the combined samples from Study 1 and Study 2 (total n = 528) to compare the revised measure to the Experiences in Close Relationships and the Measure of Parental Style. Results indicate that the revised 21-item PBS has good reliability and convergent validity with related measures, consistent with previous studies of the longer version of the PBS. The 21-item revised PBS is included as supplemental material, and freely available to clinicians and researchers.

Maladaptive Beliefs of Young Adults in Interpersonal Relationships: A Systematic Literature Review

Beliefs that are too rigid and misadjusted may legitimize interpersonal relationships marked by verbal, physical, or sexual violence. A systematic literature review was performed to identify the existence of maladaptive beliefs (MBs) in interpersonal relationships of young adults and their association with problematic behaviors. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, studies were obtained through a search in multiple databases: EBSCOhost, PubMed, and Web of Science. Of the 1,280 articles retrieved, 42 were retained for further analysis and 15 were considered eligible for inclusion. In addition, seven studies were added through manual search, leading to a final sample of 15 articles, published between 1964 and 2021. Only empirical studies with quantitative methodologies were included. Objectives, sample (age in years), sample type, country of origin of studies, instruments, control group, and results and main conclusions were extracted from each study. Results suggest the existence of MBs that may legitimize antisocial behavior and violence, whether physical, sexual, gender, domestic, or in intimate relationships. Some intervention programs were also identified, with different approaches with a reasonable degree of efficacy in changing these beliefs or in reducing the rates of recidivism by the aggressors.

[Belief updating and mood congruence in depressive disorder]

Depressive disorder is characterized by a polymorphic symptomatology associating emotional, cognitive and behavioral disturbances. One of the most specific symptoms is negative beliefs, called congruent to mood. Despite the importance of these beliefs in the development, the maintenance, and the recurrence of depressive episodes, little is known about the processes underlying the generation of depressive beliefs. In this paper, we detail the link between belief updating mechanisms and the genesis of depressive beliefs. We show how depression alters information processing, generating cognitive immunization when processing positive information, affective updating bias related to the valence of belief and prediction error, and difficultie to disengage from negative information. We suggest that disruption of belief-updating mechanisms forms the basis of belief-mood congruence in depression.

Interpersonal and Social Functioning Among Psychotherapy Patients: The Indirect Effect of Childhood Adversity

ABSTRACT

This study examined the mediating role of pathogenic beliefs on the relationship between patients' recollections of experienced adverse parenting in childhood and adult interpersonal and social problems. A total of 210 psychotherapy outpatients rated their experiences of perceived adverse parenting in childhood and completed measures of psychological distress, interpersonal problems and social impairment, and internalized beliefs about self and others. Significant mediation effects were observed for two of the three belief domains: "cannot rely on others" and "undeserving." Although both were significant mediators between adverse parenting and symptom distress, only "cannot rely on others" was a significant mediator predicting interpersonal problems, and only "undeserving" was a significant mediator predicting impaired social functioning. Thus, patients' underlying convictions regarding their self-worth seem to play a role in the ability to develop social roles, whereas the beliefs about the steadfastness of others play an important role in the capacity for interpersonal relating.

Perceived Adverse Parenting in Childhood and Psychological Distress Among Psychotherapy Patients: The Mediating Role of Pathogenic Beliefs

ABSTRACT

The way people derive inferences from actual adverse experiences plays an important role in the development of psychopathology. This study aims to examine the mediating role of pathogenic beliefs (i.e., emotion-laden, powerful, painful convictions about self and others) on the relation between perceived adverse parenting behaviors in childhood and subsequent adult psychopathology. Participants (mostly Caucasian and heterosexual) were 204 consecutively admitted patients with a range of psychological difficulties, including depression, anxiety, and interpersonal problems, at a low-fee outpatient clinic. Participants completed standard self-report assessments of perceived parental style, depressive and anxiety symptoms, and a clinically derived measure of pathogenic beliefs. We examined the indirect effects of adverse parenting on anxiety and depressive symptom severity through pathogenic beliefs. Pathogenic beliefs reflecting the unreliability of others significantly mediated the relationship between adverse parenting and anxiety symptoms. The other mediation model is consistent with the theory that perceived adverse parenting contributes to the severity of depressive symptoms through beliefs about not being deserving and other people being unreliable. Within the limitations of the cross-sectional, retrospective, and self-report nature of the data, our results seem to suggest that attending to intermediary subjective beliefs might be important in understanding psychopathology development in the context of childhood adversity. Aiming to modify the beliefs in therapy might modify the symptoms. However, this would remain to be demonstrated through formal intervention research.

Pathogenic beliefs among patients with schizotypal personality disorder

This study aimed to explore the differences in pathogenic beliefs (PBs) between patients with schizotypal personality disorder (PD) and those with other PDs or without any PD. The study was conducted among 212 patients treated with psychotherapy at the Psychotherapy and Personality Disorder Clinic, Chiang Mai University between 2007 and 2019. Collected data included sociodemographic information, psychiatric disorders and personality disorder as determined by the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition, and the Pathogenic Belief Scale (PBS). An analysis was conducted to compare three groups, i.e., patients with schizotypal PD, patients with other PDs and patients without any PD. The PBS score was compared by two outcomes: a total score and a categorical score of individual items. The entire sample was predominantly female (62.3%) with a mean age of 31.41 years. Most participants had a bachelor's degree (76.9%), lived alone (72.6%) and received diagnoses of major depressive disorder (45.8%). No significant differences were found in participants' characteristics regarding age, sex, educational level, marital status and psychiatric clinical diagnosis among the three groups. The mean PBS total score was highest for schizotypal PD (mean = 58.74, SD = 11.54), compared with non-schizotypal PD (mean = 46.14, SD = 13.15) and non-PD (mean = 46.07, SD = 11.17). Twenty of 27 items were significantly higher in the schizotypal PD group than in other groups, after adjusting for type I error. The number of PBs was significantly prominent for schizotypal PD. Possible explanations were provided.

Assessing internalized beliefs: Development of the Pathogenic Belief Scale

The way that people internalize adverse experiences plays an important role in the development of psychopathology. The Pathogenic Belief Scale (PBS) is intended to operationalize a transtheoretical understanding of repetitive patterns of emotion-laden beliefs that develop in childhood and continue to influence people's current experience. Using a cross-sectional survey design, we recruited a large heterogeneous sample of 246 clinic outpatients and 732 adults in the community. Besides the PBS, measures of adverse parenting experiences and common psychopathology were administered. An exploratory factor analysis of the total sample of 978 participants was conducted followed by a convergent validity analysis for the 246 clinic outpatients. The three-factor solution included "cannot rely on others," "undeserving," and "interpersonal guilt," and it showed good psychometric properties, including convergent validity with the measures of adverse parenting experiences and psychopathology. The 34-item PBS offers a promising self-report measure that could help delineate and understand the pathogenic beliefs that heterogeneous samples of patients may hold. Pathogenic beliefs may be relevant to the psychotherapy process, regardless of model or theoretical context.

Resilience as a Mediator Between Interpersonal Risk Factors and Hopelessness in Depression

Several studies investigated the role of resilience as a mediating factor for psychopathological phenotypes. The aim of the current study is to explore the putative role of resilience as a mediator between different vulnerability factors and depressive symptoms. One hundred and fifty patients with a major depressive disorder diagnosis have been evaluated on the basis of humiliation (Humiliation Inventory), adverse past family experiences (Risky Family Questionnaire), hopelessness (Beck Hopelessness Scale), and resilience (Resilience Scale for Adult) scores. A multiple regression analysis and a bootstrapping method were carried out to assess the hypothesis that resilience could mediate the relationships between these risk factors as predictors and hopelessness as a dependent variable. Our results show that resilience has a mediating role in the relationship between several risk factors that are specifically involved in interpersonal functioning and hopelessness. The main limitations of the study are the cross-sectional nature of the study, the use of self-report instruments, the lack of personality assessment, and the consideration of the resilience as a unique construct. The understanding of the mechanisms through which resilience mediates the effects of different interpersonal risk factors is crucial in the study of depression. In fact, future prevention-oriented studies can also be carried out considering the mediating role of resilience between interpersonal risk factors and depressive symptoms.

A short screening tool for borderline personality disorder (Short-Bord): Validated by Rasch analysis

The study aimed to development a short screening scale for borderline personality disorder (Short-Bord), and to validate its psychometric properties using Rasch analysis. Ninety-eight outpatients undergoing psychotherapy were evaluated using a semistructured diagnostic interview for DSM-IV Personality disorders. Correlational analysis and Rasch analysis were used to identify the best-fitted items for the shorter scale. Rasch analysis identified three underfitted items. The best five items were selected for the Short-Bord using two analyses, resulting in two sets of Short-Bord which included item 1 (becoming frantic when someone left), item 2 (up- and- down relationships), item 3 (sudden change of sense of self), item 8 (self-harm or suicide), item 9 (self-mutilation), item 10 (sudden mood change) and item 11 (feeling empty inside). Each set of the five-item Short-Bord were tested against the original 15-item BPD scale. Results showed that both sets of the Short-Bord yielded minimally lower in area under curve (AUC = 0.95 and 0.96, respectively) compared with the total score of 15 items (AUC = 0.97), but none significantly differed (chi-square = 0.89-2.87, df 1, p >.05). Internal consistency for the set from Rasch analysis was slightly higher than correlation methods (Cronbach's alpha = 0.80, and 0.78, respectively). The Short-Bord presents promising tool to screen for borderline personality disorder. Its diagnostic validity was comparable to the total 15 items despite completing in a shorter time. The Short-Bord derived from Rasch analysis was, however, preferable as all items were shown to have unidimensional construct with good fit statistics and good internal consistency.