Early maladaptive schemas, behavioral inhibition/approach systems, and defense styles in the users of natural and synthetic substances and healthy subjects

Early maladaptive schemas and addictive behaviours: A systematic review and meta-analysis

BACKGROUND

Recently, early maladaptive schemas have been increasingly focused as the underlying factor of several psychopathologies. The primary objective is to systematically review and meta-analytically analyse the evidence on the relationship between early maladaptive schemas and types of addictive behaviours. Additionally, the secondary objective was to examine potential moderators of the effect sizes.

METHODS

The systematic search was conducted on three databases including 'Scopus', 'Web of Science' and 'PubMed'. They were searched for quantitative studies investigating the relationship between early maladaptive schemas and addictive behaviours. The studies that were non-English and had insufficient information to calculate effect sizes were excluded. The random-effect model was utilized to estimate the pool effect sizes, and the meta-regression was used for moderation analysis.

RESULTS

Thirty-three studies with 12,577 participants were included for analyses. Most of included studies were conducted in the United States (k = 12, 36.36%). The mean ages of participants varied from 13.32 to 46.09 years. The findings indicated that all of early maladaptive schemas and schema domains positively correlated with addictive behaviours. The disconnection and rejection, impaired limits and impaired autonomy were the domains with the highest association with substance addictions (pool r = 0.338, 3.26 and 3.16, respectively). Furthermore, disconnection and rejection and impaired autonomy were the schema domains with the highest association with behavioural addictions (0.310 and 0.304, respectively). The moderation analysis demonstrated that study design was the factor affecting the effect sizes between schema domain and addictive behaviours.

LIMITATION

All included studies were from peer-reviewed journals in English. Moreover, the number of research examining the relationship between early maladaptive schemas and behavioural addictions was limited.

CONCLUSION

The findings provide evidence supporting the idea that substance addictions and behavioural addictions have shared risk factors, supporting the validity of the schema model, which can be applied for targeting and preventing addictive behaviours.

The effect of maladaptive schemas and psychological flexibility approaches on the addiction severity of drug addicts

PURPOSE

This study tested a model of the effect of maladaptive schemas on addiction severity and the mediating role of psychological flexibility between the two.

METHODS

The descriptive and methodological study was conducted with 661 opioid users. Data were collected using the questionnaire, including sociodemographic Characteristics, Addiction Profile Index, Young Schema Questionnaire 3 Short Form, Freiburg Mindfulness Inventory, Acceptance and Action Questionnaire-II and Cognitive Fusion Questionnaire. Data were analyzed using descriptive and correlational analysis and structural equation model.

RESULTS

The mean age was 27.43 ± 7.04 years. Of participants, 52.3% had a secondary school degree, 76.7% had no children, 90.8% were men, 69.3% single, 71.9% unemployed, and 71.4% lived with their parents. Relationship between schemas and addiction severity was 0.36 (p < 0.05), which was reduced to 0.10 by psychological flexibility (p < 0.05). Psychological flexibility affects addiction severity directly, but maladaptive schemas affect addiction severity through psychological flexibility.

CONCLUSIONS

Maladaptive schemas and psychological flexibility are constructs that need to be addressed in substance use treatment.

Early maladaptive schemas and suicidal risk in inpatients with bipolar disorder

The present study aimed to assess the associations of early maladaptive schemas (EMSs) and clinical factors (hypomanic/manic and depressive symptoms) with suicidal risk (current suicidal ideation and lifetime suicide attempts) in inpatients with bipolar disorder (BD). One hundred inpatients with BD completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Bipolar Depression Rating Scale (BDRS), the Young Mania Rating Scale (YMRS), and the Beck Scale for Suicide Ideation (BSSI). 59% of patients had lifetime suicide attempts and 59% showed high suicidal risk (BSSI ≥ 6). BD patients with lifetime suicide attempts had higher scores on the entitlement and social isolation schemas, depression, and hypomanic/manic symptoms than those without such attempts. Patients with high suicidal risk had higher levels of depressive and hypomanic/manic symptoms as well as some EMSs than those without high suicidal risk. Logistic regression analyses revealed that hypomanic/manic symptoms as well as the entitlement and defectiveness schemas were significantly associated with current suicidal ideation. Also, the entitlement and social isolation schemas were associated with lifetime suicide attempts. These results suggest that the entitlement, social isolation, and defectiveness schemas may relate to suicidal risk in patients with BD.

Exploration of Associations Between Early Maladaptive Schemas, Impaired Emotional Regulation, Coping Strategies and Resilience in Opioid Dependent Poly-Drug Users

BACKGROUND

Early Maladaptive Schema (EMS) are self-beliefs regarding oneself, others and the world, developed in childhood as the result of cumulative negative experiences (Young, 1993). High levels of EMS are present in the opioid using population along with high levels of emotional dysregulation and maladaptive coping alongside traits of resilience.

OBJECTIVES

The study explored the associations between EMS in relation to emotional dysregulation, maladaptive coping, adaptive coping and resilience between a clinical group composed of opioid dependent polydrug users attending a facility for opioid substitution treatment (n = 52) and a healthy comparison group (n = 70).

METHODS

A cross-sectional design was used to compare group differences using MANOVAs, and multiple regression analysis identified associations between EMS and emotional dysregulation, coping and resilience.

RESULTS

The groups significantly differed in relation to emotional dysregulation, maladaptive coping, adaptive coping and resilience. Specific EMS were significant independent predictors in regards to high emotional dysregulation, maladaptive coping, adaptive coping and resilience.

CONCLUSION

EMS appear to have a significant impact on emotional dysregulation, coping and resilience. Clinical implications suggest that EMS should be addressed when treating opioid dependent polydrug users.

Early maladaptive schemas and suicidal risk in an Iranian sample of patients with obsessive-compulsive disorder

There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide.