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McGuire N, Gumley A, Hasson-Ohayon I, Allan S, Aunjitsakul W, Aydin O, Bo S, Bonfils KA, Bröcker AL, de Jong S, Dimaggio G, Inchausti F, Jansen JE, Lecomte T, Luther L, MacBeth A, Montag C, Pedersen MB, Pijnenborg GHM, Popolo R, Schwannauer M, Trauelsen AM, van Donkersgoed R, Wu W, Wang K, Lysaker PH, McLeod H. Investigating the relationship between negative symptoms and metacognitive functioning in psychosis: An individual participant data meta-analysis. Psychol Psychother 2023; 96:918-933. [PMID: 37530433 DOI: 10.1111/papt.12484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/24/2023] [Accepted: 07/10/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Negative symptoms are a persistent, yet under-explored problem in psychosis. Disturbances in metacognition are a potential causal factor in negative symptom development and maintenance. This meta-analysis uses individual participant data (IPD) from existing research to assess the relationship between negative symptoms and metacognition treated as summed scores and domains. METHODS Data sets containing individuals with negative symptoms and metacognition data, aged 16+ with psychosis, were identified according to pre-specific parameters. IPD integrity and completeness were checked and data were synthesized in two-stage meta-analyses of each negative symptoms cluster compared with metacognition in seemingly unrelated regression using restricted maximum likelihood estimation. Planned and exploratory sensitivity analyses were also conducted. RESULTS Thirty-three eligible data sets were identified with 21 with sufficient similarity and availability to be included in meta-analyses, corresponding to 1301 participants. The strongest relationships observed were between summed scores of negative symptoms and metacognition. Metacognitive domains of self-reflectivity and understanding others' minds, and expressive negative symptoms emerged as significant in some meta-analyses. The uncertainty of several effect estimates increased significantly when controlling for covariates. CONCLUSIONS This robust meta-analysis highlights the impact of using summed versus domain-specific scores of metacognition and negative symptoms, and relationships are not as clear-cut as once believed. Findings support arguments for further differentiation of negative symptom profiles and continued granular exploration of the relationship between metacognition and negative symptoms.
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Affiliation(s)
| | | | | | | | | | - Orkun Aydin
- International University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Steven de Jong
- Lentis Psychiatric Institute, Groningen, The Netherlands
| | | | - Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | | | | | | | | | | | - Marlene Buch Pedersen
- Early Psychosis Intervention Centre, Psychiatry East, Region Zealand, Roskilde, Denmark
| | | | | | | | - Anne-Marie Trauelsen
- Assessment and Brief Treatment Team (Newham), East London Foundation Trust, London, UK
| | | | | | - Kai Wang
- Anhui Medical University, Hefei, China
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2
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Marconi E, Monti L, Fredda G, Kotzalidis GD, Janiri D, Zani V, Vitaletti D, Simone MV, Piciollo S, Moriconi F, Di Pietro E, Popolo R, Dimaggio G, Veredice C, Sani G, Chieffo DPR. Outpatient care for adolescents' and young adults' mental health: promoting self- and others' understanding through a metacognitive interpersonal therapy-informed psychological intervention. Front Psychiatry 2023; 14:1221158. [PMID: 38025443 PMCID: PMC10651761 DOI: 10.3389/fpsyt.2023.1221158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Psychological distress may result in impairment and difficulty understanding oneself and others. Thus, addressing metacognitive issues in psychotherapy may improve psychopathology in adolescents and young adults (AYAs). We aimed to compare metacognitive interpersonal therapy (MIT)-informed psychotherapy with other treatment-as-usual (TAU) therapies. Methods We administered the Global Assessment of Functioning (GAF) scale, the Clinical Global Impressions-Severity (CGI-S) scale, and the Brief Psychiatric Rating Scale (BPRS) at baseline (BL) and at treatment termination (the endpoint was at 6 months and any last results obtained before that term were carried forward in analyzes). Patients received concomitant psychiatric and psychological treatment. Results Sixty AYAs were involved in the study. There was a significant reduction in symptomatology after the intervention. Twelve patients (17%) dropped out; treatment adherence was 83%. In the MIT group, 2 patients dropped out (11%), and in the TAU group, 9 patients dropped out (19%). All scales showed a significant reduction in symptoms between baseline (BL) and the 6-month endpoint: GAF (χ2 = 6.61, p < 0.001), BPRS (χ2 = 6.77, p < 0.001), and CGI (χ2 = 7.20, p < 0.001). There was a greater efficacy for the MIT group in terms of symptom reduction on the BPRS (t = 2.31; p < 0.05). Conclusion The study confirmed the efficacy of early and integrated care in adolescence and suggested greater symptom reduction for a psychotherapeutic intervention focused on stimulating mentalization skills. The study indicates the usefulness of this type of approach in the treatment of adolescent psychopathology. Due to the small sample size, the results need replication.
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Affiliation(s)
- Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Fredda
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Georgios D. Kotzalidis
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), University of Rome “La Sapienza”, Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Zani
- Catholic University of the Sacred Heart–Rome, Rome, Italy
| | | | | | | | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy
- Department of Mental Health, Rome, Italy
| | | | - Chiara Veredice
- Pediatric Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart–Rome, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Life Sciences and Public Health Department, Catholic University of Sacred Heart, Rome, Italy
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3
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McGuire N, Gumley A, Hasson-Ohayon I, Allan S, Aunjitsakul W, Aydin O, Bo S, Bonfils KA, Bröcker AL, de Jong S, Dimaggio G, Inchausti F, Jansen JE, Lecomte T, Luther L, MacBeth A, Montag C, Pedersen MB, Pijnenborg GHM, Popolo R, Schwannauer M, Trauelsen AM, van Donkersgoed R, Wu W, Wang K, Lysaker PH, McLeod H. Investigating the relationship between specific negative symptoms and metacognitive functioning in psychosis: A systematic review. Psychol Psychother 2023. [PMID: 37864383 DOI: 10.1111/papt.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/20/2023] [Accepted: 09/25/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Disrupted metacognition is implicated in development and maintenance of negative symptoms, but more fine-grained analyses would inform precise treatment targeting for individual negative symptoms. AIMS This systematic review identifies and examines datasets that test whether specific metacognitive capacities distinctly influence negative symptoms. MATERIALS & METHODS PsycINFO, EMBASE, Medline and Cochrane Library databases plus hand searching of relevant articles, journals and grey literature identified quantitative research investigating negative symptoms and metacognition in adults aged 16+ with psychosis. Authors of included articles were contacted to identify unique datasets and missing information. Data were extracted for a risk of bias assessment using the Quality in Prognostic Studies tool. RESULTS 85 published reports met criteria and are estimated to reflect 32 distinct datasets and 1623 unique participants. The data indicated uncertainty about the relationship between summed scores of negative symptoms and domains of metacognition, with significant findings indicating correlation coefficients from 0.88 to -0.23. Only eight studies investigated the relationship between metacognition and individual negative symptoms, with mixed findings. Studies were mostly moderate-to-low risk of bias. DISCUSSION The relationship between negative symptoms and metacognition is rarely the focus of studies reviewed here, and negative symptom scores are often summed. This approach may obscure relationships between metacognitive domains and individual negative symptoms which may be important for understanding how negative symptoms are developed and maintained. CONLCLUSION Methodological challenges around overlapping participants, variation in aggregation of negative symptom items and types of analyses used, make a strong case for use of Individual Participant Data Meta-Analysis to further elucidate these relationships.
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Affiliation(s)
| | | | | | | | | | - Orkun Aydin
- International University of Sarajevo, Sarajevo, Bosnia and Herzegovinia
| | - Sune Bo
- Psychiatric Research Unit, Region Zealand, Slagelse, Denmark
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | | | - Steven de Jong
- Lentis Psychiatric Institute, Groningen, The Netherlands
| | | | - Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | - Jens Einar Jansen
- Mental Health Center Copenhagen, Capital Region, Copenhagen, Denmark
| | | | | | | | | | - Marlene Buch Pedersen
- Early Psychosis Intervention Centre, Psychiatry East, Region Zealand, Roskilde, Denmark
| | | | | | | | | | | | - Weiming Wu
- Anhui Medical University, Hefei City, China
| | - Kai Wang
- Anhui Medical University, Hefei City, China
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4
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Fioravanti G, Nicolis M, MacBeth A, Dimaggio G, Popolo R. Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial. Res Psychother 2023; 26:690. [PMID: 37667887 PMCID: PMC10519278 DOI: 10.4081/ripppo.2023.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
Eating disorders (ED) are serious disorders characterized by an alteration of eating habits and excessive concern about weight and body shapes (Fairburn, 2002), accompanied by significant impairment inequality of life, high mortality rates and serious organic consequences (Jenkins et al., 2011; Treasure et al., 2015; 2020). Although evidence-based psychological therapies for nonunderweight ED presentations such as cognitive behavioral therapy for eating disorders (CBT-ED) are widely available, there is substantial scope for improvements, particularly in terms of efficacy and adherence. One option is to develop interventions to address elements of pathology not fully addressed by existing empirical supported treatments, such as incorporating techniques aimed at addressing interpersonal problems and personality disorder features into existing treatment delivery. We adapted Metacognitive Interpersonal Therapy, a psychological intervention supported by evidence for treating personality disorders and integrated it with existing CBT techniques for eating disorders (MIT-ED). MIT-ED targets aspects of ED that are not included in the transdiagnostic CBT-E model such as poor metacognition, or maladaptive interpersonal schemas. This is a pre-registered (Protocol number: 0000781) pilot randomized clinical trial aimed at assessing acceptability and feasibility of MIT-ED and establishing preliminary evidence of effectiveness for future larger studies. Twenty patients (10 in each arm) will be randomized to 20 sessions of individual psychotherapy, either MIT-ED or CBTE. Repeated follow-ups will be collected up to 24 months. Participants are recruited at a private outpatient clinic for ED treatment. Acceptability will be assessed via session attendance, completion rates and preliminary outcomes. The primary outcome is ED pathology assessed with the Eating Disorder Examination Questionnaire-6. Other ED outcomes assessed will be eating disorder attitudes, clinical impairment and binge eating pathology. Secondary treatment outcomes are anxiety, depression, and global symptomatology. We will also assess emotional awareness, emotion regulation and therapeutic alliance. Based on previous studies of MIT for personality disorders we hypothesize that MIT-ED will be acceptable to patients, evidenced by high treatment adherence and retention. We hypothesize that MIT-ED will be associated with reductions in eating disorder pathology, at least equivalent to CBT-E. Results will be used to inform the study design, sampling, likely effect sizes and choice of outcome measures for future larger trials of MIT-ED in ED samples.
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Affiliation(s)
- Gloria Fioravanti
- Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Martina Nicolis
- 1Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Edinburgh.
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Centonze A, Popolo R, MacBeth A, Dimaggio G. Experiential techniques and therapeutic relationship in the treatment of narcissistic personality disorder: The case of Laura. J Clin Psychol 2023. [DOI: 10.1002/jclp.23514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
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Inchausti F, Velázquez-Basterra G, Fonseca-Pedrero E, MacBeth A, Popolo R, Dimaggio G. Metacognitive interpersonal group therapy for adolescents with avoidant personality disorder: The case of Sofia. J Clin Psychol 2022; 78:1579-1589. [PMID: 35355266 DOI: 10.1002/jclp.23356] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/25/2022] [Accepted: 03/16/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Early intervention studies for adolescents and early adults are required to explore the acceptability and effectiveness of psychological therapies across the full range of personality disorders (PDs) beyond just borderline PD. The main aim of the current paper was to describe a Metacognitive Interpersonal Therapy group adaptation for adolescents (MIT-GA) presenting with PDs featuring overcontrol and social inhibition, and in particular Avoidant PD characteristics. METHODS We report findings from a single case of a female adolescent diagnosed with Avoidant PD providing preliminary data on feasibility and the possible effectiveness of MIT-GA. RESULTS Evidence of acceptability and meaningful clinical gains are described. CONCLUSIONS Results suggest that MIT-GA could be a powerful treatment option in patients with generalized social avoidance who do not currently receive gold-standard psychotherapeutic treatments. This intervention also appears to be effective and cost-effective in initiating significant clinical changes in profiles of young patients with non-borderline PD symptoms.
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Affiliation(s)
- Felix Inchausti
- Department of Mental Health, Servicio Riojano de Salud, Logroño, Spain
| | | | | | - Angus MacBeth
- Centre for Applied Developmental Psychology, Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland
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7
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Simonsen S, Popolo R, Juul S, Frandsen FW, Sørensen P, Dimaggio G. Treating Avoidant Personality Disorder With Combined Individual Metacognitive Interpersonal Therapy and Group Mentalization-Based Treatment: A Pilot Study. J Nerv Ment Dis 2022; 210:163-171. [PMID: 34710894 DOI: 10.1097/nmd.0000000000001432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Avoidant personality disorder (AvPD) is a severe but understudied condition. The current pilot project reports data on acceptability and outcomes of a novel treatment combining biweekly individual metacognitive interpersonal therapy (MIT) and weekly mentalization-based therapy (MBT) group therapy. A total of 30 patients with AvPD were consecutively included in the program. The primary outcome was AvPD-specific personality functioning measured by self-report after treatment. Secondary outcomes were symptom distress, interpersonal problems, quality of life, and psychosocial functioning. Twenty-two patients completed treatment, with a mean duration of 13 months. On the primary outcome, effect sizes were generally moderate to large (effect size range: 0.59-1.10). On secondary outcomes, effect sizes were large (effect size range: 0.77-2.3). Both in terms of acceptability and outcomes, results are promising for the combination of MIT and MBT for AvPD. The approach is a strong candidate for further investigation in future large-scale randomized controlled trial.
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Affiliation(s)
- Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | | | - Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
| | | | - Per Sørensen
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Gentofte, Denmark
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8
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Popolo R, MacBeth A, Lazzerini L, Brunello S, Venturelli G, Rebecchi D, Morales MF, Dimaggio G. Metacognitive interpersonal therapy in group versus TAU + waiting list for young adults with personality disorders: Randomized clinical trial. Personal Disord 2021; 13:619-628. [PMID: 34383540 DOI: 10.1037/per0000497] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Young adults presenting with personality disorders (PDs) featuring overcontrol and social inhibition urgently require effective psychological interventions to help them navigate important life transitions. metacognitive interpersonal therapy-group (MIT-G) is a time-limited group program designed to enable individuals to find adaptive solutions to their social difficulties. A small randomized clinical trial (RCT) of MIT-G versus treatment as usual (TAU) was conducted with the primary outcomes of improvements in social and interpersonal functioning and global psychological symptoms. Secondary outcomes were specific symptoms of anxiety and depression and changes in alexithymia and emotion dysregulation. From 40 participants, 20 were randomized to 16 weekly sessions of MIT-G, plus 3 individual sessions and 20 to TAU + waiting list. All 20 patients allocated to MIT-G completed treatments, while 2 dropped-out in the TAU arm. Patients in the MIT-G arm reported significant improvements on primary outcomes of functioning, interpersonal problems and global symptoms of medium magnitude, medium effect sizes for changes in depression and anxiety, and large magnitude changes for alexithymia. However, other than alexithymia no significant differences were observed between groups at treatment end. A Time × Condition interaction, indicated that MIT-G was associated with more rapid and larger magnitude improvements in functioning and alexithymia. MIT-G is a well-tolerated treatment option for young adults with overcontrolled PD. Further effectiveness studies in larger samples are underway. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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9
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Cheli S, Cavalletti V, Popolo R, Dimaggio G. A case study on a severe paranoid personality disorder client treated with metacognitive interpersonal therapy. J Clin Psychol 2021; 77:1807-1820. [PMID: 34263957 DOI: 10.1002/jclp.23201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
Paranoid personality disorder (PPD) is a severe condition, lacking specialized and empirically supported treatment. To provide the clinician with insights into how to treat this condition, we present a case study of a 61-year-old man with severe PPD who presented with ideas of persecution, emotionally charged hostility, and comorbid antisocial personality disorder. The client was treated with 6 months of Metacognitive Interpersonal Therapy, which included: creating a shared formulation of his paranoid attitudes; trying to change his inner self-image of self-as-inadequate and his interpersonal schemas where he saw the others as threatening. Guided imagery and rescripting techniques, coupled with behavioral experiments, were used to promote a change. At the end of the therapy the client reported a reliable change in general symptomatology and, specifically, in interpersonal sensitivity, hostility, and paranoid ideation; he could no longer be diagnosed as PPD and only some paranoid and antisocial characteristics remained.
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Affiliation(s)
- Simone Cheli
- Center for Psychology and Health, Tages Charity, Florence, Italy.,School of Human Health Sciences, University of Florence, Florence, Italy
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10
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Centonze A, Popolo R, MacBeth A, Dimaggio G. Building the alliance and using experiential techniques in the early phases of psychotherapy for avoidant personality disorder. J Clin Psychol 2021; 77:1219-1232. [DOI: 10.1002/jclp.23143] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, Center for Applied Developmental Psychology University of Edimburgh Edimburgh Scotland UK
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11
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Salvatore G, Bianchi L, Buonocore L, Disturco N, Macbeth A, Manfredi N, Ottavi P, Popolo R, Proto MG, Dimaggio G. Metacognitive Interpersonal Therapy for Borderline Personality Disorder: A Single Case Study. Clin Case Stud 2020. [DOI: 10.1177/1534650120960234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Borderline personality disorder (BPD) is a severe disease, characterized by severe instabilities in identity, affect and relationships. Clinical improvement of BPD can be facilitated by psychotherapy aimed at tackling multiple specific cross-modality impairments and their patterns of interaction: impaired sense of self, maladaptive interpersonal schemas, impaired metacognition, emotion dysregulation and impulsivity. Herein, we describe the steps in the treatment of a young woman meeting the criteria for with BPD with paranoid traits, successfully treated with Metacognitive Interpersonal Therapy, a treatment based on comprehensive assessment of domains. In the initial phase, treatment focused on promoting emotion regulation, integrating opposing patient representations of the therapist, enhancing metacognition, and increasing focus on the maladaptive schema that elicited dysregulated behaviors. Later in therapy, treatment focused on supporting the patient to realize her ideas about self and others were schema-driven; and improving metacognitive capacity to understand others’ minds. General implications for psychotherapy of BPD are discussed.
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Affiliation(s)
- Giampaolo Salvatore
- Centre for Metacognitive Interpersonal Therapy, Rome, Italy
- Studio Maya – Centre for Metacognitive Interpersonal Therapy of Salerno, Italy
| | - Lorena Bianchi
- Centre for Metacognitive Interpersonal Therapy, Rome, Italy
| | - Luisa Buonocore
- Centre for Metacognitive Interpersonal Therapy, Rome, Italy
- Studio Maya – Centre for Metacognitive Interpersonal Therapy of Salerno, Italy
| | - Nadia Disturco
- Centre for Metacognitive Interpersonal Therapy, Rome, Italy
- Studio Maya – Centre for Metacognitive Interpersonal Therapy of Salerno, Italy
| | - Angus Macbeth
- Centre for Applied Developmental Psychology, Clinical and Health Psychology, School of Health in Social Science, The University of Edinburgh, UK
| | - Nicoletta Manfredi
- Studio Maya – Centre for Metacognitive Interpersonal Therapy of Salerno, Italy
| | - Paolo Ottavi
- Centre for Metacognitive Interpersonal Therapy, Rome, Italy
| | | | - Maria Grazia Proto
- Studio Maya – Centre for Metacognitive Interpersonal Therapy of Salerno, Italy
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12
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Cheli S, MacBeth A, Popolo R, Dimaggio G. The intertwined path of perfectionism and self‐criticism in a client with obsessive‐compulsive personality disorder. J Clin Psychol 2020; 76:2055-2066. [DOI: 10.1002/jclp.23051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Simone Cheli
- Center for Psychology and Health Tages Charity Florence Italy
- School of Education Science Guglielmo Marconi University Rome Italy
| | - Angus MacBeth
- Clinical and Health Psychology University of Edinburgh Edinburgh Scotland
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13
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Salvatore G, Ottavi P, Popolo R, Dimaggio G. An inter-subjective multi-factorial model of auditory verbal hallucinations in schizophrenia. New Ideas in Psychology 2020. [DOI: 10.1016/j.newideapsych.2020.100783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Popolo R, MacBeth A, Canfora F, Rebecchi D, Toselli C, Salvatore G, Dimaggio G. Metacognitive Interpersonal Therapy in group (MIT-G) for young adults with personality disorders: A pilot randomized controlled trial. Psychol Psychother 2019; 92:342-358. [PMID: 29624832 DOI: 10.1111/papt.12182] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/09/2018] [Indexed: 11/29/2022]
Abstract
Young adults with personality disorders (PD) other than borderline are in urgent need of validated treatments to help them in managing important life transitions. Therapeutic interventions focused upon social and interpersonal difficulties may facilitate these individuals in maximizing opportunities for employment, forming stable romantic relationships, and belong to social groups. It is also important that they are offered evidence-based, first-line time-limited treatments in order to maximize effectiveness and reduce costs. We developed a 16-session programme of group-based Metacognitive Interpersonal Therapy (MIT-G) including psychoeducation on the main interpersonal motives, an experiential component enabling practice of awareness of mental states; and use of mentalistic knowledge for purposeful problem-solving. We report a feasibility, acceptability, and clinical significance randomized clinical trial. Participants meeting inclusion criteria were randomized to receive MIT-G (n = 10) or waiting list+TAU (n = 10). Dropout rate was low and session attendance high (92.19%). Participants in the MIT-G arm had symptomatic and functional improvements consistent with large effect sizes. In the MIT-G arm similarly large effects were noted for increased capacity to understand mental states and regulate social interactions using mentalistic knowledge. Results were sustained at follow-up. Our findings suggest potential for applying MIT-G in larger samples to further test its effectiveness in reducing PD-related symptoms and problematic social functioning.
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Affiliation(s)
- Raffaele Popolo
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy.,Studi Cognitivi Modena, Italy
| | | | | | - Daniela Rebecchi
- Studi Cognitivi Modena, Italy.,Unity for clinical psychology AUSL Modena, Italy
| | | | - Giampaolo Salvatore
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy.,Psychotherapy School Humanitas, Rome, Italy
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Popolo R, MacBeth A, Brunello S, Canfora F, Ozdemir E, Rebecchi D, Toselli C, Venturelli G, Salvatore G, Dimaggio G. Metacognitive interpersonal therapy in group: a feasibility study. Res Psychother 2018; 21:338. [PMID: 32913773 PMCID: PMC7451332 DOI: 10.4081/ripppo.2018.338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
Abstract
Patients with personality disorders (PDs) other than borderline, with prominent features of social inhibition and over-regulation of emotions, are in need of specialized treatments. Individuals present with poor metacognition, that is the capacity to understand mental states and use psychological knowledge for the sake of purposeful problem solving; and are guided by maladaptive interpersonal schemas. We developed a short-term group intervention, Metacognitive Interpersonal Therapy in Groups (MIT-G), incorporating psychoeducational and experiential elements, to help these individuals become more aware of their drives when interacting with others; and to help them adopt more flexible behaviors via improvements in metacognition. We present results of an effectiveness study, evaluating whether we could replicate the initial positive results of our first pilot randomized controlled trial. Seventeen young adults outpatients with personality disorders were included in the 16 session program. Effect sizes were calculated for change from baseline to treatment end for the primary outcome, symptoms and functioning (Clinical Outcomes in Routine Evaluation Outcome Measure) and then for one putative mechanism of change - metacognition. Emotional dysregulation and alexithymia were also assessed. Qualitative evaluations of the acceptability and subjective impact of the treatment were also performed. MIT-G was acceptable to participants. There were medium to large magnitude changes from pre- to post- treatment on wellbeing, emotion dysregulation, alexithymia and metacognition. These gains were maintained at follow-up. There was evidence of clinically significant change on key variables. MITG appears acceptable to patients, as evidenced by the absence of drop-out from treatment. In light of the positive outcomes of this study and the expanding evidence base, MIT-G is a candidate for dissemination and investigations in larger trials as a possible effective intervention for PDs characterized by tendencies to overcontrol.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Giampaolo Salvatore
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
- Scuola di Specializzazione “Humanitas”, Rome, Italy
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Salvatore G, Buonocore L, Ottavi P, Popolo R, Dimaggio G. Metacognitive Interpersonal Therapy for Treating Persecutory Delusions in Schizophrenia. Am J Psychother 2018; 71:164-174. [DOI: 10.1176/appi.psychotherapy.20180039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giampaolo Salvatore
- Center for Metacognitive Interpersonal Therapy, Rome (Salvatore, Buonocore, Ottavi, Popolo, Dimaggio); Humanitas, School of Psychotherapy, Rome (Salvatore, Popolo); Istituto A. T. Beck, School of Cognitive Behavioral Therapy, Rome (Ottavi, Dimaggio)
| | - Luisa Buonocore
- Center for Metacognitive Interpersonal Therapy, Rome (Salvatore, Buonocore, Ottavi, Popolo, Dimaggio); Humanitas, School of Psychotherapy, Rome (Salvatore, Popolo); Istituto A. T. Beck, School of Cognitive Behavioral Therapy, Rome (Ottavi, Dimaggio)
| | - Paolo Ottavi
- Center for Metacognitive Interpersonal Therapy, Rome (Salvatore, Buonocore, Ottavi, Popolo, Dimaggio); Humanitas, School of Psychotherapy, Rome (Salvatore, Popolo); Istituto A. T. Beck, School of Cognitive Behavioral Therapy, Rome (Ottavi, Dimaggio)
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome (Salvatore, Buonocore, Ottavi, Popolo, Dimaggio); Humanitas, School of Psychotherapy, Rome (Salvatore, Popolo); Istituto A. T. Beck, School of Cognitive Behavioral Therapy, Rome (Ottavi, Dimaggio)
| | - Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy, Rome (Salvatore, Buonocore, Ottavi, Popolo, Dimaggio); Humanitas, School of Psychotherapy, Rome (Salvatore, Popolo); Istituto A. T. Beck, School of Cognitive Behavioral Therapy, Rome (Ottavi, Dimaggio)
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Garofalo C, Velotti P, Callea A, Popolo R, Salvatore G, Cavallo F, Dimaggio G. Emotion dysregulation, impulsivity and personality disorder traits: A community sample study. Psychiatry Res 2018; 266:186-192. [PMID: 29870955 DOI: 10.1016/j.psychres.2018.05.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/26/2018] [Accepted: 05/26/2018] [Indexed: 11/18/2022]
Abstract
The present study was designed to test an emotion regulation framework to understand individual differences in personality disorder (PD) traits in a non-clinical sample. Specifically, we tested whether: selected dimensions of emotion dysregulation were differentially related to PD traits; and whether emotion dysregulation and impulsivity had independent associations with PD traits. A community sample of 399 individuals (mean age = 37.91; 56.6% males) completed self-report measures of PDs, emotion dysregulation and impulsivity. Emotion dysregulation facets and impulsivity had uniform bivariate associations with PD traits, but also evidenced unique associations in multiple regression analyses. Nonacceptance of emotional responses was the emotion dysregulation dimension underlying a wide array of PD. A limited repertoire of effective emotion regulation strategies was characteristic of cluster C PD, whereas emotional unawareness distinctly predicted schizoid PD. Antisocial PD traits were uniquely related to difficulties controlling impulsive behavior when upset. Finally, histrionic, narcissistic, and obsessive-compulsive PD were related to better self-reported emotion regulation. Impulsivity further explained a significant amount of variance in schizotypal, antisocial, borderline (positively), and obsessive-compulsive PD traits (negatively). If replicated in clinical samples, our findings will support the usefulness of targeting both emotional dysregulation and impulsivity in PDs psychotherapy.
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Affiliation(s)
- Carlo Garofalo
- Department of Developmental Psychology, Tilburg University, Warandelaan 2, Tilburg 5037AB, The Netherlands.
| | - Patrizia Velotti
- Department of Educational Sciences, University of Genoa, Genoa, Italy
| | | | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy; Studi Cognitivi, Modena, Italy
| | | | - Francesca Cavallo
- Spinal Unit San Raffaele Sulmona Institute, Il Negozio di Psicologia Pescara, Pescara, Italy
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Dimaggio G, Popolo R, Montano A, Velotti P, Perrini F, Buonocore L, Garofalo C, D'Aguanno M, Salvatore G. Emotion dysregulation, symptoms, and interpersonal problems as independent predictors of a broad range of personality disorders in an outpatient sample. Psychol Psychother 2017; 90:586-599. [PMID: 28585718 DOI: 10.1111/papt.12126] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/20/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED Emotion dysregulation (ED) is considered a hallmark of borderline personality disorder and is prominent in other personality disorders (PDs). Its presence and contribution to personality pathology need to be explored in the whole range of PDs. In this study, we investigated the association of ED with the whole range of PD traits, symptoms, and interpersonal problems and then investigated whether ED had a unique contribution in predicting the different PDs. A sample of 478 treatment-seeking outpatients was interviewed with the SCID-II. The patients were then tested for symptoms (SCL-90-R), interpersonal problems (IIP-32), and ED (DERS). RESULTS ED correlated with the large majority of PDs and with symptoms and interpersonal problems. Regression showed how ED explained a unique part of the variance for many PDs. ED appears to be a relevant feature of pathology in many PDs; with replication, it can be considered a treatment target in this population. PRACTITIONER POINTS Emotion dysregulation is present in many personality disorders. Emotion dysregulation is not just explained by heightened symptoms and interpersonal problems in personality disorders. Emotion dysregulation could be considered a treatment target in personality disorders other than borderline.
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Affiliation(s)
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome, Italy.,Studi Cognitivi, Milan, Italy
| | | | | | | | | | - Carlo Garofalo
- Department of Developmental Psychology, Tilburg University, The Netherlands
| | - Mario D'Aguanno
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Italy
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Popolo R, Smith E, Lysaker PH, Lestingi K, Cavallo F, Melchiorre L, Santone C, Dimaggio G. Metacognitive profiles in schizophrenia and bipolar disorder: Comparisons with healthy controls and correlations with negative symptoms. Psychiatry Res 2017; 257:45-50. [PMID: 28719831 DOI: 10.1016/j.psychres.2017.07.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/05/2017] [Accepted: 07/10/2017] [Indexed: 02/06/2023]
Abstract
While deficits in metacognition, or the ability to notice and reflect upon mental states has been observed in schizophrenia and linked with poorer concurrent and future function, it is unknown whether these deficits are unique to schizophrenia. Accordingly, this study assessed metacognition using the Metacognitive Assessment Scale-Abbreviated (MAS-A) and the Metacognitions Questionnaire- 30 (MCQ-30) among 26 adults with schizophrenia, 23 with bipolar disorder and 23 healthy controls. Symptom levels of the psychiatric groups were assessed with the Brief Psychiatric Rating Scale. ANCOVA controlling for age and education revealed that the schizophrenia group had lower scores on the MAS-A total and its subscales compared to the bipolar group and healthy controls. The bipolar disorder group also had lower MAS-A scores than the healthy control group. No group differences were found for the MCQ-30. Examination of symptom correlates revealed MAS-A scores were most commonly related to negative symptoms in both clinical groups. The total score and need for control subscale of MCQ-30 was related to total symptomatology and positive symptoms in patients with bipolar disorder. Correlations between the two measures of metacognition revealed that higher MAS-A scores were significantly related to lower scores on the Need to Control Thoughts MCQ-30 subscale.
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Affiliation(s)
- Raffaele Popolo
- Center for Metacognitive Psychotherapy, Rome, Italy; Studi Cognitivi, Modena, Italy
| | - Elizabeth Smith
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Paul H Lysaker
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
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Phalen PL, Dimaggio G, Popolo R, Lysaker PH. Aspects of Theory of Mind that attenuate the relationship between persecutory delusions and social functioning in schizophrenia spectrum disorders. J Behav Ther Exp Psychiatry 2017; 56:65-70. [PMID: 27432819 DOI: 10.1016/j.jbtep.2016.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the apparent relevance of persecutory delusions to social relationships, evidence linking these beliefs to social functioning has been inconsistent. In this study, we examined the hypothesis that theory of mind moderates the relationship between persecutory delusions and social functioning. METHODS 88 adults with schizophrenia or schizoaffective disorder were assessed concurrently for social functioning, severity of persecutory delusions, and two components of theory of mind: mental state decoding and mental state reasoning. Mental state decoding was assessed using the Eyes Test, mental state reasoning using the Hinting Task, and social functioning assessed with the Social Functioning Scale. Moderation effects were evaluated using linear models and the Johnson-Neyman procedure. RESULTS Mental state reasoning was found to moderate the relationship between persecutory delusions and social functioning, controlling for overall psychopathology. For participants with reasoning scores in the bottom 78th percentile, persecutory delusions showed a significant negative relationship with social functioning. However, for those participants with mental state reasoning scores in the top 22nd percentile, more severe persecutory delusions were not significantly associated with worse social functioning. Mental state decoding was not a statistically significant moderator. LIMITATIONS Generalizability is limited as participants were generally men in later phases of illness. CONCLUSIONS Mental state reasoning abilities may buffer the impact of persecutory delusions on social functioning, possibly by helping individuals avoid applying global beliefs of persecution to specific individuals or by allowing for the correction of paranoid inferences.
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Affiliation(s)
| | | | | | - Paul H Lysaker
- Roudebush VA Medical Center, USA; Indiana University School of Medicine, USA
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Dimaggio G, Conti C, Lysaker PH, Popolo R, Salvatore G, Sofia SA. Reauthoring One's Own Life in the Face of Being HIV+: Promoting Healthier Narratives with Metacognitive Interpersonal Therapy. Journal of Constructivist Psychology 2016. [DOI: 10.1080/10720537.2016.1238788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Caterina Conti
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
| | - Paul H. Lysaker
- Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA, and Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Sonia A. Sofia
- Division of Infectious Disease, University of Catania, Italy
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Salvatore G, Popolo R, Buonocore L, Ferrigno AM, Proto M, Sateriale A, Serio M, Dimaggio G. Metacognitive Interpersonal Therapy for Personality Disorders Swinging from Emotional Over-Regulation to Dysregulation: A Case Study. Am J Psychother 2016; 70:365-381. [DOI: 10.1176/appi.psychotherapy.2016.70.4.365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Rome and Salerno, Italy
| | - Luisa Buonocore
- Center for Metacognitive Interpersonal Therapy, Rome and Salerno, Italy
| | | | - Mariagrazia Proto
- Center for Metacognitive Interpersonal Therapy, Rome and Salerno, Italy
| | - Anna Sateriale
- Center for Metacognitive Interpersonal Therapy, Rome and Salerno, Italy
| | - Marianna Serio
- Center for Metacognitive Interpersonal Therapy, Rome and Salerno, Italy
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Velotti P, Garofalo C, Petrocchi C, Cavallo F, Popolo R, Dimaggio G. Alexithymia, emotion dysregulation, impulsivity and aggression: A multiple mediation model. Psychiatry Res 2016; 237:296-303. [PMID: 26803364 DOI: 10.1016/j.psychres.2016.01.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 11/19/2022]
Abstract
There is a need to better understand the antecedent of aggressive behaviors in order to tailor treatments and reduce the associated damage to the others and the self. Possible mechanisms underlying aggression are poor emotional awareness and emotion dysregulation, as well as impulsivity. Here, we examined the relationships among alexithymia, emotion dysregulation, impulsivity and aggression, comparing a mixed psychiatric sample (N=257) and a community sample (N=617). The clinical sample reported greater levels of alexithymia, emotion dysregulation, trait impulsivity and aggression, than the community sample. Furthermore, in the community sample, emotion dysregulation and impulsivity mediated the relationship (i.e., accounted for the shared variance) between alexithymia and aggression. In the clinical sample, only emotion dysregulation explained the alexithymia-aggression link. In particular, specific dimensions of the emotion dysregulation (i.e., Negative Urgency) and impulsivity constructs (i.e., cognitive and motor impulsivity) played a unique role in explaining these associations. Finally, controlling for depressive symptoms reduced some of the findings involving impulsivity to nonsignificant results. Overall, our findings add to the extant literature attesting to the relevance of alexithymia and emotion dysregulation for understanding aggression, and providing concrete recommendation for the treatment and prevention of aggressive tendencies.
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Affiliation(s)
- Patrizia Velotti
- Department of Educational Sciences, University of Genoa, Corso Andrea Podestà 2, 16128 Genoa, Italy.
| | - Carlo Garofalo
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy; Department of Developmental Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands.
| | - Chiara Petrocchi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Rome, Italy.
| | - Francesca Cavallo
- Il Negozio di Psicologia Pescara, Spinal Unit San Raffaele Sulmona Institute, Corso Umberto I 25, 65122 Pescara, Italy.
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Piazza dei Martiri di Belfiore 4, 00195 Rome, Italy; Studi Cognitivi, Via Pietro Giardini, 472, 41100 Modena, Italy.
| | - Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy, Piazza dei Martiri di Belfiore 4, 00195 Rome, Italy.
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Outcalt J, Dimaggio G, Popolo R, Buck K, Chaudoin-Patzoldt KA, Kukla M, Olesek KL, Lysaker PH. Metacognition moderates the relationship of disturbances in attachment with severity of borderline personality disorder among persons in treatment of substance use disorders. Compr Psychiatry 2016; 64:22-8. [PMID: 26541558 DOI: 10.1016/j.comppsych.2015.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/07/2015] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES Borderline personality disorder traits have been observed to be linked with both insecure attachment styles as well as deficits in mentalizing and metacognition. Less is known, however, about how attachment style does or does not interact with deficits in mentalizing and metacognition to create, sustain, or influence levels of borderline personality disorder traits. In this study, we examined the hypothesis that metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems, moderates the relationship of anxious attachment style with the severity of borderline personality disorder traits. METHODS Concurrent assessments were gathered of metacognitive mastery using the Metacognitive Assessment Scale Abbreviated, anxious attachment style using the Experiences of in Close Relationships Scale, and borderline personality disorder traits using the Structured Clinical Interview for DSM-IV Axis II Disorders. Participants were 59 adults in an early phase of recovery from substance use disorders in a residential setting. RESULTS Multiple regression revealed that metacognitive mastery moderated the relationship of anxious attachment style with the number of borderline personality disorder traits. A median split of the anxious attachment and metacognitive mastery scores was performed yielding 4 groups. An analysis of covariance revealed that participants with higher levels of anxious attachment and poorer metacognitive mastery had more borderline personality disorder traits did than the other groups after controlling for levels of psychopathology. CONCLUSION Insecure attachment may be associated with higher number of borderline personality disorder traits in the presence of deficits in metacognitive mastery. Patients with substance use and borderline personality disorder traits may benefit from treatment which addresses metacognitive mastery.
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Affiliation(s)
| | | | | | - Kelly Buck
- Roudebush VA Medical Center, Indianapolis, IN
| | | | - Marina Kukla
- HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN; Department of Psychology, Indiana University Purdue University, Indianapolis, IN
| | | | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN; Indiana University School of Medicine, Indianapolis, IN.
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Velotti P, Garofalo C, D'Aguanno M, Petrocchi C, Popolo R, Salvatore G, Dimaggio G. Mindfulness moderates the relationship between aggression and Antisocial Personality Disorder traits: Preliminary investigation with an offender sample. Compr Psychiatry 2016; 64:38-45. [PMID: 26350275 DOI: 10.1016/j.comppsych.2015.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/09/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Poor mentalizing has been described as a characteristic of Antisocial Personality Disorder (ASPD), along with the well-established role of aggressiveness. In the current study, we tested this hypothesis focusing on a specific aspect of mentalization (i.e., mindfulness). METHOD We explored the unique and joint contribution of aggression dimensions and mindfulness facets to ASPD traits in an offender sample (N=83). RESULTS Mindfulness deficits were associated with ASPD traits, and a significant unique association emerged between difficulties in acting with awareness and ASPD traits. Likewise, physical aggression confirmed its association with ASPD traits. Moderation analyses revealed that mindfulness interacted with aggression in predicting ASPD. Specifically, at low levels of mindfulness, the association between aggression and ASPD dropped to nonsignificance. CONCLUSIONS Results suggest that fostering self-mentalizing is a relevant treatment target when treating offenders with ASPD.
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Affiliation(s)
- Patrizia Velotti
- University of Genoa, Department of Educational Sciences, Corso Andrea Podestà, 2, 16126, Genoa, Italy.
| | - Carlo Garofalo
- Sapienza University of Rome, Department of Dynamic and Clinical Psychology, Via degli Apuli, 1, 00185, Rome, Italy; Tilburg University, Department of Developmental Psychology, Warandelaan 2, 5037 AB Tilburg, The Netherlands.
| | - Mario D'Aguanno
- Sapienza University of Rome, Department of Dynamic and Clinical Psychology, Via degli Apuli, 1, 00185, Rome, Italy.
| | - Chiara Petrocchi
- Sapienza University of Rome, Department of Dynamic and Clinical Psychology, Via degli Apuli, 1, 00185, Rome, Italy.
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, Piazza dei Martiri di Belfiore, 4, 00195, Rome, Italy.
| | - Giampaolo Salvatore
- Center for Metacognitive Interpersonal Therapy, Piazza dei Martiri di Belfiore, 4, 00195, Rome, Italy.
| | - Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy, Piazza dei Martiri di Belfiore, 4, 00195, Rome, Italy.
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Lysaker PH, Kukla M, Dubreucq J, Gumley A, McLeod H, Vohs JL, Buck KD, Minor KS, Luther L, Leonhardt BL, Belanger EA, Popolo R, Dimaggio G. Metacognitive deficits predict future levels of negative symptoms in schizophrenia controlling for neurocognition, affect recognition, and self-expectation of goal attainment. Schizophr Res 2015; 168:267-72. [PMID: 26164820 DOI: 10.1016/j.schres.2015.06.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 01/19/2023]
Abstract
The recalcitrance of negative symptoms in the face of pharmacologic treatment has spurred interest in understanding the psychological factors that contribute to their formation and persistence. Accordingly, this study investigated whether deficits in metacognition, or the ability to form integrated ideas about oneself, others, and the world, prospectively predicted levels of negative symptoms independent of deficits in neurocognition, affect recognition and defeatist beliefs. Participants were 53 adults with a schizophrenia spectrum disorder. Prior to entry into a rehabilitation program, all participants completed concurrent assessments of metacognition with the Metacognitive Assessment Scale-Abbreviated, negative symptoms with the Positive and Negative Syndrome Scale, neurocognition with the MATRICS battery, affect recognition with the Bell Lysaker Emotion Recognition Task, and one form of defeatist beliefs with the Recovery Assessment Scale. Negative symptoms were then reassessed one week, 9weeks, and 17weeks after entry into the program. A mixed effects regression model revealed that after controlling for baseline negative symptoms, a general index of neurocognition, defeatist beliefs and capacity for affect recognition, lower levels of metacognition predicted higher levels of negative symptoms across all subsequent time points. Poorer metacognition was able to predict later levels of elevated negative symptoms even after controlling for initial levels of negative symptoms. Results may suggest that metacognitive deficits are a risk factor for elevated levels of negative symptoms in the future. Clinical implications are also discussed.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Marina Kukla
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA; Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Julien Dubreucq
- Center of Reference for Psychosocial Rehabilitation, CH Alpes Isère, Grenoble, France; Réseau Handicap Psychique (RéHPsy), Grenoble, France.
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hamish McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jenifer L Vohs
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA; Prevention and Recovery Center for Early Psychosis, Midtown Community Mental Health Centers, Wishard Hospital, Indianapolis, IN, USA; Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA.
| | - Kelly D Buck
- Roudebush VA Medical Center, (116a) 1481 W. 10th St., Indianapolis, IN 46219, USA.
| | - Kyle S Minor
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Lauren Luther
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford, LD 124, Indianapolis, IN 46202, USA.
| | - Bethany L Leonhardt
- Indiana University School of Medicine, 340 West 10th Street, Suite 6200, Indianapolis, IN, USA.
| | - Elizabeth A Belanger
- School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Avenue, GH 109, Indianapolis, IN 46227, USA.
| | - Raffaele Popolo
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
| | - Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy, via Ravenna 9/c, 00161, Rome, Italy.
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Popolo R, Lysaker PH, Salvatore G, Montano A, Buonocore L, Sirri L, Imbimbo A, Dimaggio G. Emotional inhibition in personality disorders. Psychother Psychosom 2015; 83:377-8. [PMID: 25323635 DOI: 10.1159/000365110] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/04/2014] [Indexed: 11/19/2022]
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Dimaggio G, Salvatore G, Lysaker PH, Ottavi P, Popolo R. Behavioral activation revisited as a key principle of change in personality disorders psychotherapy. Journal of Psychotherapy Integration 2015. [DOI: 10.1037/a0038769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dimaggio G, D'Urzo M, Pasinetti M, Salvatore G, Lysaker PH, Catania D, Popolo R. Metacognitive Interpersonal Therapy for Co-Occurrent Avoidant Personality Disorder and Substance Abuse. J Clin Psychol 2014; 71:157-66. [DOI: 10.1002/jclp.22151] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | | | | | - Paul H. Lysaker
- Richard L. Roudebush VA Medical Center
- Indiana University School of Medicine
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Hillis JD, Leonhardt BL, Vohs JL, Buck KD, Salvatore G, Popolo R, Dimaggio G, Lysaker PH. Metacognitive reflective and insight therapy for people in early phase of a schizophrenia spectrum disorder. J Clin Psychol 2014; 71:125-35. [PMID: 25557425 DOI: 10.1002/jclp.22148] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties of engaging in goal-directed activities in social and vocational settings. Within this backdrop, we provide a case report of the effects of Metacognitive Reflective Insight Therapy (MERIT) that assisted a patient suffering from first episode schizophrenia during 2 years of individual psychotherapy. A total of 8 elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this report, these procedures helped the patient move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and the identity of others. He then could use these representations to understand and effectively respond to life challenges.
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Lysaker PH, Olesek K, Buck K, Leonhardt BL, Vohs J, Ringer J, Dimaggio G, Popolo R, Outcalt J. Metacognitive mastery moderates the relationship of alexithymia with cluster C personality disorder traits in adults with substance use disorders. Addict Behav 2014; 39:558-61. [PMID: 24300836 DOI: 10.1016/j.addbeh.2013.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/16/2013] [Accepted: 11/04/2013] [Indexed: 11/19/2022]
Abstract
Cluster C personality disorder traits have been observed in substance use disorders and linked with poorer outcome. One potential factor which may cause these disturbances in personality function is alexithymia, or the inability to name and express emotion. There may be other proximate factors which moderate the impact of alexithymia on the expression of cluster C traits, such as metacognitive mastery, which is the ability to use knowledge about mental states of self and others to cope with distress and solve social problems. To examine the possibility that mastery mediated the effects of alexithymia on cluster C traits, we assessed each of these constructs using the Metacognitive Assessment Scale Abbreviated, Toronto Alexithymia Scale and SCID II among 58 adults in an early phase of recovery from substance misuse disorders in a residential setting. Results of a multiple regression revealed that, after controlling for symptom severity and severity of substance misuse history, metacognitive mastery moderated the effect of alexithymia on number of cluster C traits. A median split and subsequent ANCOVA revealed that participants with higher levels of alexithymia and poorer metacognitive mastery had more cluster C traits than the other groups. These findings may have clinical implications, suggesting that patients with substance use disorders may benefit from treatment which addresses metacognitive mastery.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Kyle Olesek
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Kelly Buck
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA
| | - Bethany L Leonhardt
- School of Psychological Science, University of Indianapolis, Indianapolis, IN, USA
| | - Jenifer Vohs
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jamie Ringer
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | | | - Jared Outcalt
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Indianapolis, IN 46202, USA; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Lysaker PH, Buck KD, Salvatore G, Popolo R, Dimaggio G. Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Rev Neurother 2014; 9:1035-43. [DOI: 10.1586/ern.09.55] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Lysaker PH, Vohs J, Hillis JD, Kukla M, Popolo R, Salvatore G, Dimaggio G. Poor insight into schizophrenia: contributing factors, consequences and emerging treatment approaches. Expert Rev Neurother 2013; 13:785-93. [PMID: 23898850 DOI: 10.1586/14737175.2013.811150] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Poor insight or unawareness of illness has been commonly observed in schizophrenia and has been long recognized as a potent barrier to treatment adherence and a risk factor for a range of poorer outcomes. Paradoxically, the achievement of insight often poses a different set of problems including depression and low self-esteem. One barrier to the treatment of poor insight has been a lack of understanding of the phenomenon, which causes poor insight to develop and persist over time. Without knowing what promotes poor insight, treatment to date has had little to offer beyond the supportive provision of information. To explore these issues, this article reviews emerging literature on the correlates of poor insight in schizophrenia, and newly developing ways of conceptualizing insight. It then details a number of innovative integrative group and individual treatment approaches in the early stages of development, which take into account some of the potential causal forces behind poor insight, including deficits in neurocognition, social cognition, metacognition and heightened self-stigma. A plan for further research is presented to develop a model of the factors whose interaction influences insight, and to refine and test integrative treatments.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Ottavi P, D'Alia D, Lysaker P, Kent J, Popolo R, Salvatore G, Dimaggio G. Metacognition-oriented social skills training for individuals with long-term schizophrenia: methodology and clinical illustration. Clin Psychol Psychother 2013; 21:465-73. [PMID: 23754780 DOI: 10.1002/cpp.1850] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE There is much evidence indicating the presence of social deficits in schizophrenia and the detrimental effect of these deficits on global functioning in this population. As a result, social skills training (SST) has emerged as a legitimate psychosocial treatment, although effectiveness research has revealed small effect sizes and limited generalizability regarding the benefits of this treatment. METHODS In light of the strong evidence of metacognitive deficits in schizophrenia and the importance of metacognition to successful social functioning, we propose a novel therapeutic intervention wherein metacognitive remediation is integrated into SST: metacognition-oriented social skills training (MOSST). In the current paper, we present MOSST, an adapted SST programme wherein clients are also encouraged to have mindful contact with their own thoughts and to better consider and understand the mental states of others as well as the connection between mental states and behaviour. RESULTS We present a case wherein an individual with schizophrenia successfully completed the MOSST programme. CONCLUSION We outline directions for future research, starting with the logical next step of empirically testing the efficacy of MOSST. KEY PRACTITIONER MESSAGE Currently social skills training is considered to be the elected psychosocial treatment for people affected by schizophrenia, although evidence indicates limited benefits. People with schizophrenia have metacognitive deficits, which interfere with proper social functioning. A metacognitive-oriented social skills training (MOSST) intervention has been developed by the authors.A treatment such as MOSST, which integrates social skills training and metacognitive training, promises to improve social skills through improving the metacognition.
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Affiliation(s)
- Paolo Ottavi
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
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Dimaggio G, Carcione A, Nicolò G, Lysaker PH, d'Angerio S, Conti ML, Fiore D, Pedone R, Procacci M, Popolo R, Semerari A. Differences between axes depend on where you set the bar: associations among symptoms, interpersonal relationship and alexithymia with number of personality disorder criteria. J Pers Disord 2013; 27:371-82. [PMID: 23130814 DOI: 10.1521/pedi_2012_26_043] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorders are better understood as entities that vary according to severity along specific domains rather than a phenomenon separate from and unrelated to Axis I disorders. This study explores whether patients who were rated as having greater numbers of personality disorder traits reported greater levels of interpersonal problems, psychiatric symptoms, and alexithymia. The sample was composed of 506 consecutive patients assessed in a private outpatient center who were administered the SCID-II Symptom-Checklist (SCL-90-R), Inventory of Interpersonal Problems (IIP-47), and Toronto Alexithymia-Scale (TAS-.20). Based upon the number of personality disorder traits identified in the SCID, participants were classified into five groups: 0-4, 5-9, 10-14, 15-19, and 20 or more personality disorder traits met. Comparisons between groups revealed that symptom severity and levels of interpersonal problems increased between groups as the number of personality disorder traits increased. After covarying for symptom severity, there were no significant between-groups differences for levels of alexithymia. Findings are consistent with the claims that the simple Axis I-Axis II distinction is not an optimal strategy to understand personality pathology. It instead may be more fruitful to consider group differences in terms of numbers of personality disorder traits met.
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Lysaker PH, Gumley A, Luedtke B, Buck KD, Ringer JM, Olesek K, Kukla M, Leonhardt BL, Popolo R, Dimaggio G. Social cognition and metacognition in schizophrenia: evidence of their independence and linkage with outcomes. Acta Psychiatr Scand 2013; 127:239-47. [PMID: 22967227 DOI: 10.1111/acps.12012] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Research suggests that many with schizophrenia experience deficits in the ability to make discrete judgments about the thoughts and feelings of others as well as to form larger integrated representations of themselves and others. Little is known about whether these difficulties may be distinguished from one another and whether they are linked with different outcomes. METHOD We administered three assessments of social cognition which tapped the ability to identify emotions and intentions and two metacognitive tasks which called for the formation of more integrated and flexible representations of the self and others. We additionally assessed symptoms, social functioning and neurocognition. Participants were 95 individuals with a schizophrenia spectrum disorder. RESULTS A principle components analysis followed by a varimax rotation revealed two factors which accounted for 62% of the variance. The first factor was comprised of the three social cognition tests and the second of two tasks that tapped the ability to create representations of oneself and others which integrate more discreet information. The first factor was uniquely correlated with negative symptoms, and the second was uniquely correlated with social function. CONCLUSION Results suggest that deficits in social cognition and metacognition represent different forms of dysfunction in schizophrenia.
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Affiliation(s)
- P H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Dimaggio G, Popolo R, Salvatore G, Lysaker PH. Mentalizing in schizophrenia is more than just solving theory of mind tasks. Front Psychol 2013; 4:83. [PMID: 23450982 PMCID: PMC3582989 DOI: 10.3389/fpsyg.2013.00083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/06/2013] [Indexed: 11/21/2022] Open
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Lysaker PH, Vohs JL, Ballard R, Fogley R, Salvatore G, Popolo R, Dimaggio G. Metacognition, self-reflection and recovery in schizophrenia. Future Neurology 2013. [DOI: 10.2217/fnl.12.78] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Dimaggio G, Salvatore G, Popolo R, Lysaker PH. Autobiographical memory and mentalizing impairment in personality disorders and schizophrenia: clinical and research implications. Front Psychol 2012. [PMID: 23189069 PMCID: PMC3505873 DOI: 10.3389/fpsyg.2012.00529] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Giancarlo Dimaggio
- Center for Metacognitive Interpersonal Therapy Rome, Italy ; School for Cognitive Therapy "Istituto A.T. Beck," Rome, Italy
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Salvatore G, Russo B, Russo M, Popolo R, Dimaggio G. Metacognition-oriented therapy for psychosis: The case of a woman with delusional disorder and paranoid personality disorder. Journal of Psychotherapy Integration 2012. [DOI: 10.1037/a0029577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Salvatore G, Lysaker PH, Gumley A, Popolo R, Mari J, Dimaggio G. Out of Illness Experience: Metacognition-Oriented Therapy for Promoting Self-Awareness in Individuals with Psychosis. Am J Psychother 2012; 66:85-106. [DOI: 10.1176/appi.psychotherapy.2012.66.1.85] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Paul H. Lysaker
- Roudebush VA Medical Center and the Indiana University School of Medicine, Indianapolis, Indiana
| | - Andrew Gumley
- University of Glasgow and the North Glasgow First Episode Psychosis Service, Glasgow, Scotland
| | | | - Jessica Mari
- Third Center of Cognitive Psichotherapy—Associazione di Psicologia Cognitiva (APC), Rome, Italy
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Nicolò G, Semerari A, Lysaker PH, Dimaggio G, Conti L, D'Angerio S, Procacci M, Popolo R, Carcione A. Alexithymia in personality disorders: correlations with symptoms and interpersonal functioning. Psychiatry Res 2011; 190:37-42. [PMID: 20800288 DOI: 10.1016/j.psychres.2010.07.046] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 05/31/2010] [Accepted: 07/29/2010] [Indexed: 11/15/2022]
Abstract
Impairment in the ability to recognize and make sense of emotions has been hypothesized to be present in a sub-sample of people suffering from personality disorder (PD). In particular it is possible that difficulty recognizing and expressing feelings, or alexithymia, is related to many of the symptoms and problems in making sense of social interactions which are hallmarks of PD. In this study we measured levels of alexithymia with the Toronto Alexithymia Scale-20 and explored its correlations with the overall presence of PD and different PD diagnoses, symptoms, and interpersonal difficulties. Results were largely consistent with the hypothesis. Higher levels of alexithymia were related to high levels of global psychopathology and with dysfunctional representation of interpersonal relations. A sub-sample of patients, mostly suffering from avoidant, dependent, passive-aggressive and depressive PD, had alexithymic features and, in particular reported difficulties describing their feelings to others. A patient with cluster B PD featured no alexithymia. Implications of this study for future research and treatment are discussed.
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Affiliation(s)
- Giuseppe Nicolò
- SPC Training School of Cognitive Therapy, Terzocentro Psicoterapia Cognitiva, Rome, Italy.
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Carcione A, Nicolò G, Pedone R, Popolo R, Conti L, Fiore D, Procacci M, Semerari A, Dimaggio G. Metacognitive mastery dysfunctions in personality disorder psychotherapy. Psychiatry Res 2011; 190:60-71. [PMID: 21329989 DOI: 10.1016/j.psychres.2010.12.032] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 11/27/2010] [Accepted: 12/29/2010] [Indexed: 11/28/2022]
Abstract
Individuals with personality disorders (PDs) have difficulties in modulating mental states and in coping with interpersonal problems according to a mentalistic formulation of the problem. In this article we analyzed the first 16 psychotherapy sessions of 14 PD patients in order to explore whether their abilities to master distress and interpersonal problems were actually impaired and how they changed during the early therapy phase. We used the Mastery Section of the Metacognition Assessment Scale, which assesses the use of mentalistic knowledge to solve problems and promote adaptation. We explored the hypotheses that a) PD patients had problems in using their mentalistic knowledge to master distress and solve social problems; b) the impairments were partially stable and only a minimal improvement could be observed during the analyzed period; c) patients' mastery preferences differed from one another; d) at the beginning of treatment the more effective strategies were those involving minimal knowledge about mental states. Results seemed to support the hypotheses; the patients examined had significant difficulties in mastery abilities, and these difficulties persisted after 16 sessions. Moreover, the attitudes towards problem-solving were not homogenous across the patients. Lastly, we discuss implications for assessment and treatment of metacognitive disorders in psychotherapy.
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Affiliation(s)
- Antonino Carcione
- Terzo Centro di Psicoterapia Cognitiva - Scuola di Psicoterapia Cognitiva (SPC)/Training School in Cognitive Psychotherapy, Rome, Italy.
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Lysaker PH, Erickson MA, Buck B, Buck KD, Olesek K, Grant MLA, Salvatore G, Popolo R, Dimaggio G. Metacognition and social function in schizophrenia: associations over a period of five months. Cogn Neuropsychiatry 2011; 16:241-55. [PMID: 21154067 DOI: 10.1080/13546805.2010.530470] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Deficits in the ability to think about thinking have been widely observed in persons with schizophrenia and linked with concurrent assessments of various forms of function. Less is known though about their links to outcome over time. To address this issue, the current study explores whether Mastery, a domain of metacognition that reflects the ability to use knowledge about one's own mental states and those of others to respond to psychological challenges, is related to the frequency of social contact and persons' capacity for social relatedness. METHODS Participants were 72 adults with schizophrenia spectrum disorders enrolled in vocational rehabilitation; these patients completed a baseline assessment as well as a follow-up assessment 5 months later. Mastery was assessed using the Metacognitive Assessment Scale and social functioning by the Quality of Life Scale. RESULTS Using structural equation modelling, the proposed model demonstrated acceptable fit even when a range of possible confounding variables were entered as covariates. CONCLUSIONS . Results are consistent with the possibility that certain forms of metacognition affect social function among persons with schizophrenia, both concurrently and over time.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA
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Salvatore G, Lysaker PH, Popolo R, Procacci M, Carcione A, Dimaggio G. Vulnerable Self, Poor Understanding of Others' Minds, Threat Anticipation and Cognitive Biases as Triggers for Delusional Experience in Schizophrenia: A Theoretical Model. Clin Psychol Psychother 2011; 19:247-59. [DOI: 10.1002/cpp.746] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giampaolo Salvatore
- Third Center of Cognitive Psychotherapy-Associazione di Psicologia Cognitiva (APC); Rome; Italy
| | | | - Raffaele Popolo
- Third Center of Cognitive Psychotherapy-Associazione di Psicologia Cognitiva (APC); Rome; Italy
| | - Michele Procacci
- Third Center of Cognitive Psychotherapy-Associazione di Psicologia Cognitiva (APC); Rome; Italy
| | - Antonino Carcione
- Third Center of Cognitive Psychotherapy-Associazione di Psicologia Cognitiva (APC); Rome; Italy
| | - Giancarlo Dimaggio
- Third Center of Cognitive Psychotherapy-Associazione di Psicologia Cognitiva (APC); Rome; Italy
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Abstract
Abstract Objective. The majority of patients with schizophrenia have cognitive deficits early in the disease. We evaluated the relationship between cognitive function, social functioning and quality of life in patients with first-episode psychosis. Methods. This was a longitudinal study in 15 patients aged 18-30 years who had recently experienced a first psychotic episode and were treated with the atypical antipsychotic aripiprazole, cognitive-behavioural therapy, psycho-educational sessions, family supportive sessions and social interventions. Patients were evaluated at baseline and after 1 year. Cognitive assessment included attention, memory, language skills and problem solving. Social functioning, quality of life, and psychopathological evaluation were performed with validated tools. Results. At baseline, patients had a severe impairment of social functioning and a low quality of life, while a specific pattern of cognitive functions was not identified. After 1-year, we observed a significant improvement in social functioning and quality of life, without a significant decrease in cognitive function. Conclusion. Contrary to previous findings, we found that social functioning and quality of life are related, but independent of cognitive impairment. The use of antipsychotic agents that do not interefere with cognitive function plus psychological assistance is a valuable treatment approach in patients with first-episode schizophrenia.
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Affiliation(s)
- Raffaele Popolo
- Terzo Centro di Psicoterapia Cognitiva, Associazione di Psicologia Cognitiva (APC), Rome, Italy
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Dimaggio G, Carcione A, Nicolò G, Conti L, Fiore D, Pedone R, Popolo R, Procacci M, Semerari A. Impaired decentration in personality disorder: a series of single cases analysed with the Metacognition Assessment Scale. Clin Psychol Psychother 2010; 16:450-62. [PMID: 19475698 DOI: 10.1002/cpp.619] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is growing support for the idea that an impaired understanding of others' mental states is an underlying feature of personality disorder (PD). Only recently has there begun to be evidence of impairments to subjects' ability to infer and reason about others' intentions and emotions, and detach from their own perspective when doing so. METHOD We analysed the transcripts from the first 16 psychotherapy sessions of 14 PD patients. Scales for understanding others' minds from the Metacognition Assessment Scale were used. RESULTS Patients were generally able to describe others' mental states, although, at times, they had problems. There was, on the other hand, an inability to decentre while reasoning about others, and this was common to all the patients. CONCLUSIONS PDs indeed feature a poor decentration, which is not easily identified with the usual lab tasks. Implications for further research and treatment are discussed. KEY PRACTITIONER MESSAGE *Patients with personality disorders have substantial difficulties in adopting others' point of view and standing back from their own, and grasping that they are not the center of other peoples' thoughts.
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Salvatore G, Procacci M, Popolo R, Nicolò G, Carcione A, Semerari A, Dimaggio G. Adapted Metacognitive Interpersonal Therapy for Improving Adherence to Intersubjective Contexts in a Person With Schizophrenia. Clin Case Stud 2009. [DOI: 10.1177/1534650109354916] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deficits in the ability to make sense of mental states both of oneself and others, which we term metacognition, is a key difficulty in persons with schizophrenia and psychotherapy needs to address this deficit in order to be effective. We describe here the steps in the treatment of a young woman meeting the criteria for paranoid schizophrenia. Treatment was aimed at helping her to progressively improve her ability to comprehend mental states in order to reduce the intensity of her delusional beliefs and social withdrawal. She was treated with an adapted version of Metacognitive Interpersonal Therapy, the aims of which were to (a) encourage the reconstruction of autobiographical episodes in order to place symptoms in the context of life episodes; (b) stimulate an understanding of the link between problematic feelings and onset of symptoms; (c) build up psychological links between feelings, inability to understand others’ intentions and delusional reasoning; and (d) prevent social withdrawal. Implications for considering poor metacognition a key target of psychotherapy of schizophrenia are discussed.
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Affiliation(s)
- Giampaolo Salvatore
- Third Center of Cognitive Psychotherapy—Associazione
di Psicologia Cognitiva (APC), Rome, Italy
| | - Michele Procacci
- Third Center of Cognitive Psychotherapy-Associazione
di Psicologia Cognitiva (APC), Rome, Italy
| | - Raffaele Popolo
- Third Center of Cognitive Psychotherapy-Associazione
di Psicologia Cognitiva (APC), Rome, Italy
| | - Giuseppe Nicolò
- Third Center of Cognitive Psychotherapy-Associazione
di Psicologia Cognitiva (APC), Rome, Italy
| | - Antonino Carcione
- Third Center of Cognitive Psychotherapy-Associazione
di Psicologia Cognitiva (APC), Rome, Italy
| | - Antonio Semerari
- Third Center of Cognitive Psychotherapy-Associazione
di Psicologia Cognitiva (APC), Rome, Italy
| | - Giancarlo Dimaggio
- Third Center of Cognitive Psychotherapy-Associazione
di Psicologia Cognitiva (APC), Rome, Italy,
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Salvatore G, Dimaggio G, Popolo R, Lysaker PH. Deficits in mindreading in stressful contexts and their relationships to social withdrawal in schizophrenia. Bull Menninger Clin 2008; 72:191-209. [DOI: 10.1521/bumc.2008.72.3.191] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dimaggio G, Procacci M, Nicolò G, Popolo R, Semerari A, Carcione A, Lysaker PH. Poor metacognition in Narcissistic and Avoidant Personality Disorders: four psychotherapy patients analysed using the Metacognition Assessment Scale. Clin Psychol Psychother 2007. [DOI: 10.1002/cpp.541] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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