The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda

Trauma-Related Symptom Improvement in Multimodal Triphasic Trauma Therapy: Findings From a Community-Based Study

OBJECTIVE

This single-arm effectiveness study explored changes in trauma-related symptoms-including dissociation, depression, anxiety, sexual issues and sleep disturbances-throughout a multimodal, phased trauma intervention, to explore treatment response in real-world settings with varied populations and complex clinical presentations, as well as varied degrees of clinician experience.

METHOD

Symptom change was assessed among participants undergoing a triphasic trauma therapy called trauma practice. Data were collected at five time points: pretreatment (n = 41), Phase 1 (n = 37), Phase 2 (n = 25), Phase 3 (n = 20) and follow-up (n = 16). Participants completed self-report measures at the start of therapy, after each therapy phase and 6 months post treatment. The average age of participants was 37.6 years (SD = 12.5). Approximately 63.8% identified as female, 55% were born in Canada and 47.5% identified as Caucasian.

RESULTS

The findings revealed statistically and clinically significant reductions in symptoms across all measured domains. On average, participants transitioned from clinically elevated levels of dissociation, anxiety, depression, sexual difficulties and sleep disturbances at baseline to non-clinical levels by the end of therapy. Moderate to large effect sizes, clinically significant reliable change indices and sustained treatment gains were demonstrated at follow-up.

CONCLUSION

These results suggest that trauma practice holds promise as an effective intervention for trauma in community clinical settings.

Exploring Exercise Addiction, Self-Esteem, and Early Maladaptive Schemas: A Cross-Sectional Study Among Female University Students

BACKGROUND/OBJECTIVES

Although physical exercise provides numerous health benefits, it can occasionally become addictive, leading to negative consequences for physical and mental health. Specifically, the role of maladaptive schemas in the relationship between exercise addiction and self-esteem underscores the importance of addressing these cognitive patterns in therapeutic settings to develop practical interventions that enhance exercise with healthier self-perceptions. This study aims to analyze the role of early maladaptive schemas in the relationship between exercise addiction and self-esteem.

METHODS

The design of this study is non-experimental, correlational, and cross-sectional. The sample comprised 788 university women students (mean age 20.39 years, SD = 2.28).

RESULTS

Exercise addiction is negatively associated with self-esteem and shows positive but weak correlations with most early maladaptive schemas, except for Impaired Autonomy. A mediating effect was identified for Disconnection and Rejection (β = -0.08, p = 0.008), Impaired Limits (β = -0.03, p = 0.019), Other Directedness (β = -0.04, p = 0.032), and Over-Vigilance and Inhibition (β = -0.05, p < 0.001). Full mediation was observed for Disconnection and Rejection and Over-Vigilance and Inhibition, while Impaired Limits and Other Directedness showed partial mediation.

CONCLUSIONS

These findings suggest that the decrease in self-esteem among individuals with exercise addiction could be explained by the activation of maladaptive schemas that influence exercise motivation, with Over-Vigilance and Inhibition standing out in particular. Furthermore, it is necessary to develop cognitive behavioral therapy (CBT)-based interventions focused on modifying early maladaptive schemas and strengthening self-esteem. Additionally, it would be advisable to implement educational programs in university and sports settings that promote well-being and enjoyment over the pursuit of external validation or obsession with body image. These strategies could help prevent exercise addiction and mitigate its negative effects on self-esteem.

Religious scrupulosity and early maladaptive schemas: a network analysis

Scrupulosity is treated as a particular presentation of the symptomatology characteristic for obsessive-compulsive disorder (OCD). However, typical treatment of OCD (e.g. cognitive-behavioral therapy) is less effective in the case of religious scruples. Recently, schema therapy has appeared as an alternative effective treatment in obsessive-compulsive symptomatology. The present study investigated the associations between early maladaptive schemas (EMSs) and scrupulosity in a non-clinical sample of 376 poles. The participants assessed their EMSs with the Young Schema Questionnaire 3 - Short Form and their scrupulosity with the Pennsylvania Inventory of Scrupulosity. We used network analysis to control for the EMS interconnectivity. We showed that accounting for the interactions within the EMSs, three schemas, namely, Punitiveness, Subjugation, and Enmeshment/Undeveloped Self, were positively correlated with scrupulosity. Given the central position of the Negativity/Pessimism schema in the examined network, we suggested that activation of this schema could be indirectly correlated to scruples via an escalation of activation to the Punitiveness, Subjugation, and Enmeshment schemas. The findings suggest that dependency and fear of rejection problems (present in Subjugation and Enmeshment EMSs) and over-compensation by perfectionism (present in Punitiveness EMS) could be addressed in the treatment of scruples.

Group schema therapy for personality disorders: Systematic review, research agenda and treatment implications

OBJECTIVE

There are significant temporal and financial barriers for individuals with personality disorders (PD) receiving evidence-based psychological treatments. Emerging research indicates Group Schema Therapy (GST) may be an accessible, efficient, and cost-effective PD intervention, however, there has been no synthesis of the available evidence to date. This review therefore aimed to investigate the efficacy of GST for PDs by systematically synthesizing available literature.

METHOD

Five electronic databases were screened with resulting studies subjected to a specific eligibility criteria, which yielded fourteen relevant studies. Characteristics were extracted and methodological quality rigorously assessed.

RESULTS

Strong support was evidenced for GST's ability to reduce Cluster B and C symptomology, particularly for Borderline and Avoidant PD. GST appeared to improve global symptom severity, quality of life and functional capacity, as well as treatment targets such as schemas and modes.

CONCLUSION

Although not without limitations and a moderate risk of bias, the current body of evidence supports GST as a potential solution to current service deficits in economical and evidence-based care for individuals with PD. Implications for treatment and future research are discussed.

Group schema therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: A randomized controlled trial

BACKGROUND

Patients with social anxiety (SAD) and comorbid avoidant personality disorder (AVPD) are severely impaired. Group cognitive behavioral therapy (GCBT) is considered an effective treatment for SAD. More knowledge on treatment of SAD with comorbid AVPD is needed. Schema therapy, developed for personality and chronic mental disorders, may be a promising treatment.

METHODS

We conducted a randomized controlled trial in an outpatient population (n = 154) with both SAD and AVPD. Group Schema Therapy (GST) and GCBT were compared on SAD symptoms (Liebowitz Social Anxiety Scale) and manifestations of AVPD (Avoidant Personality Disorder Severity Index).

RESULTS

Intention-to-treat analysis showed no significant differences between treatments at 3 months post-treatment and one-year follow-up. Both modalities led to significant and substantial improvements. No significant between-differences were found in depressive symptoms (Inventory of Depressive Symptoms) and quality of life (World Health Organization Quality of Life-BREF). Per-protocol analysis showed similar outcomes and no significant differences in recovery from SAD and AVPD. Significantly more patients completed GST.

CONCLUSION

GST and GCBT are valuable treatments for SAD with comorbid AVPD. The higher treatment retention in ST indicates ST is more acceptable than GCBT. Future studies should focus on enhancing treatment effects and improving retention to GCBT.

The importance of examining early maladaptive schemas in the diagnosis and treatment of obsessive-compulsive disorder

Introduction

The aim of the study was twofolded: to identify the early maladaptive schemas characteristic of obsessive-compulsive disorder in a Hungarian sample and, to examine the presence and severity of comorbid anxiety and depressive symptoms in the light of early maladaptive schemas.

Methods

112 participants (58 men and 54 women) diagnosed with OCD were involved in the study. The questionnaire package consisted of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Penn State Worry Questionnaire (PSWQ) and the Schema Questionnaire (SQ).

Results

We identified five early maladaptive schemas with a direct effect on the manifestation of obsessive-compulsive symptoms: Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/Self-Discipline and Entitlement/Grandiosity (reversed effect). Based on the severity of the early maladaptive schemas, three significantly different groups could be identified in our sample: patients with mild, moderate and high schema-values. Among the groups significant differences can be found in the appearance and severity of compulsive symptoms, as well as in the presence of anxiety and depressive symptoms. But contrary to our expectations, not the severity, but the numberof the early maladaptive schemas showed a stronger correlation with the symptom variables. An additional result of our study derives from canonical correlation, addressing the relationship among early maladaptive schemas, OCD symptoms, anxiety and depressive symptoms from a new perspective. The results highlight that OCD is only one and not the most serious consequence of personality damage, indicated by early maladaptive schemas.

Discussion

The results of our study suggest that obsessive-compulsive disorder can be divided into several subgroups, which can be separated in terms of symptom severity, comorbid psychiatric symptoms and personality impairment patterns. The relationship between OCD symptom severity and personality impairment seems to be not directly proportional. Our results strengthen the new dimensional view of OCD, which can determine the selection of the appropriate therapeutic treatment method beyond the diagnostic process.

Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)

BACKGROUND

About one third of patients with depression are in a condition that can be termed as "difficult-to-treat". Some evidence suggests that difficult-to-treat depression is associated with a higher frequency of childhood trauma and comorbid personality disorders or accentuated features. However, the condition is understudied, and the effects of psychotherapy for difficult-to-treat depression are currently uncertain. The aim of this trial is to investigate the beneficial and harmful effects of 30 sessions of individual schema therapy versus treatment as usual for difficult-to-treat depression in the Danish secondary, public mental health sector.

METHODS

In this randomized, multi-centre, parallel-group, superiority clinical trial, 129 outpatients with difficult-to-treat depression will be randomized (1:1) to 30 sessions of individual schema therapy or treatment as usual; in this context mainly group-based, short-term cognitive behaviour or psychodynamic therapy. The primary outcome is the change from baseline in depressive symptoms 12 months after randomization, measured on the observer-rated 6-item Hamilton Rating Scale for Depression. The secondary outcomes are health-related quality of life assessed with the European Quality of Life 5 Dimensions 5 Level Version, functional impairment assessed with the Work and Social Adjustment Scale, psychological wellbeing assessed with the WHO-5 Well-being Index, and negative effects of treatment assessed with the Negative Effects Questionnaire. Exploratory outcomes are improvement on patient self-defined outcomes, personal recovery, anxiety symptoms, anger reactions, metacognitive beliefs about anger, and perseverative negative thinking. Outcomes will be assessed at 6, 12, and 24 months after randomization; the 12-month time-point being the primary time-point of interest. Outcome assessors performing the depression-rating, data managers, statisticians, the data safety and monitoring committee, and conclusion makers for the outcome article will be blinded to treatment allocation and results. To assess cost-effectiveness of the intervention, a health economic analysis will be performed.

DISCUSSION

This trial will provide evidence on the beneficial and harmful effects, as well as the cost-effectiveness of schema therapy versus treatment as usual for outpatients with difficult-to-treat depression. The results can potentially improve treatment for a large and understudied patient group.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05833087. Registered on 15th April 2023 (approved without prompts for revision on 27th April 2023).

Healing wounded trees: clinicians' perspectives on treatment of complex posttraumatic stress disorder

While treatment guidelines agree on the first-line interventions for the treatment of posttraumatic stress disorder (PTSD), there is an ongoing debate between experts regarding the treatment of complex posttraumatic stress disorder (C-PTSD). As scientific research is slowly emerging, different treatment approaches are used in clinical practice This article aims to provide a set of treatment options for C-PTSD in adult survivors of repeated exposure to severe violence and abuse, both in childhood and later on in life. The developmental-contextual perspective on mental health forms the basis of this approach. This perspective is elaborated using the tree metaphor. Then, several treatment strategies are suggested. The presented strategies are a combination of the existing evidence-based approaches for the treatment of PTSD and personality disorders. They target psychological damage in survivors while taking their developmental trajectories and ecological environments into consideration. The treatment model presented is based on longstanding clinical practice and it may be a promising framework for treating C-PTSD. However, it still needs to be scientifically examined for acceptability and effectiveness.

Needs, Modes, and Stances: Three Cardinal Questions for Psychotherapy Practice and Training

Background

Advances in motivational science (Dweck, 2017), personality dynamics (Lazarus & Rafaeli, 2023), and process-based psychotherapy (Hofmann & Hayes, 2019) converge into a pragmatic, integrative, and transtheoretical model of practice and training.

Method

The model comprises three elements: a formulation centered on clients' psychological needs which provides guidance regarding the goals and processes most profitable to pursue; a recognition that such pursuit frequently requires contending with a multiplicity of clients' internal self-states (i.e., modes); and an enumeration of pragmatic therapeutic stances likely to help address clients' need-related goals in light of their modes.

Results

We distill these elements into three cardinal questions: What needs does this client have that are not currently met, and what are the most profitable ways of remedying that frustration? What mode or modes does this client manifest - both generally and at this very moment? and What stance should I adopt in response to the client's current mode? We suggest that clinicians should be trained to continually pose these questions and seek to answer them collaboratively with their clients.

Conclusion

This model - illustrated here using schema therapy terms - offers a process-based approach which serves as a theoretically integrative starting point but is general enough to provide an assimilative integration roadmap for therapists anchored in most primary orientations. Integrative or assimilative therapists trained to attend to needs, modes, and stances are likely to be (and be perceived as) particularly responsive, and thus, to enact "common factor" practices known to be conducive to therapeutic alliance and gains.

Group Schema Therapy for Refugees with Treatment-Resistant PTSD and Personality Pathology

Introduction

Patients with complex forms of posttraumatic stress disorder (PTSD) may benefit from schema therapy. While a small number of studies point to the effectiveness of individual schema therapy in refugees with PTSD, no evidence on group schema therapy (GST) in refugees exists. To illustrate and advocate for the use of GST in refugee patients with treatment-resistant PTSD and comorbid personality pathology, a case report is presented. Presentation. The case concerned the treatment of an East African female refugee who survived sexual and physical violence and loss as a child, as the hostage of a rebel army, and as a victim of human trafficking. She was diagnosed with PTSD, major depressive disorder, and borderline personality disorder. Trauma-focused therapy was hampered by insufficient treatment attendance due to current stress factors and early destructive coping strategies. One year of GST enabled the patient to overcome treatment-undermining patterns and benefit from subsequent trauma-focused therapy.

Conclusion

This case suggests that GST may have the potential to improve treatment adherence and the effectiveness of trauma-focused treatment in complex refugee patients. Clinical impressions need to be confirmed in a study that examines the feasibility, acceptability, and preliminary efficacy of GST in refugees with treatment-resistant PTSD and personality pathology.

Schema therapy in adults with autism spectrum disorder: A scoping review

BACKGROUND

Schema therapy (ST) in adults with autism spectrum disorder (ASD) have gained increasing interest in clinical practice and research. However, to date, there has been no synthesis of the literature on ST as treatment for adults with ASD. Through a scoping review, we aim to summarize the emerging research and literature on ST for adults with ASD.

METHODS

A comprehensive literature search of three electronic databases was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications were included that examined ST in adults with ASD and non-clinical adults with autistic traits.

RESULTS

Systematic searches identified a total of 11 publications, all published since 2014, with the majority being conducted by Dutch and Japanese researchers. Of the 11 publications, 1 described an ST-informed social interaction training, 1 was an ST protocol, 2 described conceptual ST models, 2 were case examples, 2 examined early maladaptive schemas (EMSs) and 3 investigated the effectiveness of ST interventions. In summary, the theoretical exploration, practical examples of the application of ST and research findings with preliminary evidence of ST, EMSs and schema modes (SMs) in adults with ASD point towards the potential of ST for the treatment of adults with ASD.

DISCUSSION

The current scoping review highlights preliminary research findings and offers valuable suggestions for clinicians treating adults with ASD. This review underscores the need for development of and research in specialized ST protocols and programmes tailored to adults with ASD with chronic mental conditions, such as personality disorders (PDs).

Therapists' problematic experiences when working with obsessive-compulsive disorder: a qualitative investigation of schema modes, mode cycles, and strategies to return to healthy adult mode

Introduction

Obsessive-compulsive disorder (OCD) is one of the most challenging pathologies for therapists, being chronic and often characterized by frequent relapses. The therapeutic relationship plays a critical role in the outcome of therapy. The dynamic interaction between therapist and client schema modes determines the quality of the relationship.

The objective

of the present qualitative research is to investigate and conceptualize the triggers for therapists when working with OCD clients, the therapists' schema modes that are activated, and the strategies they use to get back into the Healthy Adult mode.

Method

Using the in-depth interview technique, we interviewed 15 psychotherapists of various therapeutic orientations. After several demographic items, the therapists answered some introductory questions about their general perceptions of working with this pathology. They were then guided to go through a specific therapeutic situation in imagery that they identified as particularly difficult to manage in the therapeutic relationship. For data analysis, we used the interpretative phenomenological analysis (IPA) method and thematic analysis.

Results

For therapists working with clients with OCD, two main categories of triggers have been identified: Perceived resistance to change and Superiority. Two other categories, Client immobilized by conflict and Abusive, emerged from our analysis. Therapists' reactions to triggers were synthesized into mode processes that (1) were not acted on and (2) were displayed in relation with the client. For mode processes that therapists did not explicitly act on, there was triggering of the Vulnerable Child in relationship with a Demanding Parent, followed by various coping modes, depending on the category of trigger, and in the displayed mode, most therapists operated in the Healthy Adult mode. With respect to the process, strategies used by therapists to return to Healthy Adult mode that stood out were: focusing on the process, self-acceptance, self-compassion, and somatic grounding strategies, and focusing on the client's resources.

Assessment of Personality Disorders in Older Adults. A Practice Guide

Assessment of personality disorders (PDs) in older adults is a nuanced trade of its own. The aim of this practice guide is to illustrate gerontological assessment challenges using 3 case vignettes. We argue that it is important to pay extra attention to the influence of cognitive and medical (somatic) disorders on personality functioning in older adults during personality assessment. We also note that information provided by informants contributes added value to personality assessment. Personality assessment should be sufficiently age-specific to prevent overdiagnosis or underdiagnosis in older adults. Furthermore, given the reduced psychological or somatic capacity of some older adults, phased or sequential personality assessment is recommended. This should be focused on the assessment questions to be answered, for example starting with short general screening of personality functioning, followed by more in-depth exploration. Personality assessment should be kept as brief and simple as possible in terms of formulation of the items.

Understanding the reparative effects of schema modes: an in-depth analysis of the healthy adult mode

Objectives

Evidence in favor of schema therapy's effectiveness in treating personality disorders is growing. One of the central and recently popular concepts of schema therapy is schema modes [i.e., temporary emotional-cognitive-behavioral states resulting from the activation of early maladaptive schemas (EMSs)]. A key aspect herein is self-reparenting, i.e., a healing relationship between the healthy adult (HA, i.e., compassionate and healthy emotional states, and functional dealing with reality) and the child modes (i.e., representation of fragile and hurt feelings and dysfunctional coping). Through an in-depth qualitative analysis, we aimed to better understand the components of the HA that enable self-reparenting.

Method

Purposive sampling procedures were used to recruit eligible participants (n = 10) with relatively strong HA modes, as determined by high scores on positive affect and satisfaction with life measures and low scores on EMSs and psychopathological symptom measures. Semi-structured 45- to 60-min face-to-face interviews were conducted individually, in which individuals were asked to help the child modes reflected in the pictures. Interviews were then analyzed using deductive thematic analysis in MaxQDA.

Results and discussion

The analysis revealed three superordinate themes comprising of a total of 10 group themes: (1) bonding between HA and the vulnerable child modes ("Bond"); (2) balancing expression and inhibition of adult and child mode emotions ("Balancing"); and (3) opposing demanding and critical voices and maladaptive coping styles ("Battle"). Furthermore, a strong HA mode seems to have a reciprocal relationship with the child modes: the HA gives nurturance and protection to the child modes, and the child modes boost up the HA with spontaneity and happiness. In conclusion, emotional stability and resilience may be highest when HA-child mode interaction happens bidirectionally; when the child modes get reparented by the HA, and the HA is informed by the child modes.

Early maladaptive schemas and obsessive-compulsive disorder: A systematic review and meta-analysis

BACKGROUND

Obsessive-compulsive disorder (OCD) is a condition with poor treatment outcomes. Improved understanding of the aetiology can inform prevention and treatment approaches; hence several studies have assessed early maladaptive schemas (EMSs) in OCD. This systematic review and meta-analysis aimed to synthesise the evidence on relationships between the 18 EMSs and OCD.

METHODS

The study was conducted according to PRISMA guidelines and registered on PROSPERO (CRD42022329337). A systematic search of PubMed, PsycINFO, and CINAHL Complete was conducted on 4 June 2022. Studies in peer-reviewed journal articles were included if they assessed EMSs and OCD (diagnosis or symptom severity) in adults with a mean age of 18 years or older. Studies were excluded if they were not in English, did not include original quantitative data, or reported on case studies. Study details were tabulated and the meta-analysis findings were presented using forest plots. Methodological quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS).

RESULTS

Based on 22 studies (pooled N = 3699), all 18 EMSs were positively correlated with OCD. The largest associations were with the dependence/incompetence (r = 0.40 95 % CI [0.32, 0.47]), vulnerability to harm or illness (r = 0.40 95 % CI [0.32, 0.48]), and negativity/pessimism schemas (r = 0.42 95 % CI [0.22, 0.58]).

LIMITATIONS

Several meta-analyses showed considerable heterogeneity and publication bias.

CONCLUSIONS

The findings suggest all EMSs, particularly those relating to disproportionate negative expectations and a perceived inability to cope, are implicated in OCD. Psychological prevention and treatment for OCD may benefit from targeting these schemas.

Cognitive-Affective Risk Factors of Female Intimate Partner Violence Victimization: The Role of Early Maladaptive Schemas and Strategic Emotional Intelligence

(1) Background: Intimate partner violence (IPV) is a pervasive and destructive phenomenon. There is a need for an integrated and comprehensive approach to IPV in order to align prevention, support and treatment. Still little is known about the cognitive and affective markers of IPV that are modifiable. Such knowledge, therefore, can support the effectiveness of prevention and intervention programs. In this study, we put forward a hypothesis that, after accounting for the influence of sociodemographic variables, the domains of early maladaptive schemas (EMS) and strategic emotional intelligence would provide additional information for predicting female IPV victimization. (2) Methods: 48 female survivors of IPV and 48 age-matched women with no prior experience of IPV completed the Young Schema Questionnaire-Short Form 3 (YSQ-SF3) and The Emotional Understanding Test (TRE). (3) Results: The domains of disconnection and rejection and impaired limits were significant predictors of IPV victimization, but the results did not support the predictive value for impaired autonomy, other-directedness and strategic emotional intelligence. (4) Conclusions: Our findings add to the emerging evidence of a link between disconnection and rejection domain and IPV victimization. As a consequence, maladaptive beliefs that interpersonal relationships are unstable and insecure and expose to the risk of humiliation and harm, and that basic emotional needs cannot be satisfied in close relationships, are associated with a higher risk of intimate partner violence. In this context, schema therapy appears to be a promising support for IPV victims.

A Systematic Review of the Heterogeneity of Schema Therapy

We aimed to explore the heterogeneity of schema therapy regarding (a) patient characteristics, (b) content, and (c) way of delivering schema therapy. A search was conducted of the electronic databases EMBASE, PsycINFO, Web of Science, MEDLINE, and COCHRANE up to June 15, 2022. Treatment studies were eligible if they (a) used schema therapy as (component of) the intervention examined, and (b) reported an outcome measure quantitatively. A total of 101 studies met the inclusion criteria, including randomized controlled trials (n = 30), non-randomized controlled trials (n = 8), pre-post designs (n = 22), cases series (n = 13), and case reports (n = 28), including 4006 patients. Good feasibility was consistently reported irrespective of format (group versus individual), setting (outpatient, day-treatment, inpatient), intensity of treatment, and the specific therapeutic components included. Schema therapy was applied to various (psychiatric) disorders. All studies presented promising results. Effectiveness of the different models of schema therapy as well as application beyond personality disorders should be examined more rigorously.

The association between OCD and Shame: A systematic review and meta-analysis

BACKGROUND

Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed.

OBJECTIVES

Our review systematically examines the association of shame with OCD and unacceptable thoughts.

METHODS

The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model.

RESULTS

The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [-0.467, 0.9708], harm obsessions r = .224, CI [-0.190, 0.638] and symmetry concerns r = .200, CI [-0.108, 0.509].

LIMITATIONS

Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant.

CONCLUSIONS

Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.

Schema therapy with cognitive behaviour day-treatment in patients with treatment-resistant anxiety disorders and obsessive-compulsive disorder: an uncontrolled pilot study

BACKGROUND

Treatment resistance in patients with anxiety disorders and obsessive-compulsive disorder (OCD) might be caused by dysfunctional personality traits or, more specifically, early maladaptive schemas (EMSs) and schema modes, that can be treated with schema therapy (ST).

AIM

To explore possible effectiveness of ST-CBT day-treatment in patients with treatment-resistant anxiety disorders and OCD in an uncontrolled pilot study.

METHOD

Treatment-resistant patients with anxiety disorders or OCD (n = 27) were treated with ST-CBT day-treatment for 37 weeks on average including 11.5 therapy hours per week. The Symptom Questionnaire-48, Young Schema Questionnaire-2 and Schema Mode Inventory were completed before and after treatment.

RESULTS

General psychopathology, EMSs and schema modes significantly improved after treatment. Spearman's correlations between pre- to post-treatment difference scores of general psychopathology, EMSs and schema modes were significant and high. The level of pre-treatment EMSs and schema modes did not predict post-treatment general psychopathology.

CONCLUSIONS

Symptom reduction was strongly correlated with improvement of EMSs and schema modes. Stronger pre-treatment EMSs and schema modes did not hinder improvement of symptoms. ST-CBT day-treatment is promising for patients with treatment-resistant anxiety disorders and OCD. Further controlled research is needed to substantiate evidence for schema therapy in patients with treatment-resistant anxiety disorders and OCD.

The Relationship Between Obsessive-Compulsive Symptoms and Dissociation: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to investigate the relationship between dissociation and obsessive-compulsive symptoms (OCS) and disorder (OCD). Specifically, the study aimed to (a) estimate the pooled prevalence of dissociative disorders among individuals with OCD; (b) systematically review the prevalence of OCD among individuals with dissociative disorders; (c) compare the severity of dissociative symptoms between individuals with OCD and non-clinical controls; (d) estimate the association between OCS and dissociative symptoms in the clinical and non-clinical populations. A systematic search was carried out in biomedical databases from inception to January 2022 according to PRISMA guidelines. A total of 41 studies met inclusion criteria (n = 9,438, 34.3% males). The pooled prevalence of dissociative disorders in adult samples with OCD was 8% (95% CI [3, 15], k = 5). Studies on adolescent and adult patients with dissociative disorders found that 17-32% reported comorbid OCD, while a prospective study of patients with early-onset dissociative disorders found no evidence of association with OCD. Individuals affected by OCD reported more dissociative symptoms than non-clinical controls (g = .67, 95% CI [.18, 1.16], k = 9). A moderate correlation between dissociative symptoms and OCS was detected (r = .43, 95% CI [.36, .51], k = 18). Sensitivity analyses showed small/moderate correlations between dissociative experiences and specific types of obsessions and compulsions. Findings suggest that dissociative symptoms are moderately related to OCS in both clinical and non-clinical populations. Interventions aimed to reduce dissociation might improve treatment response of patients suffering from OCD.

Early Maladaptive Schemas and Their Impact on Parenting: Do Dysfunctional Schemas Pass Generationally?-A Systematic Review

There are several factors that play a key role in the development of early maladaptive schemas, i.e., temperament, unmet core emotional needs, and adverse childhood events (e.g., traumatization and victimization, overindulgence, overprotection). Thus, the parental care that a child experiences has a substantial impact on the potential development of early maladaptive schemas. Negative parenting can range from unconscious neglect to overt abuse. Previous research supports the theoretical concept that there is a clear and close relationship between adverse childhood experiences and the development of early maladaptive schemas. Maternal mental health problems have been proven to be a factor that has strengthened the link between a mother's history of negative childhood experiences and subsequent negative parenting. Consistent with the theoretical background, early maladaptive schemas are associated with a wide variety of mental health problems. Clear links have been found for EMSs and personality disorders, depression, eating disorders, anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder. In light of these theoretical and clinical connections, we decided to summarize the available literature on the multigenerational transmission of early maladaptive schemas, which is also an introduction to our research project.

Overprotective parenting experiences and early maladaptive schemas in adolescence and adulthood: A systematic review and meta-analysis

Young's schema model identifies overprotection as a type of childhood experience associated with early maladaptive schemas. This review evaluated the evidence base examining overprotective parenting as a predictor of schema endorsement in adolescence and adulthood. A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, and registered on PROSPERO (CRD42021258990). PsycINFO, CINAHL and PubMed databases were searched on 5 June 2021 for eligible studies reporting original data on unadjusted association(s) between overprotective parenting and schema endorsement in samples with a mean age of 12 years or older. Studies were excluded if they were not in English or peer reviewed or participants were exposed to an intervention. Meta-analyses using Meta-Essentials software examined the relationship between maternal and paternal overprotective parenting with Young's 18 schemas. An adapted version of the Appraisal tool for Cross-Sectional Studies (AXIS) was used to assess methodological quality. A total of 16 articles were included. Based on 36 meta-analyses (Pooled N = 1,496 to 3,218), several schemas demonstrated positive small correlations with maternal overprotective parenting (range: r = 0.15, 95% CI = 0.10, 0.19 [Entitlement] to r = 0.29, 95% CI = 0.13, 0.43 [Enmeshment]) and paternal overprotective parenting (range: r = 0.15, 95% CI = 0.10, 0.20 [Abandonment] to r = 0.24, 95% CI = 0.10, .36 [Enmeshment]). Considerable heterogeneity was detected, but subgroup analyses were not significant. Overall, recollections of overprotective parenting experiences were primarily associated with schemas relating to disconnection and rejection, and impaired autonomy and performance. However, the literature has thus far relied on retrospective measures of parenting, and longitudinal research is needed to establish causality.

Relationships between positive schemas and life satisfaction in psychiatric inpatients

Introduction

Unlike the extensively examined early maladaptive schemas, positive schemas have rarely been examined in psychiatric patients. This study aimed to investigate the relationships between anxiety, depression, life satisfaction, resilience, and positive schemas in psychiatric inpatients with generalized anxiety disorder or major depressive disorder and explore their associations. A sample of 140 psychiatric inpatients with anxiety and depression, aged between 18 and 72 years (M_age  = 35.62, SD = 13.87) participated in this study.

Methods

A majority were women (n = 98, 70.0%). The analyses examined resilience and anxiety/depression as mediators between positive schema and life satisfaction.

Results

Based on statistical analyses, resilience and anxiety/depression were parallel rather than serial mediators between positive schemas and life satisfaction. These results confirmed the positive association between positive schemas and life satisfaction, and identified mechanisms between them: directly associated and indirectly associated through the parallel mediations of resilience and anxiety/depression.

Discussion

The findings of this study suggest that higher levels of positive schemas in psychiatric inpatients are associated with greater life satisfaction directly and through the mediation of reduced psychopathological emotions and increased resilience. Longitudinal studies are needed to explore the associations between positive schemas and negative and positive outcomes and the mechanisms underlying these associations in clinical populations.

Validity and reliability of the Chinese version of the Young Positive Schema Questionnaire

Introduction

The Young Positive Schema Questionnaire (YPSQ) examines early adaptive or positive schemas as a counterpart to early maladaptive ones. This study investigated the validity and reliability of the Chinese version of the YPSQ (CYPSQ).

Methods

A convenient community sample of 634 individuals, most of whom were college students, were recruited through a mobile survey. R Careless was used to screen for careless responses. A final sample of 336 was obtained. Confirmatory factor analyses (CFA) of the CYPSQ were conducted using SPSS AMOS 25. Other statistical analyses were conducted using SPSS 25.

Results

An 11-factor CYPSQ was identified with an acceptable factor structure (χ2/df = 2.13, SRMR = 0.04, RMSEA = 0.06, GFI = 0.80, TLI = 0.90, and CFI = 0.91). Convergent and discriminant validity were confirmed in most aspects. Concurrent validity was evident with resilience, life satisfaction, depression, and anxiety. Internal reliability was satisfied as the Cronbach’s alphas of the 11 factors of the CYPSQ ranged between 0.70 and 0.88.

Conclusion

The findings supported the reliability and validity of the CYPSQ in Mainland China.

Turkish Adaptation of the Dusseldorf Illustrated Schema Questionnaire for Children: Psychometric Properties and Relationship with Childhood Difficulties

Dusseldorf Illustrated Schema Questionnaire for Children (DISC) measures early maladaptive schemas (EMS) in childhood. EMS are emotional and cognitive rules and patterns formed in childhood and adolescence because of unmet emotional needs which are maintained throughout life and negatively affect one’s potential. The first aim of the current study is to adapt DISC to the Turkish language and examine its psychometric properties to facilitate preventive intervention during early childhood. The second aim of the study is to investigate the relationship between schemas and childhood difficulties. The sample consisted of 771 (419 females, 352 males) children of first graders (8-year-old) to twelfth graders (14-year-old) from 54 of the 81 cities in Turkey. Cronbach’s α value for the total of 36 items was calculated as .89 and α values for subscales ranged between .42 and .83. The test–retest reliability coefficient of the total of the scale was .79 at 1 month and subscales’ test–retest values ranged between .31 and .91. Confirmatory factor analysis showed a good fit for the purported 18-factor model of the original DISC in the Turkish version within a sample of children from diverse socio-economic and cultural backgrounds from Turkey. The Turkish version of the DISC indicated a reliable and valid instrument to assess maladaptive schemas in children.

The higher-order structure of early maladaptive schemas: A meta-analytical approach

BACKGROUND

Early maladaptive schemas (EMSs) are themes regarding oneself and one's relationship with others. In schema therapy, 18 EMSs are described that were initially proposed to be clustered in five domains. The current EMS model comprises four domains. However, empirical investigations into the grouping of EMSs have yielded divergent results. The purpose of the present study was to use a meta-analytical approach to examine the higher-order organization of EMSs.

METHODS

To be included in the statistical analyses, studies had to report the associations between all 18 EMSs using a form of the Young Schema Questionnaire. In a systematic literature review in PsycInfo, Embase, MEDLINE, Web of Science, and Google scholar, 27 studies were identified that reported the associations between EMSs in 33 independent samples (N = 13,958, M _age = 16-72.3 years, 64.0% female). The correlations between EMSs were pooled across samples and analyzed using confirmatory factor analysis (CFA) and principal component analysis (PCA).

RESULTS

The CFA results showed weak support for any of the previously suggested EMS domains. After PCA, four EMS domains were retained that closely resembled the theoretically proposed organization of EMSs. The four components showed fair to good congruence in the clinical and non-clinical subsamples. However, a model with three EMS domains showed a simpler structure.

DISCUSSION

The results suggest a need for further theoretical and empirical clarification of the higher-order structure of EMSs.

SYSTEMATIC REVIEW REGISTRATION

https://osf.io/57wyz.