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Cheli S, Goldzweig G, Chiarello F, Cavalletti V. Evolutionary systems therapy for paranoid personality disorder: A seven cases series. Bull Menninger Clin 2024; 88:61-80. [PMID: 38527104 DOI: 10.1521/bumc.2024.88.1.61] [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] [Indexed: 03/27/2024]
Abstract
Little is known about effective psychosocial treatments for paranoid personality disorder. This study explores the feasibility of a novel treatment, namely Evolutionary Systems Therapy, in supporting individuals diagnosed with paranoid personality disorder. Seven patients attended 10 months of individual therapy without receiving any psychopharmacological treatment. The primary outcome was the feasibility of the intervention, while the secondary outcomes were remission from the diagnosis and reliable changes in personality pathology and paranoid ideation. All recruited patients completed the intervention and did not report any adverse events. Six out of seven patients experienced remission from the diagnosis of paranoid personality disorder. All participants showed reliable changes in personality pathology and paranoid ideation, which were maintained at the 1-month follow-up. Further research is needed to confirm these encouraging results.
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Affiliation(s)
- Simone Cheli
- PhD, is affiliated with the Department of Psychology, St. John's University, Rome, Italy, and the Center for Psychology and Health, Tages Charity, Florence, Italy
| | - Gil Goldzweig
- Academic College of Tel Aviv Yaffo, Tel Aviv, Israel
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Cheli S, Cavalletti V, Hopwood CJ. Threatening Beliefs About Self and Others Moderate the Association Between Psychoticism and Psychological Distress. J Nerv Ment Dis 2023; 211:819-827. [PMID: 37738457 DOI: 10.1097/nmd.0000000000001726] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/24/2023]
Abstract
ABSTRACT Psychoticism is a multidimensional personality construct involving odd or eccentric behavior, quasi-psychotic experiences, mistrust, interpersonal detachment, and liability for schizophrenia-spectrum disorders, as well as significant distress. Recent advances suggest it can be understood as a dimension that is continuously distributed in the population, leading to questions about factors that contribute to distress and dysfunction among people with a schizotypal liability. We investigated in a large nonclinical sample of young adults whether associations between psychoticism and psychological distress would increase in the presence of threatening beliefs. In our study ( N = 2127), we found that the association between psychoticism and psychological distress is moderated by threatening beliefs including self-criticism, fear of compassion, and socially prescribed perfectionism. These results suggest that distress increases among people with schizotypal traits in the context of negative beliefs about self and others. We discuss implications for clinical practice and directions for further research.
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Cheli S, Cavalletti V, Lysaker PH, Dimaggio G, Petrocchi N, Chiarello F, Enzo C, Velicogna F, Mancini F, Goldzweig G. A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment. BMC Psychiatry 2023; 23:113. [PMID: 36803673 PMCID: PMC9942388 DOI: 10.1186/s12888-023-04610-5] [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: 07/07/2022] [Accepted: 02/13/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Schizotypal personality disorder is characterized by a pervasive pattern of maladaptive behavior that has been associated with the liability for schizophrenia. Little is known about effective psychosocial interventions. This pilot non-inferiority randomized controlled trial aimed to compare a novel form of psychotherapy tailored for this disorder and a combination of cognitive therapy and psychopharmacological treatment. The former treatment - namely, Evolutionary Systems Therapy for Schizotypy-integrated evolutionary, metacognitively oriented, and compassion focused approaches. METHODS Thirty-three participants were assessed for eligibility, twenty-four randomized on a 1:1 ratio, nineteen included in the final analysis. The treatments lasted 6 months (24 sessions). The primary outcome was change across nine measurements in personality pathology, the secondary outcomes were remission from diagnosis and pre-post changes in general symptomatology and metacognition. RESULTS Primary outcome suggested a non-inferiority of the experimental treatment in respect to control condition. Secondary outcomes reported mixed results. There was no significant difference in terms of remission, but experimental treatment showed a larger reduction of general symptomatology (η2 = 0.558) and a larger increase in metacognition (η2 = 0.734). CONCLUSIONS This pilot study reported promising results about the effectiveness of the proposed novel approach. A confirmatory trial on large sample size is needed to provide evidence about relative effectiveness of the two treatment conditions. TRIAL REGISTRATION ClinicalTrials.gov; NCT04764708; Registration day 21/02/2021.
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Affiliation(s)
- Simone Cheli
- School of Human Health Sciences, University of Florence, Florence, Italy. .,Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137, Florence, Italy.
| | - Veronica Cavalletti
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Paul H. Lysaker
- grid.280828.80000 0000 9681 3540Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, USA ,grid.257413.60000 0001 2287 3919Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA
| | - Giancarlo Dimaggio
- grid.512576.20000 0004 7475 2686Centro Di Terapia Metacognitiva Interpersonale, Rome, Italy
| | - Nicola Petrocchi
- grid.449441.80000 0004 1789 8806John Cabot University, Rome, Italy
| | - Francesca Chiarello
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Consuelo Enzo
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Francesco Velicogna
- Center for Psychology and Health (Centro Di Psicologia e Psicoterapia), Tages Charity (Tages Onlus), Via Della Torretta 14, 50137 Florence, Italy
| | - Francesco Mancini
- grid.440899.80000 0004 1780 761XGuglielmo Marconi University, Rome, Italy
| | - Gil Goldzweig
- grid.430432.20000 0004 0604 7651The Academic College of Tel Aviv Yaffo, Tel Aviv, Israel
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Cheli S, Pino MS, Goldzweig G, Scoccianti S, Fabbroni V, Giordano C, Cavalletti V, Bassetti A, Fioretto L. The Relationship Between Covid-19 Risk Perception and Vaccine Hesitancy in Cancer Patients: The Moderating Role of Externalizing Traits. Clin Neuropsychiatry 2022; 19:355-364. [PMID: 36627943 PMCID: PMC9807116 DOI: 10.36131/cnfioritieditore20220602] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective This mixed-methods study aimed to explore the role of externalizing traits in moderating the relationship between COVID-19 risk perception and vaccine hesitancy in patients diagnosed with cancer. A community-based participatory approach - comprising a preliminary qualitative inquiry and a subsequent cross-sectional research - was used to promote effective vaccination campaigns. Method 12 people diagnosed with cancer and 7 cancer professionals were recruited for the qualitative inquiry, 356 people either under cancer treatment or in follow-up care for the cross-sectional research.A phenomenological analysis explored the transcripts of two focus groups. The cross-sectional research tested the hypothesis emerged during the previous qualitative inquiry through self-reported questionnaires and moderated regression. Results Phenomenological analysis suggested a pivotal role of externalizing traits in vaccine hesitancy. Moderated regression revealed how the association between risk perception and vaccine hesitancy is moderated by externalizing traits, even when controlled for treatment adherence. Conclusions In the present study we found a stronger relationship between risk perception and vaccine hesitancy for patients with higher levels of externalizing traits. We suggest that vaccination campaigns should be personality-informed to offer individualized and effective solutions. Patients with externalizing traits may cope dysfunctionally with vaccination campaigns.
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Affiliation(s)
- Simone Cheli
- Center for Psychology and Health, Tages Charity, Florence, Italy, St. John’s University, Rome, Italy,Corresponding author Simone Cheli E-mail:
| | - Maria Simona Pino
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Gil Goldzweig
- The Academic College of Tel Aviv Yaffo – Tel Aviv, Israel
| | - Silvia Scoccianti
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence
| | - Valentina Fabbroni
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Clara Giordano
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | | | - Andrea Bassetti
- Direzione Sanitaria Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
| | - Luisa Fioretto
- Medical Oncology Unit, Santa Maria Annunziata Hospital, Department of Oncology, Azienda USL Toscana Centro, Florence, Italy
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Cheli S, Cavalletti V, Flett GL, Hewitt PL. Perfectionism unbound: An integrated individual and group intervention for those hiding imperfections. J Clin Psychol 2022; 78:1624-1636. [PMID: 35486835 DOI: 10.1002/jclp.23365] [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: 03/11/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 11/06/2022]
Abstract
The tendency to hide and mask suffering and one's perceived imperfections is one of the biggest obstacles in treating those with prominent perfectionistic traits. In this single case, we present an integrative form of psychotherapy for patients with recurrent strategies aimed at neither displaying nor disclosing their perfectionism. Emily was a 26-year-old woman diagnosed with Major Depressive Disorder and reported a personality pathology as diagnosed through the Alternative Model of Personality Disorders. The intervention comprised of a 4-month individual therapy and 2-month group therapy. The former is based on Metacognitive Interpersonal Therapy protocol for personality disorders. The latter is a protocol that integrates the Dynamic Relational Treatment for Perfectionism and Compassion Focused Therapy. At the end of this integrative treatment, Emily remitted from Major Depressive Disorder and personality pathology. Further studies should confirm our promising results in larger samples.
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Affiliation(s)
- Simone Cheli
- School of Human Health Sciences, University of Florence, Florence, Italy.,Center for Psychology & Health, Tages Charity, Florence, Italy
| | | | - Gordon L Flett
- LaMarsh Centre for Child and Youth Research, York University, Toronto, Ontario, Canada
| | - Paul L Hewitt
- Perfectionism and Psychopathology Lab, University of British Columbia, Vancouver, British Columbia, Canada
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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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Cheli S, Cavalletti V, Petrocchi N. An online compassion-focused crisis intervention during COVID-19 lockdown: a cases series on patients at high risk for psychosis. Psychosis 2020. [DOI: 10.1080/17522439.2020.1786148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Simone Cheli
- School of Human Health Sciences, University of Florence, Florence, Italy
- Center for Psychology & Health, Tages Charity, Florence, Italy
| | | | - Nicola Petrocchi
- Department of Economics and Social Sciences, John Cabot University, Rome, Italy
- Compassionate Mind Italia, Rome, Italy
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Saggino A, Balsamo M, Carlucci L, Cavalletti V, Sergi MR, da Fermo G, Dèttore D, Marsigli N, Petruccelli I, Pizzo S, Tommasi M. Psychometric Properties of the Italian Version of the Young Schema Questionnaire L-3: Preliminary Results. Front Psychol 2018; 9:312. [PMID: 29636710 PMCID: PMC5880909 DOI: 10.3389/fpsyg.2018.00312] [Citation(s) in RCA: 16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/26/2018] [Indexed: 11/29/2022] Open
Abstract
Schema Therapy (ST) is a well-known approach for the treatment of personality disorders. This therapy integrates different theories and techniques into an original and systematic treatment model. The Young Schema Questionnaire L-3 (YSQ-L3) is a self-report instrument, based on the ST model, designed to assess 18 Early Maladaptive Schemas (EMSs). During the last decade, it has been translated and validated in different countries and languages. This study aims to establish the psychometric properties of the Italian Version of the YSQ-L3. We enrolled two groups: a clinical (n = 148) and a non-clinical one (n = 918). We investigated the factor structure, reliability and convergent validity with anxiety and depression between clinical and non-clinical groups. The results highlighted a few relevant findings. Cronbach's alpha showed significant values for all the schemas. All of the factor models do not seem highly adequate, even if the hierarchical model has proven to be the most significant one. Furthermore, the questionnaire confirms the ability to discriminate between clinical and non-clinical groups and could represent a useful tool in the clinical practice. Limitations and future directions are discussed.
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Affiliation(s)
- Aristide Saggino
- School of Medicine and Health Sciences, Università degli Studi 'G. d'Annunzio' Chieti - Pescara, Chieti, Italy.,Center for the Study of Personality, Napoli, Italy
| | - Michela Balsamo
- School of Medicine and Health Sciences, Università degli Studi 'G. d'Annunzio' Chieti - Pescara, Chieti, Italy
| | - Leonardo Carlucci
- School of Medicine and Health Sciences, Università degli Studi 'G. d'Annunzio' Chieti - Pescara, Chieti, Italy
| | - Veronica Cavalletti
- IPSICO - Istituto di Psicologia e Psicoterapia Comportamentale e Cognitiva, Firenze, Italy
| | - Maria R Sergi
- School of Medicine and Health Sciences, Università degli Studi 'G. d'Annunzio' Chieti - Pescara, Chieti, Italy
| | - Giorgio da Fermo
- Azienda USL di Pescara, Pescara, Italy.,Centro di Psicologia Clinica, Pescara, Italy
| | - Davide Dèttore
- Department of Health Sciences, Florence University, Florence, Italy
| | - Nicola Marsigli
- IPSICO - Istituto di Psicologia e Psicoterapia Comportamentale e Cognitiva, Firenze, Italy
| | - Irene Petruccelli
- Department of Human Sciences and Society, Enna "Kore" University, Enna, Italy
| | - Susanna Pizzo
- Cognitive and Behavioral Therapy Institute, Padua, Italy
| | - Marco Tommasi
- School of Medicine and Health Sciences, Università degli Studi 'G. d'Annunzio' Chieti - Pescara, Chieti, Italy.,Center for the Study of Personality, Napoli, Italy
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