Efficacy of an Intensive Exposure Intervention for Individuals With Persistent Concussion Symptoms Following Concussion: A Concurrent Multiple Baseline Single-Case Experimental Design (SCED) Study.

OBJECTIVE: After a concussion, 1 in 3 patients report persistent symptoms and experience long-term consequences interfering with daily functioning, known as persistent concussion symptoms (PCS). Evidence suggests PCS is (partly) maintained by anxious thoughts about brain functioning, recovery, and experienced symptoms, leading to avoidance behaviors, which may prevent patients from meeting life demands. We aimed to investigate the efficacy of a newly developed intensive exposure intervention for individuals with PCS after concussion aimed to tackle avoidance behavior. SETTING: Participants took part in the intervention at the Maastricht University faculty. PARTICIPANTS: Four participants who experienced PCS after concussion partook in the exploratory study. Participants' age ranged between 20 and 32 (mean = 26.5, SD = 5.9) years, with an average length of time after the concussion of 9.8 months. DESIGN: A concurrent multiple-baseline single-case design was conducted. The baseline period (A phase) length was randomly determined across participants (3, 4, 5, or 6 weeks). The exposure intervention (B phase) was conducted by psychologists over a 4-week period and consisted of 3 stages: exploration (2 sessions), active exposure (12 sessions conducted over 1 week), and 2 booster sessions. MAIN MEASURES: Participants answered daily questions on a visual analog scale related to symptom experience, satisfaction with daily functioning, and degree of avoidance of feared activities. Additional outcomes included symptom severity, catastrophizing, fear of mental activity, anxiety, depression, and societal participation. RESULTS: Tau-U yielded significant effects ( P < .05) for all participants on all measures when comparing baseline and intervention phases. The pooled standardized mean difference was high for all measures (symptom experience = 0.93, satisfaction of daily functioning = 1.86, and activity avoidance = -2.05). CONCLUSIONS: The results show efficacy of the newly developed intensive exposure treatment for PCS after concussion, which is based on the fear avoidance model. Replication in a larger heterogeneous sample is warranted and needed.

Interventions Targeting Negative Mental Imagery in Social Anxiety: A Systematic Review and Meta-Analysis of Characteristics and Outcomes.

Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.

Negative Flashforward Imagery in Adolescent Social Anxiety Disorder: A Pilot Study of Imagery Reports and a Short EMDR Intervention.

Psychological treatments for social anxiety disorder (SAD) in adolescents have shown poorer outcomes than for other anxiety disorders. A relevant factor to consider for improving outcomes may be negative imagery. In this pilot study, we examined negative 'flashforward' imagery of feared catastrophic outcomes in adolescents with SAD and evaluated the feasibility and preliminary outcomes of a short eye movement desensitization and reprocessing (EMDR) intervention targeting this imagery. We used a case series design with a 1-week baseline period. Outcomes included symptoms of social anxiety and avoidance related to selected social situations and features of associated flashforward imagery as the proposed mechanism of change during the intervention. We found that six out of seven assessed adolescents reported to experience flashforwards and rated image distress, vividness and threat appraisal as high. In these six participants (aged 14-17 years old), the short EMDR flashforward intervention appeared feasible and was followed by a decrease in social anxiety and avoidance in five participants, while no notable changes were observed during the baseline period. Furthermore, we observed a decrease in flashforward imagery features in at least five participants. Nonparametric tests of the overall (group-based) changes during the intervention period partially supported these findings. Limitations include the small sample size and the lack of a control group. Results suggest that vivid and distressing flashforward imagery is a common experience and that targeting flashforwards with EMDR may be beneficial in treating social anxiety in youth. Further experimental research on effects and added value to current treatments is necessary. Trial Registration: Dutch Clinical Trial Register (National Trial Register [NTR]): NL8974.

Personality disorder traits, maladaptive schemas, modes and coping styles in participants with complex dissociative disorders, borderline personality disorder and avoidant personality disorder.

OBJECTIVE: The schema mode model offers a new conceptualisation of complex dissociative disorders (CDD) as it explains shifts between identities as shifts between schema modes. Furthermore, in this model CDD is conceived as personality pathology, incorporating core features of personality disorders. This study tested the assumptions of this schema mode model of CDD. METHOD: Questionnaires measuring personality disorder traits, schemas, schema modes and coping styles were filled out by patients with CDD, borderline personality disorder and avoidant personality disorder (N = 210), and their scores on the various constructs were compared. RESULTS: Participants with CDD were characterised by specific schizoid, schizotypal, borderline and avoidant personality traits and early maladaptive schemas in the domains of disconnection and rejection and over-vigilance and inhibition. The most pronounced schema modes were the dysfunctional parent modes, avoidant coping modes and the vulnerable child mode. For coping styles, no differences were found between the diagnostic groups. CONCLUSION AND DISCUSSION: On all outcome measures participants with CDD scored at the level of personality disorders and showed a unique pattern different from participants with borderline and avoidant personality disorder. This suggests that CDD shows features akin to a personality disorder. A clinical implication is that an adapted form of schema therapy might present a viable treatment option for CDD.

No Effects of D-Cycloserine Enhancement in Exposure With Response Prevention Therapy in Panic Disorder With Agoraphobia: A Double-Blind, Randomized Controlled Trial.

PURPOSE/BACKGROUND: D-cycloserine (DCS) is a partial N-methyl-D-aspartate receptor agonist that potentially augments response to exposure therapy in anxiety disorders by enhancing extinction learning. This randomized, double-blinded, placebo-controlled augmentation trial examined (1) the effectiveness of adding 125 mg of DCS to exposure therapy (before or directly after the first 6 treatment sessions) in patients with panic disorder with agoraphobia and (2) the effectiveness of DCS augmentation preceding exposure relative to DCS augmentation directly postexposure. METHODS/PROCEDURES: Fifty-seven patients were allocated to 1 of 3 medication conditions (placebo and pre-exposure and postexposure DCS) as an addition to 6 exposure sessions within a 12-session exposure and response prevention protocol. The primary outcome measure was the mean score on the "alone" subscale of the Mobility Inventory (MI). FINDINGS/RESULTS: No differences were found in treatment outcome between DCS and placebo, administered either pre-exposure or postexposure therapy, although at 3-month follow-up, the DCS postexposure group compared with DCS pre-exposure, exhibited greater symptom reduction on the MI-alone subscale. Ancillary analyses in specific subgroups (responders vs nonresponders, early vs late responders, severely vs mildly affected patients) did not reveal any between-group DCS versus placebo differences. Finally, the study did not find an effect of DCS relative to placebo to be specific for successful exposure sessions. IMPLICATIONS/CONCLUSIONS: This study does not find an effect of augmentation with DCS in patients with severe panic disorder and agoraphobia administered either pretreatment or directly posttreatment sessions. Moreover, no preferential effects are revealed in specific subgroups nor in successful exposure sessions. Yet, a small effect of DCS administration postexposure therapy cannot be ruled out, given the relatively small sample size of this study.

Childhood-related PTSD: the role of cognitions in EMDR and imagery rescripting.

Background: The relationship between trauma-related negative cognitions and post-traumatic stress disorder (PTSD) symptoms has been studied frequently. Several studies found a mediating effect of trauma-related negative cognitions on symptom reduction in studies on different psychotherapeutic treatments, however, this relationship has never been studied in imagery rescripting (ImRs) or eye movement desensitization and reprocessing (EMDR).Objective: To analyse the role of trauma-related negative cognitions in the treatment of PTSD due to childhood trauma with EMDR and ImRs.Method: N = 155 patients with PTSD due to childhood trauma aged between 18 and 65 (M = 38.54) participated in a randomized clinical trial and were treated with either EMDR or ImRs in Australia, Germany, and the Netherlands between October 2014 and June 2019. We analysed the relationship between PTSD symptoms (Clinician-administered PTSD Scale for DSM-5, CAPS-5 and Impact of Event Scale revised; IES-R, completed twice for index trauma and for all other traumas) and trauma-related negative cognitions (Post-Traumatic Cognitions Inventory, PTCI) using Granger Causality analyses with linear mixed models on person-centered variables. Assessments were conducted pre-treatment, post-treatment (12 sessions in 6 weeks), eight weeks post-treatment, and one year after the pre-treatment assessment.Results: Changes in negative cognitions (PTCI) preceded changes in PTSD symptoms (unidirectional) as measured by the CAPS and the IES-R for index trauma. For the IES-R related to all other traumas, a unidirectional relationship was found in which changes in PTSD symptoms preceded changes in negative cognitions. No moderating effect of treatment was found. On the level of PTCI subscales only changes in cognitions about oneself preceeded changes in PTSD symptoms.Conclusions: The results support the idea of a general role of trauma-related negative cognitions in the treatment of PTSD. The analyses should be replicated with a higher frequency of assessments.

We studied the role of trauma-related negative cognitions in the treatment of post-traumatic stress disorder (PTSD) with either EMDR or ImRs.Within-person changes in trauma-related negative cognitions preceded changes in PTSD symptoms, except for self-reported PTSD symptoms of all other trauma's than the index trauma, where the opposite relationship was found.We found no moderation by treatment condition, this supports the idea of a general role of trauma-related negative cognitions in the treatment of post-traumatic stress disorder.

Psychometric properties of two instruments assessing catastrophizing and fear-avoidance behavior in mild traumatic brain injury.

OBJECTIVE: Psychometrically sound measures of catastrophizing about symptoms and fear avoidance behavior are needed to further applications of the fear-avoidance model in mild traumatic brain injury (mTBI) for research and clinical purposes. To this end, two questionnaires were adapted (minor), the Postconcussion Symptom Catastrophizing Scale (PCS-CS) and the Fear of Mental Activity Scale (FMA). This study aimed to investigate the factor structure, internal consistency, test-retest reliability, and concurrent and construct validity of two adapted questionnaires in a sample of participants with mTBI compared to participants with orthopedic injury and healthy adults. METHOD: One hundred eighty-five mTBI participants (40% female), 180 participants with orthopedic injury (55% female), and 116 healthy adults (55% female) participated in the study. All participants were assessed at two time points (2 weeks postinjury and 3 months) using self-reported questionnaires. Data were collected using online questionnaires. RESULTS: Findings indicated a three-factor model (magnification, rumination, helplessness) with a higher order factor (catastrophizing) for the PCS-CS and a two-factor model (activity avoidance and somatic focus) for the FMA. The results showed strong internal consistency, good test-retest reliability, and good concurrent and convergent validity for the PCS-CS and FMA across all samples. CONCLUSIONS: This study has shown that the PCS-CS and FMA are psychometrically sound instruments and can be considered for valid and reliable assessment of catastrophizing about postconcussion like symptoms and fear-avoidance beliefs about mental activities. These instruments can be used in research and clinical practice applications of the fear-avoidance model and add to explanations of prolonged recovery after mTBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Targeting negative flashforward imagery in speech anxiety with a visuospatial dual-task: Do attenuated flashforwards lead to less anxiety and avoidance?

BACKGROUND AND OBJECTIVES: It has been proposed that negative mental imagery plays an important role in the persistence of social fears. Experiencing vivid and distressing 'flashforward' images of a potential social catastrophe appears to be of relevance in speech anxiety. To clarify the role of these images, the current experimental study tested if reducing the vividness and distressing properties of recurring negative flashforward images subsequently reduces anxiety and avoidance tendencies regarding a speech. METHODS: Participants were female undergraduates high in speech anxiety (N = 134) who joined our study online. In the experimental condition, we used a visuospatial dual-task to reduce the vividness and distress of flashforward imagery. Primary outcomes were participants' self-reported anxiety and avoidance ratings in anticipation of and during an actual speech. As a secondary outcome, we used observer ratings of participants' anxiety during the speech. RESULTS: Participants reported moderate to high frequency and interference of their vivid and distressing flashforward images in daily life. The dual-task resulted in reductions in image vividness and distress. However, we found no differences between conditions in anxiety and avoidance ratings before and during the speech. LIMITATIONS: The imagery manipulation effect was moderate to small. Moreover, we included a subclinical sample. CONCLUSIONS: Reducing negative flashforward imagery vividness and distress with a visuospatial dual-task did not directly lead to less anxiety and avoidance tendencies related to a later speech. Thus, findings provided no support for the hypothesis that experiencing highly vivid and distressing flashforward images causally contributes to social fears.

Early Maladaptive Schemas and Schema Modes in clinical disorders: A systematic review.

PURPOSE: Although schema therapy has been predominantly applied to treat personality disorders, interest into its application in other clinical disorders is growing. Central to schema therapy are Early Maladaptive Schemas (EMS) and Schema Modes. Since existing EMS and Schema Modes were primarily developed in the context of personality disorders, their relevance for clinical disorders is unclear. METHODS: We conducted a systematic review of the presence of EMS and Schema Modes in clinical disorders according to DSM criteria. Per disorder, we evaluated which EMS and Schema Modes were more pronounced in comparison with clinical as well as non-clinical control groups and which EMS and Schema Modes were most highly endorsed within the disorder. RESULTS: Although evidence concerning EMS was scarce for several disorders, and only few studies on Schema Modes survived inclusion criteria, we identified meaningful relationships and patterns for EMS and Schema Modes in various clinical disorders. CONCLUSIONS: The present review highlights the relevance of EMS and Schema Modes for clinical disorders beyond personality disorders. Depending on the theme of the representation, EMS act as vulnerabilities both across diagnoses and for specific disorders. Thus, EMS and resulting Schema Modes are potential, valuable targets for the prevention and treatment of clinical disorders.

Schema therapy for Dissociative Identity Disorder: a case report.

Treatment for Dissociative Identity Disorder (DID) often follows a practice-based psychodynamic psychotherapy approach that is conducted in three phases: symptom stabilization, trauma processing, and identity integration and rehabilitation. The percentage of patients that reach the third phase is relatively low, treatment duration is long, and the effects of this treatment on the core DID symptoms have been found to be small or absent, leaving room for improvement in the treatment of DID. Schema Therapy (ST) is an integrative psychotherapy that has been proposed as a treatment for DID. This approach is currently being investigated in several studies and has the potential to become an evidence-based treatment for DID. This case report presents an overview of the protocol adaptations for DID ST treatment. The presented case concerns a 43-year-old female patient with DID, depressive disorder (recurrent type), PTSD, cannabis use disorder, and BPD. Functioning was very low. She received 220 sessions of ST, which included direct trauma processing through Imagery Rescripting (ImRs). The patient improved in several domains: she experienced a reduction of PTSD symptoms, as well as dissociative symptoms, there were structural changes in the beliefs about the self, and loss of suicidal behaviors. After treatment she was able to stop her punitive mode, to express her feelings and needs to others, and to participate adequately in social interaction. This case report indicates that ST might be a viable treatment for DID, adding to a broader scope of treatment options for this patient group.

The role of dissociation-related beliefs about memory in trauma-focused treatment.

OBJECTIVE: Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD: Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS: Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION: The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.

This study investigated the role of dissociation-related beliefs about memory on trauma-focused treatment.Dissociation-related beliefs were related to post-traumatic and dissociative symptoms, and were especially prominent in patients with the dissociative subtype of post-traumatic stress disorder.Dissociation-related beliefs about memory do not impact the effectiveness of trauma-focused treatment. In fact, trauma-focused treatment effectively decreased these beliefs, suggesting that dissociation-related beliefs about memory should not be a determining factor in withholding patients from receiving trauma-focused therapy.

Flashforward imagery in speech anxiety: Characteristics and associations with anxiety and avoidance.

Speech anxiety (SA) is a highly prevalent social fear. Prospective 'flashforward' (FF) imagery of an upcoming social catastrophe may be a particularly important cognitive factor in SA persistence via eliciting anxiety and avoidance behaviors. Since earlier research on imagery and social anxiety has not strictly differentiated between types of negative imagery, the occurrence, precise features, and impact of FF imagery remain unclear. We therefore examined the phenomenological characteristics of FF imagery in SA and mapped the relationship between FF imagery features and anxiety and avoidance. Female participants who approached clinical levels of SA (N = 60) completed questionnaires on SA and avoidance behaviors, and rated anxiety and avoidance in anticipation of an actual speech. FF imagery and emotionally linked autobiographical memories were assessed with semi-structured interviews. All participants reported recurring FF images, which were experienced as vivid, distressing, field perspective images with accompanying negative feelings. Image distress and feelings of threat showed most consistent associations with SA and avoidance measures. Findings add to the conceptualization of SA, and support the clinical relevance of assessing FF imagery. Future experimental studies on FF imagery characteristics are necessary to test the proposed causal impact in SA persistence and to inform additional treatment targets.

Rescripting experimental trauma: Effects of imagery and writing as a way to reduce the development of intrusive memories.

BACKGROUND AND OBJECTIVES: Imagery rescripting is an effective treatment strategy for trauma related disorders, but its underlying mechanisms are still largely unknown. The aim of the present study was to test whether a) imagery (versus writing) is essential in the process of rescripting, and b) rescripting affects emotional memories on an implicit level. METHODS: Healthy participants were subjected to an experimental trauma ('trauma film'), and randomly allocated to four conditions: recall of film + Imagery Rescripting (ImRs), recall of film + Writing Rescripting (WRs), recall only (ImRE), or no recall + no manipulation (NM). Next, participants recorded intrusion frequency and distress during one week, after which they executed a visual interference task (VIT) including neutral and trauma film stills, to access implicit emotional memory. RESULTS: Main findings were that ImRs and WRs resulted in fewer intrusions than NM, with no differences between both rescripting conditions. We did not find an effect on intrusion distress and the VIT. LIMITATIONS: Stills in the VIT were distracted from all four film scenes, whereas rescripting was done on one scene only, possibly obscuring the effect. Also, an analogue sample was used, which may limit generalizability to clinical samples. CONCLUSIONS: We replicated previous effects of ImRs on intrusion development. Furthermore, no superior effect of imagery as key modality for rescripting was found; writing seems a viable alternative. Measures for implicit emotional memory such as the VIT may have to be applied relatively soon after the experimental session (e.g., same day as the experimental session).

Schema therapy for Dissociative Identity Disorder (DID): rationale and study protocol.

Background: A category of disorders frequently associated with a history of trauma are the dissociative disorders, of which Dissociative Identity Disorder (DID) is the most severe and chronic form. DID is associated with high levels of impairment, treatment utilization, and treatment costs, yet systematic research into treatment effects is scarce. Practice-based clinical guidelines advise a phase-based approach which is lengthy and has rather high reported dropout rates. Therefore, in the current proposal the efficacy of an alternative treatment for DID (i.e. schema therapy) is tested. Objective: The aim of this study is to critically test the effectiveness of schema therapy for DID patients, for whom at present no evidence-based treatment is available. Method: In light of the low prevalence of DID, and the proposed treatment length of three years, a case series experimental approach is used (non-concurrent multiple baseline design). Ten outpatients are included, who are diagnosed with DID by an independent rater using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), which is double-checked by another independent expert. Primary outcomes are a (bi)weekly assessed state measure of dissociative symptoms, a pre-, post- and follow-up measure of the presence of the DID diagnosis, and drop-out rate. Secondary outcomes include various measures of trait dissociative symptoms, comorbid symptomatology, and global symptomatic distress. Trial registration: Netherlands Trial Register (NTR): NTR4496.

Antecedentes: Una categoría de trastornos frecuentemente asociados con un historial de trauma son los trastornos disociativos, de los cuales el trastorno de identidad disociativo (DID, por sus siglas en inglés) es la forma más grave y crónica. El DID se asocia con altos niveles de deterioro, utilización y costos de tratamiento, aunque la investigación sistemática sobre los efectos de tratamiento es escasa. Las guías clínicas basadas en la práctica aconsejan un enfoque basado en fases que es largo y tiene tasas reportadas de deserción más bien altas. Por lo tanto, en la propuesta actual, se prueba la eficacia de un tratamiento alternativo para DID (es decir, terapia de esquema). Objetivo: El objetivo de este estudio es probar críticamente la efectividad de la terapia de esquema para pacientes con DID, para quienes en la actualidad no hay disponible un tratamiento basado en la evidencia. Método: En vista de la baja prevalencia de DID y la duración del tratamiento de tres años propuesto, se utiliza un enfoque experimental de series de casos (diseño de línea base múltiple no concurrente). Se incluyen diez pacientes ambulatorios, que son diagnosticados con DID por un evaluador independiente usando el SCID-D-R, que es verificado por otro experto independiente. Los resultados primarios son una medida (bi)semanal de estado de síntomas disociativos, una medida previa, posterior y de seguimiento de la presencia del diagnóstico de DID, y tasa de deserción. Los resultados secundarios incluyen diversas medidas de los síntomas de rasgos disociativos, sintomatología comórbida y malestar sintomático global.

Correction to: Internalizing and Externalizing Behaviors Share a Common Predictor: the Effects of Early Maladaptive Schemas Are Mediated by Coping Responses and Schema Modes.

The authors would like to note that one of the co-author's names was displayed incorrectly. Not Arnoud A. Arntz, but Arnoud Arntz co-authored this article as shown above.

Validation of Schema Coping Inventory and Schema Mode Inventory in Adolescents.

This study investigated whether the schema therapy constructs of schema coping and schema modes have val dity in adolescents. We examined the validity and reliability of the Schema Coping Inventory (SCI) and an 80-item version of the Schema Mode Inventory (SMI) in a mixed sample of adolescents. Confirmatory factor analyse showed that the first-order factor structures of the SCI and SMI were replicated, but that the hypothesized higher-order models of the SMI were not confirmed. Instead, we proposed an alternative higher-order model of Internalizing, Externalizing, Overachieving, and Healthy modes. In general, the SCI and SMI scales were able o distinguish the clinical sample from the community sample, and meaningful relationships were found between oping styles, schema modes, and behavior problems. In conclusion, our study supports the theorized relations ips between schema coping styles, schema modes, and behavior, problems in adolescents, and provides initial validation for the SCI and the, 80-item SMI in adolescent populations.

Internalizing and Externalizing Behaviors Share a Common Predictor: the Effects of Early Maladaptive Schemas Are Mediated by Coping Responses and Schema Modes.

We investigated the relationships of adolescents' internalizing and externalizing behaviors with their early maladaptive schemas (EMS), coping responses, and schema modes. We focused on EMS related to experiences of disconnection and rejection that comprise vulnerable emotions, such as shame, mistrust, deprivation, abandonment, and isolation/alienation. This cross-sectional study included a total of 699 adolescents (combined clinical and non-referred sample) who were 11 to 18 years old (M = 14.6; SD = 1.6), and of which 45% was male. All participants completed self-report questionnaires on EMS, coping responses, schema modes, and behavior problems. We aimed to clarify the relationships between these variables by testing mediation, moderation, and moderated mediation models. In general, coping responses functioned as mediators rather than moderators in the relationships between EMS and schema modes. Furthermore, EMS regarding experiences of disconnection and rejection were related to both internalizing and externalizing behavior problems, and coping responses and schema modes mediated these effects. In conclusion, although adolescent internalizing and externalizing behavior problems manifest quite differently, they seem related to the same EMS.

The relationship between tics, OC, ADHD and autism symptoms: A cross- disorder symptom analysis in Gilles de la Tourette syndrome patients and family-members.

Gilles de la Tourette's syndrome (GTS) is a disorder in which obsessive-compulsive (OC), Attention Deficit Hyperactivity Disorder (ADHD) and autism symptoms occur in up to 60% of patients, suggesting shared etiology. We explored the phenotypic structure of tic, OC, ADHD, and autism symptoms as measured by the YGTSS,Y-BOCS,CAARS and AQ, in 225 GTS patients and 371 family members. First, Confirmatory Factor Analyses (CFA) were performed on the symptom structure of each separate symptom scale. Second, the symptom dimensions derived from each scale were combined in one model, and correlations between them were calculated. Using the correlation matrix, Exploratory Factor Analyses (EFA) were performed on the symptom dimensions across the scales. EFA revealed a five factor structure: tic/aggression/symmetry; OC symptoms/compulsive tics/ numbers and patterns; ADHD symptoms; autism symptoms; and hoarding/inattention symptoms. The results are partly in line with the traditional categorical boundaries of the symptom scales used, and partly reveal a symptom structure that cuts through the diagnostic categories. This phenotypic structure might more closely reflect underlying etiologies than a structure that classically describes GTS patients according to absence or presence of comorbid OCD, ADHD and autism, and might inform both future genetic and treatment studies.

Stability and discriminative power of the Young Schema-Questionnaire in a Dutch clinical versus non-clinical population.

In this study the temporal stability and general discriminative and classifying ability of the Young Schema-Questionnaire (YSQ) was examined in a clinical and non-clinical sample. To be able to cross-validate on the variables, two parallel subtests, drawn from the YSQ item pool, were utilized. Results suggest adequate rank order stability. However, mean scores tended to drop systematically over time, most likely caused by transient error. Therefore, to assess progress in therapy, the alternate utilization of the parallel parts is advised. Findings from discriminant analysis suggest high sensitivity of the YSQ and its subscales in predicting the presence or absence of psychopathology.