Early maladaptive schemas in patients with somatoform disorders and somatization.

Maladaptive schemas are stable relational patterns that develop through harmful childhood experiences with primary caregivers. Schemas within somatoform disorders are rarely explored even though these disorders are clinically important due to high prevalence, co-morbidity, and cost for the health care system. This study investigates schemas according to Young's schema theory in patients with somatoform disorders in comparison with healthy controls and patients with depressive or anxiety disorders. Further associations between schemas and somatization were explored. We included 134 patients with a somatoform disorder and 39 age-matched healthy controls, 83 patients with a unipolar depression, and 34 patients with an anxiety disorder. The clinical sample consists of day care patients, diagnosed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, but without a personality disorder. Primary measures were the Young Schema Questionnaire (YSQ-S2), the Screening for Somatoform Disorders (SOMS-7T), the Beck Depression Inventory, Second Edition, and the Childhood Trauma Questionnaire. Analyses of variance indicated that somatoform patients scored higher on almost all schemas than do healthy controls (p < 0.001, η2  = 0.148). The highest mean scores were reached for the schemas "self-sacrifice" and "unrelenting standards," with significant higher values in the patient sample. However, when compared with patients with depressive or anxiety disorders, somatoform patients scored equally or even lower. High somatization was associated with generally higher schema activation. This effect was to a great extent mediated by depressive symptoms. Only the schema "vulnerability to harm or illness" was exclusively related to somatization. These findings suggest that schemas should be systematically assessed within psychotherapy of somatoform patients.

The clinical trait self-criticism and its relation to psychopathology: A systematic review - Update.

BACKGROUND: Self-criticism represents a central phenomenon in a variety of mental disorders. The review looks at the recent body of literature (2012-2018) to summarize the relation of self-criticism and psychopathology beyond depression and aims at detecting how different conceptualizations of self-criticism with psychoanalytical, psychodynamic, or cognitive-evolutionary background are related to psychopathology. Furthermore, latest treatment approaches for dysfunctional forms of self-criticism are reviewed. METHODS: The literature research of five databases (PsycINFO, PSYNDEX, PubMed, Medline, and Cochrane Library) took place in August 2018. Inclusion criteria for studies to enter the review narrative were an adult sample, non-clinical samples as well as clinical samples, and an empirical approach, which resulted in quantitative data. RESULTS: 48 studies entered the review. Besides depressive symptoms, self-criticism showed positive relations to symptoms of eating disorders, social anxiety disorder, and personality disorders as well as to psychotic symptoms or interpersonal problems through different conceptualizations of self-criticism. Regarding the treatment of self-criticism, compassion- or emotion-focused therapy interventions were investigated in most of the reviewed studies and both reduced self-criticism in clinical and non-clinical samples. However, harsh forms of self-criticism were more persistent and difficult to change. LIMITATIONS: The review focused only on the latest empirical findings regarding self-criticism and psychopathology. CONCLUSION: Potentially functional forms and functions of self-criticism need further consideration, as they represent a possible goal of psychotherapeutic treatment. Future research should address specific questions regarding antecedents and consequences of self-criticism.

Effects of cognitive-behavioral therapy with relaxation vs. imagery rescripting on psychophysiological stress responses of students with test anxiety in a randomized controlled trial.

Background and objectives: Psychophysiological measures were assessed in university students during a test simulation before and after group treatment for test anxiety based on cognitive behavioral therapy (CBT), including relaxation techniques (CBT + R) or imagery rescripting (CBT + ImRs) and a moderated self-help group (SH) to understand if psychophysiological stress responses change after treatment. Design: Students suffering from test anxiety were recruited (n = 180) and three different test anxiety treatments administered in 3-hr group sessions once a week over a period of five weeks. Methods: During an experimental socially evaluative situation state anxiety and physiological stress responses of participants were obtained before and after treatment. Results: In all treatment groups, self-reported state anxiety in a stressful socially evaluative situation declined after treatment. Contrary to our hypotheses no significant reduction of physiological reactivity scores after intervention was found in any of the three group treatments. Conclusions: CBT and SH treatments are successful in reducing self-reported state anxiety in a socially evaluative situation, but psychophysiological stress responses in test anxiety patients remained unchanged despite all treatments.

The relation between social identity and test anxiety in university students.

Social identification has been shown to be a protective resource for mental health. In this study, the relationships between social identification and emotional, as well as cognitive symptoms of test anxiety are investigated. Participants were university students diagnosed with test anxiety (N = 108). They completed questionnaires regarding a range of psychopathologic stress symptoms, and their social identification with fellow students and with their study program. Results reveal negative relations between social identification and almost all investigated emotional and cognitive symptoms of test anxiety. Based on this study, interventions could be developed that strengthen the social identity of university students.

Group schema therapy for personality disorders: A pilot study for implementation in acute psychiatric in-patient settings.

Group schema therapy (GST) has been proposed as a novel long-term treatment programme for borderline and cluster C personality disorders. We implemented a short-term GST programme (12-15 sessions, based on the manual by Farrell and Shaw (2012), including both cognitive / behavioural and experiential interventions for in-patients (n=9) with either borderline or cluster C personality disorders (and axis I co-morbidities) treated in a (sub)acute psychiatric in-patient setting. We evaluated pre- and post-treatment self-report of maladaptive and adaptive schema modes (using the SMI) and early maladaptive schemas (YSQ-3), as well as overall symptom severity (brief symptom check list, BSCL-53-S), patient satisfaction (ZUF-8) and group climate and coherence (GCQ-S). We found significant reduction of symptoms, and trend-level improvement for schema mode activation, but not maladaptive schemas. Effect sizes of Cohen's d=0.857 for symptoms and d=0.693 for maladaptive schema mode reduction were, however, lower than previous GST trials in in-patient settings with a longer treatment phase and outpatient GST trials using the Farrell and Shaw-model, indicating importance of duration in ST treatment. Our findings in this uncontrolled study provide first evidence that GST (based on the Farrell and Shaw model) can be implemented and adapted for use in short-term in-patient (sub)acute settings.

Effects of cognitive behavioral therapy with relaxation vs. imagery rescripting on test anxiety: A randomized controlled trial.

BACKGROUND: Test anxiety is a common condition in students, which may lead to impaired academic performance as well as to distress. The primary objective of this study was to evaluate the effectiveness of two cognitive-behavioral interventions designed to reduce test anxiety. Test anxiety in the participants was diagnosed as social or specific phobia according to DSM-IV. Subsequently subjects were randomized to three groups: a moderated self-help group, which served as a control group, and two treatment groups, where either relaxation techniques or imagery rescripting were applied. METHODS: Students suffering from test anxiety were recruited at two German universities (n=180). The randomized controlled design comprised three groups which received test anxiety treatment in weekly three-hour sessions over a period of five weeks. Treatment outcome was assessed with a test anxiety questionnaire, which was administered before and after treatment, as well as in a six-month follow-up. RESULTS: A repeated-measures ANOVA for participants with complete data (n=59) revealed a significant reduction of test anxiety from baseline to six-month follow-up in all three treatment groups (p<.001). LIMITATIONS: Participants were included if they had a clinical diagnosis of test anxiety. The sample may therefore represent only more severe forms of text anxiety . Moreover, the sample size in this study was small, the numbers of participants per group differed, and treatment results were based on self-report. Due to the length of the treatment, an implementation of the group treatments used in this study might not be feasible in all settings. CONCLUSIONS: Group treatments constitute an effective method of treating test anxiety, e.g. in university settings. Imagery rescripting may particularly contribute to treatment efficacy.

Conflicts of interest and spin in reviews of psychological therapies: a systematic review.

OBJECTIVE: To explore conflicts of interest (COI) and their reporting in systematic reviews of psychological therapies, and to evaluate spin in the conclusions of the reviews. METHODS: MEDLINE and PsycINFO databases were searched for systematic reviews published between 2010 and 2013 that assessed effects of psychological therapies for anxiety, depressive or personality disorders, and included at least one randomised controlled trial. Required COI disclosure by journal, disclosed COI by review authors, and the inclusion of own primary studies by review authors were extracted. Researcher allegiance, that is, that researchers concluded favourably about the interventions they have studied, as well as spin, that is, differences between results and conclusions of the reviews, were rated by 2 independent raters. RESULTS: 936 references were retrieved, 95 reviews fulfilled eligibility criteria. 59 compared psychological therapies with other forms of psychological therapies, and 36 psychological therapies with pharmacological interventions. Financial, non-financial, and personal COI were disclosed in 22, 4 and 1 review, respectively. 2 of 86 own primary studies of review authors included in 34 reviews were disclosed by review authors. In 15 of the reviews, authors showed an allegiance effect to the evaluated psychological therapy that was never disclosed. Spin in review conclusions was found in 27 of 95 reviews. Reviews with a conclusion in favour of psychological therapies (vs pharmacological interventions) were at high risk for a spin in conclusions (OR=8.31 (1.41 to 49.05)). Spin was related in trend to the inclusion of own primary studies in the systematic review (OR=2.08 (CI 0.83 to 5.18) p=0.11) and researcher allegiance (OR=2.63 (0.84 to 8.16) p=0.16). CONCLUSIONS: Non-financial COI, especially the inclusion of own primary studies into reviews and researcher allegiance, are frequently seen in systematic reviews of psychological therapies and need more transparency and better management.

Reliability and validity of the Danish version of the Schema Mode Inventory (SMI).

Schema modes are conceptualized as different parts of oneself, related to specific emotions, cognitions, and behaviors. They are a central concept in schema therapy for personality pathology and other chronic psychiatric disorders. Prior research confirms the factorial validity of the Schema Mode Inventory (SMI), an instrument to assess schema modes. This study presents an evaluation of the Danish version of the SMI, including reliability and validity analyses. Psychometric properties, such as factor structure, internal reliability, as well as intercorrelations between subscales were assessed. This was done on the basis of a mixed Danish sample (N = 657; M age = 29.32 years; range = 18-66 years; 78.5% females) composed of 266 clinical and 391 nonclinical adult participants. Results indicated model fit for the 14-factor structure of the SMI and adequate to excellent internal reliabilities of the 14 subscales (Cronbach's α =.74-.96). Furthermore, the SMI scales differentiated between clinical and nonclinical participants as theoretically predicted. These findings imply that the SMI is a sound instrument to measure the schema mode model in a Danish setting, both for clinical and research purposes, and in particular for assessment prior to schema therapy.

Responding to the treatment challenge of patients with severe BPD: results of three pilot studies of inpatient schema therapy.

BACKGROUND: Schema Therapy (ST), a psychotherapy model integrating cognitive, experiential and behavioural interventions, was initially developed and evaluated as an outpatient treatment for patients with severe and chronic disorders, among them Borderline Personality Disorder (BPD). Two randomized controlled trials have demonstrated the effectiveness of ST for BPD, delivered in an individual or group format, in the outpatient setting. However, the most severely impaired BPD patients are referred to inpatient treatment due to suicidality and severe self-harm. Specialized inpatient treatment programs are limited, with little evaluative research. AIMS: The pilot studies are designed to be first steps in naturalistic clinical settings to evaluate the effects of an intensive inpatient ST treatment program. METHOD: This report presents the results of three independent uncontrolled pilot studies with a total of 92 BPD patients. The programs combine individual and group modalities and are consistent theoretically with the ST model for BPD patients. RESULTS: RESULTS show that inpatient ST can significantly reduce symptoms of severe BPD and global severity of psychopathology with effect sizes ranging from Cohen's d = 2.84 to Cohen's d = .43. CONCLUSIONS: Differences in the effect sizes across the three pilot studies could be explained by length of treatment, number of group psychotherapists and their training. Although there are limitations to the presented pilot studies such as differences in the samples, treatment settings, variations in the treatment itself and the use of different measures, which may have influenced outcome, they are a starting point for describing and evaluating inpatient treatment for BPD in naturalistic settings.

[Treatment satisfaction of patients with borderline personality disorder in inpatient schema therapy]. / Behandlungszufriedenheit von Patientinnen mit Borderline Persönlichkeitsstörung bei stationärer Schematherapie.

Patients with severe and chronic psychiatric disorders, such as Borderline Personality Disorder (BPD), are hospitalized frequently, but we often find a high ambivalence regarding treatment in this group of patients. 31 patients with severe BPD participated in an inpatient Schema Therapy (ST) treatment program and evaluated both the intensive ST treatment program and group therapy elements regarding their treatment -satisfaction. A high global treatment satisfaction with the ST treatment program was demonstrated and we found a higher treatment satisfaction in patients with than without BPD specific symptom reductions. Remarkable differences in treatment satisfaction showed when looking at the evaluation of group therapies. The results of the present study demonstrate treatment satisfaction of BPD patients in inpatient ST and give directions for the future development of these programs.

Positive erotic picture stimuli for emotion research in heterosexual females.

In most experimental studies, emotional pictures are widely used as stimulus material. However, there is still a lack of standardization of picture stimuli displaying erotic relationships, despite the association between a number of psychological problems and severe impairments and problems in intimate relationships. The aim of the study was to test a set of erotic stimuli, with the potential to be used in experimental studies, with heterosexual female subjects. Twenty International Affective Picture System (IAPS) pictures and an additional 100 pictures showing romantic but not explicitly sexual scenes and/or attractive single males were selected. All pictures were rated with respect to valence, arousal, and dominance by 41 heterosexual women and compared to pictures with negative, positive, and neutral emotional valence. Erotic IAPS pictures and our additional erotic pictures did not differ in any of the evaluation dimensions. Analyses of variance (ANOVAs) for valence, arousal, and dominance comparing different picture valence categories showed strong effects for category. However, valence was not significantly different between erotic and positive pictures, while arousal and control were not significantly different between positive and neutral pictures. The pictures of our new set are as positive for heterosexual women as highly positive IAPS pictures, but higher in arousal and dominance. The picture set can be used in experimental psychiatric studies requiring high numbers of stimuli per category. Limitations are the restriction of stimuli application to heterosexual females only and to self-report data.