Early maladaptive schemas mediate the relationship between severe childhood trauma and eating disorder symptoms: evidence from an exploratory study.

BACKGROUND: Childhood trauma history has frequently been linked to eating disorders (EDs); nevertheless, the scientific literature calls for extending knowledge regarding mediators between EDs and childhood trauma. This study explored whether ED symptoms and early maladaptive schemas were more severe in ED patients with severe childhood trauma than in ED patients with no/mild childhood trauma and whether early maladaptive schemas mediated the relationship between childhood trauma and ED symptom severity. METHODS: Data were extracted from the Regional Centre for Eating Disorders registry at the University Hospital of Verona. The extracted data included self-reported data, including the Eating Disorder Inventory-3 score, Young Schema Questionnaire score, Childhood Experience and Experience of Care and Abuse Questionnaire score, and sociodemographic and clinical information on the ED outpatients seeking care. A mediation analysis using the structural equation modeling procedure was conducted. RESULTS: Forty-two outpatients, 31% of whom exhibited severe childhood trauma, satisfied the criteria for registry data extraction. The severity of ED symptoms, as well as the early maladaptive schemas' scores for emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity, were greater in ED outpatients with severe childhood trauma. Furthermore, early maladaptive schemas related to defectiveness, failure, and negativity had a mediating role in the relationship between severe childhood trauma and ED symptom severity. CONCLUSIONS: This exploratory study provides preliminary evidence about the importance of early maladaptive schemas in the relationship between trauma history and ED psychopathology. In addition, ED symptoms may represent a dysfunctional attempt to avoid unpleasant emotions associated with schema activation. The results support the need to consider early maladaptive schemas in the treatment of traumatized patients with ED symptoms. Study limitations, research and clinical implications are discussed.

Eating disorder psychopathology was found to be related to a history of trauma. Nonetheless, our understanding of the mediators of the relationship between childhood trauma and eating disorders remains to be improved. The current study revealed that certain early maladaptive schemas (i.e., defectiveness, failure, and negativity) mediated the relationship between childhood trauma and eating disorder symptoms and that outpatients who experienced severe childhood trauma reported more severe eating disorder symptoms and greater severity of certain early maladaptive schemas, such as emotional deprivation, defectiveness, failure, vulnerability, insufficient self-control, and negativity. Our findings support the need to consider early maladaptive schemas in the treatment of traumatized patients with eating disorders.

Schema-driven prediction effects on episodic memory across the lifespan.

The predictive processing framework posits that one of the main functions of the brain is to anticipate the incoming information. Internal models facilitate interactions with the world by predicting future states against which actual evidence is compared. The difference between predicted and actual states, the prediction error (PE), signals novel information. However, how PE affects cognitive processing downstream is not fully understood: one such aspect pertains to how PE influences episodic memories, and whether those effect on memory differ across the lifespan. We examine the relationship between PE and episodic memory in children, young and older adults. We use a novel paradigm whereby rich visual narratives are used to build action schemas that enable probing different mnemonic aspects. To create different levels of PE, we manipulate the story endings to be either expected, neutral or unexpected with respect to the unfolded action. We show that (i) expected endings are better encoded than neutral endings and (ii) unexpected endings improve the encoding of mismatching events and other aspects of the narrative. These effects are differentially modulated across the lifespan with PE-driven encoding being more prominent in children and young adults and with schema integration playing a larger role on memory encoding in older adults. These results highlight the role of predictions by enriching past experiences and informing future anticipations.This article is part of the theme issue 'Elements of episodic memory: lessons from 40 years of research'.

Effects of social anxiety and self-schemas on the impact and meaningfulness of positive versus negative social autobiographical memories.

OBJECTIVE: Social anxiety is characterized by maladaptive self-schemas about being socially undesirable. Self-schemas are deeply held beliefs which are derived from negative autobiographical memories of painful social experiences. In contrast to the plethora of past research on negative memories in social anxiety, almost no research has investigated objectively positive social autobiographical memories. In this preregistered study, we examined the effects of social anxiety and self-schemas on the appraised impact and meaningfulness of retrieved positive versus negative social autobiographical memories. METHOD: Participants recruited via Prolific (final n = 343) were randomized to one of two conditions in which they were instructed to retrieve, orally narrate, and appraise a positive or negative social autobiographical memory of a specific experience from their personal past where they felt either valued or unvalued, respectively. RESULTS: Results demonstrated that participants rated their positive memories as more impactful and meaningful than negative memories overall, but this effect was reversed for participants who endorsed having either stronger negative self-schemas or greater social anxiety symptoms, for whom negative memories were more impactful. Additionally, participants who endorsed having stronger positive self-schemas rated their negative memories as significantly less impactful and their positive memories as nearly more impactful. CONCLUSION: Together, these results elucidate how self-schemas and social anxiety are related to autobiographical memory appraisals, paving the way for future research on memory-based therapeutic interventions for social anxiety disorder.

Examining Social Anxiety Symptoms with Early Maladaptive Schemas: The Mediating Role of Mindfulness and Self-Compassion. / Sosyal Kaygi Belirtilerinin Erken Dönem Uyumsuz Semalar Açisindan Incelenmesi: Bilinçli Farkindalik ve Öz-Sefkatin Araci Rolü.

OBJECTIVE: This study aims to determine early maladaptive schema domains that significantly predict social anxiety symptoms in university students and to examine whether mindfulness and self-compassion play mediating roles in the correlation of these schema domains with social anxiety symptoms. METHOD: 440 students from various departments of universities participated in the study. Liebowitz Social Anxiety Scale, Young Schema QuestionnaireShort Form 3, Five Facets Mindfulness Questionnaire, and Self-Compassion Scale were used to evaluate social anxiety, early maladaptive schema domains, mindfulness, and self-compassion, respectively. RESULTS: The hierarchical regression analyses demonstrated that maladaptive schemas in the domains of disconnection, impaired autonomy, and unrelenting standards significantly predicted the increase in social anxiety symptoms. It was found that the level of mindfulness mediated the correlations between these three schema domains and social anxiety symptoms. Moreover, self-compassion mediated the correlations between the schema domains of impaired autonomy and unrelenting standards and social anxiety symptoms. CONCLUSION: Findings indicate the importance of both specific schema domains and the level of mindfulness and self-compassion in explaining social anxiety symptoms in university students. The results' possible causes and clinical implications were discussed in light of the current literature.

The Relationship Between Early Maladaptive Schemas and Coping Styles, Reasons for Drinking, Craving and Remission in Patients with Alcohol Use Disorder. / Alkol Kullanim Bozuklugu Hastalarinda Erken Dönem Uyumsuz Semalar ve Basa Çikma Biçimlerinin, Içme Nedenleri, Aserme ve Remisyon Öyküsü ile Iliskisi.

OBJECTIVE: Alcohol Use Disorder (AUD) is a serious mental disorder that affects the individual, family, environment and society as a whole. In this study, we aimed to analyze the relationship between early maladaptive schemas and coping styles, with craving, reasons for consumption and finally remission history. METHOD: This is a cross sectional study. We included 90 Erenköy Mental Health and Neurological Diseases Training and Research Hospital AMATEM patients with AUD according to DSM-5. AUD diagnosis is confirmed by SCID-5 CV. Subjects with additional psychiatric conditions are excluded. Subjects without withdrawal symptoms by CIWA-Ar are included. Sociodemographic data form, Young Schema Questionnaire Short form-3, Young Rygh Avoidance Inventory, Young Compensation Inventory, Drinking Motives Questionnaire-Revised, Obsessive Compulsive Drinking Scale was applied. RESULTS: Our findings show that male subjects who have early maladaptive schemas, especially in Impaired autonomy and performance; Failure, Disconnection and rejection; Social Isolation/alienation, Impaired Limits; Insufficient Self-Control/Self-Discipline domains, experience more cravings. Individuals coping with the Psychosomatism, Activity and Distraction, and Rebellion schemes experienced more craving. Those who coped with 'schema avoidance' tended towards alcohol consumption with Coping Motivation, and those who coped with 'schema compensation' with Impact Enhancement and Social motivations. There was no significant difference between the scores of the scales and the craving levels between the groups with and without a history of permanent remission. CONCLUSION: The data in our study showed that early maladaptive schemas and ways of coping with schemas are associated with craving. In the early stages of treatment, it is important to consider cognitive intervention focused on schemas and coping styles.

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.

Substance Use and Its Relationship With Attachment and Early Maladaptive Schemes in Adolescents in Ecuador.

Given the scarcity of studies addressing substance consumption and its relationship with attachment styles and early maladaptive schemas in adolescents, the present study is proposed. Aims of this study are to analyze the relationship among attachment styles, early maladaptive schemas, and substance use; test the predictive role of attachment styles on substance use; and observe the mediating role of early maladaptive schemas in the relationship between attachment and substance use. The sample consisted of 1533 adolescents from Ecuador (53.9% males) aged between 14 and 18 years (M = 15.76; SD = 1.25). The attachment styles of security, value to parental authority, parental permissiveness, parental interference, self-sufficiency and resentment against parents, childhood trauma, and family concern predict substance use (tobacco, alcohol, tranquilizers/sedatives or sleeping pills, hashish or marijuana, cocaine, GHB or liquid ecstasy, ecstasy, amphetamines/speed, hallucinogens, heroin, inhalants/volatiles), and the mediating role of early maladaptive schemas is confirmed (explained variance up to 33.33%). Identifying risk or vulnerability factors, such as attachment and early maladaptive schemas related to substance consumption, is especially relevant for designing and implementing preventive interventions in the adolescent population.

Early adaptive schemas, emotional regulation, and cognitive flexibility in eating disorders: subtype specific predictors of eating disorder symptoms using hierarchical linear regression.

PURPOSE: Understanding how early adaptive schemas, cognitive flexibility, and emotional regulation influence eating disorder (ED) symptoms, and whether this differs across diagnostic subtypes is critical to optimising treatment. The current study investigated the relationship between these variables and ED symptomology in individuals self-reporting an ED diagnosis and healthy controls. METHODS: A dataset of 1576 online survey responses yielded subsamples for anorexia nervosa (n = 155), bulimia nervosa (n = 55), binge eating disorder (n = 33), other specified feeding or eating disorder (n = 93), and healthy participants (n = 505). The hierarchical linear regression analysis included Eating Disorder Examination Questionnaire 6.0 Global Score as the dependent variable; Young Positive Schema Questionnaire, Emotional Regulation Questionnaire, and Cognitive Flexibility Inventory subscale scores as the independent variables; and demographic measures as the covariates. RESULTS: The number of significant predictors varied considerably by ED sub-group. Amongst the anorexia nervosa, bulimia nervosa, and healthy subsamples, the adaptive schema Self-Compassion and Realistic Expectations was associated with lower ED symptom severity. In comparison, age and body mass index were the strongest predictors for binge eating disorder, whilst the Expressive Suppression (a subscale of the Emotional Regulation Questionnaire) was the strongest predictor for other specified feeding or eating disorders. CONCLUSION: Early adaptive schemas, cognitive flexibility, and emotional regulation vary across ED subtype, suggesting the need for tailored treatment that disrupts the self-reinforcing cycle of ED psychopathology. Future research investigating how early adaptive schemas may predict or be associated with treatment response across diagnostic subtypes is needed. LEVEL OF EVIDENCE: Level IV, evidence obtained from multiple time-series with or without the intervention, such as case studies.

The influence of social knowledge structures on hostile attribution bias in aggressive and nonaggressive individuals: An ERP study.

According to several social-cognitive models, social knowledge structures described as hostile scripts or schemas may explain why aggressive individuals are prone to attribute hostile intention to others' ambiguous behaviors, a cognitive bias called hostile attribution bias (HAB). The aggression-related concepts in aggressive individuals' semantic memory would be highly accessible, notably through the activation of hostile concepts in nonhostile social contexts, and such an activation would result in HAB. The aim of the study was to test this hypothesis using the N400 component with EEG measurements to assess objectively, in real time, the violation of hostile expectations following a nonhostile situation. To this end, scenarios with a clear nonhostile context (mismatch condition) vs. without nonhostile context (match condition) followed by a character's ambiguous provocative behavior were presented to readers, and ERPs to critical words that specified the hostile intent behind the behavior were analysed. Twelve aggressive and twelve nonaggressive individuals participated in the study. The presentation of a critical word (hostile intent) that violated nonhostile expectation caused an N400 response among nonaggressive whereas such an N400 effect was absent in aggressive individuals. The results suggest that, in nonaggressive individuals, a nonhostile social context activates nonhostile concepts, whereas in the same context, aggressive individuals activate nonhostile as well as hostile concepts. Numerous research applications of the Hostile Expectancy Violation paradigm in the field of HAB are discussed.

A person-centered, transdiagnostic schema and mode profile approach to predict outcome in time-limited schema group therapy.

OBJECTIVE: This study employs a person-centered transdiagnostic approach to examine how schema and mode profiles predict symptom severity reduction in schema group therapy for patients with personality disorders and enduring clinical syndromes. METHOD: We analyzed symptom reduction in 248 patients across three formats of manualized, time-limited schema group therapy. Latent profile analysis and mixed multilevel modeling were used to determine the extent to which schema/mode classes predict symptom reduction, and whether the inclusion of individual schemas and modes enhances these predictions. RESULTS: No significant differences in treatment outcomes were found across the group modalities. A three latent profile solution for schemas and modes showed external validity with clinical variables and demonstrated that declines in symptom severity varied by schema and mode class, even after adjusting for baseline symptom severity. Adding the Vulnerability to Harm schema and Vulnerable Child mode to the model increased the explained variance. CONCLUSION: Patients with more severe personality problems show more substantial symptom reduction. Both schema and mode profiles significantly contribute to predicting post-treatment symptom levels. Understanding these profiles may help therapists tailor interventions more effectively, consistent with Young's theoretical model.Trial registration: ISRCTN.org identifier: ISRCTN17262253.

Memory's gatekeeper: The role of PFC in the encoding of congruent events.

Theoretical models conventionally portray the consolidation of memories as a slow process that unfolds during sleep. According to the classical Complementary Learning Systems theory, the hippocampus (HPC) rapidly changes its connectivity during wakefulness to encode ongoing events and create memory ensembles that are later transferred to the prefrontal cortex (PFC) during sleep. However, recent experimental studies challenge this notion by showing that new information consistent with prior knowledge can be rapidly consolidated in PFC during wakefulness and that PFC lesions disrupt the encoding of congruent events in the HPC. The contributions of the PFC to memory encoding have therefore largely been overlooked. Moreover, most theoretical frameworks assume random and uncorrelated patterns representing memories, disregarding the correlations between our experiences. To address these shortcomings, we developed a HPC-PFC network model that simulates interactions between the HPC and PFC during the encoding of a memory (awake stage), and subsequent consolidation (sleeping stage) to examine the contributions of each region to the consolidation of novel and congruent memories. Our results show that the PFC network uses stored memory "schemas" consolidated during previous experiences to identify inputs that evoke congruent patterns of activity, quickly integrate it into its network, and gate which components are encoded in the HPC. More specifically, the PFC uses GABAergic long-range projections to inhibit HPC neurons representing input components correlated with a previously stored memory "schema," eliciting sparse hippocampal activity during exposure to congruent events, as it has been experimentally observed.

Early maladaptive schemas in autogenous and reactive subtypes of obsessive-compulsive disorder.

AIMS: The aim of this study is to identify early maladaptive schemas in patients with obsessive-compulsive disorder (OCD) and to determine the use of these schemas in OCD autogenous and reactive subtypes. METHODS: The study population included 40 healthy volunteers, and 90 patients diagnosed with OCD. The Yale-Brown Obsession-Compulsion Scale (Y-BOCS) was administered to the OCD group to determine the severity of the disorder, and the Y-BOCS Symptom Checklist was applied to determine the patients with autogenous (n = 37) and reactive (n = 53) subtypes of OCD. Young Schema Questionnaire-Short Form 3 (YSQ-SF3) scales were applied to all participants. RESULTS: When autogenous and reactive subtype groups of OCD were compared with each other, the schema domains of disconnection (p = 0.004), high standards (p = 0.008), other-directedness (p < 0.001) and the schema dimensions of failure (p < 0.001), emotional deprivation (p < 0.001), defectiveness (p = 0.007), approval seeking (p = 0.007) and punishment (p = 0.001) were found to be more dominant in the autogenous group. CONCLUSIONS: The findings of the study support that there are differences between autogenous and reactive subtypes of OCD in terms of dominant schemas. Therefore, its thought that the use of Schema Therapy methods in which schemas appropriate for subtypes are investigated in the treatment of OCD patients will contribute favorably to the treatment response.

Involving Parents in Cognitive Behavioral Therapy for Children and Adolescents with Conduct Problems: Goals, Outcome Expectations, and Normative Beliefs About Aggression are Targeted in Sessions with Parents and Their Child.

Children and adolescents with conduct problems participate in Cognitive Behavioral Therapy (CBT), either in individual or group format, in view of learning social problem-solving skills that enable them to behave in more independent and situation-appropriate ways. Parents must support their child's learning processes in everyday life and therefore these processes need attention in CBT sessions in which parents and their child participate. The social problem-solving model of CBT previously described (Matthys & Schutter, Clin Child Fam Psychol Rev 25:552-572, 2022; Matthys & Schutter, Clin Child Fam Psychol Rev 26:401-415, 2023) consists of nine psychological skills. In this narrative review we propose that instead of addressing each skill separately in sessions with both parents and their child, therapists work on three schemas (latent mental structures): (1) goals, (2) outcome expectations, and (3) normative beliefs about aggression. Based on social-cognitive and cognitive neuroscience studies we argue that these three schemas affect five core social problem-solving skills: (1) interpretation, (2) clarification of goals, (3) generations of solutions, (4) evaluation of solutions, and (5) decision-making. In view of tailoring CBT to the individual child's characteristic schemas and associated social problem-solving skills, we suggest that children and adolescents participate in individual sessions with their parents. The therapist uses Socratic questioning in order to find out characteristic schemas of the child, encourage reflection on these schemas, and explore alternative schemas that had previously been outside the child's attention. The therapist functions as a model for parents to ask their child questions about the relevant schemas with a view of achieving changes in the schemas.

To update or to create? The influence of novelty and prior knowledge on memory networks.

Schemas are foundational mental structures shaped by experience. They influence behaviour, guide the encoding of new memories and are shaped by associated information. The adaptability of memory schemas facilitates the integration of new information that aligns with existing knowledge structures. First, we discuss how novel information consistent with an existing schema can be swiftly assimilated when presented. This cognitive updating is facilitated by the interaction between the hippocampus and the prefrontal cortex. Second, when novel information is inconsistent with the schema, it likely engages the hippocampus to encode the information as part of an episodic memory trace. Third, novelty may enhance hippocampal dopamine through either the locus coeruleus or ventral tegmental area pathways, with the pathway involved potentially depending on the type of novelty encountered. We propose a gradient theory of schema and novelty to elucidate the neural processes by which schema updating or novel memory traces are formed. It is likely that experiences vary along a familiarity-novelty continuum, and the degree to which new experiences are increasingly novel will guide whether memory for a new experience either integrates into an existing schema or prompts the creation of a new cognitive framework. This article is part of the theme issue 'Long-term potentiation: 50 years on'.

Early Maladaptive Schemas and Depression in Caregivers of Individuals With Schizophrenia Spectrum and Bipolar Disorders.

OBJECTIVES: Early maladaptive schemas represent unhelpful frameworks of cognitions, emotions and subsequent behavioural responses and can be associated with depressive symptoms. Caregivers of individuals with serious mental illness (SMI) frequently report experiencing depressive symptoms. It is unclear whether depressive symptoms in caregivers are influenced by schemas. We aimed to compare activated schemas in caregivers of people with schizophrenia spectrum (SSD) and bipolar disorder (BD) diagnoses and to determine whether they were differentially related to depressive symptoms. DESIGN AND METHODS: Caregivers completed validated measures of depression and schemas. Independent samples t-tests and multivariate generalised linear models were used to assess differences in schemas and depressive symptoms between caregiver groups. Interrelationships between schema domains and caregiver depressive symptoms were delineated using correlational analyses and forward stepwise regressions. RESULTS: One hundred eight caregivers participated in the study (SSD n = 68, BD n = 40). No differences in depressive symptom severity or activated schemas were observed between caregiver groups. All schemas were significantly associated with depressive symptoms, and the Disconnection-Rejection schema domain explained the most variance in depressive symptoms in both caregiver groups. CONCLUSIONS: Schemas contribute to the severity of caregiver depression regardless of whether the person receiving care is diagnosed with SSD or BD. Schema therapeutic frameworks may be beneficial for use with caregivers to address schemas within the Disconnection-Rejection domain and alleviate depressive symptoms by reducing experiences of social isolation and alienation.

Understanding College Students' Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences.

Understanding healthcare avoidance among college students is critical. In this study, we consider two broad cognitive contributors to greater healthcare avoidance: specific early maladaptive schema and negative appraisals of students' prior worst healthcare experiences. From schema theory, we proposed college students holding greater levels of two early maladaptive schema (disconnection/rejection and impaired autonomy/performance EMS) would be more likely to appraise their problematic healthcare experience as both containing healthcare institutional betrayal (HIB) behaviors and as traumatic and betrayal-inducing; both EMS and these appraisals would predict healthcare avoidance. Using a cross-sectional survey in a large, diverse college student sample (n = 1383, 61.1% female, 18.9% African American, 7.2% Asian, 6.4% Hispanic/Latino), as predicted, both EMS were significantly related to healthcare avoidance. Furthermore, a sequential mediation model was supported, indicating students holding greater EMS of disconnection/rejection or impaired autonomy/rejection reported more HIB in their worst healthcare experience, and appraised that experience as more betraying. Taken altogether, this model accounted for 23% of the variance in students' reports of healthcare avoidance. Core beliefs formed early in life may be a foundational lens through which potentially traumatic healthcare experiences are processed in ways that can impact emerging adults' future healthcare engagement. Findings also support the importance of addressing HIB actions and repairing trauma appraisals accrued during problematic healthcare experiences to prevent healthcare avoidance by emerging adults.

How schema knowledge influences memory in older adults: Filling in the gaps, or leading memory astray?

Age-related declines in episodic memory do not affect all types of mnemonic information equally: when to-be-remembered information is in line with one's prior knowledge, or schema-congruent, older adults often show no impairments. There are two major accounts of this effect: One proposes that schemas compensate for memory failures in aging, and the other proposes that schemas instead actively impair older adults' otherwise intact memory for incongruent information. However, the evidence thus far is inconclusive, likely due to methodological constraints in teasing apart these complex underlying dynamics. We developed a paradigm that separately examines the contributions of underlying memory and schema knowledge to a final memory decision, allowing these dynamics to be examined directly. In the present study, healthy older and younger adults first searched for target objects in congruent or incongruent locations within scenes. In a subsequent test, participants indicated where in each scene the target had been located previously, and provided confidence-based recognition memory judgments that indexed underlying memory, in terms of recollection and familiarity, for the background scenes. We found that age-related increases in schema effects on target location spatial recall were predicted and statistically mediated by age-related increases in underlying memory failures, specifically within recollection. We also found that, relative to younger adults, older adults had poorer spatial memory precision within recollected scenes but slightly better precision within familiar scenes-and age increases in schema bias were primarily exhibited within recollected scenes. Interestingly, however, there were also slight age-related increases in schema effects that could not be explained by memory deficits alone, outlining a role for active schema influences as well. Together, these findings support the account that age-related schema effects on memory are compensatory in that they are driven primarily by underlying memory failures, and further suggest that age-related deficits in memory precision may also drive schema effects.

Clinical and Research Perspectives on the Therapeutic Conversation: The Case of MS. M.

This paper presents a collaboration between a clinician (C.M.J.) and a research team (W.B., B.M., and S.M.) to address the question: At an operational level, what happens in the special form of conversation that is psychotherapy? How can we study, beyond a priori lenses of psychoanalytic models, what we are actually doing when we engage in this process? How can we capture from the linear flow of conversation, the simultaneous, complex, active, interwoven, dimensional emotion schemas that words can only point toward? To address the question, we first present the need for new approaches in the current climate within the clinical and research communities. Next, we address the challenges for clinicians and researchers by using multiple code theory and derived linguistic measures that offer an objective view of the processes of subjectivity. We then apply the research methods to the clinical data to illustrate the yield of the collaborative effort-a yield that captures the connection between the linear flow of words and the arousal, verbal expression, and reflection/integration of emotion schemas without the usual filters of psychoanalytic models of process and change. The project illustrates the critical value of clinicians' perspectives to guide researchers and encourages clinicians to participate in research to advance our field. For researchers, this project represents a "fourth generation" of process research that includes the criteria of video-recorded, transcribed data; the clinician's report of their experience; a theory of how emotion-laden meaning and motivations (emotion schemas) are expressed in the therapeutic conversation; and reliable, valid measures to capture and represent those processes; and that encourages researchers to access the rich contributions of clinicians' understanding. The implication for clinical practice is a new way to look beyond the lens of psychoanalytic models into what is actually unfolding in real time.

Early maladaptive schemas, distress tolerance and self-injury in Iranian adolescents: serial mediation model of transdiagnostic factors.

BACKGROUND: Non-suicidal self-injury (NSSI) is prevalent behaviour among adolescents. Although there are different etiological models of NSSI, there is a general lack of evidence-based, comprehensive and transdiagnostic models of NSSI in adolescents. AIMS: The aim of this study was to investigate a model of transdiagnostic factors of NSSI in adolescents, testing a serial mediation model of the relationship between early maladaptive schemas (EMS), distress tolerance and NSSI through experiential avoidance and rumination. METHOD: A community sample was identified of 1014 adolescents aged 13-17, of whom 425 had a history of NSSI. A serial mediation path analytic method was utilised to examine the relationships between NSSI and its associated functions as criterion variables, EMS and distress tolerance as predictors, experiential avoidance as the first mediator and rumination as the second mediator. RESULTS: The path analytic model fit indices were good (X2/d.f. = 2.25, goodness of fit index = 0.98, normed fit index = 0.97, comparative fit index = 0.98, root mean square error of approximation = 0.054, standardised root mean squared residual = 0.028). Rumination significantly mediated the relationship between schemas of 'vulnerability to harm', 'emotional deprivation', 'social isolation', 'insufficient self-control', and NSSI frequency and intrapersonal functions. In serial fashion, experiential avoidance mediated the role of rumination in the relationship between social isolation, and insufficient self-control and NSSI frequency and intrapersonal functions. All indirect effects were significant. CONCLUSIONS: Key indirect effects were found linking maladaptive schemas and distress tolerance to NSSI frequency, and NSSI intrapersonal functions via experiential avoidance and rumination. Thus, it is important to address these transdiagnostic factors with particular emphasis on the sequential mediating role of experiential avoidance and rumination in conceptualisation and therapeutic interventions for NSSI.

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.