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.

Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short-term schema cognitive-behavioural group therapy: a naturalistic pre-treatment and post-treatment design in an outpatient clinic.

UNLABELLED: Schema therapy has proven to be an effective treatment for patients with borderline personality disorder. However, little is known of its merits in other psychiatric (personality) disorders. OBJECTIVE: This study investigated whether schema therapy in a group setting (group schema cognitive-behavioural therapy [SCBT-g]) was associated with changes in symptom and schema and mode severity. Furthermore, the aim was to search for baseline predictors and possible mediators of treatment outcome. DESIGN AND METHOD: Sixty-three heterogeneous psychiatric outpatients who attended the SCBT-g were included as participants. In this naturalistic pre-treatment and post-treatment design, data were available on the Symptom Checklist 90, the Schema Questionnaire and the Young-Atkinson Mode Inventory. RESULTS: All outcome measurements showed changes with moderate to high effect sizes, with 53.2% of the patients showing a significant reduction in severity of psychiatric symptoms and schemas and modes. Higher pre-treatment levels of the schema domain Other Directedness predicted greater symptom reduction. Pre-treatment to mid-treatment changes in schema severity predicted subsequent symptom improvement, but change in symptoms and schemas proved to be strongly correlated. CONCLUSIONS: In this naturalistic study, SCBT-g was associated with reduced symptom and schema and mode severity in more than half of the psychiatric outpatients. Furthermore, the results suggest that changes in schemas and symptomatology mutually reinforce each other. KEY PRACTITIONER MESSAGE: Over 50% of ambulatory patients show clinical improvement after treatment in a short-term schema therapy group. Other Directedness seems to be a predictor of schema group therapy success. More randomized controlled trial studies and prediction and mediation studies on (short-term) schema group therapy are sorely needed.

[Personality disorders in an institution for ambulatory mental health care. Prevalence, type and severity, treatment indication and drop out]. / Persoonlijkheidsstoornissen in een instelling voor tweedelijns geestelijke gezondheidszorg. Prevalentie, kenmerken, behandelindicatie en drop-out.

BACKGROUND: Personality disorders occur frequently. The presence of one or more personality disorders can influence the severity of the symptoms and can affect coping, treatment indication and drop out. AIM: To study the prevalence of personality disorders in an ambulatory health care centre and to investigate the influence of both the severity and the nature of personality disorders on the following: symptomatology, interpersonal behaviour, coping and defence mechanisms, personality traits, treatment indication and drop out. METHOD: We studied the prevalence of personality disorders in 100 patients using the International Personality Disorder Examination (IPDE), a semi-structured interview. Symptoms, interpersonal behaviour, coping and defence mechanisms and personality traits were assessed by means of self-reports. Patients were assigned to specific types of treatment by their own doctors, who were not aware of the assessment results. results Most of the patients suffered from a personality disorder. Patients with cluster-A-type personality disorders were all assigned to treatment. The majority of patients with cluster- B-type personality disorders were assigned to Axis-ii-type treatment but most patients with cluster-A-and cluster-C personality disorders were assigned to Axis-I-type treatment. The dropout percentage was higher among patients with a personality disorder than among those without. Among patients with personality disorders the drop-out percentage was highest in those from the A and C clusters. Patients with personality pathology from the A cluster were 13 times more likely to drop out than those without A cluster pathology, patients with C cluster pathology were 11 times more likely to drop out than those without C cluster pathology. CONCLUSION: In ambulatory mental health care more attention needs to be given to the diagnosis of personality disorders. Results suggest that in the treatment of patients with A and C cluster pathology much effort must be directed at fostering therapeutic alliance and compliance to treatment.

Psychological distress, social support and social support seeking: a prospective study among primary mental health care patients.

This study addresses the time ordering of both quantitative and qualitative social support variables, social support seeking and psychological distress. Number of contacts, perceived understanding, satisfaction, severity of network conflicts, social support seeking and symptomatology were assessed at two points in time: at the start of a short term behavioural therapy (T1) and six months later (T2). Severity of symptomatology at T2 was best predicted by the severity of symptomatology at referral and by the change in interpersonal problems. Social support-seeking was at both measurements unrelated to symptomatology. The number of contacts, satisfaction, understanding and social support seeking demonstrated high temporal stability, in contrast to symptomatology and interpersonal problems. A more fine-grained analysis demonstrated that of all social support variables, interpersonal conflicts were most strongly related to symptomatology, especially to interpersonal sensitivity and depression. It is concluded that interventions aimed in particular at relieving interpersonal sensitivity and interpersonal stress and at fostering interpersonal effectiveness may prove to be critical in breaking vicious circles.

Clinical experience with patients suffering from hyperemesis gravidarum (severe nausea and vomiting during pregnancy): thoughts about subtyping of patients, treatment and counseling models.

The medical and psychological treatment of hyperemesis gravidarum (HG) is generally acknowledged as being difficult. It is also recognized that the somatic changes during pregnancy play a role in the process of HG and that psychosocial factors are of particular importance. The following issues have been studied: psychosocial stressors; personality disorders; coping mechanisms and stress tolerance. The reviewed studies mention many different causes of HG. Some produce symptoms in certain women and some will not. As a result of clinical experience and observation during several years treating women with HG from a broad social, cultural and ethnic background in a large inner-city general hospital, we have been able to identify several subgroups of HG patients according to personality pathology, psychiatric symptoms and psychosocial stress factors. Accurate assessment is necessary in order to be able to tailor the interventions to the characteristics and needs of the individual patient. For the various subgroups different treatment strategies are recommended.

Symptomatology, social support and social support seeking: long-term results of a prospective study among primary mental health care patients.

The long-term association between social support and symptomatology is studied. Social support variables were: experienced understanding, satisfaction, number of contacts, social support seeking and severity of interpersonal conflicts. Data were collected at the start of a short-term behavioural therapy (T1) and 6 (T2) and 18 months later (T3). In addition, a comparison is made between patients who had finished their therapy by the second measurement and those who were by that time still in therapy. A fine-grained analysis demonstrated that of all social support variables interpersonal problems were most strongly related to symptomatology, in particular to interpersonal sensitivity. The tendency to seek social support becomes associated with well-being in the long term. The best predictors of symptomatology at T3 were the initial severity of symptomatology, the change in severity of symptomatology between T1 and T2 and the severity of symptomatology at T2. The social support variables did not have any prognostic significance. All social support variables retained their high temporal stability. Results are translated into practical suggestions that might help maximize gains of short-term behavioural therapy within primary mental health care.

Workshops to support the bereavement process.

When a bereaved person is in need of extra support during the bereavement process, at present four types of support can be distinguished: professional individual- and group counseling and non-professional individual- and group counseling. In this article another support facility is proposed: the workshop. It is indicated that the workshop can be considered as a valuable addition to the current counseling alternatives for bereavement and can possibly prevent more serious bereavement problems. After an explanation of bereavement counseling, the set-up of the workshop is described. Special attention is payed to the group dynamic aspects of the workshop.

DSM-III-R and ICD-10 personality disorder features among women experiencing two types of self-reported homesickness: an exploratory study.

This study investigated the intensity of DSM-III-R and ICD-10 personality disorder features among females experiencing self-reported homesickness. Three groups were compared: (a) a group of women experiencing chronic feelings of homesickness (CHS); (b) a group of women experiencing episodic attacks of homesickness, each time they go on holidays (EHS); and (c) a group of healthy control females, recruited from the general population (HC). This study aimed to investigate whether the homesick participants showed stronger features of personality pathology than the controls and whether those who report experiencing chronic feelings of homesickness showed stronger features of personality pathology than those who at the moment of testing were not in an actual state of homesickness. Glass effect sizes revealed that the DSM-III-R avoidant and dependent and the ICD-10 anxious and dependent traits were most strongly associated with either type of homesickness. Finally, CHS was particularly associated with passive-aggressive traits and EHS with sadistic traits. Based on the stories of 21 homesick women, a link between adverse attachment experiences in childhood and certain personality features on the one hand and homesickness on the other is tentatively suggested.

An exploratory investigation into types of adult homesickness.

BACKGROUND: It is not clear yet whether or not homesickness is a singular syndrome. Some authors have proposed different subtypes or forms of homesickness. Since there may be great differences between various subtypes of homesickness regarding etiology, causes, manifestations and consequences, a distinction of subtypes may have far-reaching implications for research and therapy. This exploratory study was conducted to find out whether homesickness can be considered a homogeneous syndrome, or whether there are distinct subtypes that differ in etiology, severity of the condition and manifestations. METHOD: Thirty-one individuals, who have had severe homesickness experiences, were interviewed, and verbal scripts were typed out. Twenty-four interviews were suited for analyses. All text related to the topics most relevant to the purpose of the study was extracted. The text was first analyzed searching for meaning and categories and afterwards coded and used in a HOMALS analysis. RESULTS: The HOMALS analysis yielded two dimensions. The first dimension can be described as a dimension of psychopathology differentiating 'recovered' and recurrent homesickness. The second dimension was strongly dominated by homesickness during holidays. CONCLUSIONS: It seems that there are reasons to presume the existence of at least two subtypes of homesickness: (1) recurrent homesickness related to signs of psychopathology and recurrent homesickness experiences and (2) recovered homesickness, which can be considered as a normal adjustment problem which most people overcome. Very tentatively, a third type of homesickness might be distinguished: holiday homesickness, which is associated with difficulties in breaking with old routines. Consequences for research and therapy are discussed. Furthermore, the need of validation studies is underlined.