Interpersonal Schemas Research Articles

Dyadic relationship of adult attachment patterns and interpersonal schemas in marital adjustment: Actor–partner effect model

AbstractObjectiveThis study examined the associations between romantic attachment and relationship satisfaction as mediated by interp ersonal schemas (friendly × hostile) with Turkish couples.BackgroundPrevious studies showed that adult romantic attachment is strongly associated with couple relationship functioning, and many efforts have been made to identify the mechanisms underlying this link. However, no study has considered interpersonal schemas when investigating the connection between romantic attachment and marital adjustment in couples.MethodIn total, 230 Turkish married couples completed measures of interpersonal schemas, adult attachment, and marital adjustment.ResultsAttachment anxiety is indirectly related to marital adjustment in couples via interpersonal schemas. However, attachment avoidance is both directly and indirectly related to marital adjustment via interpersonal schemas. Whereas friendly schemas are related to attachment anxiety negatively, hostile schemas are related to both attachment anxiety and avoidance positively.ConclusionThe current study extended previous research by providing evidence concerning the influence of each partner's attachment dimension on the interpersonal schemas and marital adjustment of both spouses.ImplicationsIn romantic relationships being aware of the impact of interpersonal cycles on dyadic adjustment in clinical settings can help therapists shape their strategies in therapy sessions.

Validation of a Brief Internet-Based Self-Report Measure of Maladaptive Personality and Interpersonal Schema: Confirmatory Factor Analysis.

Existing digital mental health interventions mainly focus on the symptoms of specific mental disorders, but do not focus on Maladaptive Personalities and Interpersonal Schemas (MPISs). As an initial step toward considering personalities and schemas in intervention programs, there is a need for the development of tools for measuring core personality traits and interpersonal schemas known to cause psychological discomfort among potential users of digital mental health interventions. Thus, the MPIS was developed. The objectives of this study are to validate the MPIS by comparing 2 models of the MPIS factor structure and to understand the characteristics of the MPIS by assessing its correlations with other measures. Data were collected from 234 participants who were using web-based community sites in South Korea, including university students, graduate students, working professionals, and homemakers. All the data were gathered through web-based surveys. Confirmatory factor analysis was used to compare a single-factor model with a 5-factor model. Reliability and correlation analyses with other scales were performed. The results of confirmatory factor analysis indicated that the 5-factor model (χ2550=1278.1; Tucker-Lewis index=0.80; comparative fit index=0.81; and Root Mean Square Error of Approximation=0.07) was more suitable than the single-factor model (χ2560=2341.5; Tucker-Lewis index=0.52; comparative fit index=0.54; and Root Mean Square Error of Approximation=0.11) for measuring maladaptive personality traits and interpersonal relationship patterns. The internal consistency of each factor of the MPIS was good (Cronbach α=.71-.88), and the correlations with existing measures were statistically significant. The MPIS is a validated 35-item tool for measuring 5 essential personality traits and interpersonal schemas in adults aged 18-39 years. This study introduced the MPIS, a concise and effective questionnaire capable of measuring maladaptive personality traits and interpersonal relationship schemas. Through analysis, the MPIS was shown to reliably assess these psychological constructs and validate them. Its web-based accessibility and reduced item count make it a valuable tool for mental health assessment. Future applications include its integration into digital mental health care services, allowing easy web-based administration and aiding in the classification of psychological therapy programs based on the obtained results. ClinicalTrials.gov NCT05952063; https://www.clinicaltrials.gov/study/NCT05952063.

Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial.

Eating disorders (ED) are serious disorders characterized by an alteration of eating habits and excessive concern about weight and body shapes (Fairburn, 2002), accompanied by significant impairment inequality of life, high mortality rates and serious organic consequences (Jenkins et al., 2011; Treasure et al., 2015; 2020). Although evidence-based psychological therapies for nonunderweight ED presentations such as cognitive behavioral therapy for eating disorders (CBT-ED) are widely available, there is substantial scope for improvements, particularly in terms of efficacy and adherence. One option is to develop interventions to address elements of pathology not fully addressed by existing empirical supported treatments, such as incorporating techniques aimed at addressing interpersonal problems and personality disorder features into existing treatment delivery. We adapted Metacognitive Interpersonal Therapy, a psychological intervention supported by evidence for treating personality disorders and integrated it with existing CBT techniques for eating disorders (MIT-ED). MIT-ED targets aspects of ED that are not included in the transdiagnostic CBT-E model such as poor metacognition, or maladaptive interpersonal schemas. This is a pre-registered (Protocol number: 0000781) pilot randomized clinical trial aimed at assessing acceptability and feasibility of MIT-ED and establishing preliminary evidence of effectiveness for future larger studies. Twenty patients (10 in each arm) will be randomized to 20 sessions of individual psychotherapy, either MIT-ED or CBTE. Repeated follow-ups will be collected up to 24 months. Participants are recruited at a private outpatient clinic for ED treatment. Acceptability will be assessed via session attendance, completion rates and preliminary outcomes. The primary outcome is ED pathology assessed with the Eating Disorder Examination Questionnaire-6. Other ED outcomes assessed will be eating disorder attitudes, clinical impairment and binge eating pathology. Secondary treatment outcomes are anxiety, depression, and global symptomatology. We will also assess emotional awareness, emotion regulation and therapeutic alliance. Based on previous studies of MIT for personality disorders we hypothesize that MIT-ED will be acceptable to patients, evidenced by high treatment adherence and retention. We hypothesize that MIT-ED will be associated with reductions in eating disorder pathology, at least equivalent to CBT-E. Results will be used to inform the study design, sampling, likely effect sizes and choice of outcome measures for future larger trials of MIT-ED in ED samples.

Dysfunctional Schemas from Preadolescence as One Major Avenue by Which Meaning Has Impact on Mental Health

A main way by which meaning influences mental health is by the formation of interpersonal schemas that specify what to expect from others and how to treat them. Particularly during preadolescence (a developmental phase focused on interpersonal skills), young people living in a stressful or hurtful environment can form atypical schemas that can help them survive but that produce serious problems when later applied to newly forming adult relationships. We provide three case studies illustrating this process. A boy learned to cope by withdrawing from social interaction and excelling in schoolwork. A girl learned to cope by denying her own needs and sacrificing herself for the welfare of others. Another girl coped by pervasive distrust of others and by becoming assertively independent. These children learned well enough to adapt to these dysfunctional relationships so as to suffer as little as possible, and they even developed some personal skills and resources. However, the rigid schemas had a destructive impact on their adult relationships. Proposals for interventions to change meaning and behaviors are discussed.

Narcissism on interpersonal circumplex model: Reactions to imaginary abandonment and rejection.

Narcissism is a direct result of the lack of self-expression. Thus, this trait is enshrined in cycles of strategies to protect self-worth in interpersonal relationships. The aim of the present study was to understand in what way narcissistic individuals understand their interactions with themselves and others. The study included two groups comprising high grandiose narcissism (GN, n = 43) and high vulnerable narcissism (VN, n = 44). The participants who received scores that were one standard deviation (SD) above the mean, either on the PNI-grandiosity or on the PNI-vulnerable dimensions, constituted the GN and VN groups among 518 students (Age: M = 23.57, Sd = 2.13). The chi-square test was performed to evaluate the dimensions of narcissism with respect to responses of the participants and their partners (behavioral, cognitive, and emotional). The Pathological Narcissism Inventory (PNI) was administered to evaluate narcissistic characteristics. The "Criticism Story" of the Story Completion Inventory in Romantic Relationships (SCIRR) was used for criticism. The circular pattern between the responses of the participants and their partners was examined using the Interpersonal Schemas Scale (ISS). The results revealed that the vulnerable group gave more complementary responses emotionally and made more complementary predictions in terms of the expected reactions from the romantic partner than the grandiose group. The results were discussed in reference to the basic self-esteem-protecting motivations of the groups.

Rupture Repair

A strong therapeutic relationship provides the optimal context for CBT, and an important component of this relationship is the alliance. An alliance rupture is a difficulty or deterioration in the alliance manifested by a lack of collaboration on therapy tasks or goals or a strain in the bond. The process of rupture repair can facilitate the work of therapy by renewing collaboration and strengthening the bond. Rupture repair can also provide the opportunity for a corrective experience of successfully navigating interpersonal conflict. A review of research on rupture repair in CBT treatments highlights that ruptures are common, and that failure to repair ruptures is associated with poor outcome and premature dropout. Therapists can reduce the likelihood of contributing to ruptures by adhering to the principle of collaborative empiricism. Therapists can facilitate rupture repair by recognizing ruptures when they occur and employing repair strategies: immediate repair strategies such as modifying the treatment task, or expressive repair strategies such as metacommunicating about the rupture and exploring the interpersonal schemas that underlie it. Training in rupture repair has demonstrated benefits for CBT therapists, particularly trainees.

Narratives Triggering Challenging Experiences of Failure, Abandonment, Rejection, and Criticism in Romantic Relationships

Kiesler's interpersonal cycle model has become a powerful tool for conceptualizing, organizing, and evaluating interpersonal tendencies in recent years. Accordingly, the interpersonal cyclical model provides a theoretical basis for the nature of relationships and thus facilitates an understanding of 'self' and 'the others’' relationships. The first of the two main purposes of our study is to create valid and reliable stories about the four themes (failure, abandonment, rejection, and criticism) that we define as challenging life events. The second one offers a theoretical example of these stories in interpersonal relations, based on the model. For this purpose, two different samples were defined. In the first, twelve stories were created, inspired by sample situations of failure, abandonment, rejection, and criticism, received from a total of 40 people aged between 18-35 (age: M= 25.46, Sd=1.66). The level of representation of the target theme of the stories was examined by three judges and ten reviewers who are experts in clinical psychology. Secondly, to test the effectiveness of the scenarios, five judges with theoretical knowledge on Interpersonal Schemas and three separate judges were involved to evaluate their codability in accordance with the Model. At this stage, the reliability coefficient for all stories was found to be high and significant (ICC: .84 to .99, p= .025) according to the results of the pilot study, which was performed on 15 people (age: M= 22.43, S=3.87), seven of whom were male, and the intraclass correlation coefficiency. It was decided that the psychometric properties of the Story Completion Inventory in Romantic Relationships were at levels that could be studied within the framework of Cognitive Interpersonal Theory and could be used in the literature.

Esoteric power, useless, useful: considerations about dreams in cognitive-behavioural therapy.

For a long time dreamwork in cognitive-behavioural therapy (CBT) was considered useless and as a technique specific to psychodynamic approaches, consequently overlooked in the treatment course. In the last twenty years, thanks to the contribution of neuroscience studies on sleep and dreams, dreams joined the attention and interest of authors belonging to the CBT field. The central feature of dreamwork in CBT is the abandonment of the exploration of latent meaning, which is instead considered in continuity with the waking life. Dreams reflect a patient’s view of self, world, and future, and are subject to the same cognitive biases as the waking state. Consequently, the dreamwork can be used to get information about the patient, overcome impasses in therapy, restructure self and interpersonal schemas, and stimulate reflective functioning. Therefore, guidelines have been defined and models of well-articulated intervention in terms of process and content, replicable and teachable through specific training structured. This paper aims to provide an overview of theories regarding the use of dreams in CBT, from a clinical perspective, from Beck to more recent proposals.

The importance of social connectedness: From interpersonal schemas in depression to relationship functioning and well-being.

The importance of social connectedness: From interpersonal schemas in depression to relationship functioning and well-being.

The importance of social connectedness: From interpersonal schemas in depression to relationship functioning and well-being.

The importance of social connectedness: From interpersonal schemas in depression to relationship functioning and well-being.

Caregivers' Grief in Acquired Non-death Interpersonal Loss (NoDIL): A Process Based Model With Implications for Theory, Research, and Intervention.

The number of family members caring and caregiving for a loved one undergoing physical and mental changes continues to increase dramatically. For many, this ongoing experience not only involves the “burden of caregiving” but also the “burden of grief” as their loved-one’s newfound medical condition can result in the loss of the person they previously knew. Dramatic cognitive, behavioral, and personality changes, often leave caregivers bereft of the significant relationship they shared with the affected person prior to the illness or injury. This results in what we term conditions of acquired “non-death interpersonal loss” (NoDIL). Current approaches to these losses use an amalgam of models drawn from both death and non-death loss. Despite their utility, these frameworks have not adequately addressed the unique processes occurring in the interpersonal sphere where the grieving caregiver needs to reach some modus vivendi regarding the triad of “who the person was,” “who they are now,” and “who they will yet become.” In this paper we propose a process-based model which addresses cognitive-emotional-behavioral challenges caregivers meet in the face of their new reality. These require a revision of the interpersonal schemas and the relationships that takes into account the ongoing interactions with the affected family member. The model and its utility to identify adaptive and maladaptive responses to NoDIL is elaborated upon with clinical material obtained from caregivers of people diagnosed with major neuro-cognitive disorder and pediatric traumatic brain injury. The article concludes with implications for theory, research and clinical intervention.

Motivational Monitoring: How to Identify Ruptures and Impasses and Enhance Interpersonal Attunement

Attachment theory is useful, but per se it may not be sufficient to understand the complexity of human relationships. For this reason, we believe that there is the need to refer to a broader (evolutionary theory of motivation; Liotti, Psychoanal Inquiry 37(5):319–331, 2017) that considers normal functioning as the result of the harmonious activation of various motivational systems, each aimed at achieving an objective of high evolutionary value (adaptive for the individual, the social group, and the species). In this approach, pathology results from the disharmonious and dysfunctional activation of one or more motivational systems. This leads to a theory of care aimed at modulating the maladaptive activation of motivational systems by recognizing each patient’s dysfunctional interpersonal schemas and restoring his ability to function in more flexible ways. Motivational monitoring allows us to recognize impasses/ruptures within the therapeutic alliance and effectively use interventions to restore it. It may enhance patients’ emotional regulation and the interpersonal attunement between patient and therapist, reducing the risk of dropouts and leading to better therapeutic outcomes.

Using termination as an intervention (UTAI): A view from an integrative, cognitive-existential psychodynamics perspective.

Treatment termination is, arguably, one of the most important events in the course of psychotherapy. In the present article, we present an approach to termination that views the latter as a key intervention. Developed from an integrated, cognitive-existential psychodynamics (CEP) perspective (Shahar & Govrin, 2017), Using Termination as an Intervention (UTAI) is a prescheduled, albeit tentative, treatment termination that may be used as an intervention for patients' remoralization (Howard, Kopta, Krause, & Orlinsky, 1986). Specifically, for some psychotherapy patients, prescheduling a treatment termination is useful in instilling a sense of responsibility and agency and in deepening a therapeutic examination of patients' interpersonal schemas and scripts (i.e., "object relations"). The integrative nature of Using Termination as an Intervention is delineated, and caveats are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Metacognitive Interpersonal Therapy for Borderline Personality Disorder: A Single Case Study

Borderline personality disorder (BPD) is a severe disease, characterized by severe instabilities in identity, affect and relationships. Clinical improvement of BPD can be facilitated by psychotherapy aimed at tackling multiple specific cross-modality impairments and their patterns of interaction: impaired sense of self, maladaptive interpersonal schemas, impaired metacognition, emotion dysregulation and impulsivity. Herein, we describe the steps in the treatment of a young woman meeting the criteria for with BPD with paranoid traits, successfully treated with Metacognitive Interpersonal Therapy, a treatment based on comprehensive assessment of domains. In the initial phase, treatment focused on promoting emotion regulation, integrating opposing patient representations of the therapist, enhancing metacognition, and increasing focus on the maladaptive schema that elicited dysregulated behaviors. Later in therapy, treatment focused on supporting the patient to realize her ideas about self and others were schema-driven; and improving metacognitive capacity to understand others’ minds. General implications for psychotherapy of BPD are discussed.

An inter-subjective multi-factorial model of auditory verbal hallucinations in schizophrenia

Auditory verbal hallucinations (AVHs) are perceptive-like experiences happening without appropriate stimuli that in individuals with schizophrenia very often feature distressing contents. AVH frequently interfere with social relationships or result in dangerous behaviours. We hypothesize that in schizophrenia several vulnerability factors, especially when a subject is engaged in real or represented interpersonal transactions, lead to the appearance of AVHs, and favour their self-perpetuation over time. We analyse the different psychological factors that, according to empirical studies and clinical experience with persons with schizophrenia, seem involved in the genesis of AVHs. Several vulnerability factors appear to interact with situational ones to trigger AVHs: a) a facilitation of neural transmission from the premotor regions to the perceptual ones; b) a difficulty attuning with others, c) interpersonal schemas, provoking emotional suffering, intrusive thoughts and rumination; d) metacognitive dysfunctions. Once AVHs have appeared, further factors promote their perpetuation over time: a) cognitive factors like ruminative processing on AVHs, b) metacognitive beliefs about AVHs. An integrated theoretical model of AVHs is described and ideas for its empirical testing are suggested.

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach.

Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the ‘levels of structural integration’ of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 ‘levels of structural integration’ axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person’s actual reflexive and metacognitive capabilities. Psychotherapeutic procedures specific for psychoses may promote and challenge a patient’s metacognitive capacities, but should equally take the need for maturing structural skills into account. Modern psychodynamic approaches to psychosis are shortly presented, providing concepts and techniques for the implicit regulation of interpersonal experience and aiming at structural integration in this patient group.

Revealing Homo Donans: Liberating the Unilateral Gift from Commodity Exchange

The nurturing of the infant from birth onwards provides an example of unilateral gift giving made necessary by the helplessness of the child who cannot exchange an equivalent for what she is given. This material transaction, the giving and receiving of goods and care, creates basic interpersonal schemas of material communication, which underlie verbal communication. They differ from the schemas created by quid pro quo exchange. The market economy is composed of both types of transactions, but unilateral gifts are given to and taken by the exchange transaction mechanism in order to create profit. Reinterpreting maternal care as a free communicative economy points towards a redefinition of the human as Homo Donans and provides a way out of the end of the world scenario to which capitalism has brought us. Using ideas of Marx, Vygotsky, Rossi-Landi, Sohn-Rethel, Lakoff, the findings of recent infancy research, interpersonal neurobiology and modern matriarchal (Goettner-Abendroth) and matricentric (O’Reilly) feminism, I propose a radical shift towards the gift paradigm.

Misophonia, Maladaptive Schemas and Personality Disorders: A Report of Three Cases

Misophonia is a chronic condition in which specific sounds cause intense negative emotions and autonomic arousal. Misophonia is considered a psychological disorder without any relationship with specific alterations of hearing receptors and independent from physical characteristics of the sound. Moreover if misophonia can be defined as a specific psychiatric disorder or a correlate of other conditions is still under debate. The patients were two women and one man. In this case series we first identified the presence of triggers sounds inducing misophonia as reported during the psychotherapy sessions. At a qualitative level all the three patients perceived that the others were intentionally acting with the purpose of underline their maladaptive interpersonal schemas. All the patients were evaluated with the use of questionnaires. Regarding personality disorders (PD) all three patients suffered from at least one PD. As regard depression, one had moderate depression and one had severe depression. Two patients had moderate/severe anxiety. All the three patients can be considered as highly problematic in the interpersonal domain. Our findings have clinical implications for the treatment of misophonia because it seems to be sustained by underlying PD or maladaptive interpersonal schemas. The qualitative analysis of these cases has highlighted how patients with misophonia tended to ascribe intentionality to the people who emit the sounds that trigger their negative emotional reactions. Further studies are necessary to evaluate which kind of interpersonal patterns occur in these patients.

The flip side of collaborative alliance: a single-case study.

The present single case study explored whether a positive collaboration may conceal some of the patient’s dysfunctional interpersonal schemas, hence reflecting a non-authentic collaboration. In particular, we reasoned that conceiving collaborations only as adaptive relations may prevent a comprehensive insight of the therapeutic relationship itself. To explore this possibility, we used an intersubjective approach that emphasizes the integration of specific and non-specific factors in an interdependent way. In particular, we assessed different constructs (i.e. therapeutic alliance, technical interventions, defense mechanism, therapeutic relationship) of the therapeutic process and combined them through statistical methods able to investigate the micro- and macro-analytic processes that define each interaction. Results of a single case study (Sara) showed that the collaborative functioning may hold back many critical aspects, that hardly conciliate with the classic positive definition of collaboration. These findings, therefore, indicate that Sara’s collaborative alliance works mainly as a pseudo-alliance.

Dysfunctional Personality Beliefs Linked to Emotion Recognition Deficits in Individuals With Cocaine Addiction and Personality Disorders.

Background: Facial emotion recognition is impaired in addiction and personality disorders. Dysfunctional personality beliefs reflect negative interpersonal schemas that may underpin emotion recognition deficits. We aimed to examine the association between personality beliefs and emotion recognition among participants with cocaine use disorder including those with comorbid personality disorders. Methods: We recruited 70 participants with cocaine use disorder aged between 19 and 52 who had used 14 g of cocaine over 4.8 years on average. Thirty-eight participants had an additional personality disorder (11 Borderline, 7 Histrionic, 5 Antisocial, 10 Avoidant, and 5 Obsessive–Compulsive). Dysfunctional beliefs were indicated with the Personality Belief Questionnaire, and facial emotion recognition was indicated with the Ekman’s Test. We applied correlations/multiple regressions to test the relationship between beliefs and emotion recognition. Results: Personality beliefs reflecting paranoid, borderline, and antisocial schemas were negatively associated with emotion recognition. Antisocial beliefs were associated with poorer recognition of fear, and paranoid beliefs with poorer recognition of disgust. Antisocial beliefs were significantly associated with emotion recognition after adjusting for cocaine use. Conclusion: Dysfunctional personality beliefs are associated with poorer emotion recognition in cocaine addiction. Personality-related negative schemas about the self and others can impact social cognition and interaction during cocaine treatment.