Maladaptive Interpersonal Schemas Research Articles

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.

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.

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.

Metacognitive interpersonal therapy in group: a feasibility study.

Patients with personality disorders (PDs) other than borderline, with prominent features of social inhibition and over-regulation of emotions, are in need of specialized treatments. Individuals present with poor metacognition, that is the capacity to understand mental states and use psychological knowledge for the sake of purposeful problem solving; and are guided by maladaptive interpersonal schemas. We developed a short-term group intervention, Metacognitive Interpersonal Therapy in Groups (MIT-G), incorporating psychoeducational and experiential elements, to help these individuals become more aware of their drives when interacting with others; and to help them adopt more flexible behaviors via improvements in metacognition. We present results of an effectiveness study, evaluating whether we could replicate the initial positive results of our first pilot randomized controlled trial. Seventeen young adults outpatients with personality disorders were included in the 16 session program. Effect sizes were calculated for change from baseline to treatment end for the primary outcome, symptoms and functioning (Clinical Outcomes in Routine Evaluation Outcome Measure) and then for one putative mechanism of change – metacognition. Emotional dysregulation and alexithymia were also assessed. Qualitative evaluations of the acceptability and subjective impact of the treatment were also performed. MIT-G was acceptable to participants. There were medium to large magnitude changes from pre- to post- treatment on wellbeing, emotion dysregulation, alexithymia and metacognition. These gains were maintained at follow-up. There was evidence of clinically significant change on key variables. MITG appears acceptable to patients, as evidenced by the absence of drop-out from treatment. In light of the positive outcomes of this study and the expanding evidence base, MIT-G is a candidate for dissemination and investigations in larger trials as a possible effective intervention for PDs characterized by tendencies to overcontrol.

Thinking about feeling: Using trait emotional intelligence in understanding the associations between early maladaptive schemas and coping styles.

ObjectivesMaladaptive interpersonal schemas can trigger distressing emotions and drive dysfunctional behaviour that leads to difficulties in interpersonal relationships and perpetuates the original maladaptive schemas. This study sought to identify patterns of association between trait emotional intelligence (TEI), early maladaptive schemas (EMS), and coping styles in a non‐clinical sample. Emotionality profiles were hypothesized to be associated with EMS severity and poorer coping, as early experiences can shape an individual's self‐perceptions through reinforcement by maladaptive responses.DesignCross‐sectional study with 142 undergraduate students.MethodsWe obtained self‐reports of TEI, coping styles, and EMS.ResultsDisengagement coping was strongly correlated with EMS severity (r = .565, p < .01). TEI was negatively correlated with EMS (r = −.660, p < .01) and Disengagement (r = −.405, p < .01). Emotionality, Impaired Autonomy, and Overvigilance partially mediated the relationship between Disconnection and Emotion‐Focused Disengagement. Self‐Control fully mediated the relationship between Impaired Limits and Problem‐Focused Disengagement.ConclusionsThe findings suggest that lower TEI is associated with the likelihood for maladaptive coping in response to EMS. The preference for certain coping styles associated with a particular domain of EMS may be explained by an individual's perceived metacognitive ability to regulate their stress and emotions. When individuals’ needs for love, safety, and acceptance from others are not met, there might be poorer perceived self‐efficacies in Emotionality and the tendency to cope through emotional avoidance. Individuals with difficulties establishing internal limits are more likely to respond with problem avoidance, possibly due to deficient distress tolerance. Longitudinal studies with a clinical population are warranted to replicate these findings.Practitioner points Clinicians will likely find it helpful to consider their clients’ TEI to facilitate more individualized formulation and treatment planning, by considering whether related emotional regulation problems might be innate or a deficit in skillsImplies the need to do more basic emotional regulation work to supplement and strengthen the established imagery work in schema therapy (ST).

Metacognitive Interpersonal Therapy for Personality Disorders: The Case of a Man with Obsessive–Compulsive Personality Disorder and Avoidant Personality Disorder

Personality disorders have a deleterious impact on individual quality of life, and are associated with a significant social burden. Despite a broad range of presentations across the various personality disorders, clinical research has shown a strong bias toward borderline personality disorder. In contrast to the emotional dysregulation of borderline personality disorder, a number of personality disorders are characterised by emotional inhibition and alexithymia. Research increasingly suggests that these deficits in emotional regulation may be symptomatic of problems with metacognition—the ability to identify, understand, and influence mental states. Research and specific treatment approaches are needed which target personality dysfunction characterised by emotional inhibition, rather than dysregulation. Emerging evidence suggests that metacognitive interpersonal therapy may be an effective treatment approach for personality disorders characterised by emotional inhibition. The current case study provides an in-depth examination of the application of metacognitive interpersonal therapy for a man diagnosed with comorbid avoidant personality disorder, and obsessive compulsive personality disorder. The patient described a history of bullying and unmet needs throughout his childhood, resulting in maladaptive interpersonal schemas and metacognitive deficits. Treatment focused on building the patient’s ability to identify and understand his mental states, and targeted schema-driven behaviour. The patient reported experiencing the therapy as helpful, and stated that it contributed to a marked improvement in his quality of life. Results indicate that a 1 year intervention was successful in achieving diagnostic recovery and symptom reduction, supporting metacognitive interpersonal therapy as an effective intervention.

Maladaptive interpersonal schemas as sensitive and specific markers of borderline personality disorder among psychiatric inpatients

Diagnostic criteria for borderline personality disorder (BPD) and mood and psychotic disorders characterized by major mood episodes (i.e., major depressive, bipolar and schizoaffective disorder) share marked overlap in symptom presentation, complicating differential diagnosis. The current study tests the hypothesis that maladaptive interpersonal schemas (MIS) are characteristic of BPD, but not of the major mood disorders. One hundred psychiatric inpatients were assessed by SCID I, SCID II and the Young Schema Questionnaire (YSQ-S2). Logistic regression analyses tested the association between MIS (measured by the YSQ-S2) and BPD, bipolar, major depressive and schizoaffective disorder. Receiver operator characteristic (ROC) curve analyses assessed the sensitivity and specificity of MIS as a marker of BPD. After covariation for comorbidity with each of the 3 mood disorders, BPD was robustly associated with 4 out of 5 schema domains. In contrast, only one of fifteen regression analyses demonstrated a significant association between any mood disorder and schema domain after covariation for comorbid BPD. ROC analyses of the 5 schema domains suggested Disconnection/Rejection had the greatest power for identification of BPD cases. These data support the specific role of maladaptive interpersonal schemas in BPD and potentially contribute to greater conceptual clarity about the distinction between BPD and the major mood disorders.

Awareness of maladaptive interpersonal schemas as a core element of change in psychotherapy for personality disorders.

Awareness of maladaptive interpersonal schemas as a core element of change in psychotherapy for personality disorders.

Adopting Metacognitive Interpersonal Therapy to Treat Narcissistic Personality Disorder with Somatization

Narcissistic personality disorder (NPD) is characterized by an intellectualizing narrative style, poor metacognition, maladaptive interpersonal schemas, a restricted set of states of mind, impaired agency and perfectionism. Metacognitive Interpersonal therapy targets these dysfunctions with a series of formalized procedures aimed at first forming a shared formulation of functioning which patients and therapists can then use to plan change. We describe here the core NPD pathology and illustrate the therapy process of a patient with NPD and a somatization disorder. Implications for treatment of NPD are discussed together with a call for empirical testing of therapies for this severe condition.

The predictive value of interpersonal schemas, perfectionism, and thought action-fusion in obsessive-compulsive disorder / Obsesif-kompulsif bozuklukta kişilerarası şemalar, mükemmeliyetçilik ve düşünce-eylem kaynaşmasının yordayıcı rolü

The predictive value of interpersonal schemas, perfectionism, and thought action-fusion in obsessive-compulsive disorder Objective: Cognitive vulnerability factors are central in the etiology of obsessive-compulsive disorder. Nosological classifications among symptom clusters have been developed to enable the understanding of possible mechanisms underlying obsessive compulsive symptoms. Previous researchers have emphasized that perfectionist attitudes and thought action-fusion link to increase in obsessive compulsive symptom severity in clinical and nonclinical samples. However, multi-dimensional relations between obsessive compulsive symptoms and vulnerability factors such as interpersonal schemas have received little attention. This study examined connections between cognitive vulnerability factors and obsessive-compulsive symptoms. Method: The data collected from 263 university students. Associations between variables were analyzed by using structural equation modeling. Results: The results of the study indicated that dysfunctional interpersonal schemas were the most hazardous factors that predict perfectionist attitudes, thought action-fusion, and symptom severity in obsessive compulsive disorder. Washing and precision were the final manifestation symptoms mediated by checking. Maladaptive interpersonal schemas, perfectionist attitudes, and thought action-fusion were all vulnerability agents in the development of obsessive compulsive symptoms. Checking played a prominent role in exacerbation of obsessive –compulsive symptoms. Conclusion: Onset and maintenance of obsessive-compulsive disorder is a multidimensional process. Negativistic interpersonal beliefs seem to be an important risk factor. Findings are discussed in the light of current theoretical considerations.

Affective scripts: A systematic case study of change in psychotherapy

This article presents a systematic case study of maladaptive interpersonal schemas. These schemas are conceived of as affective scripts, or sequences of behaviors that regulate emotion in interpersonal relationships. Part I presents a test of the method for identifying affective scripts. Independent raters applied FRAMES (Fundamental Repetitive and Maladaptive Emotion Structures; Hoelzer & Dahl, 1996) to a representative sample of transcripts of a long-term psychotherapy. Empirical checks of each assessment procedure verified the identification of five maladaptive scripts in hundreds of narratives and enactments with the therapist. In Part II, these scripts were tracked across treatment to identify adaptive changes. Statistical analyses indicated a reduction in maladaptive scripts and an increase in adaptive changes. The evolution of the most pervasive script is described in detail. Strengths and weaknesses of the method are discussed.

Childhood emotional maltreatment and later psychological distress among college students: The mediating role of maladaptive schemas

Objective Theoretically, exposure to experiences of emotional abuse (EA) and emotional neglect (EN) in childhood may threaten the security of attachment relationships and result in maladaptive models of self and self-in-relation to others. The purpose of this study was to explore the extent to which EA and EN treatment by parents contributed uniquely to young adult maladaptive long-term outcome with respect to symptoms of anxiety, depression, and dissociation. The extent to which the relationships between EA and EN and later symptoms were mediated by specific internalized maladaptive interpersonal schemas was also explored. Methods Questionnaires completed by 301 college men and women (52% female) assessed perceptions of experiences of childhood abuse and neglect, exposure to parental alcoholism, current symptoms of psychological distress, and endorsement of maladaptive interpersonal schemas. Results Hierarchical regression analyses revealed that perceptions of childhood EA and EN each continued to exert an influence on later symptoms after controlling for gender, income, parental alcoholism, and other child abuse experiences. Both EA and EN were associated with later symptoms of anxiety and depression and were mediated by schemas of vulnerability to harm, shame, and self-sacrifice. Only EN was related to later symptoms of dissociation; this relationship was mediated by the schemas of shame and vulnerability to harm. Conclusion The findings are discussed from an attachment perspective, focusing on how early interactions with parents contribute to the development of internal working models of self and self-in-relation to others that influence later cognitive schemas and psychological adjustment. Practice implications Although emotional abuse and emotional neglect are the least studied of all forms of child maltreatment, they may be the most prevalent. The current findings suggest that how college students have evaluated and internalized these experiences may be even more important than the events themselves in determining the extent to which these experiences exert a long-term impact. For this reason, early intervention might be particularly important in helping to modify internal working models of the self as worthless, others as abusive, or the world as threatening and dangerous as a result of past abuse experiences. This study underscores the need for counselors to actively elicit and explore experiences of emotional abuse and neglect in clients, in addition to inquiring about other abuse experiences and types of family dysfunction. The results of this study also support existing data suggesting that internalized representational models of self and others are a key mechanism underlying the relationship between emotional maltreatment and later psychopathology. Young's schema questionnaire proved to be quite sensitive in detecting specific maladaptive schemas that mediated later difficulties with depression, anxiety, and dissociation. Targeting these negative schemas in therapy may help to ameliorate such symptoms. The therapeutic relationship provides a particularly effective context for developing more positive models of self and others, as well as providing a context to explore core relationship themes across different relationship contexts (e.g., intimate partner, parent, friend, and work relationships). In particular, if the assessment of the client reveals that dissociative symptoms are present, counselors can acknowledge the adaptive function that this strategy once served, while also addressing potential limitations to over-reliance on this coping strategy.

Book Review: Child Abuse, Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life

Child Abuse Treating Survivors of Childhood Abuse: Psychotherapy for the Interrupted Life Marylene Cloitre, Lisa R Cohen, Karestan C Koenen. New York (NY): The Guilford Press; 2006. 338 p. US$38.00. Reviewer rating: Excellent The purpose of this book is to provide therapists with an empirically supported intervention to effectively treat adult survivors of childhood abuse. It includes a clear description of the theoretical framework, session guidelines, and techniques that have been found in a randomized controlled trial to produce substantial improvement in posttraumatic stress disorder (PTSD) symptoms, affect regulation, and interpersonal problems in women survivors of childhood abuse. The treatment has also been used with men and women who were exposed to trauma related to the collapse of the World Trade Center in 2001, where it was found to be equally effective for both sexes. The treatment is a 2-phase intervention involving a total of 16 sessions. Phase 1, skills training in affective and interpersonal regulation (STAIR), aims to help the client build and strengthen resources for effective living in the present. Phase 2, narrative storytelling (NST), focuses on reducing PTSD symptoms and revising maladaptive interpersonal schemas by having the client repeatedly recount specific traumatic memories, organize them into a coherent and meaningful narrative, and consider the place of the traumatic experiences in her or his life history. One of the many strengths of the book is the encouragement to use the intervention flexibly so that it responds to the individual needs of the client. This includes flexibility in the number of sessions and in the emphasis on particular skills and interpersonal schemas. The theoretical framework is a well-articulated blend of principles from cognitive-behavioral and the attachment-interpersonal-object relational traditions.p xi This book, which could be called a manual of the STAIR-NST approach, will be a useful resource to both students and experienced clinicians. It begins with 3 chapters describing the effects of childhood abuse from an attachment-developmental perspective. These chapters are useful in helping the reader appreciate the impact of abuse on the developing child, especially abuse by a parent or caregiver. The authors emphasize that, in addition to symptoms of posttraumatic stress related to the actual abuse, experiencing childhood abuse leads to losses of important resources, including the loss of healthy attachment, the loss of useful guidance in the development of emotional and social competencies, and the loss of support and connection to the larger social community. They argue that effective treatment must help the survivor build or rebuild these lost resources. The next 6 chapters describe the rationale for specific aspects of the treatment, provide overviews of the treatment components, outline useful guidelines for implementing the treatment, offer suggestions about how to talk to clients about their trauma histories, and discuss the type of clients likely to benefit from this approach. …