Early Maladaptive Schemas Are Associated with Increased Suicidal Risk among Individuals with Schizophrenia Abstract Early maladaptive schemas (EMSs) are a dysfunctional cognitive pattern that can result from maladaptive functioning during childhood. EMSs are broad patterns of memories, emotions, cognitions, and bodily sensations related to the self and others. The aims of this study were to evaluate EMSs among individuals with schizophrenia and to evaluate the relations of EMSs and clinical factors (e.g., depression, positive, and negative symptoms of psychosis) to suicidal risk (e.g., current suicidal ideation, lifetime suicide attempts). Eighty-two inpatients with schizophrenia completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Beck Depression Inventory-II (BDI-II), the Beck Scale for Suicide Ideation (BSSI), and the Positive and Negative Syndrome Scale (PANSS). Individuals with schizophrenia who had attempted suicide (relative to those who had not attempted suicide) had significantly higher EMSs, current suicidal ideation, and a family history of suicide attempts. Logistic regression analysis revealed that the emotional deprivation schema, positive symptoms, and depression were significantly associated with current suicidal ideation. In addition, emotional deprivation was significantly associated with lifetime suicide attempts. These findings suggest that the emotional deprivation schema, positive symptoms, and depression may be related to suicide in individuals with schizophrenia.

Effects of Psychological Distress and Exposure to Terror-Related Stress on the Self in Emerging Adulthood Abstract We compared vulnerability and scarring models linking self-concept and psychological distress in young adulthood. Whereas the vulnerability model posits self-concept pathology leading to psychological distress, the prediction of the scarring model is inverse. We also examined the moderating role of exposure to missile attacks. Israeli young adults (N = 124), who had participated in a previous study (Schiller et al. Self and Identity 15(3)302–326, 2016), were followed up with again 15 months after the third assessment, and subsequent to a dramatic exposure to missiles. Baseline psychological distress and exposure to terror-related stress predicted impairment in six self-concept dimensions: self-criticism, self-concept clarity, generalized self-efficacy, inadequate self, hated self and reassured self. On the other hand only two variables: self-esteem and exposure to terror-related stress predicted elevated levels of psychological distress. Findings attest to the viability of self-concept scarring by psychopathology and traumatic stress during young adulthood.

Measuring the Cognitive Attentional Syndrome Associated with Emotional Distress: Psychometric Properties of the CAS-1 Abstract The self-regulatory executive function model is the basis of metacognitive therapy and proposes that psychological disorders are caused by maladaptive beliefs about thinking (metacognitive beliefs) and a perseverative negative thinking style associated with them, named the cognitive attentional syndrome (CAS). The CAS-1 was devised and has been used as a clinical tool for assessment and monitoring of the cognitive attentional syndrome and underlying positive and negative metacognitive beliefs during the course of treatment. The aim of this study is to assess the psychometric properties of the CAS-1. Seven hundred and seventy-three participants completed a battery of self-report questionnaires at the cross-sectional level, and 431 individuals also completed the same measures 6 and 12 weeks later. Confirmatory factor analysis supported the proposed three-factor solution of the measure, and the factors demonstrated good internal consistency (α ranging from .77 to .89), convergent validity, incremental validity, stability and discriminative validity were satisfactory. Our findings support the continued use of the CAS-1 in clinical and research settings.

Cognitive-Behavioral Therapy for Alcohol and Other Substance Use Disorders: the Beck Model in Action Abstract The Beckian model of cognitive-behavioral therapy (CBT) for alcohol and other substance use disorders is highly consistent with generic CBT in terms of its structure, emphasis on the therapeutic relationship and case conceptualization, and focusing on teaching patients psychological self-monitoring and self-change skills. The model is distinctive because it zeroes in on the substance use issue per se by identifying and managing high-risk situations, modifying maladaptive automatic thoughts and beliefs (about substances, cravings, “permission-giving,” etc.), learning ways to resist acting on cravings and urges, interfering with substance-related behavioral patterns, limiting the damage from lapses, and learning adaptive life habits. CBT practitioners are more effective with this population when they respond with empathic understanding, even when the patients are ambivalent about being in treatment, are at a lower “stage of change,” and therefore are not fully collaborative and/or are not optimally forthcoming or sincere in their self-report. The CBT method of guided discovery is highly congruent with the methods of motivational interviewing, and CBT can be compatible and complementary with 12-step facilitation and pharmacotherapy. The outcome research on CBT for alcohol and other substance use disorders is not as extensive as that for other disorders, and the data (while promising) indicate that more work needs to be done in terms of preventing early termination and maintaining improvement for the long term. A number of studies suggest that CBT is at its best when helping patients manage their alcohol and/or substance use problems in the context of also providing effective treatment for their comorbid depression.

Construct validity of “Not Just Right Experiences”: results from a picture-based assessment procedure Abstract It has been contended that research about “Not Just Right Experiences” (NJREs) would be biased by the type of measures prevalently utilized to assess such phenomenon. That is, items intended to assess a construct conceptualized as a possible vulnerability factor of obsessive–compulsive (OC) symptoms may have tapped the symptoms themselves. In the current study, a picture-based measure of NJREs (NJR-PM) not derived from OC themes was administered to two samples of undergraduate students along with questionnaires of OC symptoms, general distress, and NJREs (the NJRE-Q-R). Exploratory and confirmatory factor analyses in these undergraduate samples showed that the NJR-PM had a unidimensional structure. The total score derived by the sum of ratings to each picture proved insensitive to gender. The NJR-PM was more strongly associated with the NJRE-Q-R than to general distress. Commonality analysis showed that the NJR-PM and the two NJRE-Q-R indices predicted OC symptoms both conjointly and in a distinct way. In addition, the NJR-PM predicted all common types of obsessive–compulsive disorder (OCD) symptoms over and beyond general distress and discriminated individuals with high scores in OC symptoms from low-score counterparts. NJREs can be measured also without reference to patients’ symptoms and may therefore be useful in advancing our understanding of obsessive–compulsive disorder.

The Unique and Interacting Contributions of Intolerance of Uncertainty and Rumination to Individual Differences in, and Diagnoses of, Depression Abstract Intolerance of uncertainty (IU) and the tendency to repetitively think in a negative way about oneself are established contributors to depression; however, no study has yet examined the unique and interacting effects of these variables to depression symptoms and diagnoses amongst people with major depressive disorder (MDD). People with MDD (n = 48) and diagnoses-free, community controls (n = 66) completed self-report measures of depression, anxiety and IU, as well as constructive (focusing on how events occurred) and unconstructive (focusing on how events felt) rumination. In a linear regression, greater IU and diminished constructive rumination, and the interaction between IU and unconstructive rumination, each explained variance in depression symptoms, even when anxiety symptoms were accounted for. In a logistic regression, these variables did not contribute towards MDD diagnoses once anxiety symptoms were accounted for. Rumination about one’s mood is associated with enhanced distress during uncertainty, with detrimental effects for one’s depression symptoms.

Cognitive Schemas and Eating Disorder Risk: the Role of Distress Tolerance Abstract The current study tested the role of distress tolerance between cognitive schemas (emotional inhibition, defectiveness/shame, social isolation, and insufficient self-control) and eating disorder (ED) risk in a sample of 469 college students via structural equation analysis. While research indicates maladaptive cognitive schemas are positively associated with dysregulated eating, mechanisms of this relationship are not well established. Distress tolerance has been consistently associated with bulimia behaviors and body dissatisfaction; however, few studies have evaluated the role of distress tolerance in relation to cognitive schemas. In the current study, distress tolerance mediated associations between specific schemas of social isolation and insufficient self-control and eating disorder risk. These findings provide preliminary evidence suggesting specific cognitive schemas may contribute to low distress tolerance, which increases risk of ED-related behaviors and cognitions.

Negative Cognitive Style and Cortisol Reactivity to a Laboratory Stressor: a Preliminary Study Abstract According to the hopelessness theory of depression, some individuals have a cognitive vulnerability (i.e., negative cognitive style) that interacts with stressful life events to produce depression. A negative cognitive style is associated with a maladaptive cognitive response to stress (i.e., increased negative attributions); however, no study has assessed whether this cognitive vulnerability is also associated with a maladaptive endocrine (e.g., cortisol) response to stress. If shown to be related, individual differences in cognitive style may potentially explain why the literature on the association between cortisol stress reactivity and depression is mixed, as cortisol responses to stress may vary as a function of attributional style. The aim of the present study was to provide a preliminary test of whether cognitive vulnerability was related to cortisol reactivity to an acute laboratory stressor among a sample of young adults (n = 20; Mage = 23.1 years; 10 females). Negative cognitive style and depressive symptoms were assessed via the Cognitive Style Questionnaire and the Patient Health Questionnaire, respectively. All participants also completed the Trier Social Stress Test (TSST). Salivary cortisol was collected before, during, and after the TSST. Results showed a significant association between negative cognitive style and cortisol stress reactivity, such that a greater negative cognitive style was related to a larger cortisol response to the TSST. Post hoc analyses revealed that this association was moderated by gender (i.e., effect observed in males only). Cortisol responses to the TSST, in general, were lower among females, but this relationship was not moderated by cognitive style. These findings may be related to underlying gender differences in stress vulnerability, which may have clinical implications for understanding the interactive effect of cognitive and neuroendocrine processes on vulnerability and resiliency to depression.

Positive Self-Imagery May Not Always Be Positive: Examining the Impact of Positive and Negative Self-Imagery in Social Anxiety Abstract Socially anxious individuals often hold a negative self-image in mind during social situations. The effect of self-imagery on post-event processing has yielded conflicting results, and its effect on anticipatory processing has yet to be examined. The primary aim of this study was to compare negative and positive self-imagery on anticipatory and post-event processing, and the secondary aim was to examine the impact on state anxiety, safety behaviors, and focus of attention. Participants (N = 80 students) were randomly assigned to a positive or negative self-imagery induction and then delivered an impromptu speech. Among those low in social anxiety, outcomes were generally better for the positive self-imagery condition but among those high in social anxiety, positive self-imagery led to similar or worse outcomes than negative self-imagery. Taken together, encouraging positive self-imagery may be useful for those with lower social anxiety, but not for those with higher social anxiety.

Comparison Between Obsessive Compulsive Disorder and Panic Disorder on Metacognitive Beliefs, Emotional Schemas, and Cognitive Flexibility Abstract We aimed to investigate the similarities and differences between patients with OCD and PD, and healthy control subjects (NPC) on their metacognitive beliefs, emotional schemas, and cognitive flexibility. We hypothesized that the clinical groups would score higher than the NPC group on their dysfunctional metacognitive beliefs and negative beliefs about emotional schemas, and lower than the control subjects on their cognitive flexibility. Regarding the metacognitive beliefs, the clinical groups scored higher than the NPC group on the scores of the uncontrollability and danger, the need to control thoughts subscales, and on the total score of the MCQ-30. On the uncontrollability, comprehensibility, rumination, dissimilarity, dangerousness, and guilt dimensions, and on the total score of the LESS, the clinical groups scored significantly higher than the NPC group. The NPC group obtained higher scores than the clinical groups on the Cognitive Flexibility Inventory. Focusing on the psychological concepts that differentiate patients with OCD and PD from healthy controls might help identify potential targets for psychotherapy.