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An empirical test of schema mode conceptualizations in personality disorders

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Abstract

Although the use of schema modes in schema-focused therapy (SFT) has been very popular since its introduction, Young's schema mode concept remained largely empirically untested. In order to provide insight into the mode conceptualization of personality disorders (PDs), the current study assessed the relationships between 14 schema modes and all PDs. Relationships between dimensional PD scores and self-reported mode scores were tested in a mixed study group of 489 participants, consisting of axis I and axis II patients, and non-patients. Psychopathology was assessed by means of the Structured Clinical Interview for DSM-IV axis I and axis II disorders (SCID I and SCID II) or the Structural Interview for DSM-IV Personality Disorders (SIDP-IV), and modes were assessed by the Schema Mode Inventory. Kendall's partial tau coefficients, controlling each PD–mode correlation for all other PD scores, indicated unique mode profiles for all PDs and corroborated most of the hypothesized PD–mode correlations, supporting the construct validity of the mode model. Nevertheless, the high number of correlations found for some PDs raises concerns about the specificity of the mode model. Implications for both research and therapy are discussed.

Introduction

Although the DSM-IV (APA, 2005) conceptualization of personality disorders (PDs) as discrete categories is considered the gold standard of PD diagnostics, alternative dimensional models of PDs have been suggested. Some of these models (e.g. Morey et al., 2007; Warner et al., 2004) yielded important insights about PD pathology, as did cognitive conceptualizations of PDs (e.g. Artnz, Dreessen, Schouten, & Weertman, 2004; Beck et al., 2001). The current study focuses on PD operationalization according to Schema-Focused Therapy (SFT) as developed by Young, Klosko, and Weishaar (2003), which is an elaboration of traditional Beckian cognitive therapy. One of the central features in SFT are the so-called schema modes. These are the predominant emotional states and coping responses triggered by situations to which people are oversensitive. Schema modes were introduced to SFT in order to explain the abrupt changes in thoughts, feelings and behaviours displayed by patients with severe PDs, mainly borderline PD (Lobbestael, van Vreeswijk, & Arntz, 2007; Young et al., 2003). So far, 22 different modes have been defined of which some are hypothesized to be especially prominent in certain PDs (see Appendix A for an overview of these modes). Studies targeting borderline PD have confirmed that this disorder is characterized by the Detached Protector, Abandoned/Abused Child, Angry Child and Punitive Parent modes, when compared to patients with cluster C PD, antisocial PD and non-patients (Arntz, Klokman, & Sieswerda, 2005; Lobbestael, Arntz, & Sieswerda, 2005). Still, most associations between schema modes and PDs have remained unaddressed, both in theoretical conceptualization and in empirical founding. Therefore a large-scale study in a mixed study group consisting of non-patients and patients with axis I and axis II disorders can provide a test of the mode conceptualisation of PDs and give insight in the suitability of this model for assessment and treatment of PDs.

Thus, the aim of the present study was to investigate the correlations between PDs and schema modes and test the hypothesis of a unique mode pattern for each PD. Table 1 depicts the hypothesized PD–mode correlations. These are based on theoretical presumptions (Arntz & Young, 2007; Young et al., 2003) and earlier studies by Arntz et al. (2005) and Lobbestael et al. (2005).

Section snippets

Subjects

Data were analyzed from 489 subjects, including 390 patients from several psychiatric and forensic mental health care institutes and prisons in the Netherlands and Belgium (127 axis I patients, 240 axis II patients and 23 DSM-IV ‘not otherwise specified’ patients who did not fully met the criteria of an axis I or axis II disorder), and 99 non-patient controls. Of this group, 60.9% were female and 39.1% male, with a mean age of 32.99 years (SD=10.68, range=18–63). With respect to educational

Results

Table 2 displays the correlations between all PDs and all schema modes. Overall, 36 of the 140 correlations were significant at p<.001, and 23 at p<.05. Eight out of these 36 strong associations were negative, of which six reflected negative associations with the adaptive modes. Regarding the positive associations between the maladaptive modes and the PDs, the number of correlations varied from 0 to 9 between PDs, with a mean of 2.8 per diagnosis. The borderline and avoidant PDs correlated with

Discussion

The current study tested the correlations between PDs and schema modes. Unique patterns of modes were found for the different PDs, suggesting that the combination of mode scores rather than the scores on each isolated mode provides the best insight in that specific PD. The fact that most strong correlations found between PDs and modes were hypothesized, suggests (at least in part) good construct validity of the mode model. Overall, 18 out 26 hypothesized relations were evidenced and 11 new

Acknowledgements

Thanks are due to Annette Löbbes and Tamara Schrijvers for their help in collecting the data and to Rosanne Janssen for the development of Kendall's partial tau program. We are grateful for the collaboration of the direction board, staff and patients of the ‘Rooyse Wissel’ in Venray and Maastricht; the ‘RIAGG Maastricht’; GGZ Midden Brabant and Midden Limburg; Mutsaersoord in Venray; the Symfora group, location Amersfoort; the ‘Pompekliniek’ in Nijmegen; ‘Lianarons’ in Heerlen; GGZ Delfland in

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