Harold Sexton

The Structure of Maladaptive Schemas: A Confirmatory Factor Analysis and a Psychometric Evaluation of Factor-Derived Scales

One thousand and thirty-seven psychiatric patients and non-patients from six different sites completed the 205-item Young Schema Questionnaire or its shortended form, the 75-item Young Schema Questionnaire-S. Among 888 of the subjects, who all were patients, a confirmatory factor analysis (CFA) of the 75 items included in both forms of the questionnaire clearly yielded the 15 Early Maladaptive Schema (EMS) factors rationally developed by J. E. Young (1990). Confirmatory factor analyses, testing three models of the higher-order structure of the 15 EMSs, indicated that a four-factor model was the best alternative. The results slightly favored a correlated four second-order factor model over one also including a third-order global factor. The four factors or schema domains were Disconnection, Impaired Autonomy, Exaggerated Standards, and Impaired Limits. Scales derived from the four higher-order factors had good internal and test–retest reliabilities and were related to DSM-IV Cluster C personality traits, agoraphobic avoidance behavior, and depressive symptoms.

A three-year cohort study of the relationships between coping, job stress and burnout after a counselling intervention for help-seeking physicians

BackgroundKnowledge about important factors in reduction of burnout is needed, but there is a dearth of burnout intervention program studies and their effects among physicians. The present three-year follow-up study aimed to investigate the roles of coping strategies, job stress and personality traits in burnout reduction after a counselling intervention for distressed physicians.Methods227 physicians who attended a counselling intervention for burnout at the Resource Centre Villa Sana, Norway in 2003-2005, were followed with self-report assessments at baseline, one-year, and three-year follow-up. Main outcome measures were emotional exhaustion (one dimension of burnout), job stress, coping strategies and neuroticism. Changes in these measures were analyzed with repeated measures ANOVA. Temporal relationships between changes were examined using structural modelling with cross-lagged and synchronous panel models.Results184 physicians (81%, 83 men, 101 women) completed the three-year follow-up assessment. Significantly reduced levels of emotional exhaustion, job stress, and emotion-focused coping strategies from baseline to one year after the intervention, were maintained at three-year follow-up.Panel modelling indicated that changes in emotion-focused coping (z = 4.05, p < 0.001) and job stress (z = 3.16, p < 0.01) preceded changes in emotional exhaustion from baseline to three-year follow-up. A similar pattern was found from baseline to one-year follow-up.ConclusionA sequential relationship indicated that reduction in emotion-focused coping and in job stress preceded reduction in emotional exhaustion. As a consequence, coping strategies and job stress could be important foci in intervention programs that aim to reduce or prevent burnout in help-seeking physicians.

Therapeutic alliance, cohesion and outcome in a long-term analytic group. A preliminary study.

We studied the ongoing relationship of patients and their therapist in a long-term, analytic group. The therapeutic alliance was rated weekly and group cohesion was rated every month, by patients and therapist. The patients’ symptoms (SCL-90-R) and interpersonal problems (IIP-C) were rated every third month during therapy (self-reports). There was a steady increase in the alliance ratings by patients and therapist during the first 2 years of therapy. This differs from findings in short-term therapies, where the alliance quickly reaches a high level and then remains stable throughout therapy. Therapist ratings of early alliance correlated significantly with positive symptomatic outcome, but did not predict interpersonal change. Patients’ alliance ratings did not predict change. Early cohesion ratings did not predict change. The concordance between the patients’ and the therapists alliance ratings was highest between 16 and 30 sessions, and was essentially maintained throughout therapy. An early concordance of patient and therapist alliance ratings predicted a better symptomatic outcome. The measures of therapeutic alliance and cohesion used in this study seem to address different elements in the group process.

The factor structure of The Ways of Coping Questionnaire and the process of coping in surgical patients

Abstract The factor structure of the Ways of Coping Questionnaire (WCQ) was examined in one sample of 555 adults treated with surgery. The reproducibility of the structure and the stability of the item-factor loadings was evaluated in a separate sample of 482 adults in which coping with different surgical conditions was measured at four points of time. The goodness-of-fit to the data were tested in two postulated models representing different relationships between the derived factors. A five-factor model yielded psychometrically adequate, conceptually consistent and reproducible scales based on 26 of the original 66 items. Three of the scales, wishful thinking, avoidance, and thinking it over, appeared to represent ‘passive’ or emotion-focused strategies. The remaining two scales, goal oriented coping and seeking support, appeared to represent ‘active’ cognitive and interpersonal strategies in which efforts were made to do something actively in order to alleviate the problem causing the distress. A second order factor model in which ‘passive’ and ‘active’ coping mechanisms were influenced by their respective correlated second order factors described the relationship among the factors better than did a model with a general second order coping factor.

Change processes in residential cognitive and interpersonal psychotherapy for social phobia: a process-outcome study.

The purpose of this study was to test cognitive and interpersonal models for improving social phobia. Eighty patients with social phobia were randomized to 10-week residential cognitive (RCT) or residential interpersonal psychotherapy (RIPT). They completed process measures every Thursday and a sub-outcome measure every Monday. The ratings were analyzed with mixed models. Weekly changes in the process variables derived from the cognitive model (self-focus, estimated probability and estimated cost of negative social events, safety behaviors) predicted subsequent weekly changes in social anxiety. Changes in the interpersonal variable perceived acceptance by others also predicted subsequent changes in social anxiety. On the other hand, changes in social anxiety predicted changes in the four cognitive variables. There were no interactive effects of process with treatment. The cognitive variables decreased during treatment to a similar degree in both treatments. The results indicate that, to reduce social anxiety, therapy should target self-focus, estimated probability and cost of feared social events, safety behaviors, and perceived acceptance by others. The process of improvement may involve positive cycles in that a reduction of social anxiety, in turn, appeared to impact self-focus, probability, cost, and safety behaviors.

Self-understanding, empathy, guided discovery, and schema belief in schema-focused cognitive therapy of personality problems: A process-outcome study

The aim of this study was to examine the dispositional and/or episodic influences of the process variables of self-understanding, empathy, guided discovery, and convictions about primary early maladaptive schema, which are central concepts in the schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week inpatient program. Patients, therapists, and an expert observer rated individual therapy sessions. Greater patient-rated self-understanding the first session was related to greater decreases in schema belief and of emotional distress throughout therapy. Greater therapist-rated empathic experience the first session was related to greater decreases in distress throughout therapy. Session-by-session analyses revealed few sequential relationships. However, a greater in-session reduction of schema belief weakly predicted lower level of presessional distress the next session, and vice versa. The study illustrates how to intensively measure and model change in psychotherapy, using both growth curve and time series analyses.

Early Maladaptive Schemas in Patients with Panic Disorder with Agoraphobia

The present study explored the relationships among Early Maladaptive Schemas (EMS), beliefs about loss of control, a fear of bodily sensations, and avoidance in patients undergoing cognitive therapy. Fifty-nine patients (43 women and 16 men) being treated for panic disorder with agoraphobia (PDA) participated in the study. Two EMS that are seen as being central in PDA [vulnerability to harm (VH) and functional incompetence/dependency (DI)], beliefs about loss of control, a fear of bodily sensations, and avoidance were measured at treatment start and at six months follow-up. The data were analyzed using structural modeling techniques. The VH schema influenced beliefs about loss of control, a fear of bodily sensations, and avoidance. Beliefs about loss of control, in turn, predicted a fear of bodily sensations. DI was predicted by VH and did not influence other aspects of PDA. The results were largely in consort with the theoretical suppositions of schema theory and indicated that the VH schema may contribute to the maintenance of PDA.

The role of optimism in the process of schema-focused cognitive therapy of personality problems

The aim of this study was to examine the determinants and effects of optimism in the process of schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week residential program with one symptom-focused and one personality-focused phase. This study examines the role played by optimism during the individual sessions of the second phase, using a time series approach. Decreased patients belief in his/her primary Early Maladaptive Schema and increased patient-experienced empathy from the therapist in a session predicted increased patient-rated optimism before the subsequent session. Increased patient-rated optimism in turn predicted decreased schema belief and distress and increased insight, empathy, and therapist-rated optimism. The slope of optimism across sessions was related to change in most of the overall outcome measures. There appears to be a positive feedback in the process of schema-focused cognitive therapy between decreased schema belief and increased optimism. In addition, optimism appears to mediate the effects of schema belief and therapist empathy on overall improvement, and to serve as an antecedent to decreased distress and to increased empathy, insight, and therapists optimism.

Predictors of the process of coping in surgical patients

Abstract The present study examined predictors of coping in 482 surgical patients in which coping with different surgical conditions was measured at four points of time. Previously, conceptually consistent and psychometrically adequate coping scales from the Ways of Coping Questionnaire (WCQ), that grouped into correlated ‘passive’ and ‘active’ coping strategies, had been derived. Both strategies declined significantly over time and shared three of six different psychological predictors: emotional symptoms, stress, and the personality factor, extraversion. Chance health locus of control and neuroticism predicted passive while openness predicted active coping. Emotional symptoms predicted a prolongation in the use of active coping. The findings indicate that coping is multifactorially determined and that there is a substantial general coping-response in the stressed individual, who tends to use all of the available strategies during an acute coping response to stress.

Psychometric properties of the Type D scale (DS14) in Norwegian cardiac patients

The combination of negative affectivity (NA) and social inhibition (SI) - the Type D Personality - is associated with poor outcomes in coronary artery disease (CAD) patients. A Norwegian translation of the standard instrument measuring Type D (DS14) was tested on 432 CAD patients receiving coronary revascularization treatment. Factor analysis produced two factors with high inter-item reliability, indicating that the Norwegian DS14 has acceptable psychometric properties. Eighteen percent were classified as Type D, lower than has been reported elsewhere. Type D was associated with anxiety, depression, and passive coping. NA correlated positively with depression, anxiety, and passive coping. SI correlated positively with depression and anxiety, and negatively with active coping. The prevalence of Type D was higher among women, and negatively correlated with time since treatment. The variation in Type D prevalence among studies needs further elucidation as does the predictive power of continuous scoring of the Type D trait.