Marleen M. Rijkeboer

Early maladaptive schemas in children: development and validation of the schema inventory for children

A Schema Inventory for Children (SIC) was developed, based on Youngs schema model. Its psychometric properties were investigated in a non-clinical multi-ethnic sample of children, aged 8-13 years. The latent structure of the SIC was explored using a cross-validation design. Confirmatory factor analyses yielded satisfying fits for a modified model, that included 8 of the original 15 schema factors, as well as 3 new factors, each containing a theoretically meaningful combination of 2 or 3 original schema factors. Our data suggest that, to a certain extent, children present with the same schemas as identified in adolescents and adults, although some unique, children-specific schemas occurred. SIC item loadings were moderate to good, and all factors showed adequate discriminant validity. However, factor reliability estimates were mediocre, but in most cases still acceptable. Furthermore, results suggest adequate stability for all SIC scales. Finally, strong relations between most of the SIC scales and measures of psychopathology were found, although an opposite pattern of associations emerged for two scales (i.e., Enmeshment and Self-Sacrifice), suggesting that these schemas are not maladaptive -yet- at this young age.

The relationship between tics, OC, ADHD and autism symptoms: A cross- disorder symptom analysis in Gilles de la Tourette syndrome patients and family-members.

Gilles de la Tourettes syndrome (GTS) is a disorder in which obsessive-compulsive (OC), Attention Deficit Hyperactivity Disorder (ADHD) and autism symptoms occur in up to 60% of patients, suggesting shared etiology. We explored the phenotypic structure of tic, OC, ADHD, and autism symptoms as measured by the YGTSS,Y-BOCS,CAARS and AQ, in 225 GTS patients and 371 family members. First, Confirmatory Factor Analyses (CFA) were performed on the symptom structure of each separate symptom scale. Second, the symptom dimensions derived from each scale were combined in one model, and correlations between them were calculated. Using the correlation matrix, Exploratory Factor Analyses (EFA) were performed on the symptom dimensions across the scales. EFA revealed a five factor structure: tic/aggression/symmetry; OC symptoms/compulsive tics/ numbers and patterns; ADHD symptoms; autism symptoms; and hoarding/inattention symptoms. The results are partly in line with the traditional categorical boundaries of the symptom scales used, and partly reveal a symptom structure that cuts through the diagnostic categories. This phenotypic structure might more closely reflect underlying etiologies than a structure that classically describes GTS patients according to absence or presence of comorbid OCD, ADHD and autism, and might inform both future genetic and treatment studies.

Behavior as information about threat in anxiety disorders : A comparison of patients with anxiety disorders and non-anxious controls

BACKGROUND Gangemi, Mancini, and van den Hout (2012) argued that anxious patients use safety behaviors as information that the situation in which the safety behaviors are displayed is dangerous, even when that situation is objectively safe. This was concluded from a vignette study in which anxious patients and non-clinical controls rated the dangerousness of scripts that were safe or dangerous and in which the protagonist did or did not display safety behaviors. Patients were more likely to take safety behavior as evidence that the situation was dangerous, especially in safe situations. Their non-clinical group may not have been psychologically naïve. We critically replicated the Gangemi et al. study using a psychologically non-informed control group. METHOD The same materials were used and patients (Obsessive Compulsive Disorder, Panic Disorder, Social Phobia; n = 30 per sub-group) were compared to matched non-patients. Using Bayesian statistics, data from the Gangemi et al. samples and the present groups were (re-)analyzed testing the hypothesis relative to non-patients, patients infer threat from safety behaviors, especially if displayed in safe situations. RESULTS The Gangemi et al. data yielded a Bayes factor of 3.31 in support of the hypothesis. The present Bayes Factor was smaller (2.34), but strengthened the support for the hypothesis expressed by an updated Bayes factor of 3.31 × 2.34 = 7.75. CONCLUSIONS The finding that anxious patients infer threat from safety behaviors, in particular in safe contexts, was corroborated, suggesting one way in which safety behaviors are involved in the maintenance of anxiety disorders.

Does Repeated Ticking Maintain Tic Behavior? An Experimental Study of Eye Blinking in Healthy Individuals

Tics in Tourette syndrome (TS) are often preceded by “premonitory urges”: annoying feelings or bodily sensations. We hypothesized that, by reducing annoyance of premonitory urges, tic behaviour may be reinforced. In a 2 × 2 experimental design in healthy participants, we studied the effects of premonitory urges (operationalized as air puffs on the eye) and tic behaviour (deliberate eye blinking after a puff or a sound) on changes in subjective evaluation of air puffs and EMG responses on the m. orbicularis oculi. The experimental group with air puffs + blinking experienced a decrease in subjective annoyance of the air puff, but habituation of the EMG response was blocked and length of EMG response increased. In the control groups (air puffs without instruction to blink, no air puffs), these effects were absent. When extrapolating to the situation in TS patients, these findings suggest that performance of tics is reinforced by reducing the subjective annoyance of premonitory urges, while simultaneously preventing habituation or even inducing sensitisation of the physiological motor response.

Validation of Schema Coping Inventory and Schema Mode Inventory in Adolescents

This study investigated whether the schema therapy constructs of schema coping and schema modes have val dity in adolescents. We examined the validity and reliability of the Schema Coping Inventory (SCI) and an 80-item version of the Schema Mode Inventory (SMI) in a mixed sample of adolescents. Confirmatory factor analyse showed that the first-order factor structures of the SCI and SMI were replicated, but that the hypothesized higher-order models of the SMI were not confirmed. Instead, we proposed an alternative higher-order model of Internalizing, Externalizing, Overachieving, and Healthy modes. In general, the SCI and SMI scales were able o distinguish the clinical sample from the community sample, and meaningful relationships were found between oping styles, schema modes, and behavior problems. In conclusion, our study supports the theorized relations ips between schema coping styles, schema modes, and behavior, problems in adolescents, and provides initial validation for the SCI and the, 80-item SMI in adolescent populations.

No Effects of D-Cycloserine Enhancement in Exposure With Response Prevention Therapy in Panic Disorder With Agoraphobia: A Double-Blind, Randomized Controlled Trial

Purpose/Background D-cycloserine (DCS) is a partial N-methyl-D-aspartate receptor agonist that potentially augments response to exposure therapy in anxiety disorders by enhancing extinction learning. This randomized, double-blinded, placebo-controlled augmentation trial examined (1) the effectiveness of adding 125 mg of DCS to exposure therapy (before or directly after the first 6 treatment sessions) in patients with panic disorder with agoraphobia and (2) the effectiveness of DCS augmentation preceding exposure relative to DCS augmentation directly postexposure. Methods/Procedures Fifty-seven patients were allocated to 1 of 3 medication conditions (placebo and pre-exposure and postexposure DCS) as an addition to 6 exposure sessions within a 12-session exposure and response prevention protocol. The primary outcome measure was the mean score on the “alone” subscale of the Mobility Inventory (MI). Findings/Results No differences were found in treatment outcome between DCS and placebo, administered either pre-exposure or postexposure therapy, although at 3-month follow-up, the DCS postexposure group compared with DCS pre-exposure, exhibited greater symptom reduction on the MI-alone subscale. Ancillary analyses in specific subgroups (responders vs nonresponders, early vs late responders, severely vs mildly affected patients) did not reveal any between-group DCS versus placebo differences. Finally, the study did not find an effect of DCS relative to placebo to be specific for successful exposure sessions. Implications/Conclusions This study does not find an effect of augmentation with DCS in patients with severe panic disorder and agoraphobia administered either pretreatment or directly posttreatment sessions. Moreover, no preferential effects are revealed in specific subgroups nor in successful exposure sessions. Yet, a small effect of DCS administration postexposure therapy cannot be ruled out, given the relatively small sample size of this study.

Erratum to "Behavior as information about threat in anxiety disorders: A comparison of patients with anxiety disorders and non-anxious controls [Journal of Behavior, Therapy and Experimental Psychiatry, 45, 489–495]

In 2014 we published a paper in this Journal: Hout, M. A. van den, Gangemi, A., Mancini, F., Engelhard, I.M., Rijkeboer, M.M., van Dam, M.,& Klugkist, I. (2014): Behavior as information about threat in anxiety disorders: A comparison of patients with anxiety disorders and non-anxious controls. Journal of Behavior, Therapy and Experimental Psychiatry, 45, 489e495. In that paper we reported a replication of an experiment by Gangemi et al. (2012): Behavior as information: “If I avoid, then there must be a danger”. Journal of Behavior Therapy and Experimental Psychiatry, 43, 1032e1038. The van den Hout et al. (2014) findings were in line with the Gangemi results but, using traditional null hypothesis testing (NHT), our findings were not significant (p > 0.05). There are several problems with NHTand one of themwas encountered here: it would be irrational and misleading to argue that a study where the crucial interaction was significant (e.g.: p 1⁄4 0.04) is contradicted by a replication study showing the same pattern of interaction but with a p value of, say, 0.06. Replication is crucial to sound science, and in our 2014 paper we introduced and reported a novel analysis in this area: Bayesian analysis of constrained hypotheses. We calculated the Bayes factor (BF) for the Gangemi experiment (BF1⁄4 3.31) and for our replication (BF 1⁄4 2.34), multiplied the two BF’s and reported the product (BF 1⁄4 7.75) as the best estimate of the empirical support for the hypothesis after both experiments. We recently foundout that thismultiplication, simple as it is,was inappropriate. In the context of testing constrained hypotheses, the error can be explained as follows. The BF is a model selection criterion that combines a measure of fit (‘howwell do the data fit with the constraints of the hypotheses’) and a penalty for model size (to prevent overfitting). By multiplying two BFs of two replication studies, the correction formodel size is incorrectly applied twice. As a result, the support for smaller models is overestimated. In the general context of hypothesis testing with Bayes factors,

17 Schemagerichte therapie

Sinds de cognitieve revolutie in de tweede helft van de vorige eeuw zijn cognitieve verklaringsmodellen van psychopathologie zeer gangbaar geworden en hebben cognitieve behandelingen van psychische stoornissen een hoge vlucht genomen.

3 Theoretisch model: schema’s, copingstrategieën en modi

Schema’s nemen in de moderne psychotherapieen een belangrijke plaats in, met name in therapieen waarin aandacht is voor chronische persoonlijkheidsgerelateerde problematiek. Het begrip schema kent inmiddels een lange geschiedenis. De definities die gebruikt worden binnen de huidige cognitieve therapieen zijn ontstaan in de jaren tachtig van de vorige eeuw, onder invloed van het constructivisme (zie ook Rijkeboer, Van Genderen & Arntz, 2007).

A Psychologist’s View on Bayesian Evaluation of Informative Hypotheses

Psychologists, like other scientists, gather and analyse data to evaluate the explanatory power of theories. Typically they build on earlier studies, explicitly or implicitly formulating competing hypotheses and inferring different predictions about, for instance, the relative scores of different groups on an outcome measure in an experimental study. As a means to test their theories, psychologists are accustomed to the classical statistical tradition and most of them apply null hypothesis significance testing (NHST) that is dominant within this tradition. They are trained to use the Statistical Package for the Social Sciences (SPSS), which centers on NHST, and train their students to do the same.