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Automatic Self Recriminations and Perfectionism

Automatic self recriminations place an important role in perfectionism. Persons with perfectionistic traits usually experience internal dialogues in the form of elf-condemnatory, self-blaming spiraling.

In a new article published on the Journal of Personality Assessment, we present a new measure to assess this kind of internal dialogue. The new Automatic Self-Recrimination Scale (ASRS) has been tested in clinical and nonclinical sample showing it is best understood as a multidimensional measure.

Our findings highlight that the measure is composed of one higher-order factor and four lower-order facets: Not Mattering, Self as Failure, Undeserving Self, and Loathsomeness. The overall scale and four subscales demonstrated acceptable internal consistency and test-retest reliability.

Moreover, we show how Automatic Self-Recrimination Scale significantly correlates with measures of perfectionism, self-criticism, and dysfunctional attitudes. In short, we confirm how automatic self recriminations and perfectionism are two intertwined experiences.

Indeed perfectionism involves self-recrimination and an overgeneralized sense of the self as blameworthy and responsible that distinguishes it from other related constructs. Automatic self-recriminations are a unique and important element not only for research purposes but also as a key emphasis for clinical interventions.

As I have discussed elsewhere, Compassion Focused Therapy may cultivate – for example – a more compassionate self by promoting a healthier dialogue between parts of the self and starts with a focus on self-criticism. That is, if the goal is to help people with perfectionistic traits, an intervention that helps them reduce self-recriminations and increase a self-compassionate attitude is probably an effective choice.

Moreover, it is noteworthy how self recriminations (and interventions targeting these processes) are not only related to perfectionism. We have shown how they are pivotal – for example – in traits such as schizotypal ones.

Paul L. Hewitt, Sabrina Ge, Martin M. Smith, Gordon L. Flett, Simone Cheli, Danielle S. Molnar, Ariel Ko, Samuel F. Mikail & Thalia Lang (2024) Automatic Self Recriminations: Development and Validation of a Measure of Self-Condemnatory Internal Dialogue, Journal of Personality Assessment, DOI: 10.1080/00223891.2024.2303429

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Is Compassion Focused Therapy Effective?

Is Compassion Focused Therapy Effective?

In a recently published meta-analysis we discuss this question: Is Compassion Focused Therapy effective? I was part of an amazing team led by Nicola Petrocchi on this topic. We conducted a series of meta-analyses on diverse positive and negative outcomes of trials on Compassion Focused Therapy.

The main finding is that Compassion Focused Therapy is effective. We worked a lot on this study since last March to get all the information available. We tried to overcome the main limitation of this research (i.e., heterogeneity) by running several meta-analyses on a bunch of different outcomes.

More specifically, we explored effectiveness in terms of reduction of depression and self-criticism, and increase of compassion for self and others. This analyses were conducted on both clinical and non-clinical samples.

Compassion Focused Therapy resulted effective in reducing overall negative mental health outcomes (k = 32, g = 0.72, p < .0001), depression (k = 23, g = 0.49, p < .0001), self-criticism (k = 17, g = 0.40, p < .0001) and in improving compassion for self and others (k = 24, g = 0.51, p < .0001).

A summary of the study has been published by the blog of the Society of Clinical Psychology of American Psychological Association.

Petrocchi, N., Ottaviani, C., Cheli, S., Matos, M., Baldi, B., Basran, J. K., & Gilbert, P. (2023). The impact of compassion-focused therapy on positive and negative mental health outcomes: Results of a series of meta-analyses. Clinical Psychology: Science and Practice. Advance online publication. https://doi.org/10.1037/cps0000193

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Finally published: A dimensional approach to schizotypy

Simone Cheli, Schizotypy, Dimensional Approach, Conceptualization, treatment

Springer finally published the book I edited with Paul H. Lysaker: A dimensional approach to schizotypy. Conceptualization and treatment. It is the first book discussing schizotypy from a clear-cut clinical point of view. Amazing scholars have previously discussed this topic, but usually through the lens of neuroscience or experimental psychopathology. I was happy to read the foreword by Bob Krueger and the endorsment by Carla Sharp and Anna Docherty highlighting this novelty.

Here we talk about how to treat the clinical manifestations of schizotypy. In doing so, we invited a team of experts in the field. The book is organized in three section. In the first one we present a common theoretical and experimental background, discussing diverse point of views. In the second one five transdiagnostic processes (metacognition, mentalizing, attachment, self-criticism, interpersonal criticism) are presented as core targets of conceptualization and intervention. And in the final section several therapeutic approaches (CBT, CFT, MBT, MERIT, ESTS, etc.) are described consistent with previous knowledge.

I hope that this book may foster clinical research in the field, considering how evidence suggests that one out of ten persons would present schizotypal traits. I’m just sorry that Paul has passed away unexpectedly just a few days after the submission. In the afterword, I tried to summarize these mixed feelings and how much I (and every one in the field) owe to Paul Lysaker. He was a wonderful friend, and an amazing scholar.

Cheli, S., & Lysaker P. H. (Eds.) (2023). A Dimensional Approach to Schizotypy. Conceptualization and Treatment. Springer. https://doi.org/10.1007/978-3-031-41788-7

Please note that foreword, introduction, conclusions and afterword are freely downloadable from Springer website.

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Threatening beliefs in schizotypy

Threatening beliefs schizotypy cheli

A new paper on the role of threatening beliefs in schizotypy has been published. In this study we showed in a large sample (n= 2127) how threatening beliefs about self and others moderate the association between psychoticism and psychosocial distress.

We defined an overarching factor, consistent with my model of schizotypy (Cheli, 2023; Cheli et al., 2023), that comprises: severe form of self-criticism (hating, feel ingdisgusted with oneself), fear of other’s compassion (perceive the other’s compassion as threatening), and socially prescribed perfectionism (the others want me to adhere to standards I cannot achieve). The total factor and the single components were significant moderator of the association between schizotypal traits and distress (again an overarching factor comprising anxiety, depression and stress).

The paper supports the model of Evolutionary Systems Therapy for Schizotypy and its targets. Despite these factors are relevant also in other conditions, our analysis showed how schizotypy is particularly affected by with an explained variance which is double that of other personality traits.

Cheli, S., Cavalletti, V., & Hopwood, C. (2023). Threatening Beliefs About Self and Others Moderate the Association Between Psychoticism and Psychological Distress. The Journal of Nervous and Mental Disease ():10.1097/NMD.0000000000001726, September 21, 2023. | https://doi.org/10.1097/NMD.0000000000001726

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IPOS Congress: Severe Mental Disorders and Cancer

IPOS 2023, cancer, severe mental disorder

Just concluded the XXIV IPOS Congress, where I presented a study on severe mental disorders in cancer patients. The presentation was part of a symposium, chaired by Prof. Gil Goldzweig, on communication and intersubjectivity in underserved populations.

I discussed challenges and the (poorly explored) state of the art of studies on the comorbidity between severe mental disorders and cancer. Below a brief video-summary of the slides.

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How to treat clinical manifestations of schizotypy?

Schzitoypy

How to treat clinical manifestations of schizotypy? In an upcoming book, we try to anwser to this fascinating and elusive question. Paul H. Lysaker and I are the co-editors of a book to publish by Springer. The manuscript is finally in the hands of the production editor.

In the last year, Paul and I have involved twenty diverse teams of researchers and clinicians to address this question. Indeed, schizotypy represents a unique paradox. On one hand, we know that one out of ten persons presents schizotypal traits. On the other hand, there are no guidelines for treating schizotypal personality disorder or the clinical onset of schizotypal traits.

We don’t want to spoil the new book, but Paul and I have organized the contributions into three sections: (i) an introductory section discussing schizotypy as a feature of personality and psychopathology; (ii) a section dealing with 5 transdiagnostic processes relevant to schizotypy (attachment, mentalization, metacognition, self-criticism, interpersonal criticism); (iii) a concluding (and also the most extensive) section where numerous therapeutic approaches to schizotypy are presented.

To our knowledge this is the first book adressing clinical conceptualization and treatment of schizotypy, Despite several amazing books and papers have been puslished about, limited attention has been paid to the previous question, that is: How to treat clinical manifestations of schizotypy?

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CFT for Personality Disorders – Retreat

CFT for Personality Disorders

Just concluded the first edition of a retreat for mental health professionals interested in applying Compassion Focused Therapy (CFT) in personality disorders.

Despite CFT is genuinely transdiagnostic and usuful in targeting maladpative interpersonal schemas, little is known about its application in treating those struggling with personality disorders.

Thus, I organized this retreat where to present an evolutionary model of conceptualization of personality disorders and those tecniques that I found extremely useful when working with personality disorders. I also presented my work in this field with a specific focus on schizotypal, perfectionistic, narcisistic and borderline traits.

The retreat was located in an amazing center near Florence, surrounded by woods and vineyards! For two days, about 30 partecipants worked on mindful compassion, chairwork imagery, and so on.

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A therapy for adolescents with autism and extraordinary skills

Savant syndrome, autism, evolutionary systems therapy

Online a paper about a therapy for adolescents with autism and extraordinary skills. The research has been just published by the Journal of Contemporary Psychotherapy and presents a two cases series.

In this study we tested an evolutionarily oriented therapy for those with the so-called savant syndrome, that is the presence of extraordinary skills usually in conjunction with autistic traits. Thus, we recruited two adolescents with this syndrome and offered a 6-month therapy (plus 1-month follow-up).

The proposed therapy is an adaptation of Evolutionary Systems Therapy for Schizotypy, that is an integration of evolutionary psychopathology, metacognitively oriented therapy and compassion focused therapy. This treatment has been originally tested with persons with schizotypal o schizoid traits.

The collected results are promising. Indeed, both the adolescents showed a reliable change in symptomatology and in metacognition, that is the former decreased and the letter increased.

Future studies will hopefully confirm if and how our therapy for autism and extraordinary skills works!

Cheli, S. & Cavalletti, V. (2023). An Evolutionarily Oriented Therapy for Autistic Adolescents with Extraordinary Skills: A Two-Case Series. Journal of Contemporary Psychotherapy. https://link.springer.com/article/10.1007/s10879-023-09586-7

Open -access link by Springer: https://rdcu.be/ddtxS

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Adolescents with schizotypal traits: A cases series

Adolescents with schizotypal traits, schizotypy, simone cheli

In a cases series with five adolescents we tested a treatment for adolescents with schizotypal traits. The intervention was previously designed and tested with adults, namely Evolutionary Systems Therapy for Schizotypy (ESTS).

ESTS is an integrative form of psychotherapy that comprises an evolutionarily based conceptualization with compassion focused and metacognitvely oritented approaches. We recently published the findings of a randomized controlled trial where we showed promising results. 75% of patients remitted from diagnosis and drop-out rates was below 10%.

In this new cases series we suggest how ESTS may be a feasible treatment for adolescents with schizotypal traits. All the partecipants concluded the study and the rate of missing sessions was below 10%. Moreover, 4 out of 5 patients remitted from diagnosis at the end of the schedule 6-month treatment, 1 out of 5 after an extended 9-month intervention.

A post-hoc interview showed how the adolescents described the intervention as effective, substainable and consistent with their goals. By considering how limited informat we have about effective treatments for adolescents with personality pathology (almost nothing for those struggling with schizotypal traits), we are really excited by these findings. Despite the preliminary nature of the study, the proposed model is elegible for larger sample size studies.

Simone Cheli, Gil Goldzweig, Paul H. Lysaker, Francesca Chiarello, Courtney Wiesepape & Veronica Cavalletti (2023) An evolutionarily informed therapy for adolescents with prominent schizotypal traits: a pilot five case series, Psychosis, DOI: 10.1080/17522439.2023.2199325

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