A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial

This study tests the effectiveness of adding an eight-month, thirty-session schema-focused therapy (SFT) group to treatment-as-usual (TAU) individual psychotherapy for borderline personality disorder (BPD). Patients (N = 32) were randomly assigned to SFT-TAU and TAU alone. Dropout was 0% SFT, 25% TAU. Significant reductions in BPD symptoms and global severity of psychiatric symptoms, and improved global functioning with large treatment effect sizes were found in the SFT-TAU group. At the end of treatment, 94% of SFT-TAU compared to 16% of TAU no longer met BPD diagnosis criteria (p < .001). This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning.     

Perceptual and Motor Space Representation: An Event-Related Potential Study

The purpose of this experiment was to study the brain potentials generated during spatial tasks related to the “schema corporel” (a mental map of sensory-motor relationships). Seven right-handed subjects performed a choice reaction-time task (Experiment 1), in which the spatial position of a visual stimulus (right or left of a fixation point) was varied independently of the spatial position of the response (right or left hand). The subjects also made self-paced extensions and flexions of the right and left index fingers (Experiment 2). Experiments 1 and 2 were performed with the hands both crossed and uncrossed. Spatio-temporal maps showed that the P300 component elicited by the choice RT situation in Experiment 1 was largest ipsilateral to the hand involved in the response, whether or not the hands were crossed. The later part of the pre-movement potentials during Experiment 2 and the motor potential were significantly larger contralateral to the moving hand under all conditions. Thus this pattern of lateralization can be attributed to the superimposition of a bilateral P300 wave on the asymmetrical motor potential. This suggests that distinct neuronal populations are involved in the generation of these two components. P300 latency and RT reflected the spatial conflict: both were longer when the stimulus and response were on opposite sides than when they were on the same side, even when the hands were crossed. However, the average P300 latency was not increased when the hands were crossed, whereas the average RT was substantially increased. Since the additional time required for programming the movement in the crossed hand situation had no effect on P300 generation, we infer that the P300 does not index this motor programming. However, P300 does reflect the stimulus-response spatial matching, since its latency was delayed by spatial conflict.     

Six habits to enhance MET performance under stress: A discussion paper reviewing team mechanisms for improved patient outcomes

Effective team decision making has the potential to improve the quality of health care outcomes. Medical Emergency Teams (METs), a specific type of team led by either critical care nurses or physicians, must respond to and improve the outcomes of deteriorating patients. METs routinely make decisions under conditions of uncertainty and suboptimal care outcomes still occur. In response, the development and use of Shared Mental Models (SMMs), which have been shown to promote higher team performance under stress, may enhance patient outcomes. This discussion paper specifically focuses on the development and use of SMMs in the context of METs. Within this process, the psychological mechanisms promoting enhanced team performance are examined and the utility of this model is discussed through the narrative of six habits applied to MET interactions.A two stage, reciprocal model of both nonanalytic decision making within the acute care environment and analytic decision making during reflective action learning was developed. These habits are explored within the context of a MET, illustrating how applying SMMs and action learning processes may enhance team-based problem solving under stress. Based on this model, we make recommendations to enhance MET decision making under stress. It is suggested that the corresponding habits embedded within this model could be imparted to MET members and tested by health care researchers to assess the efficacy of this integrated decision making approach in respect to enhanced team performance and patient outcomes.     

Differential roles for medial prefrontal and medial temporal cortices in schema-dependent encoding: From congruent to incongruent

Information that is congruent with prior knowledge is generally remembered better than incongruent information. This effect of congruency on memory has been attributed to a facilitatory influence of activated schemas on memory encoding and consolidation processes, and hypothesised to reflect a shift between processing in medial temporal lobes (MTL) towards processing in medial prefrontal cortex (mPFC). To investigate this shift, we used functional magnetic resonance imaging (fMRI) to compare brain activity during paired-associate encoding across three levels of subjective congruency of the association with prior knowledge. Participants indicated how congruent they found an object-scene pair during scanning, and were tested on item and associative recognition memory for these associations one day later. Behaviourally, we found a monotonic increase in memory performance with increasing congruency for both item and associative memory. Moreover, as hypothesised, encoding-related activity in mPFC increased linearly with increasing congruency, whereas MTL showed the opposite pattern of increasing encoding-related activity with decreasing congruency. Additionally, mPFC showed increased functional connectivity with a region in the ventral visual stream, presumably related to the binding of visual representations. These results support predictions made by a recent neuroscientific framework concerning the effects of schema on memory. Specifically, our findings show that enhanced memory for more congruent information is mediated by the mPFC, which is hypothesised to guide integration of new information into a pre-existing schema represented in cortical areas, while memory for more incongruent information relies instead on automatic encoding of arbitrary associations by the MTL.     

Space perception,movement, and insight: attuning to the space of everyday life after major weight loss

Physiotherapists are well placed to help people adjust and engage meaningfully with the world following major weight loss. Recent research indicates that the body size a patient has lived with for years can continue to affect movement and perception even after largescale weight loss. This article explores this discrepancy in depth from the perspective of phenomenology and space perception and through the concepts of body image, body schema, and affordances. It draws on an empirical example in which a nautical engineer described his lived experience of returning to work following bariatric surgery and the discrepancies he experienced while adjusting to his new situation, particularly when moving his smaller body around the ship’s engine room, previously inaccessible to him. Analysis of this empirical example suggests that transitions in weight and size following bariatric surgery are both highly explicit in awareness (i.e., body image) and outside awareness (i.e., body schema). Major weight loss can open up new affordances and possibilities of being in the world, but only after adjustments in body image and body schema. The article suggests ways in which such insights can contribute to physiotherapists’ clinical development and practice when working with patients undergoing major weight loss.     

考虑类型信息的异构数据源信息交换方法研究

异构信息源模式集成中,除解决模式结构冲突外,还需要考虑模式结构对应的数据类型差异,以保证模式集成和信息交换过程的准确性.本文在考虑不同模型语言类型约束和复合对象类型的基础上形式化描述了类型体系,在公共类型体系内容定义的基础上给出了考虑约束和复合对象类型的中间模型类型体系的构建方法,建立了异构数据模式类型体系与中间模型类型体系的类型映射关系.相比其他类型匹配方法,具有搜索空间小、处理范围广的特点.     

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.     

Dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder

Objective

To examine the relationship between dysfunctional schema modes, childhood trauma and dissociation in borderline personality disorder (BPD).

Method

30 BPD patients completed the Wessex Dissociation Scale (WDS), Childhood Trauma Questionnaire (CTQ), General Health Questionnaire (GHQ), and Schema Mode Questionnaire (SMQ).

Results

The ‘Angry and Impulsive Child’ and ‘Abandoned and Abused Child’ modes uniquely predicted dissociation scores. Childhood trauma did not predict dissociation scores.

Conclusions

Findings support the schema mode model of BPD [Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioners guide. London: Guilford Press] and its emphasis on the role of dissociation. Clinically they support the emphasis on the identification and integration of dysfunctional parts of the personality in working with individuals diagnosed with BPD.     

A comparative study of patients and therapists' reports of schema modes

The current study assesses whether patients and therapists report similar levels of schema modes, one of the central features in Schema-Focused Therapy. Patient's self-report and therapists' report on an abbreviated Schema Mode Inventory were compared in a sample of 92 patients with antisocial, borderline or cluster C personality disorder. Results indicate a markedly stronger self-therapist discrepancy in mode rating in antisocial patients than in borderline and cluster C patients. Compared to their therapists, ASPD-patients report less presence of most maladaptive modes, whereas there was no difference in adaptive modes. These findings underscore the importance for the use of alternative assessment methods of cognitive concepts in antisocial patients.     

基于图示理论的涉外护理专业英语听力能力培养教学改革探索

分析医学高职英语听力教学现状,构建基于“图示理论”的培养涉外护理专业学生英语听力能力体系,从“听前导入阶段、听力理解阶段和听后巩固阶段”三个方面探讨注重学生听力能力培养的听力教学改革,为进一步提升涉外护理专业学生的英语教育提供新的视角。