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.

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

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. |

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.

How to treat clinical manifestations of schizotypy?


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?

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.

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.

Open -access link by Springer:

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

A large meta-analysis on CFT

A team of international researchers I’m a part of, just concluded and submitted a large meta-analysis on the effectiveness of Compassion Focused Therapy – CFT. CFT is an an evolutionarily oriented psychotherapy developed by Paul Gilbert (one of the co-author of the study). The main focus of the interventions is the soothing system, a mammalian affect regulation system that is usually triggered by social safeness. In humans, this system may be impaired by either external (eg interpersonal criticism) or internal (eg self-criticism) threats.

In this meta-analysis we screened a large number of studies and explored the effectiveness of CFT in improving negative and positive mental health outcomes. Our team, led by Nicola Petrocchi and Cristina Ottaviani, reported a moderate to large effect size in clinical and non-clinical samples.

We also found a relevant heterogeneity, urging scholars in CFT to outline larger-scale higher quality randomized controlled trial. That said, the final analysis of our meta-analysis included 47 RCTs and 7875 partecipants, suggesting how CFT may be considered an effective intervention for a variety of symptoms and disorders.

Fingers crossed while waiting reviwers’ feedbacks!

A randomized controlled trial about ESTS!

ESTS, Evolutionary Systems Therapy for Schizotypy, Simone Cheli, Randomized Controlled Trial, ESTS vs CBT

Our paper on the randomized controlled trial where we compared ESTS (Evolutionary Systems Therapy for Schizotypy) versus a combination of CBT and drugs is out! Finally, BMC Psychiatry has published it as an open access article.

The trial (ESTS versus CBT: Randomized Trial) reported very encouraging findings! Despite the pilot nature of the study, ESTS (withoud medication) showed at least a non-inferiority in respect to a good psychiatric managment comprising cognitive therapy for personality disorders and psychopharmacological treatment. ESTS reported drop-out rates below 10% and remission from diagnosis in 3 out of 4 patients.

I previously posted updates about the trial, the theoretical foundation of ESTS, and a new confermatory study we are starting in short, but this is very thrilling news! We can now consider ESTS a treatment that is elegible to test as therapy for schizotypy.

First, ESTS is rooted on a specific theoretical model. The clinical manifestations of schizotypy would be the failure in socializing one’s own openness to experience and introversion, leading to an impairment in metacognition and self-soothing.

Second, ESTS is based on a specific protocol comprising four modules: sharing, subjective systemts, intersubjective systems, and consolidation. The first is aimed to share the conceptualization and work on therapeutic alliance, the second and third to promote a mind-body awareness of subjective and interusbjective experience respectively, and the fourth to prevent relapses.

Finaly, a new RCT will compare ESTS with CBT without any mandatory treatment. People will be allowed to access to psychopharmacotherpy, but this will be considered as an exclusion criterion from the study (regardless of the arm they are randomized to)

Below you can find a video-summary of the study!

Cheli, S., Cavalletti, V., Lysaker, P. H., Dimaggio, D., Petrocchi, N., Chiarello, F., Enzo, C., Velicogna, F., Mancini, F., & Goldzweig, G. (2023). A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment. BMC Psychiatry,