Category: Evolutionary Systems Therapy for Schizotypy

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Psychotherapy for Paranoid Personality Disorder

Paranoid Personality

Just released a new paper we wrote on psychotherapy for Paranoid Personality Disorder. The research is a 7-cases series on the feasibility and efficacy of Evolutionary Systems Therapy for those struggling with paranoid traits.

Little is known about effective psychosocial treatments for paranoid personality disorder. This study explores the feasibility of a novel treatment, namely Evolutionary Systems Therapy, in supporting individuals diagnosed with paranoid personality disorder.

Seven patients attended 10 months of individual therapy without receiving any psychopharmacological treatment. The primary outcome was the feasibility of the intervention, while the secondary outcomes were remission from the diagnosis and reliable changes in personality pathology and paranoid ideation.

All the patients completed the treatment, and none of them reported adverse events or missed more than three sessions (less than 10%). Six out of seven patients (85.7%) achieved remission from paranoid personality disorder. diagnosis, which was maintained at the one-month follow-up. Only in the case of Case 7 was the diagnosis of paranoid personality disorder confirmed at both the final assessment and the one-month follow-up. The dimensional scores indicate a clinically significant reduction in maladaptive personality features for all the patients.

Kendall’s Tau and Spearman’s Rho analysis confirmed a significant downward trend in the means of personality pathology and paranoid ideation across the 12 measurements (p< .05). Likewise, Reliable Change Index values were reported (≥ 1.96) for both measures when comparing the initial and final assessments. Table 3 presents these reliable values for all seven participants. No differences were found in Reliable Change Index between the final assessment and the follow-up assessment. Finally, we explored measurements for an optimal treatment dose. Reliable changes (RCI ≥ 1.96) were reported for personality pathology and paranoid ideation by the sixth month of intervention.

This study suggests the feasibility and safety of psychotherapy as an option for individuals diagnosed with paranoid personality disorder. Specifically, Evolutionary Systems Therapy has shown promising, albeit preliminary, results in assisting individuals with paranoid personality disorder. We propose that the potential clinical effectiveness of Evolutionary Systems Therapy may be attributed to its early focus on the interpersonal schemas and cycles originating from paranoid ideation, where individuals perceive themselves as vulnerable and others as threatening, repeatedly perpetuating a self-fulfilling prophecy. The integrated utilization of relational and experiential techniques appears to be effective in reducing personality pathology and paranoid ideation. Further research is necessary to address the limitations inherent in the case series design employed in the present study.

Cheli, S., Goldzweig, G., Chiarello, F., & Cavalletti, V. (2024). Evolutionary systems therapy for paranoid personality disorder: A seven cases series. Bulletin of the Menninger Clinic, 88, 1, 61-80. https://doi.org/10.1521/bumc.2024.88.1.61

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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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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, https://doi.org/10.1186/s12888-023-04610-5

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ESTS: A replication study

ESTS, schizotypy, evolutionary systems therapy

We are finally ready to start the replication study about Evolutionary Systems Therapy for Schizotypy (ESTS). ESTS is an integrative form of psychotherapy that is specifically tailored on schizotypal traits.

Last year we concluded the first randomized controlled trial (RCT) showing promising results about its effectiveness. Now we have registered the new RCT aimed to confirm these findings and question the limitations we highlighted. Indeed, we are going to increase the sample size of those sperimentally treated with ESTS, and will use cognitive behavioral therapy (CBT) e as an active treatment without any mandatory drug.

In the first RCT the control group accessed to a good psychiatric management comprising of CBT and psychopharnacological drugs. During the post-hoc analysis the interviews indicated how the control group may have been biased by a more stigmatizing approach along the treatment plan. On the one hand, we suppose how ESTS may benefit from an evolutionarily oriented and non-stigmatizing approach to conceptualization. On the other hand, the mandatory drug may have been perceived as stigmatizing or patronizing.

Thus, the 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).

Another interesting difference between the new and the previous RCT will be the secondary outcomes. Despite we collected cases series about feasibility of ESTS in treating different features related to schizotypy, we want to explore the differential effectiveness on psychoticism and detachment. That is, we want to explore the differential effect of ESTS on diverse features of schizotypy, from oddity and disorganization to emotional and social withdrawal.

National Library of Medicine (U.S.). (2023, February- ). Evolutionary Systems Therapy for Schizotypy (ESTS). Identifier NCT05710926 . https://clinicaltrials.gov/ct2/show/NCT05710926 

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Psychotherapy for schizoid personality

schizoid personality disorder

The Journal of Contemporary Psychotherapy published a paper where we present a psychotherapy for schizoid personality disorder. This personality is a highly understudied area: Despite early conceptualizations were prosed one century ago, clinicians do not have guidelines to rely upon. Indeed, an early formulazion of schizoid mechanisms can be traced back to Eugen Bleuler and then to the emergence of psychoanalisis (see Fairbairn and Klein).

In a two cases series we discussed how an integration of evolutionary psychopathology, metacognitively oriented psychotherapy, and compassion focused therapy may be useful in targeting severe forms of emotional and social detachment. The paper is an attempt to apply Evolutionary Systems Therapy for Schizotypy (ESTS) to this complex and understudied pattern of personality.

The prosed intervention was a 10-month individual psychotherapy that resulted in a remission from diagnosis and reliable changes in personality pathology and general symptomatology. The focus of psychotherapy was an evolutionary conceptualization of maladative traits and then a progressive focus on critical beliefs about self (e.g. I’m not adequate enough to properly live in the society) and others (e.g. my peers constantly judge me as weird and bizzare).

Cheli, S., Chiarello, F., & Cavalletti, V. (2022). A Psychotherapy Oriented by Compassion and Metacognition for Schizoid Personality Disorder: A Two Cases Series. Journal of Contemporary Psychotherapy. https://doi.org/10.1007/s10879-022-09566-3

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Oddity, Schizotypy and Evolution?

Oddity, schizotypy, evolution, evolutionary theory

My paper on an evolutionary model of schizotypy is finally out! New Ideas in Psychology has published it. As I anticipated in a previous post here, this study aims to summarize existing kowledge about proximate and evolutionary factors involved in schizotypy and oddity, and propose an integrative model.

Such a model suggests how schizotypy may be better understood by looking at the role of social brain in the evolution of our species and the neurodevelopment of those with prominents openness to experience and introversion.

The paper is also the foundation of the the shared conceptualization of newly developed treatment for schizotypal personality disoder, namely Evolutionary Systems Therapy for Schizotypy (ESTS). In the next few months the paper – figers crossed! – about a preliminary randomized controlled trial should be pulished.

Cheli, S. (2023). An evolutionary look at oddity and schizotypy: How the rise of social brain informs clinical practice, New Ideas in Psychology, 68, 10099, https://doi.org/10.1016/j.newideapsych.2022.100993

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Adolescence and severe psychopathology

The dataset of our recently concluded cases series on adolescents with prominent schizotypal traits is available on OSF. In the study we extended the clinical utility of Evolutionary Systems Therapy for Schizotypy (ESTS) by applaying it in treating five adolescents diagnosed with schizotypal personality disorder.

The results were encouraging: 4 out of five remitted from diagnosis at the end of the 6-month intervention and all the adolescents reported reliable changes in symptomatology.

Personality pathology in adolscence is an understudied area of psychotherapy, even if researchers are publishing more and more studies on that. We know that personality and its disorders emerge during adolescence, but the “straighforward” approach to psychiatry seemingly generates a paradox by not allowing a diagnosis in adolescence!

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A new RCT on schizotypal personality disorder

RCT on schizotypal personality disorder

Fingers crossed for a recently submitted paper on our randomized controlled trial, RCT, on Schizotypal Personality Disorder!

In the last two years my team and I have dedicated so many efforts to this challange. We have tried to outline and test a new treatment for those diagnosed with Schizotypal Personality Disorder. The intervention was a 6-month therapy compared with a stardard treatment comprising of Cognitive Behavioral Therapy (CBT) for personality disorders plus psychopharmacological treatment. The RCT has been registered on ClinicalTrials.gov and the paper submitted in July.

We defined the intervention as Evolutionary Systems Therapy for Schizotypy (ESTS) since it integrates different approaches: an evolutionary look at schizotypy, a systemic framework in understanding self-to-self and self-to-other relationships, a metacognitively oriented approach to in session conceptualization, and finally a compassion focused approach to experiential tecniques.

The results of our RCT on Schizotypal Personality Disorder

were really good! We confirmed (as desidered and hypothesized) a non superiority of the control group (CBT + drugs) and in the secondary outcomes (metacognitife functioning and general symptomatology) we found a superiority of ESTS.

Preprint of the paper can be read on OSF!

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