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. |

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?

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

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 . 

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,

An evolutionary look at oddity

I’m extending the genetic background of my new paper on an evolutionary look at schizotypy. I have to thank the reviewers we asked me to improve this part of the research. The paper represents the theoretical foundation of my clinical work with those struggling with schizotypal psychopathology.

The idea at the core can be traced back to the long-standing debate about the evolutionary paradox of schizophrenia. In short, we know how schizophrenia hugely impact on quality of life, but it has always been present in our history. Or better we know how it is a very species-specific disoder. I was really surprised by discovering how those with high prevalence of Nehandertal genes were reporting a lower risk to been diagnosed with schizophrenia and if they were so they showed less severe symptoms!

In my paper I focus on schizotypy, that is a broad organization of personality that is reputed to range from healthy states (such as creativity) to severe manifestations such as schizophrenia. The hypothesis that I discuss in the submitted manuscript is that oddity (a core clinical manifestion of schizotypy defined by odd behaviors, emotions, thoughts) would represent the failure in socializing one’s own openess to experience. The latter trait is a healthy side of human personality allowing creativity and discovery, whereas oddity is a defensive stance often leading to emotional suffering and isolation.

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 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!