Tag: evolutionary psychology

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Complex cases and comorbidities between personality and eating disorders

Complex cases and comorbidities between personality and eating disorders are tricky challanges for the clinician. Indeed, patients live their experience and (rightly!) have little interest in psychiatry, psychopathology and psychotherapy manuals. The condition of a single disorder is rare. And even in the case of complex symptoms such as eating disorders it is important to consider the functioning of the personality as a whole.

Journal of Clinical Psychology has recently accepted a paper I worked on together with an amazing international team: Veronica Cavalletti (Tages Charity, Florence), Francesco Gazzillo (University of La Sapienza, Rome), Martin Brüne (Bochum University, Bochum), and Paul Hewitt (University of British Columbia, Vancouver). Here we present a clear-cut example of complex cases and comorbidities between personality and eating disorders.

In this case study we present the course of the psychotherapy of Myriam, a 19-year old female with a severe personality disorder and comorbid eating disorder. During the initial assessment she reported high levels of neuroticism that parallel the diagnosis of obsessive-compulsive personality disorder, borderline personality disorder, and anorexia nervosa. Myriam showed a severely impaired personality functioning defined by perfectionism, self-criticism, interpersonal guilt and overcontrol. Her daily experience was shaped by a self-recriminative inner dialogue associated with maladaptive patterns in the form of food, water and sleep restrictions, self-harm behaviors, and suicidal ideation. She accessed an integrative treatment based on individual (Evolutionary Systems Therapy) and group psychotherapy (Mindful Compassion for Perfectionism). At the end of 14-month intervention she remitted from all the categorical diagnoses and showed reliable changes in several measures. These outcomes were maintained at 3-month follow-up. We describe the integrative conceptualization based on Myriam’s perfectionistic self-recrimination patterns, and the consequent treatment that targeted these patterns rather than focusing on symptom reduction exclusively.

The picture presents the conceptualization of the client based on the Evolutionary Systems Therapy.

For those interested in, the preprint of the paper is freely available and and the published version will have only minimal differences due to production process:

Cheli, S., Cavalletti, V., Gazzillo, F., Brüne, M., & Hewitt P.L. (2024). I don’t deserve anything good: Perfectionistic self-recrimination in a case of comorbid personality and eating disorder. Journal of Clinical Psychology. Preprint available on Authorea, July 16, 2024. https://doi.org/10.22541/au.172114929.99232229/v1 (DOI: 10.1002/jclp.23753).

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Two new studies registered

Evolutionary Systems Therapy, Evolution and Personality Lab

Two new studies registered at our lab! The main goal of Evolution & Personality Lab is to investigare personality and its pathology through the lens of evolutionary psychology and psychopathology. Consistently with this goal and ongoing studies, we registered two research protocols.

The first study is aimed to validate cross-culturally the evolutionarily informed conceptualization model we have worked on in the last few years. The protocol has been registered on ClinicalTrials.gov and comprises three studies involving teams from USA, Italy, Spain, Poland, China: (i) to explore the inter-rater reliability of the model in therapists; (ii) to explore the acceptability by therapists and patients; (iii) to explore the cross-cultural and cross-theoretical validity of training and application of the model. We hope this project will confirm that our model can be used within different cultural contexts and by clinicians with different therapeutic backgrounds.

The second study is aimed to explore the clinical utility of the three interpersonal styles and dynamics we have tested in a previous trial. In a recently concluded study we found that patients with personality pathology may show three prominent interpersonal styles that would correspond to the three main spectra of psychopathology: perfectionistic style and internalizing spectrum; antagonistic style and externalizing spectrum; schizotypal style and reality impairing/psychosis spectrum. The methodology used was potentially biased (patients were forced to chose only one style through a dummy variable). In this new study (registered on OSF) we used de-sitgmatizing labels for the three styles and offer a continuous Likert-type scale.

These two new studies registered on ClinicalTrials and OSF will better describe the clinical utility of our protocol for conceptualizing and treating personality pathology: namely, Evolutionary Systems Therapy. This protocol may be hopefully useful not only as and independent treatment. We are not that interested in proving what we do is good! It would be more important to show how an evolutionarily informed conceptualization may support different kinds of treatments (we are involving colleagues from a variety of background: psychodynamic, integrative, humanistic, cognitive, etc.) and may be reliable in spite of the different cultural background and interpersonal style of the patient.

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Interpersonal dynamics and styles in personality pathology

We have finally presented our work on interpersonal dynamics and styles in personality pathology. During a symposium a was chairing on this topic at the 7° Congress of the European Society of Personality Disorders I summarized our pre-registered trial on the feasibility of our Evolutionary Systems Therapy for personality pathology at large.

This study is part of the activities of our Evolution and Personality Lab and showed promising results. The paper about interpersonal dynamics and styles in personality pathology is under submission….so figers crossed!

The objective of this study was to evaluate the feasibility and rationale of a six-month Evolutionary Systems Therapy for personality pathology. In doing so, we employed a conceptualization that is supposed to be consistent with dimensional models of personality disorders and evolutionary psychopathology. Twenty-one patients were recruited and stratified into three homogeneous subgroups in accordance with spectra of psychopathology (internalizing, externalizing, schizotypy). An evolutionarily informed conceptualization was shared with patients based on three interpersonal styles that we consider to be prominent in the three spectra. Feasibility indicators were evaluated monthly, while changes in clinical measures were assessed by three procedures: ecological momentary assessment, monthly self-report measures, pre-post self-reports and interviews.

Eighteen out of 21 patients remitted from diagnosis, all indicators suggested a high feasibility. Individually, all patients showed reliable changes in measures of symptomatology and personality pathology. A repeated-measures ANOVA reported large effect sizes (η2 ranging between .892 to .979) for the whole sample. Ecological momentary assessment suggests that the three interpersonal styles are prominent in the corresponding spectra both before and after the treatment. This study supports the need for a confirmatory randomized controlled trial on the clinical utility of Evolutionary Systems Therapy. Despite the limited sample size, the findings are consistent with the importance of a dimensional approach to psychopathology and of an evolutionarily informed conceptualization of personality disorders.

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New advancements in Evolutionary Systems Therapy

EST Advancements

We are collecting new advancements in Evolutionary Systems Therapy. This is a new form of psychotherapy that integrates evolutionary psychopathology, compassion focused therapy and metacognitively oriented treatments.

To date, Evolutionary Systems Therapy (EST) has shown promising results in the treatment of personality disorders with traits primarily related to psychoticism and detachment: one randomized controlled trial (RCT) suggested that EST without medication is at least as effective as CBT with medication for patients diagnosed with schizotypal personality disorder (Cheli et al, 2023); some case series have shown the feasibility of EST for paranoid and schizoid personality disorders and for autistic traits (Cheli et al., 2024; Cheli, Chiarello & Cavalletti, 2023; Cheli & Cavalletti, 2023); moreover, we suggest how it can work with adolescents with schizotypal traits (Cheli et al., 2023).

Now we are working on new advancements in Evolutionary Systems Therapy. First, a new RCT is closed to end and – fingers crossed – it should confirm and extend previous findings. Second, an open trial currently underway is investigating the clinical utility of EST for all personality disorders. Third, a single case on comorbid eating and personality disorder, plus a 5 case series on obsessive compulsive personality disorder have been submitted. The single case is accessible as preprint. It investigates the role of self-recriminatory dialogue in a young female diagnosed with anorexia nervosa, borderline and obsessive-compulsive personality disorder.

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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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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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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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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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