The Self in Psychopathology

Kyrios, Michael; Nelson, Barnaby; Ahern, Claire; Fuchs, Thomas; Parnas, Josef

doi:10.1159/000438876

Cited by 20 publications

(21 citation statements)

References 11 publications

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“…Further discussions are needed to decide whether this rate is the limit of the current CBT model of HD and whether further efforts can be directed to improve it. Several experimental and observational studies corroborated the importance of components of current model, such as increased emotional reactivity (Shaw, Timpano, Steketee, Tolin, & Frost, 2015), intolerance of uncertainty (Wheaton, Abramowitz, Jacoby, Zwerling, & Rodriguez, 2016), anxiety sensitivity (Medley, Capron, Korte, & Schmidt, 2013) and impulsivity (Timpano et al, 2013) and development of HD, such as the object-affect fusion (Kellett & Knight, 2003) and the involvement of self (Kings, Moulding, & Knight, 2017;Kyrios, Nelson, Ahern, Fuchs, & Parnas, 2015;Kyrios et al, 2016). None of these alternative components have been tested in clinical trials yet, but they could serve as improvements on the standard G-CBT protocol for HD and a potential redefinition of HD treatment could lead to better results.…”

Section: Discussionsupporting

confidence: 58%

“…Several experimental and observational studies corroborated the importance of components of current model, such as increased emotional reactivity (Shaw, Timpano, Steketee, Tolin, & Frost, ), intolerance of uncertainty (Wheaton, Abramowitz, Jacoby, Zwerling, & Rodriguez, ), anxiety sensitivity (Medley, Capron, Korte, & Schmidt, ) and impulsivity (Timpano et al., ), greater level of worry concerning the potentially catastrophic consequences of forgetting (Mataix‐Cols, Pertusa, & Snowdon, ), and differences in planning/problem‐solving in people with HD compared to controls (Mataix‐Cols et al., ). However, many other factors have been recently proposed as relevant in onset and development of HD, such as the object‐affect fusion (Kellett & Knight, ) and the involvement of self (Kings, Moulding, & Knight, ; Kyrios, Nelson, Ahern, Fuchs, & Parnas, ; Kyrios et al., ). None of these alternative components have been tested in clinical trials yet, but they could serve as improvements on the standard G‐CBT protocol for HD and a potential redefinition of HD treatment could lead to better results.…”

Section: Discussionmentioning

confidence: 99%

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Group cognitive‐behavioural therapy for hoarding disorder: Systematic review and meta‐analysis

Bodryzlova

Audet

Bergeron

et al. 2018

Health Soc Care Community

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Previous meta-analysis has reported the rate of reliable and clinically significant changes in hoarding disorder (HD) after cognitive-behavioural therapy (CBT) based on the classical CBT model of HD, as between 42% and 25%. However, in this analysis, different types of therapy (group vs individual, G-CBT and I-CBT, respectively), different providers (psychologist vs nonpsychologist), and different diagnosis (HD vs hoarding behaviour) were analysed together. Hence, it remains unclear if reported rate of changes was due to limits of the CBT model of HD or due to the fact that different applications of the model were analysed together. The aim of this meta-analysis is to highlight shortcomings in the description of existing approaches in G-CBT in HD and provide an up-to-date review of the current state of efficacy. We searched references for treatment trials of G-CBT for HD in adults with object hoarding, where treatment was conducted by a professional in PubMed, PsychINFO and Web of Science databases, and ResearchGate (for grey literature). Data on participants, treatment modalities, and outcomes were extracted; treatment effect-size was meta-analysed. Five hundred and forty-three references were found; after title and abstract screening, eight articles (178 participants) were retained of which seven were included in the meta-analysis. G-CBT showed improvement of HD severity at posttreatment (Hedge's g = 0.96). The rate of clinically reliable changes across groups of treatment was 21%-68% (M = 36.7%; SD = 12.1%). The meta-analyses showed a statistically but not clinically significant impact of age on effect-size. No publication bias was found. There is strong evidence supporting the efficacy of G-CBT including modified or extended versions of classical G-CBT protocols. However, controlled trials with follow-up assessment are needed to evaluate long-term G-CBT efficacy for HD. As well, the rate of clinically significant changes is low; further research on the HD model could improve the efficacy of G-CBT.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Group cognitive‐behavioural therapy for hoarding disorder: Systematic review and meta‐analysis

Bodryzlova

Audet

Bergeron

et al. 2018

Health Soc Care Community

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“…Individuals who do not acquire the competencies required to maintain a distinction between representations of self and other – where the actions and/or feelings of one are habitually confused and misattributed to the other – may have to develop less adaptive strategies to amplify the differences between the two, through for example forms of social withdrawal or preoccupation with other. More generally, all mental illness may be viewed as the mind misinterpreting its own experience of itself and of other ( Fonagy and Campbell, 2015 ), with a failure to establish developmentally appropriate constructs of self in the early years implicated in the etiology of various disorders ( Fink, 1988 ; Kyrios et al, 2015 ). This is particularly apparent in agency-related phenomena such as hallucinations and delusions of control thought to be rooted in difficulties in differentiating between thoughts, intentions, and actions belonging to self from those belonging to others ( Spence et al, 1997 ; Parnas and Handest, 2003 ; Sass and Parnas, 2003 ; Woodruff, 2004 ; Lindner et al, 2005 ; Ditman and Kuperberg, 2005 ; Frith, 2005 ; Bentall et al, 2007 ; Jeannerod, 2009 ).…”

Section: Implications For Mental Healthmentioning

confidence: 99%

The Necessity of Ambiguity in Self–Other Processing: A Psychosocial Perspective With Implications for Mental Health

2018

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While distinguishing between the actions and physical boundaries of self and other (non-self) is usually straightforward there are contexts in which such differentiation is challenging. For example, self–other ambiguity may occur when actions of others are similar or complementary to those of the self. Even in the absence of such situational challenges, individuals experiencing hallucinations have difficulties with this distinction, often experiencing thoughts or actions of self as belonging to other agents. This paper explores the role of ambiguity in self–other differentiation, drawing from developmental, psychodynamic, and neurocognitive perspectives. A key proposal is that engagement in contexts that make distinctions between self and other challenging yet necessary allow reality-testing skills related to agency to develop. Attunement in typical caregiver–infant interactions is framed as a safe but inherently ambiguous environment that provides optimal condition for the infant to develop a coherent self–other sense. Vulnerability to psychosis may be related to limited access to such an environment in early development. However, the perceptual, cognitive, and social skills that contribution to attribution are likely to be malleable following infancy and improve though opportunities for boundary play in similarly ambiguous settings. Using music-making to illustrate, we postulate that engagement in intricate joint-actions that blurs agentic boundaries can contribute to the continued development of an adaptive sense of self and other essential to healthy social functioning. Increased insight into the self–other ambiguity may enhance our understanding of mechanisms underlying “self-disorders” such as schizophrenia and eventually extend the range of social and arts-based therapeutic possibilities.

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“…This revival of phenomenology may have an important role to play in the advancement of nosological, treatment and pathoaetiological research (Nelson & Hartmann, 2017;Parnas, 2011Parnas, , 2014Parnas, Sass, & Zahavi, 2013;Stanghellini & Broome, 2014;Stanghellini & Fiorillo, 2015). A prominent construct in this research program has been the concept of "self" and disturbed self-experience (Kyrios, Nelson, Ahern, Fuchs, & Parnas, 2015;Nelson, 2013). Of particular relevance to psychosis research has been disturbance of the "minimal" (aka "basic," "core") self, sometimes referred to as ipseity (Parnas & Henriksen, 2014;Sass & Parnas, 2003).…”

Section: Introductionmentioning

confidence: 99%

The construct validity of the Inventory of Psychotic‐Like Anomalous Self‐Experiences (IPASE) as a measure of minimal self‐disturbance: Preliminary data

Nelson

Cicero

et al. 2018

Early Intervention Psych

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The Self in Psychopathology

Cited by 20 publications

References 11 publications

Group cognitive‐behavioural therapy for hoarding disorder: Systematic review and meta‐analysis

Group cognitive‐behavioural therapy for hoarding disorder: Systematic review and meta‐analysis

The Necessity of Ambiguity in Self–Other Processing: A Psychosocial Perspective With Implications for Mental Health

The construct validity of the Inventory of Psychotic‐Like Anomalous Self‐Experiences (IPASE) as a measure of minimal self‐disturbance: Preliminary data

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