Sage Journals: Discover world-class research

Abstract

Background

Maladaptive cognitions about the self and others are associated with a wide array of dysfunctional responses and psychopathological symptoms in non-clinical and clinical samples. Dissociative experiences (e.g., depersonalization and derealization) as a coping response to stressful situations lie on a continuum from healthy to unhealthy but are generally elevated in individuals experiencing mental illness. However, the extent to which Dialectical Core Schemas explain the relationship between dissociative experiences and symptomatology is unclear. Therefore, this study aimed to investigate the mediating role of Dialectical Core Schemas on the relationship between dissociative experiences and symptomatology.

Methods

A community sample of 179 participants were recruited (M_age = 21.2 years, SD = 8.2). Data were gathered through self-report questionnaires using a cross-sectional design.

Results

Maladaptive core schemas about self and others correlated positively with all dissociative experiences (e.g., depersonalization/derealization, amnesia), while adaptive core schemas about the self correlated negatively with depersonalization/derealization and distractibility. Maladaptive core schemas mediated the relationship between dissociative experiences and symptomatology.

Conclusions

The relationships between dissociative experiences and symptomatology are bi-directional. Exploring the mediating factors may help clinicians and researchers better understand how to enhance case conceptualization and clinical decision-making.

Keywords

Dialectical core schemas dissociative experiences symptomatology

Introduction

Dialectical Core Schemas as an Alternative Schema Perspective

According to cognitive therapy models, schemas are extreme beliefs about oneself, others, the world, and the future, that increase one’s vulnerability to psychopathology (Beck et al., 2015; Young, et al., 2003). These mental representations, referred to as maladaptive schemas, are rigid, extreme, and trait-like and tend to guide cognition, emotion, and behavior. Several schema concepts have been described in clinical literature, such as cognitive schemas (Beck et al., 1979), early maladaptive schemas (EMS, Young, et al., 2003), emotional schemas (Leahy, 2002), interpersonal schemas (Hill & Saffran, 1995), pathogenic beliefs (Aafjes van Doorn et al., 2021), and self-wounds (Wolfe, 2005). The shared tendency/commonality between these concepts is the focus on maladaptive schemas that originated in early experiences. However, recent research has suggested that positive schemas have empirical support and may be an asset in case conceptualization (Louis et al., 2018; Paetsch et al., 2022). Therefore, a different and integrative concept of dialectical core schemas was suggested.

Dialectical core schemas (DCS) are psychological structures with maladaptive and adaptive core representations about the self and others resulting from the adverse and/or adaptive experiences that individuals experience in their lifetime (Faustino, 2022a, 2022b). Self and other cognitions are organized on dialectical poles lying on a continuum from maladaptive and adaptive. Specifically, these self-other representations emerge from the dialectical negotiation between the experiential and reflexive self, which underlie the meaning-making processes (Faustino, 2022a, 2022b). Therefore, DCS are organized into four domains articulated dialectically on a continuum: (1) maladaptive self, (2) adaptive self, (3) maladaptive other, and (4) adaptive other.

The Brief Core Schemas Scale (BCSS, Fowler et al., 2006) can be used to operationalize the DCS construct because it resembles the same theoretical structure, with positive and negative schemas about the self and others. Negative schemas measured with the BCSS tend to be associated with generic psychopathological symptoms (Faustino, 2022a) and paranoia (Fowler et al., 2006). Nevertheless, research on the BCSS with other psychopathological-related variables is sparse. Previous research suggests dysfunctional core beliefs or maladaptive schemas are associated with various psychiatric disorders and psychological constructs. EMS measured by the YSQ-S3 (Young et al., 2005) are associated with eating disorders (Maher et al., 2022), affective disorders (Nilsson, 2016), depressive disorders (Bishop et al., 2022), anxiety disorders (Tariq et al., 2021), post-traumatic stress disorder (Cockram et al., 2010), personality disorders (Barazandeh et al., 2016; Kunst et al., 2020) and symptomatology in non-clinical samples (Carr & Francis, 2010). Dysfunctional core beliefs measured by the PBQ-SQ (Butler et al., 2007) are also associated with personality disorders (Beck et al., 2001) and symptomatology in non-clinical samples (Faustino et al., 2022a). Also, EMS is related to interpersonal dysfunctional cycles (Faustino & Vasco, 2020c), cognitive fusion and psychological needs (Faustino & Vasco, 2020a), emotional processing difficulties (Faustino & Vasco, 2020b), defense mechanisms (Walburg & Chiaramello, 2015), and dissociative experiences (Bortolon et al., 2017). If the results of the present study are in line with previous research, it can be suggested that the BCSS may be a valid instrument to identify the schematic functioning and, eventually, will be able to operationalize the DCS construct.

Moreover, the contribution of maladaptive schemas to emotional trauma and distress outcomes may be twofold: EMS can be regarded as risk factors, perpetuating factors, and mediators. For example, Roelofs and colleagues (2011) showed that EMS mediated the quality of attachment relationships and depressive symptomatology; Vasilopoulou and colleagues (2020) showed that EMS mediates the relationship between childhood traumatic events and complex post-traumatic stress disorder. Similarly, Khosravi (2020), showed that EMS of vulnerability to harm and defectiveness/shame were significant mediators of the relationships between emotional neglect and dissociation. Faustino & Vasco, 2020a showed that EMS mediated the relationships between emotional processing difficulties and symptomatology; Costa et al. (2022) described how EMS mediated the relationship between early life stress and psychiatric symptoms; and finally, Faustino et al., 2022b showed that the EMS of vulnerability to harm and mistrust abuse mediated the negative relationship between COVID-19 anxiety and life satisfaction. This empirical evidence supports the role of EMS as a cognitive mediator of the relationships between various risk factors and mental health and well-being outcomes.

However, despite this evidence on EMS, it is not clear if DCS have a mediating role in the relationship between dissociative experiences and symptomatology in a non-clinical sample. Thus, the DCS construct is somewhat similar but also different from the EMS construct because: (1) it is focused on core self-other cognitive representations, (2) it does not depend exclusively on early experiences, (3) it has a dimensional structure—adaptive and maladaptive, and (4) it has two domains which can be independent (self and other). Therefore, the current study sought to explore how DCS relate to dissociative experiences.

Dissociation and Dissociative Experiences

Dissociation may be viewed as a response and/or a defense mechanism (Cramer, 2000) to life events that enables the individual to disconnect from or minimize awareness of distressing thoughts, sensations, feelings, perceptions, bodily sensations, sense of self, behaviors, or memories (Waller et al., 1996). Dissociative experiences result from the dissociation process in every day, transient, peri-traumatic, and/or maladaptive (Waller et al., 1996). According to Seligman and Kirmayer (2008), dissociative experiences have been conceptualized as dimensional, lying on a continuum from everyday experiences, such as becoming absorbed by one thought or emotion to depersonalized due to trauma. The intensity of dissociated experiences relies on the type of experience; in this sense, dissociative experiences may be recurrent in non-clinical populations in a not pathological manner (Seligman & Kirmayer, 2008). Thus, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5, pp. 291), defines dissociation “as a disruption, interruption, and/or discontinuity of the normal, subjective integration of behavior, memory, identity, consciousness, emotion, perception, body representation, and motor control”. DSM-5 diagnostic criteria also include dissociative disorders (e.g., dissociative identity disorder, DID), (complex) post-traumatic stress disorder (CPTSD, PTSD), and borderline personality disorder (BPD).

Typically, four types of dissociative experiences are described, such as Depersonalization-derealization (associated with experiences of feeling disconnected, separated from oneself, one’s body, and other people); Absorption (related to experiences of involvement in an activity, memory, or fantasy with detachment from the environment, the ability to ignore the pain and being able to do usually difficult things); Distractibility (includes experiences of losing part of the information of events, of finding things that one does not remember to do and confusion about memories) and Amnesia (involves severe forgetfulness) (Bernstein & Putnam, 1986). These experiences tend to be assessed with the Dissociative Experiences Scale (DES-28, Bernstein & Putnam, 1986). Previous research showed that dissociative experiences are associated with post-traumatic stress disorder (PTSD, Waelde et al., 2009), depression (Fung et al., 2020; Parlar et al., 2017), psychosis (Laddis & Dell, 2012), borderline personality disorder, and trauma (Krause-Utz, 2022). A recent meta-analysis by Lyssenko et al. (2018) of 216 studies showed that dissociative experiences (measured with the DES-28), were prevalent in several psychiatric disorders, such as dissociative disorders, posttraumatic stress disorder, borderline personality disorder, and conversion disorder. If dissociation and dissociative experiences are present in several psychopathological disorders, they may represent transdiagnostic coping mechanisms activated by distressing experiences (Ellickson-Larew et al., 2020; Ociskova et al., 2015). Recent studies suggested that individuals experience a wide array of symptoms rather than discrete singular categorial entities (Dalgleish et al., 2020). According to the transdiagnostic perspective of psychopathology, latent factors are responsible for the shared mechanisms that articulate several psychopathological symptoms (Kotov et al., 2017). Several variables are being purposed as core transdiagnostic variables (Lynch et al., 2021) which supports the need to explore the DCS construct and dissociative experiences within a transdiagnostic perspective with generic symptomatology. Although the connection between dissociative experiences and psychopathological symptoms is well established, the interrelationships between dissociation, DCS, and psychological symptoms are yet to be explored.

The Current Study

We theorized that the relationships between dissociative experiences and symptomatology are mediated through the core self-schemas, where the maladaptive core self has a facilitating role, while the adaptive core self has an inverse role. The same can be said for the maladaptive and adaptive other schemas. Dissociative mechanisms range from adaptive to maladaptive, and if individuals experience psychological distress, some dissociative mechanisms may likely be used. If these coping mechanisms are severe, psychopathological symptoms may occur. However, if individuals see themselves as flawed, unworthy, weak, and/or undeserving of affect and see others as deceitful, bad, harsh, and/or unforgiving then it is expected that the relationship between dissociative experiences and psychopathological symptoms would be enhanced. The same can be said for adaptive views of the self and others, which will weaken this relationship. As stated previously, maladaptive schemas are significant mediators of several relationships (e.g., childhood traumatic events and CPSDS); however, the relationships with DCS are still unexplored. Therefore, the following hypotheses were formed:

Maladaptive core schemas are positively associated with dissociative experiences;

Adaptive core schemas are negatively associated with dissociative experiences;

Maladaptive schemas and dissociative experiences predict symptomatology;

Maladaptive and Adaptive core-self schemas mediate the relationship between dissociative experiences and symptomatology;

Maladaptive and Adaptive core-other schemas mediate the relationship between dissociative experiences and symptomatology.

Method

Participants and Procedures

Participants were recruited from the undergraduate course of psychology through the Qualtrics platform. All participants gave informed consent in the online platform to participate in the present study. Inclusion criteria were being aged 18–65 years, speaking Portuguese for more than 5 years, and not having a self-reported neurocognitive disorder. This research was approved by the ethics committee of BLINDED. The sample consisted of 179 participants (86% female). The age of the men varied between 18 and 65 years (M = 28.2, SD = 15.1), and the age of the women varied between 18 and 59 years (M = 20.1, SD = 5.78). Participants’ nationalities were primarily Portuguese (n = 167; 93.3%). All participants were Portuguese speakers with more than 5 years of proficiency. Most participants’ highest level of education was 12th grade (n = 153; 85.5%), while 18 (10.1%) had a Undergraduate degree, and 8 (4.5%) had a Master’s or Doctoral degree. Marital status was the following: 170 were single (95%), seven were married (3.9%), one was co-habitant (.6%), and one was divorced (.6%).

Ethical Statement

The Declaration of Helsinki research principles were used in the present study, and it was approved by the Ethical Committee of the University of Lisbon. We declare the following aspects of the present study: (1) all participants gave informed consent to participate in the study; (2) the scientific purpose of the research was explained; (3) privacy and anonymity were made clear in the instructions; (4) this paper reflects an original unpublished scientific study; (5) authors of the study declare that there is no conflict of interest and (6) data is not shared, because it belongs to an ongoing project.

Measures

Brief Core Schemas Scales (BCSS)

The BCSS (Fowler, et al., 2006, translated and adapted to European Portuguese by Faustino, 2022a) was used to assess adaptive and maladaptive core schemas about the self and others. It is a self-report questionnaire with 24 items divided into four dimensions with a five-point rating scale (0–4). The adaptive self-subscale contains items such as “I am interesting”, and “I am talented”; the maladaptive self-subscale contains items such as “I am worthless”, and “I am vulnerable”; The adaptive others-subscale contains items such as “Other people are fair” and “Other people are good” and the maladaptive others-subscale contains items such as “Other people are hostile”, “Other people are harsh”. Subscale scores range from 0 to 20, with higher scores indicating higher schema endorsement. Cronbach’s alpha of the four subscales was as follows: adaptive core self-schemas (α = .78), maladaptive core self-schemas (α = .79), adaptive core other-schemas (α = .85), and maladaptive core other-schemas (α = .81).

Dissociative Experience Scales (DES-28)

The DES-28 (Bernstein & Putnam, 1986, translated and adapted to European Portuguese by Espirito Santo & Pio Abreu, 2008) self-response instrument that aims to assess four distinct dissociative experiences: depersonalization/derealization, absorption, distractibility, and amnesia. It has 28 items answered on a Likert scale from 0 to 100. Items are summed to form a total score, and four subscales represent the four types of dissociative experiences. Higher scores indicate greater dissociation. Cronbach’s alpha of the total score was (α = .97), depersonalization/derealization (α = .83), absorption (α = .82), distractibility (α = .79), and amnesia (α = .71).

Brief Symptoms Inventory (BSI-53)

The BSI-53 (Derogatis, 1993, translated and adapted to European Portuguese by Canavarro, 1999) assessed psychopathological symptoms, including anxiety, psychoticism, depression, or interpersonal sensibility. BSI-53 is a self-report questionnaire with 53 items on a five-point Likert scale (0–4). Only the total index was used, and Cronbach’s alpha for the total score was high (α = .97).

Statistical Analyses

Normal distribution was tested through the analysis of Skewness and Kurtosis. Values were between −2 to +2 and between −7 to +7, respectively, suggesting a normal data distribution (Byrne, 2010)—see Table 1. Multicollinearity was analyzed and proved adequate for all analyses |VIF < 5; T < 2| (Pallant, 2007). The sample was described with descriptive statistics. Pearson correlations were used to explore associations between schemas, dissociative experiences, and symptoms. A hierarchical regression with stepwise criteria was used to explore the additive predictive value of schemas and dissociative experiences on symptomatology. Mediation analyses were performed using the PROCESS macro for SPSS (Hayes, 2013). Confidence intervals of 95% and 10,000 bootstrap computations were used with a significance level of p < .05. G power was used to conduct a power analysis for the mediation models. A sample size of 119 was required for a .95 of actual power (α = .05, f2 = .15). The study sample is larger (N = 179) than required for the analysis. All analyses were performed in the SPSS version 25.

Table 1.

Descriptive Statistics and Normality Indexes for Variables Under Study (N = 176).

	M	SD	Min	Max	SK	K
Maladaptive core self schemas (BCSS)	1.67	.58	1.00	3.83	1.30	1.60
Adaptive core self schemas (BCSS)	2.55	.58	1.00	4.00	−.13	−.45
Maladaptive core other schemas (BCSS)	1.70	.47	1.00	3.33	.51	−.08
Adaptive core other schemas (BCSS)	2.19	.51	1.00	4.00	.48	1.00
DES-28 total score	1.37	.58	.14	3.03	−.01	.14
Depersonalization/derealization (DES-28)	1.31	1.20	.00	9.86	2.0	4.60
Absorption (DES-28)	3.24	2.10	.00	8.71	.39	−.76
Distractibility (DES-28)	21.62	12.37	1.00	59.43	.56	−.24
Amnesia (DES-28)	4.10	5.49	.00	32.33	2.20	5.80
Symptomatology (BSI-53)	1.21	.75	.13	3.40	−.07	.01

Note: BCSS = brief core schema scales; DES-28 = dissociative experiences scale; BSI-53 = brief symptoms inventory.

Results

Table 1 provides the means, standard deviations, minimum, maximum, skewness, and kurtosis of the maladaptive and adaptive self-other schemas (BCSS), dissociative experiences (DES-28), and symptomatology (BSI-53).

Table 2 provides the Pearson correlations between the variables. Maladaptive core self-schemas correlated positively with DES-28 Total Score (r = .39, p < .05), depersonalization/derealization (r = .48, p < .05), absorption (r = .33 p < .05), distractibility (r = .25, p < .05), amnesia (r = .21, p < .05), and symptomatology (r = .62, p < .05). Adaptive core self-schemas only correlated negatively with DES-28 Total Score (r = −.23, p < .05), depersonalization/derealization (r = −.34, p < .05), distractibility (r = −.19, p < .05), and symptomatology (r = −.50, p < .05). Maladaptive core other-schemas showed a similar pattern with maladaptive core self-schemas (p < .05) and adaptive core other-schemas did not correlate with any variable (see Table 2).

Table 2.

Pearson Correlations Between Dialectical Core Schemas, Dissociation, and Symptomatology (N = 179).

	DES-28 Total Score	DEP/DES	ABS	DIS	AMNS	BSI-53
Maladaptive core self-schemas	.39^**	.48^**	.33^**	.25^**	.21^**	.62^**
Adaptive core self-schemas	−.23^**	−.34^**	−.13	−.19^*	−.11	−.50^**
Maladaptive core other-schemas	.24^**	.22^**	.22^**	.25^**	.14	.34^**
Adaptive core other-schemas	−.08	−.10	−.03	−.12	−.05	−.11
Symptomatology (BSI-53)	.57^**	.55^**	.48^**	.48^**	.39^**	—

Note: **p < .01; *p < .05.

DEP/DES = depersonalization/derealization (DES-28); ABS = absorption (DES-28); DIS = distractibility (DES-28); AMNS = amnesia (DES-28); BSI-53 = symptomatology (BSI-53).

Table 3 describes a hierarchical regression analysis with stepwise criterion with dialectical core schemas and dissociative experiences as independent variables and with symptomatology as a dependent variable. A statistically significant model with five predictors was found, with maladaptive self and other schemas, adaptive self-schemas, distractibility, and amnesia, which accounts for 55% (b = .15, p < .01) of the variance of symptomatology in the present sample (see Table 3). The stepwise criteria remove the nonsignificant variables from the analysis. All variables from the BCSS and DES-28 were used. A significant model is shown in Table 3. Removed variables were the following: Adaptive core self-schemas (BCSS), depersonalization/derealization and absorption from DES-28.

Table 3.

Hierarchical Regression Analysis With Dialectical Core Schemas and Dissociative Experiences as Independent Variables and With Symptomatology as a Dependent Variable (N = 179).

	R ²	B	Error	b	t	Sig
Maladaptive core self schemas	.38	.51	.08	.40	6.428	.01
Maladaptive core other schemas	.43	.24	.08	.15	2.881	.04
Adaptive core self schemas	.45	−.24	.08	−.19	−3.127	.02
Distractibility (DES-28)	.54	.01	.04	.23	3.897	.01
Amnesia (DES-28)	.55	.02	.08	.15	2.539	.01

Two mediation models were tested. The first model was statistically significant. The indirect effect between dissociative experiences and symptomatology was significant (b = .14, |.04 −.22|, p < .05). The relationship between dissociative experiences and symptomatology was mediated by maladaptive core self-schemas (ab = .14, |.08–.21|, p < .05). The relationship between dissociative experiences and symptomatology was also mediated by adaptive core self-schemas (ab = .05, |.01–.09|, p < .05). See Figure 1.

Figure 1.

Mediation analysis of the relationship between dissociation and symptomatology with maladaptive and adaptive core self-schemas as mediators.

The second model was partially statistically significant. The indirect effect between dissociative experiences and symptomatology was significant (b = .30 |.21–.38|, p < .05). The relationship between dissociative experiences and symptomatology was mediated by maladaptive other schemas (ab = 03, |.01–.07|, p < .05). However, the relationship between dissociative experiences and symptomatology was not mediated by adaptive core other schemas. See Figure 2.

Figure 2.

Mediation analysis of the relationship between dissociation and symptomatology with maladaptive and adaptive core other schemas as mediators.

Discussion

This study aimed to explore the role of Dialectical Core Schemas in the relationship between Dissociative Experiences and symptomatology. Results were partially in line with theoretical predictions. Hypothesis one was confirmed. All maladaptive core selves and other schemas were positively associated with dissociative experiences. This is in line with theoretical predictions in the sense that when maladaptive core schemas are stable and are activated, it is expected that individuals engage in defensive processes, such as dissociation, which may foster dissociate experiences such as depersonalization, derealization, and amnesia (Bortolon et al., 2017; Krause-Utz, 2022). Thus, Khosravi (2020) documented that EMS of defectiveness/shame, vulnerability to harm and illness, and pessimism were correlated with dissociative experiences in patients with borderline personality disorder. In another study, Karatzias et al. (2016) described a positive correlation between dependent EMS and dissociative experiences in adult survivors of interpersonal trauma. Aligned with this evidence, the present study shows that dysfunctional core cognitions about the self and others are associated with dissociative experiences. Therefore, this study supports the claim that individuals with a dysfunctional perspective about themselves and others are prone to feel dissociative experiences, which is aligned with the cognitive theory of psychopathology (Beck et al., 2015; Young et al., 2003).

The second hypothesis received partial confirmation as adaptive core other-schemas did not correlate with any variable (dissociative experiences and symptomatology). A closer inspection of the DES-28 items suggests that most of the items refer to the experience of the self, which means that they are not focused on the experience of the other. In this sense, the adaptive core and other schemas seem irrelevant to this psychological domain regarding self-dissociative experiences. Faustino, 2022a showed that the adaptive core-other schemas do not correlate with psychological distress, which suggests that this domain may be relatively independent from generic distressful states. However, in the same study, it did correlate negatively with all symptomatology and EMS domains. More research is required to explore these results in the adaptive other dimensions. Moreover, the adaptive core self-schemas correlated negatively with dissociative experiences, suggesting that individuals see themselves as valued, respected, and interesting, they are less likely to report using dissociation to cope with symptomatology.

Hypothesis three was supported. Dialectical Core Schemas and dissociative experiences predicted symptomatology as the hierarchical regression analysis demonstrated. Maladaptive core cognitions about the self and others can be regarded as vulnerability (proponent and precipitant) factors for developing psychopathological symptoms due to the distorted thinking and emotionality that emerges from the dysfunctional appraisals of self and other experiences (Beck et al., 1989, 2015). The same can be said regarding dissociative experiences. An individual who manifests steady distractibility, self-absorption, and/or amnesia because of dissociation,/may likely develop symptomatology, such as anxiety, depression, and/or interpersonal sensitivity (Ellickson-Larew et al., 2020; Seligman & Kirmayer, 2008).

Hypothesis four was also supported. Maladaptive and adaptive core self-schemas mediated the relationship between dissociative experiences and symptomatology. This result suggests that individuals may hold contradictory core cognitions about themselves, which impact several psychological variables, such as coping mechanisms (e.g., dissociation) and symptomatology. On one hand, maladaptive core self-schemas facilitate the relationship between dissociative experiences and symptomatology because when these schemata are activated, individuals see themselves as weak, unworthy, and unlovable, which may give them a sense of weakness, fragility, and vulnerability to dissociative experiences (Bortolon et al., 2017; Young et al., 2003). On the other hand, adaptive core self-schemas may impair the relationship between dissociative experiences and symptomatology because when these schemata are activated, individuals see themselves as strong, capable, and valued, meaning they do not need to avoid distressful feelings and emotions about themselves. In this sense, individuals may swing back and forth on a continuum between two dialectical poles with adaptive and maladaptive core cognitions about themselves (Faustino, 2022a, 2022b).

Finally, the fifth hypothesis received partial confirmation, because the adaptive core other schemas did not mediate the relationship between dissociative experiences and symptomatology. However, the mediation with the maladaptive core of other schemas was significant. This suggests a differential weight of the adaptive other schemas dimension on the relationship between dissociative experiences and symptomatology. As stated before, dissociative experiences are concerned with the dimension of the self and not with the dimension of the other. However, because maladaptive core other schemas were significant, maybe the relationships between dysfunctional mental contents transcend the self-other dichotomy (Faustino, 2022a, 2022b). Aligned with this, dissociative experiences as measured by DES-28 may be more in line with intrapsychic processes rather than interpsychic processes. Thus, this is also suggested by the correlational pattern, where most of the DES-28 subscales (apart from the Amnesia subscale) correlated with maladaptive and adaptive core self-schemas and correlated only with maladaptive other schemas. Another explanation may be that adaptive core other schemas underly adaptive views of others. If individuals see others as trustful, supportive, and accepting, they do not need to defend themselves. In this sense, it is expected the adaptive other domains do not have a significant effect on the relationship between dissociative experiences and symptomatology. However, more research is required to explore this aspect.

Clinical Implications

The results of the present study may have some clinical implications. DCS may help clinicians and researchers to better understand how individuals experience at the same time opposite cognitions about the self and others and how they impact dissociative experiences. Therefore, case conceptualization may be enhanced by the direct exploration of not only the maladaptive schemas but also their counterpart. Another implication is to explore how individuals disregard their adaptive schemas and how these processes may have a dysfunctional impact on mental health. Processes such as maladaptive coping and lack of behavioral skills (Young et al., 2003), cognitive distortions (Beck et al., 2015), defense mechanisms (Cramer, 2000), psychological inflexibility (Hayes et al., 1999) and emotional processing difficulties (Elliott & Greenberg, 2016), which are associated with EMS (Faustino & Vasco, 2020c, 2020b; Walburg & Chiaramello, 2015) may play a role on how individuals disregard they adaptive views of the self. However, this needs further empirical exploration. Interventions may be focused explicitly on weakening maladaptive and strengthening adaptive schemas. For instance, traumatized individuals will always have a core schema of abused or humiliated self because they effectively experienced humiliation. In this sense, the maladaptive schema is always there but can be weakened by strengthening an adaptive one. Also, individuals with personality disorders may hold deeply rooted core beliefs (Beck et al., 2015), which are extremely hard to change. Therefore, strengthening adaptive schemas that are different from the maladaptive ones may help individuals to better deal with themselves and others. Thus, previous research on early positive schemas suggested that they are negatively associated with symptomatology (Louis et al., 2018; Paetsch et al., 2022; Videler et al., 2020), which is suggestive that they can be strengthened with the objective of reducing symptoms severity. These issues may also be shared with patients to develop a common clinical objective aligned with transtheoretical principles of change and empirically supported tasks, such as imagery reprocessing and chair work.

Limitations and Future Directions

The findings need to be interpreted within the context of several limitations. Constructs were assessed via self-report measures which may be subject to biases. In addition, self-report instruments may reflect participants’ subjective thoughts and feelings during the assessment, which may not be the same as what they experience in their lives. Given the cross-sectional nature of the current study, we were not able to examine temporal causality. Dissociation can be both a reaction to maladaptive schema activation and, in turn, a schema-perpetuating experience (Lysenko et al., 2018). The distress, difficulties with functioning, and perceived loss of control that accompanies dissociation may reinforce maladaptive schemas (e.g., “I am weak”). Recurrent dissociative experiences can therefore perpetuate a maladaptive sense of self which in turn increases one’s vulnerability to mental health problems (Spiegel et al., 2011). Longitudinal investigations are needed to explore the potential bi-directional nature of the associations between dissociation, dialectical core schemas, and mental health. Our sample had more women than men which may limit the generalizability of the findings to men. Future research could explore these relationships in a gender-balanced sample. Relationships should be explored with clinical samples and with other trauma-related variables, such as early trauma and PTSD symptomatology.

Conclusions

Maladaptive and adaptive core cognitions about the self are associated with dissociative experiences and symptomatology in a non-clinical sample. These findings have contributed to identifying the mechanisms linking dissociative experiences to mental illness. Case conceptualization and clinical decision-making can be enhanced by considering the complex relationships between dialectical core schemas, dissociation, and symptomatology. Psychological schemas implicated in dissociative experiences and mental disorders are likely to be important treatment targets.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the FCT—Fundação para a Ciência e a Tecnologia, I.P., under the project (UIDB/05380/2020).

Originality

This paper reflects an original unpublished scientific study.

Informed Consent

All participants gave consent to participate.

Data Availability

Data not shared.

ORCID iDs

Bruno Faustino

Pamela Pilkington

Patrícia M. Pascoal

Author Biographies

Bruno Faustino, Ph.D. is an assistant professor and co-director of the MSc in Clinical and Health Psychology at Lusophone University (Universidade Lusófona). He is a licensed clinical psychologist, psychotherapist and neuropsychologist in private practice and a member of the Portuguese Association for Cognitive, Behavioral and Integrative Therapy (APTCCI). His research focuses on biopsychosocial pressures, dialectical schemas and core transformational processes framed in integrative psychotherapy and affective neuroscience.

Pam Pilkington, M Psych Clin PhD is a research fellow at the Australian Catholic University. She is a clinical psychologist and certified Advanced Schema Therapist in private practice in Melbourne, Australia. Her research focuses on schema therapy, adverse childhood experiences, parenting, and partner relationships.

Patrícia M. Pascoal, Ph.D. is an associate professor at Lusophone University (Universidade Lusófona), where she is the Deputy Director of the Ph.D. in Clinical Psychology, Cognitive Behavioral Approach. She is a licensed psychotherapist and sex therapist and a member of the Portuguese Association for Behavioral Therapy (APTC) board of directors. Her research is mainly developed in sexual health research using social-cognitive and cognitive-emotional models as a theoretical framework.

References

Aafjes-van Doorn

McCollum

Silberschatz

Snyder

(2021). Assessing internalized beliefs: Development of the pathogenic belief scale. Development and Psychopathology, 33(1), 96–108. https://doi.org/10.1017/S0954579419001615

Barazandeh

Kissane

D. W.

Saeedi

Gordon

(2016). A systematic review of the relationship between early maladaptive schemas and borderline personality disorder/traits. Personality and Individual Differences, 94, 130–139. https://doi.org/10.1016/j.paid.2016.01.021

Beck

A. T.

Freeman

Davis

D. D.

(2015). Cognitive therapy of personality disorders (2nd ed.). Guilford Press.

Beck

A. T.

Rush

Shaw

Emery

(1979). Cognitive therapy of depression. The Guilford Press.

Bernstein

E. M.

Putnam

F. W.

(1986). Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004

Bishop

Younan

Low

Pilkington

P. D.

(2022). Early maladaptive schemas and depression in adulthood: A systematic review and meta-analysis. Clinical Psychology and Psychotherapy, 29(1), 111–130. https://doi.org/10.1002/cpp.2630

Bortolon

Seillé

Raffard

(2017). Exploration of trauma, dissociation, maladaptive schemas and auditory hallucinations in a French sample. Cognitive Neuropsychiatry, 22(6), 468–485. https://doi.org/10.1080/13546805.2017.1387524

Butler

A. C.

Beck

A. T.

Cohen

L. H.

(2007). The personality belief questionnaire-short form: Development and preliminary findings. Cognitive Therapy and Research. 31, 357–370.

Byrne

B. M.

(2010). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Routledge.

10.

Canavarro

M. C.

(1999). Inventário de sintomas psicopatológicos: BSI. In Simões

M. R.

Gonçalves

Almeida

L. S.

(Eds.), Testes e provas psicológicas em Portugal (2, pp. 87–109). SHO/APPORT.

11.

Carr

S. N.

Francis

A. J.

(2010). Early maladaptive schemas and personality disorder symptoms: An examination in a non-clinical sample. Psychology and Psychotherapy, 83(4), 333–349. https://doi.org/10.1348/147608309X481351

12.

Cockram

D. M.

Drummond

P. D.

Lee

C. W.

(2010). Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clinical Psychology and Psychotherapy, 17(3), 165–182. https://doi.org/10.1002/cpp.690

13.

Costa

I. F. D.

Tomaz

M. P.

Pessoa

G. D. N.

Miranda

H. d. S.

Galdino

M. K.

(2020). Early maladaptive schemas and harm avoidance as mediating factors between early life stress and psychiatric symptoms in adults. Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999), 42(5), 489–495. https://doi.org/10.1590/1516-4446-2019-0593

14.

Cramer

(2000). Defense mechanisms in psychology today: Further processes for adaptation. The American Psychologist, 55(6), 637–646. https://doi.org/10.1037/0003-066X.55.6.637

15.

Dalgleish

Black

Johnston

Bevan

(2020). Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of Consulting and Clinical Psychology, 88(3), 179–195. https://doi.org/10.1037/ccp0000482

16.

Derogatis

L. R.

(1993). The Brief symptom inventory (BSI): Administration, scoring and procedures manual. National Computer Systems.

17.

Ellickson-Larew

Stasik-O'Brien

S. M.

Stanton

Watson

(2020). Dissociation as a multidimensional transdiagnostic symptom. Psychology of Consciousness: Theory, Research, and Practice, 7(2), 126–150. https://doi.org/10.1037/cns0000218

18.

Elliott

Greenberg

L. S.

(2016). Humanistic-experiential psychotherapy inPractice: Emotion-focused therapy. In Consoli

A. J.

Beutler

L. E.

Bongar

(Eds.), Comprehensive textbook of psychotherapy: Theory and practice (2nd ed., pp. 106–120). Oxford University Press.

19.

Espírito Santo

Abreu

J. L. P.

(2009). Portuguese validation of the dissociative experiences scale (DES). Journal of Trauma and Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 10(1), 69–82. https://doi.org/10.1080/15299730802485177

20.

Faustino

(2022a). Maladaptive and adaptive cognitions about the self and others: Confirmatory factor analysis of the Brief core schemas scales. Psychological Reports, 126(3), 1445–1460. https://doi.org/10.1177/00332941211063602

21.

Faustino

(2022b). A state-trait approach to self-compassion: Is it a schema or a state of mind? In Carmona

J. J.

(Ed.), The importance of self-efficacy and self-compassion (1 ed., pp. 91–105). Nova Science Publishers, Inc.

22.

Faustino

Vasco

A. B.

(2020a). Early maladaptive schemas and cognitive fusion on the regulation of psychological needs. Journal of Contemporary Psychotherapy, 50(2), 105–112. https://doi.org/10.1007/s10879-019-09446-3

23.

Faustino

Vasco

A. B.

(2020b). Relationships between emotional processing difficulties and early maladaptive schemas on the regulation of psychological needs. Clinical Psychology and Psychotherapy, 27(6), 804–813. https://doi.org/10.1002/cpp.2464

24.

Faustino

Vasco

A. B.

(2020c). Schematic functioning, interpersonal dysfunctional cycles and cognitive fusion in the complementary paradigmatic perspective: Analysis of a clinical sample. Journal of Contemporary Psychotherapy, 50(1), 47–55. https://doi.org/10.1007/s10879-019-09422-x

25.

Faustino

Vasco

A. B.

da Silva

A. N.

Matos

(2022b). Preliminary psychometric properties of the Portuguese version of the personality belief questionnaire—short form in a community sample. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 41 1–23. https://doi.org/10.1007/s10942-022-00448-0

26.

Faustino

Vasco

A. B.

Delgado

Farinha-Fernandes

Guerreiro

J. C.

(2022a). Early maladaptive schemas and COVID-19 anxiety: The mediational role of mistrustfulness and vulnerability to harm and illness. Clinical Psychology and Psychotherapy, 29(4), 1297–1308. https://doi.org/10.1002/cpp.2706

27.

Fowler

Freeman

Smith

Kuipers

Bebbington

Bashforth

Coker

Hodgekins

Gracie

Dunn

Garety

(2006). The Brief core schema scales (BCSS): Psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36(6), 749–759. https://doi.org/10.1017/S0033291706007355

28.

Fung

H. W.

Chan

Ross

C. A.

Choi

T. M.

(2020). A preliminary investigation of depression in people with pathological dissociation. Journal of Trauma and Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 21(5), 594–608. https://doi.org/10.1080/15299732.2020.1760168

29.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.

30.

Hill

C. R.

Safran

J. D.

(1994). Assessing interpersonal schemas: Anticipated responses of significant others. Journal of Social and Clinical Psychology, 13(4), 366–379. https://doi.org/10.1521/jscp.1994.13.4.366

31.

Karatzias

Jowett

Begley

Deas

(2016). Early maladaptive schemas in adult survivors of interpersonal trauma: Foundations for a cognitive theory of psychopathology. European Journal of Psychotraumatology, 7, 30713. https://doi.org/10.3402/ejpt.v7.30713

32.

Khosravi

(2020). Child maltreatment-related dissociation and it’s core mediation schemas in patients with borderline personality disorder. BMC Psychiatry, 20(1), 405. https://doi.org/10.1186/s12888-020-02797-5

33.

Kotov

Krueger

R. F.

Watson

Achenbach

T. M.

Althoff

R. R.

Bagby

R. M.

Brown

T. A.

Carpenter

W. T.

Caspi

Clark

L. A.

Eaton

N. R.

Forbes

M. K.

Forbush

K. T.

Goldberg

Hasin

Hyman

S. E.

Ivanova

M. Y.

Lynam

D. R.

Markon

Zimmerman

(2017). The hierarchical taxonomy of psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477. https://doi.org/10.1037/abn0000258

34.

Krause-Utz

(2022). Dissociation, trauma, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 9(1), 14. https://doi.org/10.1186/s40479-022-00184-y

35.

Kunst

Lobbestael

Candel

Batink

(2020). Early maladaptive schemas and their relation to personality disorders: A correlational examination in a clinical population. Clinical Psychology and Psychotherapy, 27(6), 837–846. https://doi.org/10.1002/cpp.2467

36.

Laddis

Dell

P. F.

(2012). Dissociation and psychosis in dissociative identity disorder and schizophrenia. Journal of Trauma and Dissociation: The Official Journal of the International Society for the Study of Dissociation (ISSD), 13(4), 397–413. https://doi.org/10.1080/15299732.2012.664967

37.

Leahy

R. L.

(2002). A model of emotional schemas. Cognitive and Behavioral Practice, 9(3), 177–190. https://doi.org/10.1016/S1077-7229(02)80048-7

38.

Louis

J. P.

Wood

A. M.

Lockwood

M. H. R.

Ferguson

(2018). Positive clinical psychology and schema therapy (ST): The development of the young positive schema questionnaire (YPSQ) to complement the young schema questionnaire 3 short form (YSQ-S3). Psychological Assessment, 30(9), 1199–1213. https://doi.org/10.1037/pas0000567

39.

Lynch

S. J.

Sunderland

Newton

N. C.

Chapman

(2021). A systematic review of transdiagnostic risk and protective factors for general and specific psychopathology in young people. Clinical Psychology Review, 87, 102036. https://doi.org/10.1016/j.cpr.2021.102036

40.

Lyssenko

Schmahl

Bockhacker

Vonderlin

Bohus

Kleindienst

(2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative experiences scale. The American Journal of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/appi.ajp.2017.17010025

41.

Maher

Cason

Huckstepp

Stallman

Kannis-Dymand

Millear

Mason

Wood

Allen

(2022). Early maladaptive schemas in eating disorders: A systematic review. European Eating Disorders Review: The Journal of the Eating Disorders Association, 30(1), 3–22. https://doi.org/10.1002/erv.2866

42.

Nilsson

K. K.

(2016). Early maladaptive schemas in bipolar disorder patients with and without suicide attempts. The Journal of Nervous and Mental Disease, 204(3), 236–239. https://doi.org/10.1097/NMD.0000000000000451

43.

Ociskova

Prasko

Kamaradova

Grambal

Kasalova

Sigmundova

Latalova

Vrbova

(2015). Coping strategies, hope, and treatment efficacy in pharmacoresistant inpatients with neurotic spectrum disorders. Neuropsychiatric Disease and Treatment, 11, 1191–1201. https://doi.org/10.2147/NDT.S80325

44.

Paetsch

Moultrie

Kappelmann

Fietz

Bernstein

D. P.

Kopf-Beck

(2022). Psychometric properties of the German version of the young positive schema questionnaire (YPSQ) in the general population and psychiatric patients. Journal of Personality Assessment, 104(4), 522–531. https://doi.org/10.1080/00223891.2021.1966020

45.

Pallant

(2007). SPSS survival manual: A step by step guide to data analysis using SPSS for windows (version 15). McGrow Hill Education, Open University Press.

46.

Parlar

Frewen

P. A.

Oremus

Lanius

R. A.

McKinnon

M. C.

(2016). Dissociative symptoms are associated with reduced neuropsychological performance in patients with recurrent depression and a history of trauma exposure. European Journal of Psychotraumatology, 7, 29061. https://doi.org/10.3402/ejpt.v7.29061

47.

Seligman

Kirmayer

L. J.

(2008). Dissociative experience and cultural neuroscience: Narrative, metaphor and mechanism. Culture, Medicine and Psychiatry, 32(1), 31–64. https://doi.org/10.1007/s11013-007-9077-8

48.

Spiegel

Loewenstein

R. J.

Lewis-Fernández

Sar

Simeon

Vermetten

Cardeña

Dell

P. F.

(2011). Dissociative disorders in DSM-5. Depression and Anxiety, 28(9), 824–852. https://doi.org/10.1002/da.20874

49.

Tariq

Quayle

Lawrie

S. M.

Reid

Chan

(2021). Relationship between early maladaptive schemas and anxiety in adolescence and young adulthood: A systematic review and meta-analysis. Journal of Affective Disorders, 295, 1462–1473. https://doi.org/10.1016/j.jad.2021.09.031

50.

Videler

A. C.

van Royen

R. J. J.

Legra

M. J. H.

Ouwens

M. A.

(2020). Positive schemas in schema therapy with older adults: Clinical implications and research suggestions. Behavioural and Cognitive Psychotherapy, 48(4), 481–491. https://doi.org/10.1017/S1352465820000077

51.

Waelde

L. C.

Silvern

Carlson

E. B.

Fairbank

J. A.

Kletter

(2009). Dissociation in PTSD. In Dell

P. F.

O’Neil

Somer

(Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 447–456). Routledge.

52.

Walburg

Chiaramello

(2015). Link between early maladaptive schemas and defense mechanisms. European Review of Applied Psychology, 65(5), 221–226. https://doi.org/10.1016/j.erap.2015.07.003

53.

Waller

Putnam

F. W.

Carlson

E. B.

(1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1(3), 300–321. https://doi.org/10.1037/1082-989X.1.3.300

54.

Wolfe

B. E.

(2005). The wounded self: An integrative etiological model of anxiety disorders. In Wolfe

B. E.

(Ed.), Understanding and treating anxiety disorders: An integrative approach to healing the wounded self (pp. 105–123). American Psychological Association. https://doi.org/10.1037/11198-006

55.

Young

(2005). The Young schema inventory, standardized items (3rd version). Schema Therapy Institute.

56.

Young

J. E.

Klosko

J. S.

Weishaar

M. E.

(2003). Schema therapy: A practitioner’s guide. Guilford Press.

Dialectical Core Schemas Mediate the Relationships Between Dissociative Experiences and Symptomatology in a Community Sample

Abstract

Background

Methods

Results

Conclusions

Keywords

Introduction

Dialectical Core Schemas as an Alternative Schema Perspective

Dissociation and Dissociative Experiences

The Current Study

Method

Participants and Procedures

Ethical Statement

Measures

Brief Core Schemas Scales (BCSS)

Dissociative Experience Scales (DES-28)

Brief Symptoms Inventory (BSI-53)

Statistical Analyses

Results

Discussion

Clinical Implications

Limitations and Future Directions

Conclusions

Footnotes

Declaration of Conflicting Interests

Funding

Originality

Informed Consent

Data Availability

ORCID iDs

Author Biographies

References