The relationship between childhood trauma, psychotic symptoms, and cognitive schemas in patients with schizophrenia, their siblings, and healthy controls: results from the EU-GEI study.

BACKGROUND: The relationship between childhood trauma (CT) and psychotic symptoms in patients with schizophrenia (SCZ), and subthreshold psychotic experiences in non-clinical populations is well-established. However, little is known about the relationship between subtypes of trauma and specific symptoms in patients, their siblings, and controls. It is also not clear which variables mediate the relationship between trauma and psychotic symptoms. METHODS: Seven hundred and forty-two patients with SCZ, 718 of their unaffected siblings and 1039 controls from three EU-GEI sites were assessed for CT, symptom severity, and cognitive schemas about self/others. CT was assessed with the Childhood Trauma Questionnaire, and cognitive schemas were assessed by The Brief Core Schema Scale. RESULTS: Patients with psychosis were affected by CT more than their siblings and controls in all domains. Childhood emotional abuse and neglect were more common in siblings than controls. CT was related to negative cognitive schemas toward self/others in patients, siblings, and controls. We found that negative schemas about self-mediated the relationship between emotional abuse and thought withdrawal and thought broadcasting. Approximately 33.9% of the variance in these symptoms was explained by the mediator. It also mediated the relationship between sexual abuse and persecutory delusions in SCZ. CONCLUSIONS: Our findings suggest that childhood abuse and neglect are more common in patients with schizophrenia than their siblings and healthy controls, and have different impacts on clinical domains which we searched. The relationship between CT and positive symptoms seems to be mediated by negative cognitive schemas about self in schizophrenia.

Posttraumatic Growth, Maladaptive Cognitive Schemas and Psychological Distress in Individuals Involved in Road Traffic Accidents-A Conservation of Resources Theory Perspective.

Road traffic accidents can have profound psychological impacts on the individuals involved, encompassing both negative distress and positive growth. This study, guided by the conservation of resources (COR) theory, investigates the intricate relationship between posttraumatic growth (PTG), maladaptive cognitive schemas, and psychological distress in individuals involved in road traffic accidents. PTG reflects an individual's ability to derive positive changes from adversity, while maladaptive schemas represent negative cognitive patterns. Using a 122 sample of individuals involved in road traffic accidents, we examined direct and indirect effects within this complex network. Our findings reveal significant direct effects of PTG on psychological distress (ß = 0.101, p = 0.02). Particularly noteworthy are the indirect effects mediated by cognitive schemas, emphasizing the role of impaired autonomy and perceived performance deficiencies (ß = 0.102, p = 0.05). This suggests that individuals involved in road traffic accidents experiencing higher PTG levels may indirectly experience greater psychological distress through these maladaptive cognitive schemas. This study not only advances our understanding of the psychological consequences of road traffic accidents but also aligns with self-determination theory, emphasizing autonomy and competence as fundamental needs. Individuals involved in road traffic accidents may undergo profound shifts in perspective following the trauma, which our results support. Recognizing the nuanced relationship between PTG, maladaptive cognitive schemas, and psychological distress is crucial for tailoring interventions and support systems for individuals involved in traffic accidents. As PTG can coexist with distress, interventions should foster adaptive growth while addressing maladaptive schemas to promote resilience in the face of traumatic events.

Experiencing stress impact on adolescent repetitive nonsuicidal self-injury: The Mediating role of emotion dysregulation and maladaptive cognitive schemas.

BACKGROUND: Repetitive nonsuicidal self-injury (R-NSSI) is a growing concern in adolescents and is associated with various mental health problems. However, little is known about the potential psychology and addiction mechanisms of R-NSSI in adolescents. This study aimed to examine the mediating effects of emotion dysregulation and maladaptive cognitive schemas based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and the integrated model of NSSI among adolescents who repeatedly engage in NSSI. METHODS: This longitudinal study was conducted in two waves with 6-month lags. A total of 3925 adolescents (Mage = 13.22 ± 0.86 years, 42 % female) were recruited from three middle schools. Relevant questionnaires were used to evaluate stressful life events, emotion dysregulation, maladaptive cognitive schemas, NSSI, and NSSI addictive features. The structural equation modeling approach was conducted separately for adolescents who engaged in occasional NSSI (O-NSSI) and those who engaged in R-NSSI. RESULTS: Results showed that emotion dysregulation played a significant mediating role in the associations between stressful life events and NSSI frequency, and both maladaptive cognitive schemas and emotion dysregulation played a significant mediating role in the associations between stressful life events and NSSI addictive features in adolescents who engaged in R-NSSI but not in those who engaged in O-NSSI. LIMITATIONS: The main limiting factor is self-reported data. CONCLUSIONS: These findings contribute to the understanding of the psychological and addictive mechanisms involved in R-NSSI. Both emotion dysregulation and maladaptive cognitive schemas could be a suitable therapeutic target to reduce R-NSSI in the context of stress during adolescence.

Examining Cognitive Biases Uniquely Associated with Schizotypy.

INTRODUCTION: Individuals with schizotypy can experience a number of cognitive biases that may increase their risk in developing schizophrenia-spectrum psychopathology. However, cognitive biases are also present in mood and anxiety disorders, and it is currently unclear which biases are specific to schizotypy and which may be a result of comorbid depression and/or anxiety. METHODS: 462 participants completed measures of depression, anxiety, cognitive biases, cognitive schemas, and schizotypy. Correlation analyses were conducted to examine the relationship between these constructs. Three hierarchical regression analyses were conducted to examine if schizotypy, depression, and anxiety explained a statistically significant amount of variance in cognitive biases after controlling for depression and anxiety, schizotypy and anxiety, and schizotypy and depression, respectively. Moderated regression analyses were also conducted to investigate the moderating role of biological sex and ethnicity in the association between cognitive biases and schizotypy. RESULTS: Self-referential processing, belief inflexibility, and attention for threat were associated with schizotypy. The belief inflexibility bias and social cognition problems were specifically associated with schizotypy after controlling for depression and anxiety and were not directly associated with either depression or anxiety. These associations were not moderated by biological sex or ethnicity. CONCLUSION: The belief inflexibility bias may be an important cognitive bias underlying schizotypal personality, and further research will be important to determine whether this bias is also associated with an increased likelihood of transitioning to psychosis.

Comprehensive preoperative psychological assessment of breast cancer patients.

In the context of the traumas suffered by patients following the oncological diagnosis and the expectation of the surgical intervention, it is important to unitary and multidimensional identify the psychological status, using a single interview structured to cover these psychological vulnerabilities. The overall psychological picture can help the psycho-oncologist to adapt his psychotherapeutic interventions to relieve the stress caused by the oncological diagnosis and specific treatment. 58 patients with a breast cancer diagnosis and 61 patients with breast lumps diagnosis who were waiting for the histopathological result, received several scales for assessing emotional distress, the level self-esteem, depression, anxiety and cognitive dysfunctions levels. The analysis of the answers led to the multidimensional identification of differences between the two categories of patients and establishing correlations between personality traits and the development of certain psychological changes. Statistically significant differences (p < 0.05) were observed between patients with breast cancer and those with breast lumps awaiting histopathological diagnosis, in the areas of self-esteem, depression and cognitive schemas. Diagnosed patients have predominantly dysfunctional attitudes such as negative emotions and cognitive schemas related to catastrophe and self-deprecation, while undiagnosed patients, have cognitive schemas related to low tolerance for frustration and absolutist requirements and lower dysfunctional attitudes. A global assessment with a single psychological tool can capture the overall picture of the cancer patient, including possible triggers and maintenance of symptoms, with the psychological consequences of the disease that are reflected somatically, as well as predisposing factors in the history that generates these feelings.

El papel de los esquemas cognitivos y la adversidad infantil en la probabilidad de desarrollar un trastorno depresivo mayor / The role of cognitive schemas and childhood adversity in the likelihood of developing Major Depressive Disorder

Abstract Introduction/objective: Major Depressive Disorder (MDD) is a multifactorial mental health disorder. Stressful events and childhood abuse have been included in different models to explain its etiology. However, little evidence is available on how attributional style and early maladaptive schemas are related to MDD. Method: A retrospective case-control study using a three-stage hierarchical logistic model was conducted to explore the relationship between MDD and psychosocial variables such as childhood adversity, stressful life events, attributional style, and cognitive schemas in a sample of 171 individuals with a current depressive episode and 171 healthy controls. Results: Depression could be predicted by childhood adversity, an attributional style characterized by interpreting stressful events as negative and uncontrollable and the cognitive schemas in impaired autonomy/performance domains and impaired limits. Conclusions: Our results highlight the relevance of identifying cognitive factors, beyond clinical symptoms that could be useful to better understand MDD. These findings may result in better preventive programs and create awareness of the role of cognitive domains in MDD.

Resumen Introducción/objetivo: el trastorno depresivo mayor (TDM) es un trastorno de salud mental de origen multifactorial. Los eventos estresantes y el maltrato infantil se han incluido en diferentes modelos para explicar su etiología. Sin embargo, hay poca evidencia disponible sobre cómo el estilo atribucional y los dominios de esquemas maladaptativos tempranos se relacionan con el TDM. Método: Se realizó un estudio retrospectivo de casos y controles utilizando un modelo logístico jerárquico de tres etapas para explorar la relación entre el TDM y variables psicosociales como la adversidad infantil, los eventos estresantes, el estilo atribucional y los esquemas cognitivos en una muestra de 171 individuos con un episodio depresivo actual y 171 controles sanos. Resultados: La depresión podría predecirse por la adversidad infantil, un estilo atribucional caracterizado por interpretar los eventos estresantes como negativos e incontrolables y los esquemas cognitivos en los dominios de autonomía/desempeño y límites deteriorados. Conclusiones: Nuestros resultados resaltan la relevancia de identificar factores cognitivos, más allá de los síntomas clínicos, que podrían ser útiles para alcanzar una mejor comprensión del trastorno. Estos hallazgos favorecen el diseño de programas de prevención que enfaticen en el rol de los esquemas cognitivos.

The mediating role of maladaptive cognitive schemas regarding the relationship between parenting styles and chronic pain in adolescents: a structural equation modelling approach.

BACKGROUND: Although there is a growing body of evidence linking parenting styles to health outcomes, little emphasis has been dedicated to how parenting styles affect chronic pain in adolescents. Given the high prevalence of chronic pain in adolescents and taking into consideration the complexity of chronic pain and the factors affecting it, further research is needed to better understand the processes through which parenting styles affect adolescents' pain. The purpose of the present study was to explore the mediating role of maladaptive schemas in the association between different parenting styles and chronic pain. METHOD: 1302 adolescents aged 12 to 21 in Shiraz, Iran, were randomly selected to participate in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Buri's Parental Authority Questionnaire (PAQ), and Young's Schema Questionnaire-Short Form (YSQ-SF) were used to assess the parenting styles and maladaptive cognitive schemas, respectively. The structural equation modeling approach was carried out to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain. RESULTS: The results in the SEM models revealed that disconnection/ rejection (ß = - 0.043, 95%CI = - 0.07 to - 0.02), impaired autonomy/ performance (ß = - 0.01, 95%CI = - 0.02 to -0.003), over-vigilance/inhibition (ß = - 0.007, 95%CI = - 0.01 to - 0.008), and impaired limits schemas (ß = - 0.004, 95%CI = - 0.006 to - 0.002) significantly mediated the protective effects of the authoritative parenting style on chronic pain. It was also found that the mediating effects of disconnection/ rejection (ß = 0.01, 95%CI = 0.01 to 0.02), and over-vigilance/ inhibition (ß = 0.002, 95%CI = 0.001 to 0.02) existed in the relationship between the authoritarian style and chronic pain. The permissive style may also affect chronic pain through disconnection/ rejection (ß = 0.004, 95%CI = 0.001 to 0.01), other-directedness (ß = 0.01, 95%CI = 0.005 to 0.015), and impaired limits schemas (ß = 0.05, 95%CI = 0.04 to 0.06). DISCUSSION: The findings of the present study showed that maladaptive cognitive schemas play a mediating role in the relationship between parenting styles and chronic pain in adolescents. It seems that the interventions that target the effective communication between the parents and the adolescents can be considered as an important part in the chronic pain management in adolescents.

Specific early maladaptive schemas differentially mediate the relations of emotional and sexual maltreatment to recent life events in youth with depression.

The current study provided a novel investigation of relations among particular types of childhood maltreatment (emotional vs. physical vs. sexual maltreatment), specific cognitive schema themes and the generation of dependent versus independent life events. Participants included 227 adolescents and emerging adults (74% female; aged 12-29) in a current episode of a unipolar depressive disorder drawn from three archival cross-sectional studies. Childhood maltreatment and life events from the past 6 months were assessed using detailed contextual interviews with independent, standardized ratings. Emotional maltreatment was uniquely associated with schema themes of emotional deprivation and subjugation, and sexual maltreatment was uniquely associated with schema themes of abandonment, vulnerability and dependence/incompetence. Further, subjugation and abandonment cross-sectionally mediated the relations of emotional and sexual maltreatment, respectively, to greater dependent, but not independent, life events. Physical maltreatment was not associated with cognitive schemas or recent life events after accounting for its overlap with emotional and sexual maltreatment. Results suggest targets for cognitive intervention that may improve outcomes for youth with specific histories of emotional and sexual maltreatment.

Multidimensional Analysis of Major Depression: Association Between BDNF Methylation, Psychosocial and Cognitive Domains.

Major Depression is a complex disorder with a growing incidence worldwide and multiple variables have been associated with its etiology. Nonetheless, its diagnosis is continually changing and the need to understand it from a multidimensional perspective is clear. The purpose of this study was to identify risk factors for depression in a case-control study with 100 depressive inpatients and 87 healthy controls. A multivariate logistic regression analysis was performed including psychosocial factors, cognitive maladaptive schema domains, and specific epigenetic marks (BDNF methylation levels at five CpG sites in promoter IV). A family history of depression, the cognitive schemas of impaired autonomy/performance, impaired limits, other-directedness, and the methylation level of a specific CpG site were identified as predictors. Interestingly, we found a mediating effect of those cognitive schemas in the relationship between childhood maltreatment and depression. Also, we found that depressive patients exhibited hypomethylation in a CpG site of BDNF promoter IV, which adds to the current discussion about the role of methylation in depression. We highlight that determining the methylation of a specific region of a single gene offers the possibility of accessing a highly informative an easily measurable variable, which represents benefits for diagnosis. Following complete replication and validation on larger samples, models like ours could be applicable as additional diagnostic tools in the clinical context.

The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management.

The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.

Framing real beauty: A framing approach to the effects of beauty advertisements on body image and advertising effectiveness.

Current literature is inconsistent about the effects of idealized (i.e., thin) vs. non-idealized (i.e., average or plus-size) models on young women's well-being. This inconsistency may be explained by different frames (i.e., passive body, active body, and subject) surrounding beauty ad models. The current experimental study among 568 women aged 18-30 years (M = 21.45, SD = 1.84) tested the effects of differently framed ads featuring idealized vs. non-idealized models on well-being and ad effectiveness while taking into account the mediating role of cognitive schemas and moderating role of thin-ideal internalization. Results showed that a passive body frame generated more appearance schemas compared to a subject frame. The effects of framing on body functionality schemas operated differently for idealized vs. non-idealized models. The passive body frame also induced inferior ad outcomes (i.e., lower attitudes to the advertisement and brand and lower purchase intent) compared to an active body frame. No other main framing effects nor moderating effects of thin-ideal internalization were found. These results for advertising outcomes can encourage beauty brands to stop using typical objectifying ads.

Associations between childhood adversity, cognitive schemas and attenuated psychotic symptoms.

AIM: Childhood Adversity (CA) is strongly linked to psychotic-like symptoms across the clinical spectrum, though the mechanisms underlying these associations remain poorly understood. Negative cognitive schemas are associated with both CA exposure and psychotic symptoms, highlighting the possibility that cognitive schemas may be a key risk pathway. The purpose of this study was to determine whether negative cognitive schemas mediate the association between CA and specific attenuated psychotic symptoms in a large sample of clinical-high risk youth. Given the variability in experiences that encompass CA (eg, abuse, neglect and poverty) and attenuated psychotic symptoms (eg, suspiciousness and perceptual abnormalities), we also tested whether these associations differ by CA type (threat vs deprivation) and attenuated positive psychotic symptom domain. METHODS: Data were collected from 531 clinical-high risk youth between 12 and 35 years of age (mean = 18.80, SD = 4.21) who completed a clinical assessment that included the Structured Interview of Prodromal Syndromes (SIPS), Childhood Trauma and Abuse scale and questionnaires on cognitive schemas and depressive symptoms. RESULTS: No direct effects of threat or deprivation exposure on any of the psychotic symptom domains were found. However, there was a unique indirect effect of threat, but not deprivation, on delusional thinking and suspiciousness through negative cognitive schemas about others. CONCLUSION: Cognitive vulnerability in the form of negative schemas about others may be one mechanism linking childhood threat experiences and attenuated psychotic symptoms. The results underscore the importance of targeting negative schemas in interventions to mitigate psychosis risk.

The clinical characterization of the adult patient with depression aimed at personalization of management.

Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial-and-error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta-analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self-report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above-mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.

Cognitive-Emotional Predictors of Sexual Functioning in Lesbians, Gays, and Heterosexuals.

Cognitive-emotional dimensions play a core role in predisposing and maintaining sexual difficulties. This study aimed to assess the role of personality traits, sexual beliefs, cognitive schemas, automatic thoughts and affective states in predicting sexual functioning in a Portuguese sample. A total of 226 lesbian women, 254 heterosexual women, 243 gay men, and 274 heterosexual men completed a web-survey. For each sample, hierarchical regression analyses were conducted, separately. Results indicated that positive affective states and fewer thoughts associated with failure and disengagement during sexual activity act as significant predictors for sexual functioning, in both lesbian and heterosexual women's groups. Specific predictors of better sexual functioning in lesbian women were lower activation of schemas of undesirability and incompetence, and fewer thoughts associated with sexual abuse, body-image and sexual passivity were, whereas particular predictors of better sexual functioning for heterosexual women were erotic thoughts, lower activation of schemas of undesirability and difference/loneliness, and beliefs related to sexual desire as a sin. For men's groups, the best predictor of sexual functioning was the presence of erotic thoughts. Particularly for gay men's group, fewer failure anticipation thoughts were also a predictor of better sexual functioning. Overall, this study supports the core and predictive role of cognitive-emotional dimensions in sexual functioning for lesbian and heterosexual women, as for gay and heterosexual men.

The influence of cognitive schemas on the mixed anxiety-depressive symptoms of breast cancer patients.

BACKGROUND: The surgical treatment of breast cancer involves various psychological consequences, which differ according to individual characteristics. Our study aimed to identify the role that cognitive schemas had in triggering anxiety and depressive symptoms in patients diagnosed with breast cancer that underwent oncological and plastic surgery treatment. METHODS: 64 female patients, diagnosed with breast cancer from an Oncology and Plastic Surgery Hospital, were selected to participate in this study between March-June 2018. They were divided into two groups: I. 28 patients who underwent mastectomy surgery; II. 36 patients, who required mastectomy and, subsequently, also chose to undergo breast reconstruction surgery. For the purposes of evaluating a possible change in mental health status, we employed two assessment scales: the Young Cognitive Schema Questionnaire - Short Form 3 (YSQ-S3) and the Romanian version of the Depression Anxiety Stress Scale - 21 (DASS-21R). RESULTS: Participants who underwent mastectomy and subsequent breast reconstruction surgery employed cognitive schemas that did not generate symptoms of depression or anxiety. In contrast, the cognitive schemas found in women who refused reconstructive breast surgery were significantly correlated with the presence of anxiety-depressive symptoms. The cognitive schema domain of 'disconnection and rejection' correlated uncertainly with the presence of anxiety-depressive symptoms for the group with breast reconstruction (Spearman's ρ = 0.091, p = 0.644), while for the other group the correlation was moderate-strong (Spearman's ρ = 0.647, p <  0.01). Negative emotional schemas were significantly correlated with the presence of anxiety-depressive symptoms (Spearman's ρ = 0.598, p <  0.01) in the group of participants without reconstructive surgery. CONCLUSION: A correct identification of dysfunctional cognitive schemas and coping mechanisms at the commencement of the combined treatment in breast cancer patients could serve as an indicator for the evolution of their mental health, therefore assisting professionals in establishing the most suitable psychological, psychotherapeutic and psychiatric intervention plan.

Cognitive Schemas among Mental Health Professionals and Other Health Professionals.

OBJECTIVE: Research has demonstrated that dysfunctional cognitive schemas among mental health professionals (MHPs) may influence the ability to process clients' information in an unbiased manner, may be a substantial source of error in psychotherapeutic ratings, hinder accurate reporting of clients' cognitive schemas, and have a detrimental effect on therapeutic alliance. The present study compared cognitive schemas among MHPs and other health professionals (OHPs). MATERIALS AND METHOD: A sample of 128 professionals (64 MHPs and 64 OHPs) was chosen using a purposive sampling technique. The study used a cross-sectional observational research design. The Young Schema Questionnaire Short Form 3rd version was administered on the consenting participants. RESULTS: OHPs had higher maladaptive schemas on the domains of abandonment and defectiveness. Overall, males had more maladaptive schemas in the domains of abandonment, mistrust, entitlement/superiority, admiration/recognition seeking, and emotional inhibition. Among MHPs, a weak positive correlation of years of experience with vulnerability to harm or illness was seen. Among other health professionals, a significant but weak positive correlation of age with admiration/recognition seeking was seen. CONCLUSION: This study highlights the presence of maladaptive schemas in health professionals and the need for incorporation of training modules to address these.

The Effect of an Intervention Teaching Adolescents that People can Change on Depressive Symptoms, Cognitive Schemas, and Hypothalamic-Pituitary-Adrenal Axis Hormones.

Interest is increasing in developing universal interventions to prevent depression in adolescents that are brief enough to be scaled up. The aim of this study was to test the effects on depressive symptoms, cognitive schemas, and Hypothalamic-Pituitary-Adrenal Axis Hormones of an intervention focused on teaching an element of an incremental theory of personality, namely, the belief that people can change. We also examined whether grade level moderated the effects of the intervention. A double-blind, randomized, controlled trial was conducted with 867 Spanish adolescent participants (51.9% boys, Grades 8-10) randomly assigned to an incremental theory intervention (n = 456) or an educational control intervention (n = 411). The adolescents completed measures of depressive symptoms and negative cognitive schemas at pretest, at 6-month follow-up, and at 12-month follow-up. A subsample of 503 adolescents provided salivary samples for cortisol and DHEA-S testing. In 8th grade, adolescents who received the incremental theory intervention displayed a greater decrease in depressive symptoms and cognitive schemas and a lower increase in DHEA-S. Moreover, in adolescents who received the intervention, the rate of adolescents with high depression scores decreased by almost 18% whereas in the control group, the rate increased by 37%. Surprisingly, the effects of the intervention were in the opposite direction among adolescents in 9th grade. These data indicate that a brief universal intervention could prevent depressive symptoms under some conditions, but developmental characteristics can moderate the effectiveness of this approach.

The role of distress tolerance in the relationship between cognitive schemas and alcohol problems among college students.

INTRODUCTION: The current study tested the role of distress tolerance in the relationship between three early maladaptive cognitive schemas (Abandonment, Defectiveness/Shame, and Insufficient Self-Control) and alcohol problems among college students (N=364). Previous research suggests that maladaptive cognitive schemas may be a risk factor for alcohol-related problems. However, the mechanism underlying this association is unclear. One's tolerance for emotional distress may play an important role in understanding the nature of this association. METHODS: We tested a structural equation model where distress tolerance was expected to explain or moderate associations between early maladaptive schemas and alcohol outcomes. RESULTS: Results indicated distress tolerance partially mediated the relationships between schemas of Abandonment and Insufficient Self-Control and alcohol problems. Distress tolerance also significantly moderated the relationship between the Defectiveness/Shame schema and alcohol-related problems, reducing the strength of the association. CONCLUSIONS: Distress tolerance is a modifiable risk factor and the results of this study support the inclusion of emotional regulation strategies in the prevention and treatment of alcohol problems among young adults.

What We Do and Do Not Know about Teaching Medical Image Interpretation.

Educators in medical image interpretation have difficulty finding scientific evidence as to how they should design their instruction. We review and comment on 81 papers that investigated instructional design in medical image interpretation. We distinguish between studies that evaluated complete offline courses and curricula, studies that evaluated e-learning modules, and studies that evaluated specific educational interventions. Twenty-three percent of all studies evaluated the implementation of complete courses or curricula, and 44% of the studies evaluated the implementation of e-learning modules. We argue that these studies have encouraging results but provide little information for educators: too many differences exist between conditions to unambiguously attribute the learning effects to specific instructional techniques. Moreover, concepts are not uniformly defined and methodological weaknesses further limit the usefulness of evidence provided by these studies. Thirty-two percent of the studies evaluated a specific interventional technique. We discuss three theoretical frameworks that informed these studies: diagnostic reasoning, cognitive schemas and study strategies. Research on diagnostic reasoning suggests teaching students to start with non-analytic reasoning and subsequently applying analytic reasoning, but little is known on how to train non-analytic reasoning. Research on cognitive schemas investigated activities that help the development of appropriate cognitive schemas. Finally, research on study strategies supports the effectiveness of practice testing, but more study strategies could be applicable to learning medical image interpretation. Our commentary highlights the value of evaluating specific instructional techniques, but further evidence is required to optimally inform educators in medical image interpretation.