Boecking Benjamin, Stoettner Eva, Brueggemann Petra, Mazurek Birgit
Tinnitus Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
Front Psychiatry. 2024 Feb 21;15:1257299. doi: 10.3389/fpsyt.2024.1257299. eCollection 2024.
Amongst "third-wave" cognitive behavioural therapies, schema therapy demonstrates encouraging efficacy across various mental health conditions. Within this field, clinical interest has begun to converge on the "schema-mode-model" - a conceptualization framework for affective, cognitive and behavioral states that guide individuals' perceptions and behaviours at a given point in time. Schema mode expressions in patients with chronic tinnitus are as-yet unexamined.
The present study reports self-report data from = 696 patients with chronic tinnitus who completed the Schema Mode- and Tinnitus Handicap Inventories alongside measures of perceived stress, anxiety and depression. The Schema Mode Inventory assesses so-called maladaptive "parent", "child" and "coping" modes. Parent modes can be understood as self-states which are characterized by self-critical and hostile beliefs; child modes are characterized by biographically unmet emotional needs; and coping modes by inflexible attempts to regulate emotion and stabilize one's sense of self. Descriptive, correlational and mediation analyses investigated schema mode expressions (1) in patients with chronic tinnitus, (2) as compared to published reference values from a healthy control sample, (3) in their relation to other psychological constructs, and (4) regarding their potential role in driving tinnitus-related distress.
Patients reported mild-to-moderate levels of emotional distress. Compared to healthy controls, patients showed (1) high relative expressions of child-, detachment and compliant coping modes and (2) a conspicuously low relative expression of the 'punitive parent' mode. Correlational patterns suggested strong associations of (1) parent as well as angry child modes with perceived stress and anxiety, (2) the vulnerable child mode with all measured constructs and (3) emotional distress with - intrapersonally - emotional detachment as well as - interpersonally - alleged compliance. Mediation analyses demonstrated that tinnitus-related distress was driven by significant interactions between child and coping modes.
The study provides initial clinical evidence for the relevance and applicability of schema-mode based formulation and treatment planning in patients with chronic tinnitus.
在“第三波”认知行为疗法中，图式疗法在各种心理健康状况下都显示出令人鼓舞的疗效。在这一领域，临床兴趣已开始集中于“图式模式模型”——一种用于情感、认知和行为状态的概念化框架，它在特定时间点指导个体的认知和行为。慢性耳鸣患者的图式模式表达尚未得到研究。
本研究报告了696例慢性耳鸣患者的自我报告数据，这些患者完成了图式模式和耳鸣障碍量表，同时还进行了感知压力、焦虑和抑郁的测量。图式模式量表评估所谓的适应不良“父母”、“儿童”和“应对”模式。父母模式可理解为以自我批评和敌对信念为特征的自我状态；儿童模式的特征是传记中未满足的情感需求；应对模式则是通过不灵活的方式来调节情绪和稳定自我意识。描述性、相关性和中介分析研究了图式模式表达：（1）在慢性耳鸣患者中；（2）与健康对照样本公布的参考值相比；（3）与其他心理结构的关系；（4）在驱动耳鸣相关痛苦方面的潜在作用。
患者报告了轻度至中度的情绪困扰。与健康对照相比，患者表现出：（1）儿童、超脱和顺从应对模式的相对高表达；（2）“惩罚性父母”模式的相对低表达。相关模式表明：（1）父母模式以及愤怒儿童模式与感知压力和焦虑有很强的关联；（2）脆弱儿童模式与所有测量结构有很强的关联；（3）情绪困扰在个体内部与情绪超脱以及在人际间与所谓的顺从有很强的关联。中介分析表明，耳鸣相关痛苦是由儿童模式和应对模式之间的显著相互作用驱动的。
该研究为基于图式模式的制定和治疗计划在慢性耳鸣患者中的相关性和适用性提供了初步临床证据。
