Group schema therapy for cluster-C personality disorders:A multicentre open pilot study

BackgroundGroup schema therapy (GST) is increasingly popular as a treatment for personality disorders (PDs), including Cluster-C PDs. Individual ST has proven to be effective for Cluster-C PD patients, while the evidence for GST is limited. This study aimed to investigate the effectiveness of GST for Cluster-C PD. Moreover, differ- ences between the specific Cluster-C PDs (avoidant PD, dependent PD and obsessive-compulsive PD) were explored.MethodsA multicentre open trial was conducted, including 137 patients with a Cluster-C PD (avoidant PD: n = 107, dependent PD: n = 11 and obsessive- compulsive PD: n = 19). Patients received 30 weekly GST sessions with a maximum of 180 min of individual ST and five optional monthly booster sessions. Outcome measures including Cluster-C PD severity, general psychopathological symptoms, quality of life, functional impairment, happiness, PD-related beliefs, self-esteem, self- ideal discrepancy, schemas and schema modes were assessed at baseline until 2-year follow-up with semi-structured interviews and self-report measures. Change over time and differences between the specific Cluster-C PDs were analysed with mixed regression analyses.ResultsThe outcome measures showed significant improvements for all Cluster-C PDs, with medium to large effect sizes after 2 years. A treatment dropout rate of 11.7% was found. There were some indications for differences between the Cluster-C PDs in severity at baseline, change trajectories and effectiveness of GST. ConclusionsThis study demonstrated that GST is a promising treatment for Cluster-C PDs. The following step is a randomized controlled trial to further document the (cost-)effectiveness of GST. <br/

Design of an RCT on cost-efectiveness of group schema therapy versus individual schema therapy for patients with Cluster-C personality disorder: the QUEST-CLC study protocol

Background Given the high prevalence of Cluster-C Personality Disorders (PDs) in clinical populations, disease burden, high societal costs and poor prognosis of comorbid disorders, a major gain in health care can be achieved if Cluster-C PDs are adequately treated. The only controlled cost-effectiveness study published so far found Individual Schema Therapy (IST) to be superior to Treatment as Usual (TAU). Group ST (GST) might improve cost-effectiveness as larger numbers can be treated in (>50%) less time compared to IST. However, to date there is no RCT supporting its (cost-) effectiveness. The overall aim of this study is to assess the evidence for GST for Cluster-C PDs and to improve treatment allocation for individual patients. Three main questions are addressed: 1) Is GST for Cluster-C PDs (cost-) effective compared to TAU? 2) Is GST for Cluster-C PDs (cost-) effective compared to IST? 3) Which patient-characteristics predict better response to GST, IST, or TAU? Methods In a multicenter RCT, the treatment conditions GST, IST, and TAU are compared in 378 Cluster-C PD patients within 10 sites. GST and IST follow treatment protocols and are completed within 1 year. TAU is the optimal alternative treatment available at the site according to regular procedures. Severity of the Cluster-C PD is the primary outcome, assessed with clinical interviews by independent raters blind for treatment. Functioning and wellbeing are important secondary outcomes. Assessments take place at week 0 (baseline), 17 (mid-GST), 34 (post-GST), 51 (postbooster sessions of GST), and 2 years (FU). Patient characteristics predicting better response to a specifc treatment are studied, e.g., childhood trauma, autistic features, and introversion. A tool supporting patients and clinicians in matching treatment to patient will be developed. An economic evaluation investigates the cost-effectiveness and costutility from a societal perspective. A process evaluation by qualitative methods explores experiences of participants, loved ones and therapists regarding recovery, quality of life, and improving treatment. Discussion This study will determine the (cost-)effectiveness of treatments for Cluster-C PDs regarding treatment type as well as optimal matching of patient to treatment and deliver insight into which aspects help Cluster-C-PD patients recover and create a fulfilling life. Trial registration Dutch Trial Register: NL9209. Registered on 28-01-2021

Positive and negative polar questions in discourse

This paper presents a number of experiments assessing the felicity of positive and negative polar questions in various types of discourse contexts

Does informativity modulate linearization preferences in reference production?

During referential communication, speaker choices regarding the syntactic encoding of their expressions can modulate the linear ordering of the properties necessary to identify the referent. We investigated whether such syntactic choices are influenced by the informativity of these properties in a given visual context, as quantified by Referential Entropy Reduction (RER). In two experiments, a maze-based sentence completion task was used to examine whether informativity of a particular property (animal or action) influenced the decision to produce pre- versus post-nominal modifications when describing animal-performing-action referents in a visual scene. While many participants used a fixed strategy, informativity did significantly influence linearization for the remaining participants, consistent with a maximal informativity strategy in which the high RER property is be encoded first. This suggests that speakers who vary their encodings are indeed sensitive to the informativity of properties in a visual scene, preferring syntactic linearization in which informative properties appear early

Does informativity modulate linearization preferences in reference production?

During referential communication, speaker choices regarding the syntactic encoding of their expressions can modulate the linear ordering of the properties necessary to identify the referent. We investigated whether such syntactic choices are influenced by the informativity of these properties in a given visual context, as quantified by Referential Entropy Reduction (RER). In two experiments, a maze-based sentence completion task was used to examine whether informativity of a particular property (animal or action) influenced the decision to produce pre- versus post-nominal modifications when describing animal-performing-action referents in a visual scene. While many participants used a fixed strategy, informativity did significantly influence linearization for the remaining participants, consistent with a maximal informativity strategy in which the high RER property is be encoded first. This suggests that speakers who vary their encodings are indeed sensitive to the informativity of properties in a visual scene, preferring syntactic linearization in which informative properties appear early

Single-cell transcriptomics reveals involution mimicry during the specification of the basal breast cancer subtype.

Basal breast cancer is associated with younger age, early relapse, and a high mortality rate. Here, we use unbiased droplet-based single-cell RNA sequencing (RNA-seq) to elucidate the cellular basis of tumor progression during the specification of the basal breast cancer subtype from the luminal progenitor population in the MMTV-PyMT (mouse mammary tumor virus-polyoma middle tumor-antigen) mammary tumor model. We find that basal-like cancer cells resemble the alveolar lineage that is specified upon pregnancy and encompass the acquisition of an aberrant post-lactation developmental program of involution that triggers remodeling of the tumor microenvironment and metastatic dissemination. This involution mimicry is characterized by a highly interactive multicellular network, with involution cancer-associated fibroblasts playing a pivotal role in extracellular matrix remodeling and immunosuppression. Our results may partially explain the increased risk and poor prognosis of breast cancer associated with childbirth