Metacognition as a predictor of improvements in personality disorders

Personality Disorders (PDs) are particularly hard to treat and treatment drop-out rates are high. Several authors have agreed that psychotherapy is more successful when it focuses on the core of personality pathology. For this reason, therapists dealing with PDs need to understand the psychopathological variables that characterize this pathology and exactly what contributes to maintaining psychopathological processes. Moreover, several authors have noted that one key problem that characterizes all PDs is an impairment in understanding mental states - here termed metacognition - which could also be responsible for therapy failures. Unfortunately, a limited number of studies have investigated the role of mentalization in the process of change during psychotherapy. In this paper, we assume that poor metacognition corresponds to a core element of the general pathology of personality, impacts a series of clinical variables, generates symptoms and interpersonal problems, and causes treatment to be slower and less effective. We explored whether changes in metacognition predicted an improvement among different psychopathological variables characterizing PDs; 193 outpatients were treated at the Third Center of Cognitive Psychotherapy in Rome, Italy, and followed a structured path tailored for the different psychopathological variables that emerged from a comprehensive psychodiagnostic assessment that considered patients' symptoms, metacognitive abilities, interpersonal relationships, personality psychopathology, and global functioning. The measurements were repeated after a year of treatment. The results showed that changes in metacognitive abilities predicted improvements in the analyzed variable

Lecciones de cálculo superior. Ecuaciones diferenciales y métodos matemáticos

Originalmente concebida para los estudiantes de término de carreras del área de ingeniería, en realidad esta obra especializada sirve a todos los que quieran profundizar en las ecuaciones diferenciales y en los métodos matemáticos. La importancia de las primeras radica en que constituyen una herramienta fundamental para comprender las relaciones que se dan entre las distintas variables y sus razones de cambio en cualquier proceso natural, y de ahí que sirvan para explicar, en lenguaje matemático, muchas de las leyes físicas, químicas o astronómicas. En cuanto a los segundos, suelen ser empleados en la resolución de problemas prácticos en distintos campos de las ciencias y la tecnología. Con el desarrollo de estos temas, esta obra pretende que su lector comprenda y aplique en las tareas que realice algunos de los modos de pensamiento matemático más relevantes

Three-year follow-up study exploring metacognition and function in individuals with first episode psychosis

Introduction: Research has demonstrated that functional outcome in psychosis is predicted by factors such as neurocognition, functional capacity, symptoms and, more recently, metacognition. Metacognitive ability has been demonstrated to mediate between neurocognition and functional outcome in First Episode Psychosis (FEP). Whether metacognition also predicts longer-term recovery in first episode is unknown. This study assessed whether neurocognition, functional capacity and metacognitive ability in FEP predicted functional outcome three years later. Methods: Eighty individuals with First Episode Psychosis were re-contacted after an average three years (range: 26-45 month follow-up) from baseline. Twenty-six participants (33%) completed neurocognitive measures, metacognition, functional capacity, functional outcome (hours spent in structured activity per week) and psychopathology at baseline and at follow-up. Results: Individual regression analyses demonstrated neurocognition, functional capacity and metacognitive ability at baseline significantly predicted functional outcome at three years. However, when baseline functional outcome was controlled, only metacognitive ability was a significant predictor of change in functional outcome from baseline to follow-up, p<.001. This model explained 72% (adjusted r² = .69) of the variance in functional outcome at follow-up. Negative symptoms did not change the model. Discussion: This study demonstrated that better metacognitive ability significantly predicted improvement in functioning in FEP across a 3-year period. This highlights the potential value of clinical interventions that focus on improving metacognitive ability at first point of illness to maximize recovery

Metacognition, Borderline Pathology and Psychotherapeutic Change: A Single-Case Study

The aim of this study is to analyze whether: (a) a specific type of metacognitive deficit is present in a patient with Borderline Personality Disorder; (b) a metacognitive improvement can be detected during the psychotherapy treatment; (c) if this improvement can be indicative of the effectiveness of psychotherapy itself. A single case study has been conducted; metacognitive deficits have been measured with the Metacognition Assessment Scale (MAS). In line with the hypothesis, the results show a global and progressive improvement of meta-cognitive functions. We conclude in agreement with the current literature, the existence of a major deficit in Differentiation and Integration subfunctions (belonging to Self-reflexivity), compared to Characterization and Relation between variables subfunctions (belonging to Metacognitive monitoring)

ERRATUM: Metacognition, borderline pathology and psychotherapeutic change: a single-case study

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Dialogical self strategies of self-organization: psychotherapy and restructuring of internal management

A identidade tem sido um conceito central na literatura em psicologia e na forma como as diferentes abordagens terapêuticas têm concebido os processos de mudança. Entre as inúmeras perspectivas desenvolvidas sobre essa dimensão do ser humano, destacamos o paradigma dialógico que tem vindo a influenciar de forma crescente a teoria e prática em psicoterapia. Segundo esta perspectiva, a funcionalidade psicológica está relacionada com o modo como os indivíduos conseguem articular e colocar em diálogo produtivo as suas várias vozes ou posições de identidade. Neste artigo apresentamos uma revisão da literatura sobre as estratégias que subjazem a essa capacidade auto-organizadora do sistema identitário e sobre as diretrizes que poderão orientar uma intervenção terapêutica dialógica quando essa capacidade se torna disfuncional.Self-concept has been playing a crucial role in psychological literature and in the way the different therapeutic approaches conceive the processes of change. From the diverse perspectives developed about this human dimension, we emphasise the dialogical paradigm that has been increasingly influential in the psychotherapeutic theory and practice. According to the dialogical perspective the psychological well-being is dependent on the way individuals articulate and maintain productive dialogues between the different voices of the self or “I-Positions”. In this paper we present a review of the literature on the strategies that underlie this self-regulatory ability of the self-system and the guidelines of the dialogical therapeutic intervention that could be used when these self-regulatory strategies become dysfunctional.(undefined

CDO su misura: la nuova era delle cartolarizzazioni

This paper reviews the structure of Collateralized Debt Obligations (CDOs), financial products used in the period of the 2008 sub-prime mortgage crisis, in order to understand the reasons that lead them to be considered the main responsible for it. The legacy of CDOs, which is reflected in Bespoke Tranche Opportunities (BTOs), is then discussed in order to understand whether they are equally “toxic“ products, as CDOs were defined after the outbreak of the crisis, or they are really innovative tool of securitization

Effect of metacognitive interpersonal therapy on brain structural connectivity in borderline personality disorder: Results from the CLIMAMITHE randomized clinical trial

Background: Recently, we showed that Metacognitive Interpersonal Therapy (MIT) is effective in improving clinical symptoms in borderline personality disorder (BPD). Here, we investigated whether the effect of MIT on clinical features is associated to microstructural changes in brain circuits supporting core BPD symptoms. Methods: Forty-seven BPD were randomized to MIT or structured clinical management, and underwent a clinical assessment and diffusion-weighted imaging before and after the intervention. Fractional anisotropy (FA), mean, radial, and axial diffusivities maps were computed using FSL toolbox. Microstructural changes were assessed (i) voxel-wise, with tract based spatial statistics (TBSS) and (ii) ROI-wise, in the triple network system (default mode, salience, and executive control networks). The effect of MIT on brain microstructure was assessed with paired tests using FSL PALM (voxel-wise), Linear Mixed-Effect Models or Generalized Linear Mixed Models (ROI-wise). Associations between microstructural and clinical changes were explored with linear regression (voxel-wise) and correlations (ROI-wise). Results: The voxel-wise analysis showed that MIT was associated with increased FA in the bilateral thalamic radiation and left associative tracts (p < .050, family-wise error rate corrected). At network system level, MIT increased FA and both interventions reduced AD in the executive control network (p = .05, uncorrected). Limitations: The DTI metrics can't clarify the nature of axonal changes. Conclusions: Our results indicate that MIT modulates brain structural connectivity in circuits related to associative and executive control functions. These microstructural changes may denote activity-dependent plasticity, possibly representing a neurobiological mechanism underlying MIT effects. Trial registration: ClinicalTrials.gov NCT02370316 (https://clinicaltrials.gov/study/NCT02370316)

Dissociating Profiles of Social Cognitive Disturbances Between Mixed Personality and Anxiety Disorder.

Background:An emerging body of research has begun to elucidate disturbances to social cognition in specific personality disorders (PDs). No research has been conducted on patients with Mixed Personality Disorder (MPD), however, who meet multiple diagnostic criteria. Further, very few studies have compared social cognition between patients with PD and those presenting with symptomatic diagnoses that co-occur with personality pathologies, such as anxiety disorder (AD). The aim of this study was to provide a detailed characterization of deficits to various aspects of social cognition in MPD and dissociate impairments specific to MPD from those exhibited by patients with AD who differ in the severity of personality pathology. Method:Building on our previous research, we administered a large battery of self-report and performance-based measures of social cognition to age-, sex- and education-matched groups of patients with MPD or AD, and healthy control participants (HCs; n = 29, 23, and 54, respectively). This permitted a detailed profiling of these clinical groups according to impairments in emotion recognition and regulation, imitative control, low-level visual perspective taking, and empathic awareness and expression. Results:The MPD group demonstrated poorer emotion recognition for negative facial expressions relative to both HCs and AD. Compared with HCs, both clinical groups also performed significantly worse in visual perspective taking and interference resolution, and reported higher personal distress when empathizing and more state-oriented emotion regulation. Conclusion:We interpret our results to reflect dysfunctional cognitive control that is common to patients with both MPD and AD. Given the patterns of affective dispositions that characterize these two diagnostic groups, we suggest that prolonged negative affectivity is associated with inflexible styles of emotion regulation and attribution. This might potentiate the interpersonal dysfunction exhibited in MPD, particularly in negatively valenced and challenging social situations