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The Structural Model of Early Maladaptive Schemas with Cardiac Health-Related Behaviors in General Population: The Mediating Role of Emotion Regulation and Self-compassion

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Abstract

There is a scarcity in the literature on the schema therapy model in the context of chronic diseases containing the cardiovascular disease. In this regard, the present study aimed to investigate the structural relationships of cardiac health-related behaviors in the general population based on early maladaptive schemas with the mediating role of emotion regulation and self-compassion. Participants were 700 individuals among a general community sample of Iranians (Mean age = 33.04, females = 53.14%, range = 18–60 years). Results from structural equation modeling have supported the proposed model indicating that the schematic domains of disconnection and rejection, impaired limits, and other-directedness both directly and indirectly, as well as the domains of over-vigilance and inhibition indirectly demonstrated an impact on cardiac health-related behaviors through suppression, reappraisal and self-compassion (χ2 = 1678.00, p < .001; CFI = 0.94, NFI = 0.92, RMSEA = 0.061, GFI = 0.86, SRMR = 0.075, IFI = 0.94). The final model accounted for 55.9% of the variance of cardiac health-related behaviors. According to the findings derived from the present research model, educational models based on schema therapy, emotion regulation, and self-compassion can be developed and implemented to enhance cardiac health-related behaviors.

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Data Availability

The data that support the findings of this study are available from the corresponding author, [M. A], upon reasonable request.

References

  • Ahmadi, F., Ostadian Khani, Z., & Agha Uosefi, A. (2017). Evaluation of coping strategies and early maladaptive schemas in patients with coronary artery disease and control group. MEJDS, 7, 52–52.

    Google Scholar 

  • Aloi, M., Verrastro, V., Rania, M., Sacco, R., Fernández-Aranda, F., Jiménez-Murcia, S., et al. (2020). The potential role of the early maladaptive schema in behavioral addictions among late adolescents and young adults. Frontiers in Psychology, 10, 3022. https://doi.org/10.3389/fpsyg.2019.03022

    Article  PubMed  PubMed Central  Google Scholar 

  • Appleton, A. A., & Kubzansky, L. D. (2014). Emotion regulation and cardiovascular disease risk. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 596–612). The Guilford Press.

    Google Scholar 

  • Arntz, A. (2012). Schema therapy for cluster-C personality disorders. In M. van Vreeswijk, J. Broersen, M. Nadort (Eds.), The Wiley-Blacllwell Handbook, of Schema Therapy: Theory, Hesearch, and Practice, Wiley

  • Basile, B., Tenore, K., & Mancini, F. (2019). Early maladaptive schemas in overweight and obesity: A schema mode model. Heliyon, 5, 1–9.

    Article  Google Scholar 

  • Butz, S., & Stahikerg, D. (2020). The relationship between self-compassion and sleep quality: An overview of a seven-year german research program. Behavioral Science, 10, 64. https://doi.org/10.3390/bs10030064

    Article  Google Scholar 

  • Calvete, E., Orue, I., & Gonz-alez-Diez, Z. (2013). An examination of the structure and stability of early maladaptive schemas by means of the young schema questionnaire-3. European Journal of Psychological Assessment, 29, 283–290. https://doi.org/10.1027/1015-5759/a000158

    Article  Google Scholar 

  • Celano, C. M. (2011). Secondary prevention of cardiovascular disease: CBT, in combination with standard care, is effective. Evidence-Based Mental Health, 14(3), 81. https://doi.org/10.1136/ebmh.14.3.81

    Article  PubMed  Google Scholar 

  • Consoli, S. M., Lemogne, C., Roch, B., Laurent, S., Plouin, P. F., et al. (2010). Differences in emotion processing in patients with essential and secondary hypertension. American Journal of Hypertension, 23(5), 515–521.

    Article  PubMed  Google Scholar 

  • Costa, I. F. D., Tomaz, M. P., Pessoa, G. D. N., Miranda, H. D., & Galdino, M. K. (2020). Early maladaptive schemas and harm avoidance as mediating factors between early life stress and psychiatric symptoms in adults. Brazilian Journal of Psychiatry. https://doi.org/10.1590/1516-4446-2019-0593

    Article  PubMed  PubMed Central  Google Scholar 

  • D’Onofrio, J. (2019). Examining Early Maladaptive Schemas, Depression, And Health Behaviors. A Thesis Submitted to the Department of Psychology College of Science and Mathematics In partial fulfillment of the requirement For the degree of Master of Arts in Clinical Psychology at Rowan University.

  • da Luz, F. Q., Sainsbury, A., Hay, P., Roekenes, J. A., Swinbourne, J., et al. (2017). Early Maladaptive schemas and cognitive distortions in adults with morbid obesity: Relationships with mental health status. Behavioral Sciences, 7(1), 10. https://doi.org/10.3390/bs7010010

    Article  PubMed  PubMed Central  Google Scholar 

  • Daniel, S. K., Abdel-Baki, R., & Hall, G. B. (2020). The protective effect of emotion regulation on child and adolescent wellbeing. Journal of Child and Family Studies, 29, 2010–2027.

    Article  Google Scholar 

  • Debeuf, T., Verbeken, S., Boelens, E., et al. (2020). Emotion regulation training in the treatment of obesity in young adolescents: Protocol for a randomized controlled trial. Trials, 153, 32–34.

    Google Scholar 

  • Diedrich, A., Grant, M., Hofmann, S. G., Hiller, W., & Berking, M. (2014). Self-compassion as an emotion regulation strategy in major depressive disorder. Behaviour Research and Therapy, 58, 43–51. https://doi.org/10.1016/j.brat.2014.05.006

    Article  PubMed  Google Scholar 

  • Dzaye, O., Bødtker, H., Reiter-Brennan, C., Blaha, M., & Mortensen, M. (2020). Danish national trends in cardiovascular disease and cancer drug expenditure in relation to trends in cardiovascular disease and cancer deaths. The American Journal of Medicine, in press.

  • Dzaye, O., Adelhoefer, S., Boakye, E., & Blaha, M. J. (2021). Cardiovascular-related health behaviors and lifestyle during the COVID-19 pandemic: An infodemiology study. American Journal of Preventive Cardiology, 5, 100148.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ehret, A. M., Joormann, J., & Berking, M. (2018). Self-compassion is more effective than acceptance and reappraisal in decreasing depressed mood in currently and formerly depressed individuals. Journal of Affective Disorders, 226, 220–226.

    Article  PubMed  Google Scholar 

  • Ganatra, S., Dani, S. S., Shah, S., et al. (2020). Management of cardiovascular disease during coronavirus disease (COVID-19) pandemic. Trends in Cardiovascular Medicine, 30(6), 315–325.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gao, W., Wang, F., Wang, S., & Zhang. (2019). Effect of cognitive behavioral therapy for heart failure, A systematic review protocol of randomized controlled trial. Medicine, 98(33), e16803.

    Article  PubMed  PubMed Central  Google Scholar 

  • Germans, S., Van Heck, G. L., Masthoff, E. D., Trompenaars, F. J. W. M., & Hodiamont, P. P. G. (2010). Diagnostic efficiency among psychiatric outpatients of a self-report version of a subset of screen items of the structured clinical interview for DSM–IV–TR personality disorders (SCID-II). Psychological Assessment, 22, 945–952. https://doi.org/10.1037/a0021047

    Article  PubMed  Google Scholar 

  • Goetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: An evolutionary analysis and empirical review. Psychological Bulletin, 136, 351–374.

    Article  PubMed  PubMed Central  Google Scholar 

  • Grigorian, H. L., Brem, M. J., Shorey, R. C., & Anderson, S. (2020). Mindfulness and early maladaptive schemas among men in treatment for substance use disorder. Mindfulness, 11(4), 44–56.

    Google Scholar 

  • Gross, J. J., & John, O. P. (2003). Individual difference in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.

    Article  PubMed  Google Scholar 

  • Hadavand Siri, F., Khalili, D., Hashemi Nazari, S. S., Ostovar, A., & Mahdavi, A. (2020). Adherence to Iran’s package of essential noncommunicable diseases (IraPEN) program for regular follow-up to reduce the risk of cardiovascular disease in healthcare centers. Iranian Journal of Endocrinology and Metabolism, 22(2), 116–126.

    Google Scholar 

  • Hatamian, P., Vesmoradei, M., Zahery, M., & Karami, J. (2019). Predict heart health related behaviors based on attachment styles and self-efficacy. IJNR, 14(2), 38–43.

    Google Scholar 

  • Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118

    Article  Google Scholar 

  • Hussain, M., Egan, H., Keyte, R., et al. (2020). Exploring the role of self-kindness in making healthier eating choices: A preliminary study. International Journal of Behavioral Medicine, 23, 1–6.

    Google Scholar 

  • Hwang, W. J., & Kang, S. J. (2020). Interventions to reduce the risk of cardiovascular disease among workers: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17, 1–16.

    Article  Google Scholar 

  • Janovsky, T., Rock, A. J., Thorsteinsson, E. B., Clark, G. I., & Murray, C. V. (2020). The relationship between early maladaptive schemas and interpersonal problems: A meta-analytic review. Clinical Psychology & Psychotherapy, 27(3), 1–40.

    Article  Google Scholar 

  • Jentsch, V. L., & Wolf, O. (2020). The impact of emotion regulation on cardiovascular, neuroendocrine and psychological stress responses. Biological Psychology. https://doi.org/10.1016/j.biopsycho.2020.107893

    Article  PubMed  Google Scholar 

  • Jöreskog, K. G., & Sörbom, D. (2006). LISREL 8.80. Scientific Software International Inc.

  • Karlsen, H., Saksvik-Lehouillier, I., Stone, K. L., Schernhammer, E., Yaffe, K., et al. (2020). Anxiety as a risk factor for cardiovascular disease independent of depression: a prospective examination of community-dwelling men (the MrOS study). Psychology & Health. https://doi.org/10.1080/08870446.2020.1779273

    Article  Google Scholar 

  • Keyfitz, L., Lumley, M. N., Hennig, K. H., & Dozois, D. J. A. (2013). The role of positive schemas in child psychopathology and resilience. Cognitive Therapy and Research, 3(1), 97–108. https://doi.org/10.1007/s10608-012-9455-6

    Article  Google Scholar 

  • Khosravi, S., Sadegh, M., & Yabandeh, M. R. (2014). Psychometric properties of self-compassion scale (SCS). Psychological Methods and Models, 4(13), 47–59.

    Google Scholar 

  • Loucks, E. B., Schuman-Olivier, Z., Britton, W. B., Fresco, D. M., Desbordes, G., et al. (2015). Mindfulness and cardiovascular disease risk: State of the evidence, plausible mechanisms, and theoretical framework. Current Cardiology Reports, 17(12), 112.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mahmod Alilu, M., Ghasempour, A., Azimi, Z., Akbari, E., & Fahimi, S. (2012). The role of emotion regulation strategies in prediction borderline personality trait. Thought & Behavior in Clinical Psychology, 6(24), 9–18.

    Google Scholar 

  • Marengo, S. M., Klibert, J., Langhinrichsen-Rohling, J., Warren, J., Smalley, B., et al. (2018). The relationship of early maladaptive schemas and anticipated risky behaviors in college students. Journal of Adult Development. https://doi.org/10.1007/s10804-018-9313-1

    Article  Google Scholar 

  • Mc Donnell, E., Hevey, D., McCauley, M., & Ducray, K. N. (2018). Exploration of associations between early maladaptive schemas, impaired emotional regulation, coping strategies and resilience in opioid dependent poly-drug users. Substance Use & Misuse, 53(14), 2320–2329.

    Article  Google Scholar 

  • Meneguzzo, P., Cazzola, Ch., Castegnaro, R., Buscaglia, F., Bucci, E., et al. (2021). Associations between trauma, early maladaptive schemas, personality traits, and clinical severity in eating disorder patients: A clinical presentation and mediation analysis. Frontiers in Psychology, 12, 661924. https://doi.org/10.3389/fpsyg.2021.661924

    Article  PubMed  PubMed Central  Google Scholar 

  • Mirza Hoseyni, H., Arjmand, S., & Lajvardi, H. (2017). The predictive model of eating behaviour based on early maladaptive schemas, personality disorders, and coping styles. RBS, 14(4), 479–485.

    Google Scholar 

  • Mohammadyari, S., Abdi, Sh., & Bakhtiyari, A. (2019). The effect of low volume high-intensity interval training on predictive markers of cardiovascular disease in overweight men. Sport Physiology & Management Investigations, 11(2), 133–143.

    Google Scholar 

  • Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self Identity, 2(3), 223–250.

    Article  Google Scholar 

  • Neff, K. D., & Costigan, A. P. (2017). Self-compassion, wellbeing, and happiness. Psychologie in Osterreich, 2(3), 114–9.

    Google Scholar 

  • Neff, K. D., & Germer, C. K. (2013). A pilot study and randomized controlled trial of the mindful self-compassion program. Journal of Clinical Psychology, 69(1), 28–44.

    Article  PubMed  Google Scholar 

  • Pace, T. W., Negi, L. T., Dodson-Lavelle, B., Silva, B., Reddy, S. D., Cole, S. P., et al. (2013). Engagement with cognitively-based compassion training is associated with reduced salivary C-reactive protein from before to after training in foster care program adolescents. Psychoneuroendocrinology, 38(2), 294–9.

    Article  PubMed  Google Scholar 

  • Pauwels, E., Dierckx, E., Schoevaerts, K., & Claes. (2016). Early maladaptive schemas in eating disordered patients with or without non-suicidal self-injury. European Eating Disorders Review, 24(5), 399–405.

    Article  PubMed  Google Scholar 

  • Piri, M., Habibi, R., & Agh Atabay, A. (2015). Comparing gender difference of high school students in social intelligence, emotional regulation and academic procrastination. Quarterly Journal of Education Studies, 1(1), 41–53.

    Google Scholar 

  • Reinelt, T., Peterman, F., Bauer, F., & Bauer, C.-P. (2020). Emotion regulation strategies predict weight loss during an inpatient obesity treatment for adolescents. Obesity Science and Practice, 6(3), 293–299.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roy, B., Riley, C., & Sinha, R. (2018). Emotion regulation moderates the association between chronic stress and cardiovascular disease risk in humans: A cross-sectional study. The International Journal on the Biology of Stress, 21(6), 548–555.

    Article  Google Scholar 

  • Shao, M., Lin, X., Jiang, H., Tian, H., Xu, Y., et al. (2020). Depression and cardiovascular disease: Shared molecular mechanisms and clinical implications. Psychiatry Research, 21(285), 112802. https://doi.org/10.1016/j.psychres.2020.112802

    Article  Google Scholar 

  • Shorey, R. C., Brasfield, H., Anderson, S., & Stuart, G. L. (2017). The relation between trait mindfulness and early maladaptive schemas in men seeking substance use treatment. Mindfulness, 6(2), 348–355.

    Article  Google Scholar 

  • Slepecky, M., Kotianova, A., Prasko, J., MajercakGyorgyova, I., et al. (2017). Coping, schemas, and cardiovascular risks – study protocol. Neuropsychiatric Disease and Treatment, 13, 2599–2605.

    Article  PubMed  PubMed Central  Google Scholar 

  • Song, R., Oh, H., Ahn, S., & Moorhead, S. (2018). Validation of the cardiac health behavior scale for Korean adults with cardiovascular risks or diseases. Applied Nursing Research, 39, 252–258.

    Article  PubMed  Google Scholar 

  • Thimm, J. C. (2017). Relationshis between early maladative schemas, mindfulness, self-comassion, and psychological distress. International Journal of Psychology and Psychological Therapy, 17(1), 3–17.

    Google Scholar 

  • Vasilopoulou, E., Karatzias, Th., Hyland, Ph., Wallace, H., & Guzman, A. (2019). The mediating role of early maladaptive schemas in the relationship between childhood traumatic events and complex posttraumatic stress disorder symptoms in older adults. Journal of Loss and Trauma, 25(2), 24–35.

    Google Scholar 

  • Wiener, A., Rohr, C. S., Naor, N., Villringer, A., & Okan-Singer, H. (2020). Emotion regulation in essential hypertension: Roles of anxiety, stress, and the pulvinar. Front Behav Neurosci, 14, 80.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wilson, A. C., Mackintosh, K., Power, K., & Chan, S. W. Y. (2019). Effectiveness of self-compassion related therapies: A systematic review and meta-analysis. Mindfulness, 10(6), 979–995.

    Article  Google Scholar 

  • Wirtz, P. H., Kanel, R. V., Mohiyeddini, C., Emini, L., Ruedisueli, K., et al. (2006). Low social support and poor emotional regulation are associated with increased stress hormone reactivity to mental stress in systemic hypertension. The Journal of Clinical Endocrinology and Metabolism, 91(10), 3857–3865.

    Article  PubMed  Google Scholar 

  • Yakin, D., Gencoz, T., Steenbergen, L., & Arntz, A. (2019). An integrative perspective on the interplay between early maladaptive schemas and mental health: The role of self-compassion and emotion regulation. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.22755

    Article  PubMed  PubMed Central  Google Scholar 

  • Yalcin, S. B., Kavakli, M., Kesici, S., & Ak, M. (2017). University students’ early maladaptive schemas’ prediction of their mindfulness levels. Journal of Education and Practice, 8(20), 174–181.

    Google Scholar 

  • Young, J. E. (2005). Young Schema Questionnaire-Short Form 3 (YSQ-S3), Schema Therapy Institute.

  • Young, J. E. (1999). Cognitive therapy for personality disorders: A schema focused approach. Professional Resources Press.

    Google Scholar 

  • Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy. A practitioner’s guide. The Guilford Press.

    Google Scholar 

  • Yousefi, N., & Shirbagi, N. (2017). Validating the young early maladaptive schema questionnaire (YEMSQ) among students. Iranian Journal of Psychiatry and Behavioral Sciences, 4(1), 38–46.

    Google Scholar 

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Amiri Pijakelai, A., Akbari, M., Mohammadkhani, S. et al. The Structural Model of Early Maladaptive Schemas with Cardiac Health-Related Behaviors in General Population: The Mediating Role of Emotion Regulation and Self-compassion. J Rat-Emo Cognitive-Behav Ther (2023). https://doi.org/10.1007/s10942-023-00530-1

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