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5.00 PM - 6.30 PM

Hot Topics: Session 5 

Pilot Study on Early Maladaptive Schemas and Personality Pathology in Substance Use Disorders (SUDs): An Indian Perspective

by Ratnesh Chopra, Gitanjali Narayanan & Pratima Murthy


Introduction: Maladaptive or dysfunctional schemas are defined as enduring, unconditional, negative beliefs about oneself, others, and the environment which organize one’s experiences and subsequent behaviors. Substance use may be one mechanism through which individuals attempt to avoid the negative beliefs and feelings associated with underlying schemas. Thus, schemas are believed to underlie, perpetuate, and maintain problematic substance use. Overall, research indicates that individuals with substance use have high rates of personality disorders, and early maladaptive schemas are more prevalent among substance users with a concurrent Axis II problem.

Moreover, it is important to mention that so far, no study has been done on schema therapy in India, and this study is an attempt to inform the Indian audience of the relevance of schema therapy in our setting. There are less than 10000 psychologists for a population of 1.3 billion in India; even lesser of clinical psychologists (around 1000), and about 10-15 addiction psychologists overall in the country. Thus, indicating the need for specialized and evidence-based practice and training in interventions for substance use disorders.

Aim: The current study aimed to explore the early maladaptive schemas and personality pathology in patients with substance use disorders in India. To our knowledge, no study has examined this aim in the above-mentioned clinical sample.

Method: Cross sectional, mixed methods design was used. The sample comprised of 2 groups (with 10 patients in each group)- a clinical group of patients with SUDs and a comparison group of people drawn from the community. They were matched on age, gender and SES. The following tools were used in the study: The Structured Clinical Interview for DSM-5® Clinician Version (SCID-5-CV) (First et al, 2015); Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD; First et al. 2013); Substance Use Risk Profile Scale (SURPS) (SURPS; Woicik, Conrod, Phil, Stewart, & Dongier, 1999); Young Schema Questionnaire – Short Form, Third Edition (YSQ) (Young & Brown 2003); Young Compensation Inventory (YCI) (Young, 1995) and Young–Rygh Avoidance Inventory (Young & Rygh, 1994).

Results: Findings indicate a trend towards the presence of personality pathology and elevated scores on underlying maladaptive schemas and personality risk for substance abuse in the patients with addictive disorders than the control group. The early maladaptive schemas that differed between the groups were abandonment, mistrust/ abuse, entitlement, defectiveness, failure, dependence, vulnerability, enmeshment, insufficient self-control, and negativity/pessimism. The clinical group had greater personality pathology in terms of qualifying for either Borderline, Narcissistic or Antisocial personality disorder or Avoidant, Dependent or Obsessive-Compulsive personality disorder or clinically significant features if not amounting to diagnosis.

Conclusions: This study highlights the importance of using an integrated framework in not only understanding substance use but also the associated underlying schemas and personality pathology to comprehensively address the addictive behaviours. Implications of these findings for future research and substance use treatment programs will be discussed.

About the Presenters:

Ms. Ratnesh Chopra

PhD Scholar, Department of Clinical Psychology

National Institute of Mental Health and Neuro Sciences (NIMHANS)

Bangalore 560 029, India

Ms. Ratnesh Chopra is currently a research scholar pursuing PhD in Clinical Psychology from the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India. Prior to this, she has done M.Phil in Clinical Psychology from the same department. Her interests lie in the areas of early maladaptive schemas and their relationship with personality disorders and addiction. She is a certified Schema Therapist having completed her standard level of training in Schema therapy. She is actively involved in conducting integrated psychotherapy with clients who have substance use disorders, supervision, and on organizing workshops on personality and addiction.

Dr. Gitanjali Narayanan

Associate Professor, Department of Clinical Psychology

National Institute of Mental Health and Neuro Sciences (NIMHANS)

Bangalore 560 029, India

Dr. Gitanjali Narayanan is a faculty in the Department of Clinical Psychology and Consultant, in the Centre for Addiction Medicine (CAM), National Institute of Mental Health and Neurosciences (NIMHANS), India. She has initiated the establishment and also is the faculty in-charge of the Personality and Emotions Division of Research and Applications (PEDRA) in her department. Her areas of interest include addictive and personality disorders, dialectical behaviour therapy, schema therapy and qualitative research methods. In her free time, she likes to write poetry, travel and bake.

Dr. Pratima Murthy

Dr. Pratima Murthy

Professor, Department of Psychiatry,

Director, National Institute of Mental Health and Neuro Sciences (NIMHANS)

Bangalore 560 029, India

Dr. Pratima Murthy is currently a Senior Professor in the Department of Psychiatry and Consultant, in the Centre for Addiction Medicine (CAM), and Director, NIMHANS, India. Her areas of interest include alcohol and substance use, women’s mental health, Forensic Psychiatry, History of Psychiatry, Psychiatry and Law, Psychiatric Training and Neuropsychiatry. She has served as a consultant to prominent international agencies such as the United Nations Office on Drugs and Crime (UNODC), the International Labour Organization (ILO) and the World Health Organization (WHO). She has also served as a resource person for various flagship training programmes in substance abuse prevention and tobacco cessation in the country, and across the globe.

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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