2Modal’X, Université Paris 10, 200 Avenue de la République, 92000 Nanterre, France
Method: Two hundred and ninety four subjects (282 patients from a French medical practice in psychiatry and 12 volunteers) filled in a French version of the YSQ-s3. Item scores range from 1 to 6. Only the scores of 4 ‘‘Moderately true of me’’ or higher were kept for the statistical analysis. Data analysis was conducted using descriptive statistics, principal component analysis, and hierarchical clustering analysis.
Result: The EMS mean scores ranged from 3.4 to 12.9 and standard deviations from 5.9 to 9.7. EMS score correlations range from 0.009 to 0.55. The principal component analysis, that provides linear combinations of each EMS score, yields only one meaningful component. Indeed, the screen plot that provides the Eigen values associated with each principal component, suggests keeping only the first component. This component presents a size-effect and represents the ‘‘global scores intensity’’. The hierarchical clustering analysis fits the 18 EMS in 5 clusters (r2 =0.4): (1) ‘‘Avoidance’’ (with 3 EMS: emotional deprivation, social isolation/alienation, emotional inhibition), (2)‘‘Give’’ (with 1 EMS: self-sacrifice), (3) ‘‘Take’’ (with 3 EMS: entitlement/grandiosity, insufficient self-control/self-discipline, approval-seeking/recognition-seeking) (4) ‘‘Awareness’’ (with 8 EMS: abandonment/instability, mistrust/abuse, defectiveness/shame, dependence/incompetence, vulnerability to harm or illness, enmeshment/ undeveloped self, failure, subjugation) (5) ‘‘Faith’’ (with 3 EMS: negativity/pessimism, unrelenting standards/hyper-criticalness, punitiveness). When the hierarchical clustering analysis is applied to the population (n = 294), it yields 6 classes of patients. The mean score of the 5 clusters can describe these classes.
Discussion: In our understanding the 5 clusters could fit the CBT model in which emotions and cognitions determine the subject’s behavioral response. ‘‘Avoidance, Give, Take’’ represent 3 types of relationship to others (on a behavioral level). The dimension ‘‘Awareness’’ represents the fears and losses (on the emotional level) and ‘‘Faith’’ represents beliefs and consciousness (on the cognitive level).
On a psychological perspective this model can be useful to specify personality and clinical disorders in psychiatry. The 5 clusters seem closely related to the 5 sub-scales of the NEO-PI-R (a well established personality scale) and to 4 domains of DSM-5, criteria B for personality disorders (the ongoing research for personality disorder in the fifth version of the Diagnostic System Medical).
On a robotic perspective this model may be useful to design robots human-like psychological functioning.
keywords: Psychology; Schema therapy; Young schema questionnaire; YSQ-s3; Behavior; Robot psychology;
Jeffrey Young clinically organized the 18 schemas into 5 theoretical domains:
i) Disconnection/Rejection includes 5 schemas:
Abandonment/Instability
Mistrust/Abuse
Emotional Deprivation
Defectiveness/Shame
Social Isolation/Alienation
ii) Impaired Autonomy and/or Performance include 4 schemas:
Dependence/Incompetence
Vulnerability to Harm or Illness
Enmeshment/Undeveloped Self
Failure
iii) Impaired Limits includes 2 schemas:
Entitlement/Grandiosity
Insufficient Self-Control and/or Self-Discipline
iv) Other-Directedness includes 3 schemas: Subjugation
Self-Sacrifice
Approval-Seeking/Recognition-Seeking
v) Overvigilance/Inhibition includes 4 schemas:
Negativity/Pessimism
Emotional Inhibition
Unrelenting Standards/Hypercriticalness
Punitiveness
We published, a statistical analysis of the Young Schema Questionnaire (YSQ-s3), in a french journal of psychiatry, l’Encéphale [1]. The methodology and results are given hereunder. Our interpretation of the results, in line with Cognitive and Behavioral Therapy (CBT) model proposes that the sufferings scored by the subject express a) memory of painful emotions, b) cognitive psycho-rigidity, c) excessive behavioral pervasiveness in 3 main dimensions. Excessive dominant “Take” behavior, Excessive dependent “Give” behavior, Excessive “Avoidance” behavior. This CBT model of the sufferings scored by patients can inspire the design of human-like psychological functioning for robots.
In order to identify the clusters of all the sufferings and beliefs presented by the patients, we analyze the YSQ-s3 in a clinical practice, with the methodology and the results described hereunder.
1) “I haven’t had someone to nurture me, share him/her with me, or care deeply about everything that happens to me”.
2) I find myself clinging to people; I’m close to because I’m afraid they’ll leave.
3) I find that people will take advantage of me.
4) I don’t fit in.
5) No man/woman I desire could love me once he or she saw my defects of flaws.
The patient should recall, feel and compute the frequency and duration of the EMS items in his life. Each item intensity is scored from 1 to 6.
1 = Completely untrue of me
2 = Mostly untrue of me
3 = Slightly more true than untrue
4 = Moderately true of me
5 = Mostly true of me
6 = Describes me perfectly
The EMS scores represent the patient’s perceptions and statements about him-self and the scores intensity is a measure of the degree of invasiveness. The scores of 4, 5, 6 express a truth for the subject. Scores that range from 4 to 6 express long standing true personality trait and sufferings. This is what we are looking for when we are studying the main sufferings that characterize at best the subject’s personality. We reported the 90 items scores on an excel sheet, changing the scores 1, 2, 3 into a “0” and keeping unchanged the scores of 4, 5, 6. The EMS score is the sum of the 5 item scores. EMS scores range from 0 to 30. The YSQ-s3 with 18 EMS cover different and meaningful psychological themes.
90 YSQ-s3 item scores are given by the patients on the questionnaire.
The scores of 1,2,3 are deleted (value=0), scores of 4,5,6 are kept unchanged. EMS score is the sum of five items.
“Awareness” is made of 8 EMSs: abandonment/instability, mistrust/abuse, defectiveness/shame, failure to achieve, dependence/incompetence, vulnerability to harm or illness, enmeshment/under-developed self, subjugation.
“Faith” is made of 3 EMSs: Unrelenting standards, Negativity/ Pessimism, Punitiveness.
“Take” is made of 3 EMSs: Entitlement/Grandiosity, Insufficient self-control, Approval-seeking.
“Give” is made of only one EMS: Self-sacrifice.
“Avoidance” is made of 3 EMSs: Emotional deprivation, Social isolation/Alienation, Emotional inhibition.
|
“Awareness” |
“Faith” |
“Take” |
“Give” |
“Avoidance” |
“Awareness” |
1 |
0.551 |
0.504 |
0.364 |
0.434 |
“Faith” |
- |
1 |
0.403 |
0.222 |
0.358 |
“Take” |
- |
- |
1 |
0.108 |
0.269 |
“Give” |
- |
- |
- |
1 |
0.07 |
“Avoidance” |
- |
- |
- |
- |
1 |
The scores of the 5 clusters are obviously related to the global score (sum of 18 EMS’ scores). This relation is extremely tight for “Awareness” (r=0.91) and “Faith” (r=0.90).
A reading of these results, suggest that a “human-like functioning” could yields 6 different psychological classes of robots. A psychiatric reading of these scores tentatively proposes that class 1 points toward schizoid and avoidance personality disorders with a predominant “Give and Avoidance” cluster (scores>11), class 2 is the “healthier” category with low scores except for the “Give” cluster (score >10), class 3 is the sicker, and confused patients that points toward borderline and possibly schizotypic personality disorders with high “Awareness and Faith” (scores>16) and equal “Take, Give, Avoidance” dimensions (scores>14 and< 17), class 4 points toward the dependence personality disorder with a high “Give” cluster (score> 20), class 5 points toward obsessional and paranoiac personality disorders with high “Faith and “Avoidance” cluster (scores>17), class 6 points toward histrionic, narcissistic and possibly antisocial personality with a high “Take” cluster (score>13).
Correlations of the 5 dimensions (clusters: “Awareness”, “Faith”, Take”, “Give”, “Avoidance”) with the global score of the questionnaire YSQ-s3
|
“Awareness” |
“Faith” |
“Take” |
“Give” |
“Avoidance” |
5 dimensions Average |
Class 1 |
3,54 |
10,69 |
6,64 |
12,40 |
11,53 |
8,96 |
Class 2 |
2,23 |
7,39 |
5,26 |
10,14 |
3,04 |
5,61 |
Class 3 |
16,39 |
16,22 |
16,48 |
14,39 |
14,75 |
15,65 |
Class 4 |
10,05 |
15,40 |
11,23 |
20,64 |
9,87 |
13,44 |
Class 5 |
7,77 |
17,70 |
13,48 |
8,09 |
17,23 |
12,85 |
Class 6 |
7,82 |
13,90 |
13,65 |
6,70 |
7,34 |
9,88 |
Correlation to global score |
R=0,918 |
R=0.908 |
R=0,854 |
R=0,439 |
R=0,782 |
|
These two clusters, “Awareness” and “Faith” could be seen as the 2 pressures exerted upon the patient. “Awareness” is the body’s perceptions and emotions, “Faith” is the mental perception of oneself truth. Both, “Awareness” and “Faith” have extremely high correlation with YSQ-s3 global score (r>0.90). The negative emotions described in the “Awareness” cluster and the psycho-rigidity described in the “Faith” cluster are the actors of the patient’s sufferings.
Then the sufferings are characterized at a behavioral level. Behaviors can be characterized in the “Take”, “Give”, “Avoidance” clusters. We discuss later the relations between these 3 behavioral clusters and other personality disorders models such the NEOPI and the DSM-5. Toxicity appears with high EMSs scores. All classes of patients, except the healthier class present a strong correlation with the “Faith” cluster. In clinic, excessive “Faith” + “Give”= Generosity toxicity, “Faith”+ “Take”= Grandiosity toxicity, “Faith”+ “Avoidance”= Psycho-rigidity toxicity
5 main sufferings |
EMS |
r |
DSM-5 facets |
r Max |
DSM-5 dimension |
Awareness |
AB: Abandonment |
.76 |
Separation Insecurity |
.81 |
Negative Affectivity |
MA: Mistrust / Abuse |
.87 |
Suspiciousness |
.68 |
Negative Affectivity |
|
DS: Defectiveness / Shame |
.82 |
Depressivity |
.75 |
Detachment |
|
FA: Failure to archive |
.74 |
Depressivity |
.64 |
Detachment |
|
DI: Dependance / Incompet. |
.71 |
Depressivity |
.66 |
Negative Affectivity |
|
VH: Vulnerability to Harm |
.75 |
Anxiousness |
.70 |
Negative Affectivity |
|
EM: Enmeshment |
.58 |
Anxiousness |
.62 |
Negative Affectivity |
|
SB: Subjugation |
.71 |
Depressivity |
.67 |
Negative Affectivity |
|
Faith |
US: Unrelenting standards |
.63 |
Rigid perfectionism |
.44 |
Negative Aff /Detachment |
PN: Pessimism / Negativity |
.82 |
Anxiousness |
.76 |
Negative Affectivity |
|
SP: Self Punitiveness |
.66 |
Depressivity |
.59 |
Detachment |
|
Take |
ET: Entitlement |
.64 |
Grandiosity |
.63 |
Antagonism |
IS: Insufficient self control |
.74 |
Distractibility |
.75 |
Disinhibition |
|
AS: Approval seeking |
.51 |
Attention Seeking |
.49 |
Negative Affectivity |
|
Give |
SS: Self sacrifice |
.42 |
Suspiciousness |
.42 |
Negative Affectivity |
Avoidance |
ED: Emotional Deprivation |
.66 |
Depressivity |
.65 |
Detachment |
SI: Social Isolation |
.80 |
Depressivity |
.76 |
Detachment |
|
EI: Emotional Inhibition |
.71 |
Withdrawal |
.73 |
Detachment |
How does the 5 clusters relate to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)? In the actual DSM-5 research, the criterium B, with its 5 trait domains seems closely related to the 5 clusters, except for Psychoticism. Psychoticism with its wide range of culturally incongruent odd, behaviors and cognitions does not resemble any of the 5 clusters. Bach, et al. [7], in the Journal of Personality Disorders 2015, studies “How do DSM-5 personality traits align with schema therapy constructs”. They find that the EMSs are strongly related to DSM-5 personality trait facets and domains. The Table 3 gives the DSM-5 facets and domains most strongly correlated to the 18 EMSs. From Bach’s data, we present the highest correlation (r Max) between the EMSs and the DSM-5 facets (range from 0.42 to 0.87) and between the EMSs and DSM-5 domains (range from 0.42 to 0.81) in their study (Table 3).
The 8 EMSs from the “Awareness” cluster are related to the “Negative Affectivity” (n=6/8, r from 0.62 to 0.81) and to the “Detachment” dimensions (n= 2/8, r ranges from 0.64 to 0.75). This is in line with the negative emotions of fear and loss, characteristic of “Awareness” in our study. “Awareness” covers both clinical anxiety and depression in the DSM-5.
The 3 EMSs of “Faith” relate equally to the “Negative Affectivity” and “Detachment” dimensions (range r = 0.44 to 0.76). The “Faith” cluster relates to rigid perfectionism, anxiousness and depressivity facets.
The 3 behavioral clusters relate to DSM-5 criteria B.
- The 3 EMSs from “Take” relate to 3 different DSM-5 domains: “Antagonism” (n=1/3, r = 0.63), “Disinhibition” (n=1/3, r = 0.75) and “Negative Affectivity” (n=1/3, r= 0.49). “Take” EMSs could describe a patient with a high ego (r=0.64 with Grandiosity facet) but unstable and vulnerable (r=0.74 with Distractibility facet and r=0.51 with Attention seeking facet).
-The only EMS from the “Give” cluster relates to the “Negative Affectivity” domain (r=0.42) and to “Suspiciousness” facet (r=0.42). “Give” is related to anxious feelings. From all 18 EMSs of the YSQ-s3, “Self-Sacrifice” presents the lowest “highest” correlation with DSM-5 facets (r=0.42) and domains (r=0.42). The “Give” dimension correlates poorly (ranges from 0.03 to 0.42) to DSM-5 facets. It could be because the “Give” dimension with its acceptation, humbleness and generosity is like social glue, partly protective from social sufferings, therapeutic by himself and not clinically meaningful. In the Encéphale 2015 study, EMS self-sacrifice was noted as the least toxic of all EMSs because it was the less contributive to the global score and because the “Give” cluster was high in the healthier class of patients with the lower global score. The low correlations between the “Give” cluster and the DSM-5 facets and domaines could be due to the absence of DSM-5 item expressing pathological generosity. The “Give” dimension, necessary for dependence personality disorder diagnosis is lacking in DSM-5 criteria B.
- The 3 EMSs from the “Avoidance” cluster relate tightly to the “Detachment” domain (n=3/3 range r = from 0.65 to 0.76). These EMSs relate to the facet “withdrawal” (r=0.71) and twice to the facet “Depressivity” (r=0.66 and r=0.80). “Avoidance” behavior is related to isolation and depressive mood.
No EMS has its highest correlation with DSM-5 “Psychoticism” facets or domaine. YSQ-s3 could be missing the DSM-5 “Psychoticism” trait and in clinic could be missing the schizotypic personality disorder. An alternative interpretation would be that the schizotypic personality disorder is expressed by the confusion arising from equal levels of the “Take and Give” clusters.
EMSs are also sensitive to mood induction: 30 participants completed the YSQ on three different occasions: in neutral mood, following happy and depressed mood inductions. Stopa and Waters, [16] find that EMS “emotional deprivation” and “defectiveness” scores increase after the depressed mood induction, whereas “entitlement” scores increase after the happy mood induction. It is impressive that a depressive mood induction increases the EMSs corresponding to the “Awareness and Avoidance” dimension and that a happy mood induction increases the “Take” dimension.
In summary, researches show that EMS scores are sensitive to pathology, to treatment and to mood. The 5 clusters are compatible with the NEO-PI dimensions and closely related to 4 dimensions of the DSM-5, criteria B dimensions.
Could we introduce a healthy dimension in the behaviors, in order to represent the healthy side that is not studied in the YSQ-s3? Our answer is no. “Take” and “Give” are obviously a form of opposition, and it would be elegant to characterize the behaviors in terms of 2 polarities. The “Take / Give” polarity and the “GO / Avoidance” polarity. The “GO” dimension could be the opposite of “Avoidance” and would represent desires, motivations and gains. It would be elegant but misleading. In our CBT model, the psychic life is made from the interaction of emotions and cognitions, as neurologist, Antonio Damasio proposes. The healthy part is made from positive emotions and cognitive openness, (the opposite of psycho-rigidity), they is no need to change the 3 behavioral clusters. They are appropriate even if they were selected from our understanding of CBT.
The “Go” response, in a fearful condition would be inappropriate. In a fearful situation the animal does not explore calmly the surrounding. We cannot add a Go dimension only because the YSQ-s3 does not explore the healthy personality or because it is elegant.
The “Take versus Give versus Avoidance” represents a “surface behavior” on which all behaviors could be represented. Under a fearful condition the rat can freeze, fly, or fight. Freeze would be an “avoidance” response, fly would be a submissive “Give” response, and fight would be a dominant “Take” response. The possible rat’s reaction under stress is of 3 kinds, even if, in practice the rat usually freezes or flight and rarely fights. In fact, it must be a matter of cognition. Under a fearful situation and without a way out, it is likely that the rat computes that fight is a better option than freeze or flight. It is intriguing to see the movements of these 3 behaviors. Fight goes forward, flight goes backward and freeze does not move at all. Could that means that all behaviors are basically made of only 3 meta-actions? It seems that mechanically they are basically only 3 behavioral actions: forward, backward, equilibrium. This would be appropriate for all emotions. Love and desire usually have a forward behavior but in some case, the subject computes that backward is a better strategy. Even the neuron has 3 positions: depolarization, hyperpolarization and equilibrium. Even the synapses connectivity are in 3 directions: Long term Depression, Long Term Potentiating and equilibrium. Fundamentally we propose that the 3 behavioral clusters represent the well known “Take”/”Give” opposition (dominance versus submission) to which our results, added an “Avoidance” dimension. This dimension says that they will be no “Take” or “Give” if I do not engage in the relation. As observed by clinicians “Avoidance” is very powerful behavior. By refusing the interactions, the subject keeps the power, at the cost of losing the human link.
In summary, the analysis of the 5 clusters in the CBT model, from a population that suffers psychologically could be generalized to the healthy population. In the healthy population the emotions (“Awareness” cluster) would be more positive and the cognition (“Faith” cluster) would be less psycho-rigid, but the behaviors can still be represented on a surface behavior made from a triangle, with at the angles “Awareness”, “Faith”, “Avoidance”.
We expect, from a program that would use our “surface behavior” to be able to detect a player’s personality traits during a game of go and to adapt to all situations with a “human-like psychological functioning”.
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