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Clinical Case of a Schizotypal Personality Disorder: Rumination-Focused CBT for Anger Rumination

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Abstract

Anger dysregulation is part of a broad range of clinical disorders, and as a dynamic risk factor for aggression anger is highly relevant in clinical populations. Problems of anger and reactive aggression are trans-diagnostic and treatments should target the mechanisms involved in problematic anger across disorders. There is empirical evidence that anger rumination is associated with anger as well as aggression. Because rumination-focused CBT (RfCBT) has shown that reduction in rumination seems to be associated with transdiagnostic reductions in symptoms, the present study aimed at extending the applicability of the RfCBT model to target problematic anger in a case of schizotypal personality disorder (SPD). The current study was a clinical case study with a patient suffering from problematic anger and anger rumination, and diagnosed with schizotypal personality disorder (SPD) receiving 25 sessions of rumination-focused CBT (RfCBT) for problematic anger. The primary focus was on anger and anger rumination, which was reduced during therapy, and maintained in the 3 months follow up. Results on the measures of repetitive negative thinking also showed a decrease, however symptoms of depression and anxiety had increased from pre- to post treatment. RfCBT can be applied to a case of SPD with problematic anger, thereby showing proof of concept for a transdiagnostic use of RfCBT and opening up for future research in this area. The applicability of RfCBT to anger problems among patients diagnosed with SPD needs to be replicated in a larger sample of patients diagnosed with SPD/problematic anger and anger rumination.

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Acknowledgements

This study was possible due to the willingness and courage of the participating patient to try out a new therapy without empirical evidence for his specific problems. It is with deep respect and admiration for his engagement that we express our gratitude. His commitment hopefully will “make a difference” for other patients in the future. We also want to thank Stephen Austin for insightful comments to earlier versions of the manuscript.

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Authors and Affiliations

  1. Psychotherapy Research Unit, Mental Health Centre Stolpegaard, Capital Region Psychiatry, Gentofte, Denmark

    S. B. Moeller

  2. Mental Health Center North Zealand, Capital Region Psychiatry, Hillerød, Denmark

    V. Kvist

  3. Mental Health Centre Copenhagen, Capital Region Psychiatry, Copenhagen, Denmark

    J. E. Jansen

  4. SMART Lab, University of Exeter, Exeter, EX4 4QG, UK

    E. R. Watkins

  5. Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark

    S. B. Moeller

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  1. S. B. Moeller
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Moeller, S.B., Kvist, V., Jansen, J.E. et al. Clinical Case of a Schizotypal Personality Disorder: Rumination-Focused CBT for Anger Rumination. J Contemp Psychother 51, 311–321 (2021). https://doi.org/10.1007/s10879-021-09501-y

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