The participation of Early Maladaptive Schemas (EMSs) in the perception of pain in patients with migraine: A psychological profile

Ribas, Ketlin Helenise dos Santos; Ribas, Valdenilson Ribeiro; Barros, Silano Souto Mendes; Ribas, Valéria Ribeiro; Filizola, Maria da Glória Nogueira; Ribas, Renata de Melo Guerra; Silva, Paulo César da; Kucera, Carlos Augusto Cardoso; Martins, Hugo André de Lima

doi:10.1590/1980-57642018dn12-010010

Ketlin Helenise dos Santos Ribas

Universidade Federal de Pernambuco, Mestrado em Neuropsiquiatria e Ciências do Comportamento Recife, PE, Brazil

Valdenilson Ribeiro Ribas Valdenilson Ribeiro Ribas. Av. Zequinha Barreto, 384 / Galeria Piedade Center / Sala 208 54400-090 Recife PE - Brazil. E-mail: ribas.professor@gmail.com

Universidade Federal de Pernambuco, Doutorado em Neuropsiquiatria e Ciências do Comportamento Recife, PE, Brazil

Silano Souto Mendes Barros

Universidade Federal de Pernambuco, Fisioterapia, Recife, PE, Brazil

Valéria Ribeiro Ribas

Universidade Federal de Pernambuco, Mestrado em Neuropsiquiatria e Ciências do Comportamento Recife, PE, Brazil

Maria da Glória Nogueira Filizola

Cérebro e Tecnologia Neurofeedback Recife (CTNR) - Cursos/Pesquisas Jaboatão dos Guararapes, PE, Brazil

Renata de Melo Guerra Ribas

Cérebro e Tecnologia Neurofeedback Recife (CTNR) - Cursos/Pesquisas Jaboatão dos Guararapes, PE, Brazil

Paulo César da Silva

Cérebro e Tecnologia Neurofeedback Recife (CTNR) - Cursos/Pesquisas Jaboatão dos Guararapes, PE, Brazil

Carlos Augusto Cardoso Kucera

Cérebro e Tecnologia Neurofeedback Recife (CTNR) - Cursos/Pesquisas Jaboatão dos Guararapes, PE, Brazil

Hugo André de Lima Martins

Universidade Federal de Pernambuco, Doutorado em Neuropsiquiatria e Ciências do Comportamento Recife, PE, Brazil

Valdenilson Ribeiro Ribas. Av. Zequinha Barreto, 384 / Galeria Piedade Center / Sala 208 54400-090 Recife PE - Brazil. E-mail: ribas.professor@gmail.com

Disclosure: The authors report no conflicts of interest.

Author contribution. Ketlin Helenise dos Santos Ribas: participated in the writing of the entire text, in data collection and statistical analysis. Silano Souto Mendes Barros: contributed to writing of the Introduction and was involved in the data collection. Valéria Ribeiro Ribas: assisted in data collection and sample calculations. Maria da Glória Nogueira Filizola: assisted in the data collection and devising of the methodology. Valdenilson Ribeiro Ribas: helped in the textual organization of the Results and the Discussion and also contributed to the statistical analysis and was the corresponding author. Renata de Melo Guerra Ribas: assisted in data collection and statistical analysis. Paulo César da Silva: assisted in the data collection and in the searching and organization of references. Hugo André de Lima Martins: assisted in data collection and oversaw the overall study as Advisor.

Tables (4)

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Domain Early maladaptive schemas Origin / Etiology 1st Domain:Disconnection and rejection • Fear of abandonment• Mistrust• Emotional deprivation• Defectiveness/shame• Social isolation/alienation Linked to failures of secure attachment to others, of affection and stability, of mothering in general. Serious difficulties in establishing healthy affective relationships. 2nd Domain:Impaired autonomy and performance • Dependency/incompetency• Vulnerability to harm or illness• Enmeshment• Failure Individuals cannot develop a sense of confidence, of establishing themselves in the world by themselves, generally possessing overprotective families that, in an attempt to protect the child, end up not reinforcing their autonomy. 3rd Domain:Impaired limits • Entitlement/grandiosity• Insufficient self-discipline Linked to failures to apply realistic limits, the ability to follow rules and norms, respect the rights of others and fulfill personal goals. Selfishness is the main characteristic of these individuals, and the family is generally permissive. 4th Domain:Orientation to the other • Subjugation• Self-sacrifice• Recognition-seeking In order to gain approval and avoid retaliation, patients in this domain have an overemphasis on meeting the other's wants and needs at the expense of their own needs. The family of origin usually establishes a conditional love relationship, that is, the child only receives attention and approval, if it suppresses its free expression and behaves in the desired way. 5th Domain:Hypervigilance and inhibition • Negativism/pessimism• Emotional inhibition• Unrelenting standards• Punitiveness Because of a rigid, repressive education in which there was no possibility to express their emotions in a free way, individuals with schemas linked to this domain are generally sad and introverted, with overly rigid internalized rules, exaggerated self-control and pessimism, and hypervigilance for possible negative events.

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Table 1
Association between morbidity, gender and age group.

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Table 2
Evaluation of early maladaptive schemas related to hypervigilance and inhibition according to gender.

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Table 3
Evaluation of early maladaptive schemas related to hypervigilance and inhibition according to group.

Domain	Early maladaptive schemas	Origin / Etiology
1^st Domain: Disconnection and rejection	• Fear of abandonment • Mistrust • Emotional deprivation • Defectiveness/shame • Social isolation/alienation	Linked to failures of secure attachment to others, of affection and stability, of mothering in general. Serious difficulties in establishing healthy affective relationships.
2^nd Domain: Impaired autonomy and performance	• Dependency/incompetency • Vulnerability to harm or illness • Enmeshment • Failure	Individuals cannot develop a sense of confidence, of establishing themselves in the world by themselves, generally possessing overprotective families that, in an attempt to protect the child, end up not reinforcing their autonomy.
3^rd Domain: Impaired limits	• Entitlement/grandiosity • Insufficient self-discipline	Linked to failures to apply realistic limits, the ability to follow rules and norms, respect the rights of others and fulfill personal goals. Selfishness is the main characteristic of these individuals, and the family is generally permissive.
4^th Domain: Orientation to the other	• Subjugation • Self-sacrifice • Recognition-seeking	In order to gain approval and avoid retaliation, patients in this domain have an overemphasis on meeting the other's wants and needs at the expense of their own needs. The family of origin usually establishes a conditional love relationship, that is, the child only receives attention and approval, if it suppresses its free expression and behaves in the desired way.
5^th Domain: Hypervigilance and inhibition	• Negativism/pessimism • Emotional inhibition • Unrelenting standards • Punitiveness	Because of a rigid, repressive education in which there was no possibility to express their emotions in a free way, individuals with schemas linked to this domain are generally sad and introverted, with overly rigid internalized rules, exaggerated self-control and pessimism, and hypervigilance for possible negative events.

Variable		Group				p-value Chi-square
		Control		Migraine
		n	%	n	%
Total		27/65		38/65
Gender	Male	13/27	48.14	6/38	15.78	0.018^* * Statistically significant.
Gender	Female	14/27	51.85	32/38	84.21	0.018^* * Statistically significant.
Age (years)	18-29	13/27	48.14	21/38	55.26	0.868
	30-39	5/27	18.52	9/38	23.68
	40-55	9/27	33.33	8/38	21.5

Schema		Gender				p-value Chi-square
		Male		Female
		n	%	n	%
Total		19/65		46/65
Negativism/pessimism	>3.8	1/19	5.26	8/46	17.39	0.436
Negativism/pessimism	≤3.8	18/19	94.73	38/46	82.60	0.436
Emotional inhibition	>3.8	1/19	5.26	6/46	13.04	0.654
Emotional inhibition	≤3.8	18/19	94.73	40/46	86.95	0.654
Unrelenting standards	>3.8	7/19	36.84	26/46	56.52	0.014^* * Statistically significant
Unrelenting standards	≤3.8	18/19	94.73	14/46	30.43	0.014^* * Statistically significant
Self-punishment	>3.8	-	-	28/46	60.86	<0.0001^* * Statistically significant
Self-punishment	≤3.8	18/19	94.73	19/46	41.30	<0.0001^* * Statistically significant

Schema		Group				p-value Chi-square
		Control		Migraine
		n	%	N	%
Total		27/65		38/65
Negativism/pessimism	>3.8	3/27	11.11	6/38	15.78	0.865
Negativism/pessimism	≤3.8	24/27	88.88	32/38	84.21	0.865
Emotional inhibition	>3.8	1/27	3.70	6/38	15.78	0.301
Emotional inhibition	≤3.8	26/27	96.29	32/38	84.21	0.301
Unrelenting standards	>3.8	5/27	18.51	28/38	73.68	< 0.0001^* * Statistically significant
Unrelenting standards	≤3.8	22/27	81.48	10/38	26.31	< 0.0001^* * Statistically significant
Self-punishment	>3.8	-	-	32/38	84.21	< 0.0001^* * Statistically significant
Self-punishment	≤3.8	27/27	100	6/38	15.78	< 0.0001^* * Statistically significant

[1] Valdenilson Ribeiro Ribas. Av. Zequinha Barreto, 384 / Galeria Piedade Center / Sala 208 54400-090 Recife PE - Brazil. E-mail: ribas.professor@gmail.com

Brasil

Brasil

The participation of Early Maladaptive Schemas (EMSs) in the perception of pain in patients with migraine: A psychological profile

A PARTICIPAÇÃO DOS ESQUEMAS INICIAIS DESADAPTATIVOS (EIDS) NA PERCEPÇÃO DA DOR EM PACIENTES COM MIGRÂNEA: UM PERFIL PSICOLÓGICO

ABSTRACT

Objective:

Methods:

Results:

Conclusion: