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1.
Luppino, Olga Ines; Tenore, Katia; Mancini, Francesco; Mancini, Alessandra
The Role of Childhood Experiences in the development of Disgust Sensitivity: a preliminary study on early moral memories Journal Article
In: Clinical Neuropsychiatry, vol. 20, no 2, pp. 109-121, 2023.
Abstract | Links | BibTeX | Tag: Deontological guilt, Disgust, early autobiographical memories, Early maladaptive schemas, imagery, Morality
@article{Luppino2023,
title = {The Role of Childhood Experiences in the development of Disgust Sensitivity: a preliminary study on early moral memories},
author = {Olga Ines Luppino and Katia Tenore and Francesco Mancini and Alessandra Mancini},
editor = {Giovanni Fioriti Editore s.r.l. },
url = {https://apc.it/2023-mancini-the-role-of-childhood-experiences/},
doi = {doi.org/10.36131/ cnfioritieditore2023020},
year = {2023},
date = {2023-04-01},
urldate = {2023-04-01},
journal = {Clinical Neuropsychiatry},
volume = {20},
number = {2},
pages = {109-121},
abstract = {bjective: Disgust is a basic emotion evolved to safeguard our omnivorous species from contagion. Although the factors eliciting disgust typically involve concerns related to physical contamination, physical disgust responses are also prompted by moral transgressions, (i.e. cannibalism, pedophilia, betrayal). The link between the general propensity to experience disgust (i.e. “Disgust Sensitivity”) and morality, in particular in the deontological domain, is supported by an increasing amount of data on clinical and non-clinical sample. Evolutionistic explanations of this link posit that disgust evolved to indicate the presence of a threat to the integrity of the individual not only in the physical domain but also in the social and moral domain. In addition to the evolutionary point of view, this link could also be better investigated in terms of individual development. To the best of our knowledge, literature is scarce regarding which early experiences are associated to high DS. Therefore, this study aims to explore the content of early memories associated with disgust. Based on the strict link between disgust and morality, we hypothesized an association between DS and early memories of moral criticism.
Method: 60 non-clinical participants filled in measures of DS. They were then
presented with an auditory disgust induction, after which they recalled early memories
through the technique of the “affect bridge”. 10 independent raters assessed the
emotional content of the memories on visual-analogical scales.
Results: Results showed a positive association between disgust sensitivity and
the propensity to experience deontological guilt. There was also a significant positive
association between disgust sensitivity and moral memories, in particular relating to
early experiences of being the object of contempt, moral criticism, anger, and of being
held responsible.
Conclusions: These data directly support the centrality of early morally-loaded
interpersonal experiences in the development of DS, confirming the link between
disgust and morality also at the level of individual historical developme},
keywords = {Deontological guilt, Disgust, early autobiographical memories, Early maladaptive schemas, imagery, Morality},
pubstate = {published},
tppubtype = {article}
}
bjective: Disgust is a basic emotion evolved to safeguard our omnivorous species from contagion. Although the factors eliciting disgust typically involve concerns related to physical contamination, physical disgust responses are also prompted by moral transgressions, (i.e. cannibalism, pedophilia, betrayal). The link between the general propensity to experience disgust (i.e. “Disgust Sensitivity”) and morality, in particular in the deontological domain, is supported by an increasing amount of data on clinical and non-clinical sample. Evolutionistic explanations of this link posit that disgust evolved to indicate the presence of a threat to the integrity of the individual not only in the physical domain but also in the social and moral domain. In addition to the evolutionary point of view, this link could also be better investigated in terms of individual development. To the best of our knowledge, literature is scarce regarding which early experiences are associated to high DS. Therefore, this study aims to explore the content of early memories associated with disgust. Based on the strict link between disgust and morality, we hypothesized an association between DS and early memories of moral criticism.
Method: 60 non-clinical participants filled in measures of DS. They were then
presented with an auditory disgust induction, after which they recalled early memories
through the technique of the “affect bridge”. 10 independent raters assessed the
emotional content of the memories on visual-analogical scales.
Results: Results showed a positive association between disgust sensitivity and
the propensity to experience deontological guilt. There was also a significant positive
association between disgust sensitivity and moral memories, in particular relating to
early experiences of being the object of contempt, moral criticism, anger, and of being
held responsible.
Conclusions: These data directly support the centrality of early morally-loaded
interpersonal experiences in the development of DS, confirming the link between
disgust and morality also at the level of individual historical developme
Method: 60 non-clinical participants filled in measures of DS. They were then
presented with an auditory disgust induction, after which they recalled early memories
through the technique of the “affect bridge”. 10 independent raters assessed the
emotional content of the memories on visual-analogical scales.
Results: Results showed a positive association between disgust sensitivity and
the propensity to experience deontological guilt. There was also a significant positive
association between disgust sensitivity and moral memories, in particular relating to
early experiences of being the object of contempt, moral criticism, anger, and of being
held responsible.
Conclusions: These data directly support the centrality of early morally-loaded
interpersonal experiences in the development of DS, confirming the link between
disgust and morality also at the level of individual historical developme
2.
Basile, Barbara; Novello, Chiara; Calugi, Simona; Grave, Rccardo Dalle; Mancini, Francesco
Childhood Memories in Eating Disorders: An Explorative Study Using Diagnostic Imagery Journal Article
In: Eating Behavior, vol. 12, pp. 2890, 2021, ISSN: 1664-1078.
Abstract | Links | BibTeX | Tag: Anorexia Nervosa, bulimia nervosa, diagnostic imagery, Early maladaptive schemas, eating disorders, parental schemas, unmet core needs
@article{Basile2021,
title = {Childhood Memories in Eating Disorders: An Explorative Study Using Diagnostic Imagery},
author = {Barbara Basile and Chiara Novello and Simona Calugi and Rccardo Dalle Grave and Francesco Mancini},
editor = {Frontiers in Psychlogy},
url = {https://apc.it/wp-content/uploads/2021/07/2021-mancini-childhood.pdf},
doi = {10.3389/fpsyg.2021.685194},
issn = {1664-1078},
year = {2021},
date = {2021-07-22},
journal = {Eating Behavior},
volume = {12},
pages = {2890},
abstract = {components, the family environment and early parent–child interactions play a role in the development of eating disorders. The aim of this study was to explore the nature of early parent–daughter relationships in a sample of 49 female inpatients with an eating disorder. To acquire a detailed image description of the childhood experiences of the patient, we used diagnostic imagery, a schema therapy-derived experiential technique. This procedure allows exploring specific contents within the childhood memory (i.e., emotions and unmet core needs), bypassing rational control, commonly active during direct verbal questioning. Additionally, patients completed self-report measures to assess for eating disorder severity, general psychopathology, and individual and parental schemas pervasiveness. Finally, we explored possible differences in the diagnostic imagery content and self-report measures in two subgroups of patients with anorexia nervosa and bulimia nervosa. The results showed that the most frequently reported unmet needs within the childhood memories of patients were those of safety/protection, care/nurturance, and emotional expression, referred specifically to the maternal figure. Overall, mothers were described as more abandoning, but at the same time particularly enmeshed in the relationship with their daughters. Conversely, patients perceived their fathers as more emotionally inhibited and neglecting. Imagery-based techniques might represent a powerful tool to explore the nature of early life experiences in eating disorders, allowing a more detailed case conceptualization and addressing intervention on early-life vulnerability aspects in disorder treatment.}
},
keywords = {Anorexia Nervosa, bulimia nervosa, diagnostic imagery, Early maladaptive schemas, eating disorders, parental schemas, unmet core needs},
pubstate = {published},
tppubtype = {article}
}
components, the family environment and early parent–child interactions play a role in the development of eating disorders. The aim of this study was to explore the nature of early parent–daughter relationships in a sample of 49 female inpatients with an eating disorder. To acquire a detailed image description of the childhood experiences of the patient, we used diagnostic imagery, a schema therapy-derived experiential technique. This procedure allows exploring specific contents within the childhood memory (i.e., emotions and unmet core needs), bypassing rational control, commonly active during direct verbal questioning. Additionally, patients completed self-report measures to assess for eating disorder severity, general psychopathology, and individual and parental schemas pervasiveness. Finally, we explored possible differences in the diagnostic imagery content and self-report measures in two subgroups of patients with anorexia nervosa and bulimia nervosa. The results showed that the most frequently reported unmet needs within the childhood memories of patients were those of safety/protection, care/nurturance, and emotional expression, referred specifically to the maternal figure. Overall, mothers were described as more abandoning, but at the same time particularly enmeshed in the relationship with their daughters. Conversely, patients perceived their fathers as more emotionally inhibited and neglecting. Imagery-based techniques might represent a powerful tool to explore the nature of early life experiences in eating disorders, allowing a more detailed case conceptualization and addressing intervention on early-life vulnerability aspects in disorder treatment.}
3.
Tenore, Katia; Mancini, Francesco; Basile, Barbara
Schemas, Modes and coping strategies in obsessive-compulsive like symptoms Journal Article
In: Clinical Neuropsychiatry, vol. 15, no 6, pp. 384-392, 2018.
Abstract | Links | BibTeX | Tag: coping, Early maladaptive schemas, modes, OCD, Schema therapy
@article{Tenore2018b,
title = {Schemas, Modes and coping strategies in obsessive-compulsive like symptoms},
author = {Katia Tenore and Francesco Mancini and Barbara Basile},
editor = {Giovanni Fioriti Editore},
url = {https://apc.it/wp-content/uploads/2019/04/2018-schemas-modes-and-coping-strategies-tenore-mancini-basile.pdf},
year = {2018},
date = {2018-10-01},
journal = {Clinical Neuropsychiatry},
volume = {15},
number = {6},
pages = {384-392},
abstract = {Objective: Schema Therapy (ST) integrates cognitive-behavior therapy with emotion-focused, gestalt and object relations approaches. ST postulates that unmet emotional core needs in childhood play a role in the development of Early Maladaptive Schemas, that are maintained by dysfunctional coping strategies, and reveal themselves through specific modes. Ad hoc ST conceptualizations for personality disorders or for specific psychological conditions, have been proposed in the last years. The purpose of this study was to investigate the role of schemas, modes and coping styles in non-clinical subjects, exploring the association with Obsessive-Compulsive Disorder (OCD) symptoms severity. Moreover, we explored schemas, modes and coping styles constructs in two sub-groups, characterized by higher and lower obsessive symptoms. Finally, those constructs have been investigated in specific OC subtypes.
Method: Selected from a sample of two-hundred, fifty-one subjects with high OCD symptoms (assessed through the Obsessive Compulsive Inventory–R) and fifty-nine healthy controls were recruited. Measures of schemas, modes and coping styles were collected. Additional indexes of depression were collected. Descriptive, between-group and
correlation analyses were performed. Participants were selected from a normal population, thus, the study should be
replicated involving a clinical population.
Results: Specific schemas (i.e., mistrust/abuse, vulnerability to harm and high standards), modes (i.e., demanding parent) and coping styles (i.e., intra-psychic avoidance) were identified in the high OCD symptoms group, with precise peculiarities for OCD characteristics (i.e., washing, checking and obsessions). Further, OC symptoms severity was positively associated with specific schemas and dysfunctional modes.
Conclusions: Our results confirm previous findings investigating schemas and modes in OCD populations. },
keywords = {coping, Early maladaptive schemas, modes, OCD, Schema therapy},
pubstate = {published},
tppubtype = {article}
}
Objective: Schema Therapy (ST) integrates cognitive-behavior therapy with emotion-focused, gestalt and object relations approaches. ST postulates that unmet emotional core needs in childhood play a role in the development of Early Maladaptive Schemas, that are maintained by dysfunctional coping strategies, and reveal themselves through specific modes. Ad hoc ST conceptualizations for personality disorders or for specific psychological conditions, have been proposed in the last years. The purpose of this study was to investigate the role of schemas, modes and coping styles in non-clinical subjects, exploring the association with Obsessive-Compulsive Disorder (OCD) symptoms severity. Moreover, we explored schemas, modes and coping styles constructs in two sub-groups, characterized by higher and lower obsessive symptoms. Finally, those constructs have been investigated in specific OC subtypes.
Method: Selected from a sample of two-hundred, fifty-one subjects with high OCD symptoms (assessed through the Obsessive Compulsive Inventory–R) and fifty-nine healthy controls were recruited. Measures of schemas, modes and coping styles were collected. Additional indexes of depression were collected. Descriptive, between-group and
correlation analyses were performed. Participants were selected from a normal population, thus, the study should be
replicated involving a clinical population.
Results: Specific schemas (i.e., mistrust/abuse, vulnerability to harm and high standards), modes (i.e., demanding parent) and coping styles (i.e., intra-psychic avoidance) were identified in the high OCD symptoms group, with precise peculiarities for OCD characteristics (i.e., washing, checking and obsessions). Further, OC symptoms severity was positively associated with specific schemas and dysfunctional modes.
Conclusions: Our results confirm previous findings investigating schemas and modes in OCD populations.
Method: Selected from a sample of two-hundred, fifty-one subjects with high OCD symptoms (assessed through the Obsessive Compulsive Inventory–R) and fifty-nine healthy controls were recruited. Measures of schemas, modes and coping styles were collected. Additional indexes of depression were collected. Descriptive, between-group and
correlation analyses were performed. Participants were selected from a normal population, thus, the study should be
replicated involving a clinical population.
Results: Specific schemas (i.e., mistrust/abuse, vulnerability to harm and high standards), modes (i.e., demanding parent) and coping styles (i.e., intra-psychic avoidance) were identified in the high OCD symptoms group, with precise peculiarities for OCD characteristics (i.e., washing, checking and obsessions). Further, OC symptoms severity was positively associated with specific schemas and dysfunctional modes.
Conclusions: Our results confirm previous findings investigating schemas and modes in OCD populations.
4.
Basile, Barbara; Tenore, Katia; Mancini, Francesco
Investigating schema therapy constructs in individuals with depression Journal Article
In: Journal of Psychology and Clinical Psychiatry, vol. 9, no 2, pp. 214-221, 2018.
Abstract | Links | BibTeX | Tag: avoidant coping strategies, depression, Early maladaptive schemas, modes, Schema therapy
@article{Basile2018,
title = {Investigating schema therapy constructs in individuals with depression},
author = {Barbara Basile and Katia Tenore and Francesco Mancini},
url = {https://apc.it/wp-content/uploads/2018/05/2018-Investigating-schema-therapy-Basile-et-al.pdf},
year = {2018},
date = {2018-04-25},
journal = {Journal of Psychology and Clinical Psychiatry},
volume = {9},
number = {2},
pages = {214-221},
abstract = {Background: Schema Therapy (ST) has been applied to several psychological disorders. The aim of this study was to further corroborate Renner’s ST model for depression (2012), investigating maladaptive schemas, modes, and avoidant coping styles in a large non-clinical sample and in two sub-groups of subjects with high and low depression rates. Descriptive, correlation and multiple regression analyses were run on the whole sample and in the two sub-groups, with additional analyses comparing ST constructs in highly depressed versus not depressed individuals. Within the total sample, a positive correlation was observed between levels of depression and
most maladaptive schemas, dysfunctional modes and intra-psychic avoidant coping strategies. Significant differences emerged with respect to the two sub-groups. Within the depressed group, positive associations occurred between the disconnection and rejection schema domain, the demanding parent mode and dissociative avoidant coping and symptoms severity. Multiple regression analyses also revealed the role of specific
predictor variables explaining depression levels. Despite some important caveats, like the recruitment of a non-clinical sample, our data further support Renner’s schema model for depression, adding some new evidences about the role of specific modes and avoidant coping strategies that seem to play a role in this psychopathological condition.},
keywords = {avoidant coping strategies, depression, Early maladaptive schemas, modes, Schema therapy},
pubstate = {published},
tppubtype = {article}
}
Background: Schema Therapy (ST) has been applied to several psychological disorders. The aim of this study was to further corroborate Renner’s ST model for depression (2012), investigating maladaptive schemas, modes, and avoidant coping styles in a large non-clinical sample and in two sub-groups of subjects with high and low depression rates. Descriptive, correlation and multiple regression analyses were run on the whole sample and in the two sub-groups, with additional analyses comparing ST constructs in highly depressed versus not depressed individuals. Within the total sample, a positive correlation was observed between levels of depression and
most maladaptive schemas, dysfunctional modes and intra-psychic avoidant coping strategies. Significant differences emerged with respect to the two sub-groups. Within the depressed group, positive associations occurred between the disconnection and rejection schema domain, the demanding parent mode and dissociative avoidant coping and symptoms severity. Multiple regression analyses also revealed the role of specific
predictor variables explaining depression levels. Despite some important caveats, like the recruitment of a non-clinical sample, our data further support Renner’s schema model for depression, adding some new evidences about the role of specific modes and avoidant coping strategies that seem to play a role in this psychopathological condition.
most maladaptive schemas, dysfunctional modes and intra-psychic avoidant coping strategies. Significant differences emerged with respect to the two sub-groups. Within the depressed group, positive associations occurred between the disconnection and rejection schema domain, the demanding parent mode and dissociative avoidant coping and symptoms severity. Multiple regression analyses also revealed the role of specific
predictor variables explaining depression levels. Despite some important caveats, like the recruitment of a non-clinical sample, our data further support Renner’s schema model for depression, adding some new evidences about the role of specific modes and avoidant coping strategies that seem to play a role in this psychopathological condition.
5.
Basile, Barbara; Tenore, Katia; Luppino, Olga Ines; Mancini, Francesco
Schema Therapy mode model applied to OCD Journal Article
In: Clinical Neuropsychiatry, vol. 14, no 6, pp. 407-414, 2017.
Abstract | Links | BibTeX | Tag: coping strategies, Early maladaptive schemas, modes, obsessive-compulsive disorder, Schema therapy
@article{Basile2017,
title = {Schema Therapy mode model applied to OCD},
author = {Barbara Basile and Katia Tenore and Olga Ines Luppino and Francesco Mancini},
editor = {Giovanni Fioriti Editore},
url = {https://apc.it/wp-content/uploads/2017/12/2017-schema-therapy-mode-Basile-et-al-clinical-neuropsychiatry.pdf},
year = {2017},
date = {2017-11-01},
journal = {Clinical Neuropsychiatry},
volume = {14},
number = {6},
pages = {407-414},
abstract = {Objective: Schema Therapy (ST) places particular emphasis on affective experiences, therapeutic relationship and early life experiences. Ad hoc ST conceptualizations for specific psychological conditions, mainly focusing on personality disorders, have been suggested in the last decade. The aim of this study was to explore schemas, modes and coping styles in outpatients with Obsessive-Compulsive Disorder (OCD). Method: thirty-four patients with OCD [DSM5 criteria, mean age(SD)=33(8.38) years; 12 females] were recruited. Schemas, modes and coping styles were measured. Indexes of OCD symptoms’, guilt and disgust levels were also collected. Descriptive, correlation and multiple regression analyses were performed.
Results: OCD symptoms’ severity was significantly associated with social isolation, failure, subjugation and punishment schemas, and with the punitive parent mode. A positive relationship was also detected between OCD severity, and avoidance and intra-psychic coping styles and disgust intensity. Regression analyses revealed that the social isolation and punitiveness schemas, the punitive parent mode and behavioral avoidance coping style predicted OCD severity, with behavioral avoidance playing a significant mediation role between dysfunctional schemas and symptoms.
Conclusions: Our data confirm previous findings on Schema model applied to OCD. An important limitation of the study is represented by the lack of an Italian control group. },
keywords = {coping strategies, Early maladaptive schemas, modes, obsessive-compulsive disorder, Schema therapy},
pubstate = {published},
tppubtype = {article}
}
Objective: Schema Therapy (ST) places particular emphasis on affective experiences, therapeutic relationship and early life experiences. Ad hoc ST conceptualizations for specific psychological conditions, mainly focusing on personality disorders, have been suggested in the last decade. The aim of this study was to explore schemas, modes and coping styles in outpatients with Obsessive-Compulsive Disorder (OCD). Method: thirty-four patients with OCD [DSM5 criteria, mean age(SD)=33(8.38) years; 12 females] were recruited. Schemas, modes and coping styles were measured. Indexes of OCD symptoms’, guilt and disgust levels were also collected. Descriptive, correlation and multiple regression analyses were performed.
Results: OCD symptoms’ severity was significantly associated with social isolation, failure, subjugation and punishment schemas, and with the punitive parent mode. A positive relationship was also detected between OCD severity, and avoidance and intra-psychic coping styles and disgust intensity. Regression analyses revealed that the social isolation and punitiveness schemas, the punitive parent mode and behavioral avoidance coping style predicted OCD severity, with behavioral avoidance playing a significant mediation role between dysfunctional schemas and symptoms.
Conclusions: Our data confirm previous findings on Schema model applied to OCD. An important limitation of the study is represented by the lack of an Italian control group.
Results: OCD symptoms’ severity was significantly associated with social isolation, failure, subjugation and punishment schemas, and with the punitive parent mode. A positive relationship was also detected between OCD severity, and avoidance and intra-psychic coping styles and disgust intensity. Regression analyses revealed that the social isolation and punitiveness schemas, the punitive parent mode and behavioral avoidance coping style predicted OCD severity, with behavioral avoidance playing a significant mediation role between dysfunctional schemas and symptoms.
Conclusions: Our data confirm previous findings on Schema model applied to OCD. An important limitation of the study is represented by the lack of an Italian control group.
6.
Trincas, Roberta; Ottaviani, Cristina; Couyoumdjian, Alessandro; Tenore, Katia; Spitoni, Grazia; Mancini, Francesco
Specific Dysphoric Symptoms Are Predicted by Early Maladaptive Schemas Journal Article
In: The Scientific World Journal, no 231965, pp. 7, 2013.
Abstract | Links | BibTeX | Tag: Early maladaptive schemas
@article{Trincas2013,
title = {Specific Dysphoric Symptoms Are Predicted by Early Maladaptive Schemas},
author = {Roberta Trincas and Cristina Ottaviani and Alessandro Couyoumdjian and Katia Tenore and Grazia Spitoni and Francesco Mancini},
editor = {Hindawi Publishing Corporation},
url = {https://apc.it/wp-content/uploads/2014/01/2013_Trincas_Ottaviani_Specific-Dysphoric-Symptoms_Are_Predicted_by_Early-Maladaptive_Schemas.pdf},
doi = {10.1155/2014/231965},
year = {2013},
date = {2013-10-18},
journal = {The Scientific World Journal},
number = {231965},
pages = {7},
abstract = {Early maladaptive schemas (EMSs) are cognitive patterns resulting from unmet core emotional needs in childhood that have been linked to the development of psychopathology. As depression is a multifaceted phenomenon, we hypothesized that specific dysphoric symptoms would be predicted by different EMSs. Four hundred and fifty-six participants completed a measure of EMSs (Young Schema Questionnaire) and reported on the severity of the symptoms of criterion A for major depression in DSM-IV during the occurrence of a dysphoric episode in the previous 12 months. A series of stepwise multiple regression analyses were performed to investigate the predictive power of the EMSs for the severity of each specific depressive symptom. When controlling for gender and current levels of depression, specific symptoms were predicted by different EMSs: sadness by Negativity/Pessimism; anhedonia by Failure; self-harm by Emotional Deprivation and Vulnerability to Harm or Illness; worthlessness by Failure and Negativity/Pessimism; psychomotor retardation/restlessness by Vulnerability to Harm or Illness and Entitlement/Grandiosity; and poor concentration by Insufficient Self-Control/Self-Discipline. The more physical symptoms of fatigue, insomnia/hypersomnia, and appetite loss/appetite gain were not predicted by any of the EMSs. Although the cross-sectional design of the study does not allow for conclusions about the direction of effects, results suggest that depression is not a unitary phenomenon and provide a possible explanation for previous inconsistent findings.},
keywords = {Early maladaptive schemas},
pubstate = {published},
tppubtype = {article}
}
Early maladaptive schemas (EMSs) are cognitive patterns resulting from unmet core emotional needs in childhood that have been linked to the development of psychopathology. As depression is a multifaceted phenomenon, we hypothesized that specific dysphoric symptoms would be predicted by different EMSs. Four hundred and fifty-six participants completed a measure of EMSs (Young Schema Questionnaire) and reported on the severity of the symptoms of criterion A for major depression in DSM-IV during the occurrence of a dysphoric episode in the previous 12 months. A series of stepwise multiple regression analyses were performed to investigate the predictive power of the EMSs for the severity of each specific depressive symptom. When controlling for gender and current levels of depression, specific symptoms were predicted by different EMSs: sadness by Negativity/Pessimism; anhedonia by Failure; self-harm by Emotional Deprivation and Vulnerability to Harm or Illness; worthlessness by Failure and Negativity/Pessimism; psychomotor retardation/restlessness by Vulnerability to Harm or Illness and Entitlement/Grandiosity; and poor concentration by Insufficient Self-Control/Self-Discipline. The more physical symptoms of fatigue, insomnia/hypersomnia, and appetite loss/appetite gain were not predicted by any of the EMSs. Although the cross-sectional design of the study does not allow for conclusions about the direction of effects, results suggest that depression is not a unitary phenomenon and provide a possible explanation for previous inconsistent findings.