Year: 2025

Effects of Screen Use

It is well-known that screen use, and social media, are particularly interwoven into the lives of adolescents in modern society. Due to early access to smartphones, design features meant to keep youth on games and sites, and adolescents’ affinity for feedback from their peers, it is difficult to monitor their screen use and the impact on their mental health. Like younger children, teens who spend a great deal of time on screens tend to spend less time doing healthy activities that promote their development, such as socializing in-person, exercising, and reaching their academic potential. While technology provides access to helpful information, tools to get things done, and entertainment, it can also have a negative impact on teens. Here is a sample of some of the most common effects we have discovered so far:

• Social media can support connection and sense of community, particularly for youth who feel marginalized.
• Video game use can provide positive socialization and improve some cognitive skills.
• Excessive, problematic, or passive viewing such as scrolling, is associated with:
  • symptoms of depression and/or anxiety
  • reduced self-esteem
  • sedentary lifestyle and possible weight gain
  • distraction from school
  • addictive use leading to increased interference with daily functioning such as getting enough sleep, eating well, and getting to school on-time

Recommendations for Use

Here are some recommendations to help reduce the likelihood of the negative effects of screen use. Remember, screen and social media use are developmental skills, like many other tasks of adolescence, your teen will make mistakes and need support to learn and grow in this area.

• First, watch for signs of problematic or excessive use. Examples of signs include:
  • inability to put devices away or unplug
  • not engaging with others in-person and/or social isolation
  • not engaging in physical activities
  • grades dropping or other signs of academic difficulties
  • lying to get more access
  • difficulty sleeping or reduced sleep
• Because of the serious effects of social media on many young adolescents’ mental health, it is critical to monitor their use of social media – protect from harmful and hateful behaviour.
• Due to positive social support and sense of connection, do not completely remove access to devices. Instead work towards setting age-appropriate limits both to content and amount of time on screens.
• As most adolescents are students, it is important to support them in their study habits. For example, teaching them to avoid “digital multi-tasking,” such as surfing while studying by placing their phone away from their study area.

Caregiver Strategies

It can be challenging to know how best to implement screen limits with teens. Here are some parenting strategies that can help:

• Role model healthy screen behaviour: Caregiver screen use is associated with child screen use and more negative effects.
• Have whole family, regular screen-free time: Everybody Unplug!
• Develop proactive structure and limits around screen use. Start when children are young.
• Teach adolescents social media literacy include who is safe to talk to and what is appropriate to post.
• Allow screen time only after completing other necessary tasks, for example, homework, physical activity, social activities.
• As teens display appropriate behaviour, provide intermittent periods of unsupervised access – with time limits and content monitored for young adolescents. Timing and tracking devices may be of use here.
• Do not extend the screen time in response to protests – validate their feelings of sadness and disappointment, coach them through regulating their emotions if upset and stick to the limit.
• Learn and practice emotion self-regulation strategies to cope with teen protests, for example, mindfulness, self-compassionate statements, and calm breathing.
• Teens may need to be reminded that screen and device access is a privilege, not a right and as the adult you are in charge and their well-being in your top priority.
• As older teens show ability to manage their screen use and literacy, more freedom is earned. Caregivers can gradually reduce content surveillance and screen time limit monitoring.
• Even with more freedom, check-in monthly to review the rules and how things are going. Praise youth for appropriate behaviour. If signs of problematic use emerge, time and content limits should be reinstated.
• Make sure to stay calm and approachable around discussing screen use so that teens feel comfortable to come to you if a mistake is made or a rule is broken. It is most helpful if teens come to you so you can problem-solve collaboratively how to move forward in a healthy way.
• Continue to monitor for signs of cyber-bullying as well as social exclusion. These may be similar to the signs of problematic or excessive screen use described above. Additional signs may include more serious mental health symptoms such as sudden changes to participation in activities, mood, and self-care. Similar to other times when your teen needs help, get involved in an active way, seek out mental health supports if needed, and work with your teen to set-up increased safety protocols using other strategies suggested here.
• Establish a safety and support protocol so that if they get into a risky situation or an incident occurs (much like “call home if you or your driver is unsafe to drive”) they will connect with you. This way your teen is able to get the timely support they need and problem-solve for the future, rather than hiding/making things worse due to fear of having phone/social media use removed.
• No screens in the bedroom/overnight (or ensure all notifications are turned off, and overnight usage monitored). Ideally all household electronics (parents too) go to a central location for charging overnight.

Additional Resources

We know that parenting around screen time and digital media use can be hard. Technology and programs are designed to be rewarding and make it hard to stop. Using these strategies will take time and practice but are worth the effort. Below are some additional resources to help. If you are concerned about the mental health and wellbeing of anyone in your family, please seek out additional professional support.

• Canadian Pediatric Society Digital Media Resources
  • https://caringforkids.cps.ca/handouts/behaviour-and-development#digital-media
• American Pediatric Society Family Media Plan
  • https://www.healthychildren.org/english/fmp/pages/mediaplan.aspx
• Media Smarts: Canada’s Centre for Digital and Media Literacy
  • https://mediasmarts.ca/research-reports

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology may make available a referral list of practicing psychologists that can be searched for appropriate services. For the names and coordinates of provincial and territorial associations of psychology, go to  https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Jo Ann Unger, C. Psych. and Dr. Michelle Warren, C. Psych., University of Manitoba.

Revised: May 2025

Your opinion matters! Please contact us with any questions or comments about any of the PSYCHOLOGY WORKS Fact Sheets:  factsheets@cpa.ca

References

American Psychological Association. (2023). Health advisory on social media use in adolescence. https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use

Boak, A., Elton-Marshall, T., & Hamilton, H.A. (2022). The well-being of Ontario students: Findings from the 2021 Ontario Student Drug Use and Health Survey (OSDUHS). Centre for Addiction and Mental Health. https://www.camh.ca/-/media/files/pdf—osduhs/2021-osduhs-report-pdf.pdf

Boers, E., Afzali, M.H., Newton, N., & Conrod, P. (2019). Association of screen time and depression in adolescence. JAMA Pediatrics, 173(9), 853-859. https://doi.org/10.1001/jamapediatrics.2019.1759

Boer, M., Stevens, G. W.J.M., Finkenauer, C., de Looze, M. E., & van den Eijnden, R.J.J.M. (2021). Social media use intensity, social media use problems, and mental health among adolescents: Investigating directionality and mediating processes. Computers in Human Behaviour, 116, Article 106645. https://doi.org/10.1016/j.chb.2020.106645

Kim, S., Favotto, L., Halladay, J., Wang, L., Boyle, M.H., Georgiades, K. (2020). Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders. Social Psychiatry and Psychiatric Epidemiology, 55(11), 1469-1478. https://doi.org/10.1007/s00127-020-01833-9

Li, X., Vanderloo, L.M., Keown-Stoneman, C.D.G., Cost, K.T., Charach, A., Maguire, J.L., Monga, S., Crosbie, J., Burton, C., Anagnostou, E., Georgiades, S., Nicolson, R., Kelley, E., Ayub, M., Korczak, D.J., & Birken, C.S. (2021). Screen use and mental health symptoms in Canadian children and youth during the COVID-19 pandemic. JAMA Network Open, 4(12), Article e2140875.  https://doi.org/10.1001/jamanetworkopen.2021.40875

Li, X., Vanderloo, L.M., Maguire, J.L., Keown-Stoneman, C.D.G., Aglipay, M., Andersons, L.N., Cost, K.T., Charach, A., Vanderhout, S.M., & Birken, C.S. (2021). Public health preventive measures and child health behaviours during COVID-19: A cohort study. Canadian Journal of Public Health, 112, 831-842. https://doi.org/10.17269/s41997-021-00549-w

MediaSmarts. (2022). Young Canadians in a wireless world, phase IV: Life online. https://mediasmarts.ca/sites/default/files/publication-report/full/life-online-report-en-final-11-22.pdf

Ponti, M. (2023). Screen time and preschool children: Promoting health and development in a digital world. Canadian Pediatric Society Digital Health Task Force. https://cps.ca/en/documents/position/screen-time-and-preschool-children#ref14

Toombs, E., Mushquash, C.J., Mah, L., Short, K., Young, H., Cheng, C., Zhu, L., Strudwick, G., Birken, C., Hopkins, J., Korczak, D.J., Perkhun, A., & Born, K.B. (2022). Increased screen time for children and youth during the COVID-19 pandemic. COVID-19 Science Advisory Table. https://doi.org/10.47326/ocsat.2022.03.59.1.0

Effects of Screen Use

Children have access to and use technology and electronic devices more than ever before. While technology provides access to helpful information, tools to get things done, and fun entertainment, it can also have negative impacts, particularly for children. This can include replacing other activities needed for healthy growth and development and negatively impacting emotional and social well-being. Here is a sample of some of the most commonly found effects we have discovered so far:

• While live, dynamic interactions with caring adults are best for children’s development, age-appropriate educational media can also support language, reading, cognitive and social development.
• Technologies can be used to encourage and compliment physical activity and motor milestones.
• Although specific uses of digital technology can support some developmental tasks, too much or excessive use is associated with:
  • language delays, lower cognitive abilities, and delayed reading skills
  • reduced emotional self-regulation ability and behaviour problems
  • social skills deficits
  • poorer motor development
  • poor sleep when viewed before bed

Recommendations for Use

Here are some recommendations to make sure kids are not over-exposed to screens, particularly during the early years of brain development:

• Under 2 Years: No Screen Time.
• 2-5 Years: Less Than 1 Hour per Day.
• Currently there are no specific published guidelines for amount of screen use for children over 5 years of age. It is commonly recommended by clinicians that school-aged children not exceed 1 hour of recreational screen time per school day and not over 2-3 hours per weekend day, with flexibility for age and ability level.
• Some provinces have implemented a “no personal device policy” at school. While research is pending on its effectiveness, this appears to be a useful policy and likely helpful for elementary school-aged children’s overall development and well-being.
• Short periods of use broken up by whole body movement activities.
• Avoid screens after 7pm and at least 1 hour before bed.
• Prioritize educational, age-appropriate, and interactive material – no violent content for younger children. For older children, violent content should be monitored and debriefed with parents.
• Caregivers be present and engaged while young children are using digital media. This allows for active supervision as well as an opportunity to spend time with and get to know the interests of your children.
• Turn off screens when not in use. Passive screen use (e.g., TV’s on in the background) has been found to be associated with more negative effects of screen use as described above.

Caregiver Strategies

It can be challenging to know how best to implement screen limits with children. Here are some parenting strategies that can help:

• Role model healthy screen behaviour: Caregiver screen use is associated with child screen use and more negative effects for children.
• Have whole family, regular screen-free time: Everybody Unplug!
• Develop proactive structure and limits around screen use. Timing and tracking devices may be of use here. Start when children are young.
  • Plan ahead for when children will get screen time, so you do not have to decide every time they ask.
  • Understand your child’s screen activity so that you can support them in ending well. Can it be saved at certain points? Does a video length go beyond their time limit? Help them chose the screen activity and be specific around the type of media activity they will use, for example, “surfing” is harder to end and supervise.
  • Prioritize screen activities that have positive benefits, such as educational apps and video connections with loved ones.
• Allow screen time only after completing other needed tasks, for example, homework, physical activity, social activities.
• Give a time warning before ending screen time so they can prepare to end or save their activity.
• Do not extend the screen time in response to protests – validate their feelings of sadness and disappointment, coach them through regulating their emotions if upset and stick to the limit.
• Learn and practice emotion self-regulation strategies to cope with child protests, for example, mindfulness, self-compassionate statements, and calm breathing.
• Have an activity or task ready to move to after the screen time has ended and gently guide them to it.
• Reward children with praise when they end screen time at the first request.
• If children act out when screen time ends, have a natural consequence prepared which the children know about ahead of time.
• For older children who have been allowed to engage with social media, require that they include you in their “friend” groups and allow you to follow them. This can be explained as part of your job in keeping them safe.
• For older children who have been allowed to participate in group chats, they need to allow random caregiver checks on content to ensure their safety and that they are learning to engage with friends online appropriately. While children may need more teaching, restrictions, and/or supervision if mistakes are made, make sure to stay calm and approachable around these discussions. It is most helpful if your older children come to you so you can problem-solve collaboratively how to move forward in a positive way.
• Additional strategies for monitoring and managing cyber-bulling risk factors for older children can be found on the Teens and Screens Fact Sheet.

Additional Resources

We know that parenting around screen time and digital media use can be hard. Technology and programs are designed to be rewarding and make it hard to stop. Using these strategies will take time and practice but are worth the effort. Below are some additional resources to help. If you are concerned about the mental health and wellbeing of anyone in your family, please seek out additional professional support.

• Canadian Pediatric Society Digital Media Resources
  • https://caringforkids.cps.ca/handouts/behaviour-and-development#digital-media
• American Pediatric Society Family Media Plan
  • https://www.healthychildren.org/english/fmp/pages/mediaplan.aspx
• Age-Appropriate Viewing
  • https://www.cbc.ca/kids/
  • https://rating-system.fandom.com/wiki/Canadian_Home_Video_Rating_System
  • https://www.commonsensemedia.org/
• Guidelines on Physical Activity, Sedentary Behaviour and Sleep: For Children Under 5 Years of Age
  • https://apps.who.int/iris/bitstream/handle/10665/311664/9789241550536-eng.pdf?sequence=1&isAllowed=y
• Media Smarts: Canada’s Centre for Digital and Media Literacy
  • https://mediasmarts.ca/research-reports

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology may make available a referral list of practicing psychologists that can be searched for appropriate services. For the names and coordinates of provincial and territorial associations of psychology, go to  https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Dr. Jo Ann Unger, C. Psych. and Dr. Michelle Warren, C. Psych., University of Manitoba.

Revised: May 2025

Your opinion matters! Please contact us with any questions or comments about any of the PSYCHOLOGY WORKS Fact Sheets:  factsheets@cpa.ca

References

Cost, K.T., Unternaehrer, E., Tsujimoto, K., Vanderloo, L.L., Birken, C.S., Maguire, J.L., Szatmari, P., Charach, A. (2023). Patterns of parent screen use, child screen time, and child socio-emotional problems at 5 years. Journal of Neuroendocrinology, 35(7), Article e13246. https://doi.org/10.1111/jne.13246

Farah, R., Zivan, M., Niv, L., Havron, N., Hutton, J., & Horowitz-Kraus, T. (2021). High screen use by children aged 12-36 months during the first COVID-19 lockdown was associated with parental stress and screen us. Acta Pediatrica, 110(10), 2808-2809. https://doi.org/10.1111/apa.15979

Mantilla A., & Edwards, S. (2019). Digital technology use by and with young children: A systematic review for the statement on young children and digital technologies. Australian Journal of Early Childhood, 44(2), 182-195. https://doi.org/10.1177/1836939119832744

Ponti, M. (2023). Screen time and preschool children: Promoting health and development in a digital world. Canadian Pediatric Society Digital Health Task Force. https://cps.ca/en/documents/position/screen-time-and-preschool-children#ref14

Wong, R.S., Tung, K.T.S., Rao, N., Leung, C., Hui, A.N.N., Tso, W.W.Y., Fu, K.-W.Y., Jiang, F., Zhao, J., & Ip. P. (2020). Parent technology use, parent-child interaction, child screen time, and child psychosocial problems among disadvantaged families. The Journal of Pediatrics, 226, 258-265. https://doi.org/10.1016/j.jpeds.2020.07.006

What is Narcissism?

Narcissism is part of an individual’s personality organization and is the way people maintain a positive self-image, regulate their self-esteem, and manage their needs for affirmation and validation from others. It is normal for people to possess a healthy amount of self-esteem where they are accepting of their strengths and limitations while maintaining a positive self-image. It is normal and healthy for individuals to seek adaptive and realistic ways to improve their self-concept and feel good about who they are.

Clinical narcissism, on the other hand, reflects unhealthy strategies to cope with disappointments and threats to positive self-image. Persistent difficulty in this area is what typically constitutes a clinical diagnosis of narcissistic personality disorder (NPD). Clinicians diagnose NPD when a person meets 5 or more of the following DSM-5 criteria:

• A grandiose sense of self-importance
• Preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
• Beliefs of being special and unique
• A need for excessive admiration
• A sense of entitlement
• Taking advantage of others for personal gain
• A lack of empathy
• Arrogant and haughty behaviours or attitudes

How is Clinical Narcissism Expressed?

When we think of narcissism, we usually picture someone who displays narcissistic grandiosity, or a pattern of entitled, domineering, and attention-seeking behaviour. These traits align with certain aspects of NPD, including excessive self-enhancement strategies, diminished empathy, and a disagreeable demeanor. However, impairment in the ability to regulate the emotions and behaviours associated with one’s needs for self-enhancement is at the root of pathological narcissism – understood as narcissistic vulnerability. Narcissistic vulnerability is characterized by a fragile self-image and low self-esteem reliant on external validation. It involves heightened sensitivity to threats to self-concept, leading to anxiety, helplessness, persistent negative emotions, distrust of others, and social withdrawal. Clinical narcissists oscillate between states of grandiosity and vulnerability. As the two occur in tandem, there are no officially recognized subtypes of clinical narcissism or NPD.

The representation of narcissism in the DSM-5 has received scrutiny for describing primarily grandiose and overt manifestations while overlooking the important and inevitable vulnerable aspects. Recent research suggests that vulnerability can be conceptualized as “primary narcissism”, as internalised feelings of shame, low self-worth, and difficulty processing criticism or failure are at the core of all narcissistic behaviours. Genuine grandiosity that is not an attempt to conceal feelings of low self-worth may be better understood as a manifestation of psychopathy.[1]

Moreover, narcissism can be expressed overtly (i.e., behaviours, attitudes, and emotions) or covertly (i.e., internal cognitions, motives, needs, and feelings). People often incorrectly associate overt expressions with grandiosity and covert expressions with vulnerability. However, individuals with NPD tend to exhibit both overt and covert grandiose and vulnerable traits at different times or even simultaneously. For example, overtly arrogant behaviour can mask underlying feelings of inadequacy and vulnerability.

How Can We Identify Narcissism?

Recognizing the signs that someone may have narcissistic tendencies, regardless of severity, can help us understand and address them with empathy and accuracy.

Key characteristics of narcissism include:

• Self-perception and Emotional Regulation Challenges
  • An exaggerated sense of self-importance, often coupled with feelings of insecurity, shame, or fear of being exposed as a failure.
  • A relentless drive for perfection and external validation to uphold a fragile self-image.
  • Extreme sensitivity to criticism or rejection, leading to defensive behaviours like withdrawal, aggression, or projection of blame.
• Interpersonal Challenges
  • Decreased social inhibitions, allowing for displays of entitlement and unreasonable expectations for favourable treatment or recognition.
  • Difficulty with empathy and valuing the needs and emotions of others, which may manifest as controlling, manipulative, or dismissive behaviours.
  • Trouble maintaining friendships and relationships, leading to increased isolation over time.
• Emotional and Behavioural Dysregulation
  • Persistent negative affectivity, such as depression, anxiety, or anhedonia, while often denying any feelings of depression or weakness.
  • High emotional reactivity, including intense anger, embarrassment, jealousy, or mood instability, especially when self-enhancement and reassurance needs are unmet.
  • Poor impulse control and increased thrill-seeking behaviour.

There are some complications that may arise with an NPD diagnosis that are important to be aware of:

• NPD can occur along with other conditions such as substance use disorders, mood and anxiety disorders, and other personality disorders. This can make it difficult to accurately diagnose NPD.
• A higher risk of death by suicide.
• A greater presence of hostility and aggression, increasing interpersonal difficulties and creating challenges with treatment.

What Are the Risk Factors for Developing NPD?

• Early childhood experiences including parental overvaluation, excessive admiration, praise, and beliefs that the child has exceptional abilities have been associated with narcissism in adulthood. Conversely, adverse experiences in early childhood including parental coldness, parental abuse, feeling rejected, and a fragile ego during childhood may also predict narcissism in adulthood.
• Narcissistic individuals may be genetically predisposed to developing the disorder.
• NPD is more likely to occur among individuals experiencing other personality disorders including antisocial personality disorder, histrionic personality disorder, borderline personality disorder, and schizotypal personality disorder.
• Research demonstrates that the prevalence of narcissism tends to be higher among young adults relative to older adults.
• NPD is typically more common among men than women, with research finding a lifetime prevalence of 7.7% in men and 4.8% in women.[2]

How Can You Support a Loved One with NPD?

Supporting a loved one with narcissism is a compassionate goal, but it can also be emotionally challenging. Here are some ways to provide support while prioritizing your own well-being:

• Educate yourself about NPD to understand the nuances of the disorder and possible treatment or symptom management options.
• Communicate to your loved one with NPD that you accept them. Remind yourself that their behaviours are a result of the pain they are experiencing due to their mental illness. Making them feel loved and supported can help guide them towards the proper treatment.
• Encourage your loved one to seek treatment but recognize that you cannot force change. While it can be frustrating if they are resistant to help, remember that their behaviour is their responsibility, not yours.
• Try to set and maintain healthy boundaries. Individuals with NPD may rely on others to meet their needs or expectations in ways that can feel overwhelming. Clearly express what you are willing and able to do and stay consistent in respecting your own limits.
• Make sure to take care of your own needs and mental health. Avoid letting your loved one’s disorder take over your life. Try your best to maintain other social connections and support systems. Consider attending therapy or joining a support group.
• People with NPD have an increased risk of suicide. If you notice signs of withdrawal or suspect your loved one is considering self-harm, address your concerns directly and compassionately. If they are in immediate danger, contact emergency services right away.

How Can Psychology Help?

There is no standardized treatment that exists for narcissism, but psychologists can help individuals with narcissism manage their symptoms with psychotherapy. Psychotherapy, or talk therapy, is a long-term approach to treatment focused on building a strong patient-therapist relationship.

• Transference-focused therapy (TFT) is a twice-weekly approach that focuses on the patient’s feelings towards the therapist. This method proposes that people with narcissism separate positive and negative self-perceptions as a defence mechanism. The goal is to help them understand their emotions and integrate these self-perceptions in a healthy way.
• Schema-focused therapy aims to help patients identify and adjust cognitive and behavioural patterns (i.e., schemas) that drive narcissistic traits. Narcissistic schemas, such as an inflated sense of self-importance, are enduring beliefs that develop early in life. This approach is especially useful for those who do not respond well to standard cognitive therapies.[3]

There are no medications currently available to treat personality disorders like NPD. However, many NPD patients benefit from the use of medications (e.g., antidepressants) to manage symptoms such as anxiety and depression.

In addition to treating those with NPD, psychologists play a critical role in supporting individuals affected by narcissistic behaviours, such as family members or friends. Psychoeducation can help these individuals understand the complexities of narcissism, set healthy boundaries, and develop effective coping strategies.

Psychologists can also continue to conduct research on narcissism to further our understanding and improve treatment approaches. By studying the underlying mechanisms and various expressions of narcissism, psychologists can refine existing therapeutic methods and develop new, evidence-based interventions tailored to individuals’ needs.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial, and some municipal associations of psychology may make available a referral list of practicing psychologists that can be searched for appropriate services. For the names and coordinates of provincial and territorial associations of psychology, go to  https://cpa.ca/public/whatisapsychologist/PTassociations/.

This fact sheet has been prepared for the Canadian Psychological Association by Erin Vine, MA.

Revised: January 2025

Your opinion matters! Please contact us with any questions or comments about any of the PSYCHOLOGY WORKS Fact Sheets:  factsheets@cpa.ca

[1] Kowalchyk, M., Palmieri, H., Conte, E., & Wallisch, P. (2021). Narcissism through the lens of performative self-elevation. Personality and Individual Differences, 177, Article 110780. https://doi.org/10.1016/j.paid.2021.110780

[2] Stinson, F. S., Dawson, D. A., Goldstein, R. B., Chou, S. P., Huang, B., Smith, S. M., Ruan, W. J., Pulay, A. J., Saha, T. D., Pickering, R. P., & Grant, B. F. (2008). Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: Results from the wave 2 national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 69(7), 1033-1045. https://doi.org/10.4088/jcp.v69n0701

[3] Bernstein, D. P. (2005). Schema therapy for personality disorders. In S. Strack (Ed.), Handbook of personology and psychopathology (pp. 462-477). John Wiley & Sons, Inc. https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=cdde7fb2a0b22decd35971ef82fd4473b1eb8837