Lecture 12: Schema therapy Flashcards
What are the core emotional needs?
- stability nurturance, safety, acceptance
- autonomy, competence, sense of identity
- freedom to express needs and emotions
- spontaneity and play
- realistic limits and self control
- proposed: fairness, self-coherence/comprehensible world
What is the need for fairness and justice?
- fundamental need in childhood
- animal experiments suggest fairness in specific species
- constructive collaboration between individuals in groups (survival value)
What is schema therapy theory?
Unmet core needs/trauma through inner child
-> maladaptive schemas
-> coping with schema activation which is influenced by temperament
-> schema modes
What are the schema domains?
- disconnection and rejection (abandonment, mistrust, deprivation, shame, isolation)
- impaired autonomy (dependency/incompetence, vulnerability to harm, undeveloped self, failure)
- over-vigilance and inhibition (negativity/pessimism, emotional inhibition, unrelenting standards, punitiveness)
- other directedness (subjugation, self-sacrifice, approval-seeking)
- impaired limits (entitlement/grandiosity, insufficient self-control)
- unfairness
- lack of coherence (incomprehensible world)
What are schema modes?
Emotional-cognitive-behavioural state which is a combination of activated schema and modes vary from functional (flexible and adaptive) to dysfunctional (inflexible, nonadaptive). Can explain extreme switches and opposites within 1 person
What is the difference between schema and mode?
Schema is underlying trait while mode is a state
What are the types of dysfunctional coping with the activated schema?
- surrender is giving in to the schema activation by believing it is true, involves child and internalized parental modes and resignation (resigning to schema)
- avoidance is avoiding the full schema activation through avoidant coping modes
- overcompensation is believing the opposite is true and results in overcompensation coping modes, inversion (inverting schema)
What is the basic schema mode model?
Punitive/demanding mode, angry child and vulnerable child can result in a detached protector which impedes on being a healthy adult
What are the foci?
Therapeutic relationship, past (childhood), present (in/outside therapy)
What are the channels?
Feeling, thinking, doing
What was found about treatment retention in schema therapy?
More treatment retention in ST than transference-focussed therapy and decreases over time
What was found about borderline treatment retention?
Schema therapy had the highest retention, followed by mentalization based therapy. Was higher than treatment as usual. Was found to be higher than clarification-oriented psychotherapy for cluster C personality, histrionic, narcisstic PD. In high security hospitals: treatment retention is high in ST and TAU, but ST higher/
What has been found about the effectiveness of ST for BPD?
- reduced BPD severity with 1 year follow-up
- largest pre-post effect size of psychotherapies for borderline PD
- largest number of people recovered from PD compared to COP and TAU
- ST reduced PD scale score than TAU
- combined individual and group ST more effective than group ST for BPD severity
What was found about individual vs group therapy for ST?
- group therapy increases quality of life
- individual therapy is more effective in treating early maladaptive schemas and dysfunctional modes
- group therapy most effective in implementing more functional modes than individual therapy
What are the conclusions found?
ST is an integrative model integrates insights and techniques from different schools in a cognitive schema model. ST is highly acceptable, low drop-out and effective in a wide range of personality disorders
