Schema therapy Flashcards
Underlying Theory
Schema Therapy was developed by Dr. Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies (for example, traditional cognitive behavioral therapy).
Schema Therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including cognitive behavioral therapy, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.
Evidence Base
Schema Therapy vs transference focused psychotherapy outcomes (Archives of General Psychiatry 2006)
Dutch investigators, including Dr. Josephine Giesen-Bloo and Dr. Arnoud Arntz (the project leader), compared Schema Therapy (also known as schema focused therapy or SFT) withtransference focused psychotherapy (TFP) in the treatment of borderline personality disorder.
86 patients were recruited from four mental health institutes in the Netherlands. Patients in the study received two sessions per week of SFT or TFP for three years.
After three years, full recovery was achieved in 45% of the patients in the SFT condition, and in 24% of those receiving TFP.
One year later, the percentage fully recovered increased to 52% in the SFT condition and 29% in the TFP condition, with 70% of the patients in the SFT group achieving “clinically significant and relevant improvement”.
Moreover, the dropout rate was only 27% for SFT, compared with 50% for TFP.Patients began to feel and function significantly better after the first year, with improvement occurring more rapidly in the SFT group.
There was continuing improvement in subsequent years. Thus investigators concluded that both treatments had positive effects, with Schema Therapy clearly more successful. Less intensive outpatient, individual schema therapy (Behaviour Research and Therapy 2009)
Schema therapy for Personality Disorders
Weertman & Arntz (2007) explored whether treatment of childhood memories is an effective way to change personality disorder-related schemas and psychopathology.
This study used a crossover design and therefore did not have a simul- taneous active treatment control.
Overall, ST was associated with good overall outcomes and large effect sizes. Interestingly, this study also looked at the impact therapist experience had on outcomes.
ST for BPD (and person- ality disorder in general) requires therapist training and supervision (Young et al., 2003).
This study demonstrates the positive clinical impact of increased therapist experience on therapeutic outcomes. Such findings suggest that therapist experience may be an important influence on the outcomes of ST.
Schema therapy for PTSD
Cockram et al. (2010) aimed to determine whether group ST would reduce PTSD symptoms in war veterans compared to a comparison CBT group that was previously run in the clinic.
The main difference between the ST group and the CBT group was the content of six cognitive restructuring sessions. In the ST group, these six sessions focused exclusively on schema work and included trauma imagery, which allowed reprocessing of childhood experiences.
Overall, this study suggests that the ST group had significantly better outcomes than the CBT group in reducing PTSD symptoms and anxiety. There was no significant differ- ence between the ST and CBT group in depressive symptoms.
This study benefits from having a control condition that was similar in content, structure and duration to the ST group.
Schema therapy for substance misuse
Two studies were found that targeted sub- stance misuse and concurrent personality disorders (Ball, 2007; Ball et al., 2005)
The research in this area was difficult to review for a number of reasons. Firstly, the authors of this research described difficulties retaining participants and collecting data.
Secondly, there was an absence of power calculations, which potentially means the sample size may have been too small to detect effects.
Thirdly, the main outcome measures were reductions in substance use, not reduction in EMS.
Schema therapy for eating disorders
Simpson et al., 2010
Schema therapy implementation associated with reductions in eating disorder severity, anxiety and shame.
Additionally quality of life improved.
However, study had small sample size and no control group
