Schema Therapy for Borderline Personality Disorder

The Rockefeller University, NY, USA.
Journal of Clinical Psychology (Impact Factor: 2.12). 04/2006; 62(4):445-58. DOI: 10.1002/jclp.20240
Source: PubMed


This article presents the Schema Therapy (Young, Klosko, & Weishaar, 2003) approach to the treatment of borderline personality disorder. Schema therapy draws on the cognitive-behavioral, attachment, psychodynamic, and emotion-focused traditions and conceptualizes patients who have borderline personality disorder as being under the sway of five modes or aspects of the self. The goal of the therapy is to reorganize this inner structure. To this end, there are four core mechanisms of change that are used in this therapy: (1) limited reparenting, (2) experiential imagery and dialogue work, (3) cognitive restructuring and education, and (4) behavioral pattern breaking. These interventions are used during the three phases of treatment: (1) bonding and emotional regulation, (2) schema mode change, and (3) development of autonomy.

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    • "Central to the schema model are early maladaptive schemas (EMSs), defined as broad, pervasive character traits that is developed during childhood in reaction to early toxic experiences (Young et al.,., 2003). Young et al.,., have identified 18 different EMSs to date, each with its own proposed origin and long-term impact. "
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    ABSTRACT: Objective: Early maladaptive schemas (EMSs) or fundamental beliefs that underpin stable and trait-like psychological disorders are chronic and relapsing. In, active schemas in dysthymic patients with major depression have been compared with healthy individuals.The purpose of this study was to compare early maladaptive schemas (Young, 2003, 1990) in dysthymic patients with major depression and healthy subjects. Method: For this study, 46 patients with major depression and 20 non-hospitalized patients with dysthymic during the year who referred to medical centers and clinics in Kermanshah (a city in West of Iran) were selected through structured interviews and the Beck Depression Inventory (BDI-II), and 66 patients with mild problems who referred to the clinic were considered as control group. 15 early maladaptive schemas through Young Schema Questionnaire-Short Form (YSQ-SF) were measured. Results: Analysis of variance showed that maladaptive schemas was different in the three groups. Maladaptive schemas of emotional deprivation, social isolation, defectiveness/ shame, and failure in patients with dysthymic, and maladaptive schemas of Self-sacrifice, and unrelenting standards/ hypercriticalness, entitlement/grandiosity, were active in patients with major depression. Healthy people were not active in any schema incompatibility. Maladaptive schemas in patients with dysthymic were more than the other two groups. Conclusion: In depression group, all early maladaptive schemas except abandonment and dependence / incompetence schemas, indicated higher scores. The evidence shows that schemas of emotional deprivation, social isolation, failure, and defectiveness/shame are specific keys for dysthymic disorder and emotional inhibition, and unrelenting standards are the keys for major depressive disorder.
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    • "Depending on what is being worked with, chairwork may focus on rational evaluation, articulation and clarification, reviewing the role and value of coping strategies, or on engagement with the level of affective schemas and the problematic childhood memories they carry (Arntz, Bernstein & Jacob, 2013; Kellogg & Young, 2006). "

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    • "The high morbidity, mortality, utilization and costs (van Asselt, Dirksen, Arntz and Severens, 2007) of mental health services associated with BPD and the paucity of empirical research indicate a need for the further evaluation of inpatient treatment, and the development of additional treatment approaches for non-responders to the limited treatments available. Schema Therapy (ST) is a comprehensive treatment for BPD (Young, Klosko and Weishaar, 2003; Arntz and van Genderen, 2009) with a growing body of research evidence. The idea of ST is that early maladaptive schemas trigger under-or over-modulated emotion and action states that are referred to as modes. "
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    ABSTRACT: Background: Schema Therapy (ST), a psychotherapy model integrating cognitive, experiential and behavioural interventions, was initially developed and evaluated as an outpatient treatment for patients with severe and chronic disorders, among them Borderline Personality Disorder (BPD). Two randomized controlled trials have demonstrated the effectiveness of ST for BPD, delivered in an individual or group format, in the outpatient setting. However, the most severely impaired BPD patients are referred to inpatient treatment due to suicidality and severe self-harm. Specialized inpatient treatment programs are limited, with little evaluative research. Aims: The pilot studies are designed to be first steps in naturalistic clinical settings to evaluate the effects of an intensive inpatient ST treatment program. Method: This report presents the results of three independent uncontrolled pilot studies with a total of 92 BPD patients. The programs combine individual and group modalities and are consistent theoretically with the ST model for BPD patients. Results: Results show that inpatient ST can significantly reduce symptoms of severe BPD and global severity of psychopathology with effect sizes ranging from Cohen's d = 2.84 to Cohen's d = .43. Conclusions: Differences in the effect sizes across the three pilot studies could be explained by length of treatment, number of group psychotherapists and their training. Although there are limitations to the presented pilot studies such as differences in the samples, treatment settings, variations in the treatment itself and the use of different measures, which may have influenced outcome, they are a starting point for describing and evaluating inpatient treatment for BPD in naturalistic settings.
    Behavioural and Cognitive Psychotherapy 03/2013; 42(3):1-13. DOI:10.1017/S1352465813000027 · 1.69 Impact Factor
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