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Short-term group schema cognitive-behavioral therapy for young adults with personality disorders and personality disorder features: Associations with changes in symptomatic distress, schemas, schema modes and coping styles

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Short-term group schema cognitive-behavioral therapy for young adults with personality disorders and personality disorder features: Associations with changes in symptomatic distress, schemas, schema modes and coping styles

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... Recent years have seen an increasing number of studies on the clinical effectiveness of ST for PD [4][5][6][7][8][9] and other pathologies [1,2], though research is still scarce considering the treatment's popularity. These studies are necessary for the development and maturation of a therapeutic approach, since they identify critical areas that require additional investigation. ...
... One compared ST to cognitive-behavioral therapy (CBT) in the treatment of depression [13] and another investigated ST's effectiveness in treating chronic depression patients [14]. The remaining seven articles evaluated ST in different samples of personality disorders [4,5,9,[15][16][17][18]. ...
... A combined individual and group ST for the treatment of borderline personality disorder was investigated by some researches [5], whereas others evaluated the effects of ST on inpatients [16]. A study analyzed the effects of ST on a group of personality disorders (cluster C or B) [9], while another investigated its effects on elderly patients [18]. Van Vresswijk et al. examined the relationship between group ST and changes in symptoms, schemas and modes in a heterogeneous psychiatric sample (patients with long-term Axis I and/or personality disorders) [17]. ...
... Thirty sessions of group schema therapy over an eight-month period was indeed cost-effective (Farell, Shaw, & Webber, 2009). Even shorter group schema therapy programs that mainly rely on cognitive techniques showed improvement in overall symptomatology, EMS and schema modes, both in adults with personality disorder (PD) features and long-standing mood disorders (van Vreeswijk et al., 2012) and adolescents with PD features (Renner, Van Goor, Huibers, Arntz, Butz, & Bernstein, 2013). This latter protocol also yielded promising results in 31 older outpatients with medium effectsizes on psychopathology (Videler, Rossi, Schoevaars, Van der Feltz-Cornelis, & Van Alphen, 2014), but only small effects in a subsequent study in which the protocol was adapted for older adults (Videler, van Beest, Ouwens, Rossi, van Royen, & van Alphen, 2021). ...
... Our pre-post effect-size on the change of EMS was medium (d = 0.40), which is smaller than the large effect sizes reported for schema therapy among younger patients (d = 0.75 and d = 0.88, respectively) (Renner, Van Goor, Huibers, Arntz, Butz, & Bernstein, 2013;van Vreeswijk, Spinhoven, Eurelings-Bontekoe, & Broersen, 2012), but similar to that found in older patients with mixed personality disorders (d = 0.58) and chronic mood disorders (d = 0.34) (Videler, Rossi, Schoevaars, Van der Feltz-Cornelis, & Van Alphen, 2014). Whether this implies that schema therapy becomes less effective with increasing age, remains unknown for two reasons. ...
... Interestingly, we found large pre-post effectsizes with respect to the improvement of dysfunctional modes (d = 0.68) and functional modes (d =1.09). These effects are much larger than previously reported for schema therapy without PMT in younger patients (d ~ 0.60) (van Vreeswijk et al., 2012;Renner, Van Goor, Huibers, Arntz, Butz, & Bernstein, 2013) as well as in older patients (d ~ 0.34) (Videler, Rossi, Schoevaars, Van der Feltz-Cornelis, & Van Alphen, 2014). In a recent study on an adapted schema group therapy for older adults (Videler, van Beest, Ouwens, Rossi, van Royen, & van Alphen, 2021) no significant improvement in schema modes was found. ...
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Schema group therapy is an effective treatment for personality disorders, but its focus on cognitive techniques may be a limitation for older adults. This article describes the rationale and initial evaluation of a group schema therapy protocol enriched with psychomotor therapy (GST+PMT) for older adults in geriatric mental health care. We concluded that group schema therapy enriched with PMT is feasible in later life and its effect might be mediated by targeting schema modes. The (cost-)effectiveness of the presented treatment protocol is currently being evaluated in a randomized controlled design (van Dijk et al., 2019)”
... A few studies [5][6][7][8] of short forms of group psychotherapy have indeed shown that patients could benefit. In addition, a group approach could be a cost-effective way to treat patients [9] and help to cut the long waiting lists for many PD services. ...
... The schema therapy approach has been extended to personality disorders other than borderline personality disorders only [10] and to group therapies. We have found two naturalistic studies of effectiveness for personality disorders after a short form of group psychotherapy (20 sessions) in an outpatient setting: van Vreeswijk et al. [11] and Renner et al. [7] found a moderate (SCL-90-GSI; d = 0.66) and large effect size (SCL-90-GSI; d = 0.81) respectively. However, most outcome studies of the treatment of personality disorders have failed to look at how comorbidity affects outcome, even though, in daily practice, many patients suffer from comorbid conditions, generally depressive disorders [12]. ...
... Comparable studies (11. 7, 8, 32) mostly report a slightly higher effect on psychiatric symptom severity, with small [28] to high [7] effect sizes, than in our study. ...
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Background: This naturalistic study examined the outcomes of Short-Term Schema Cognitive Behavioural Therapy in groups with personality disorders, and with high and low severity of depressive symptoms. Methods: Assessments were made at baseline, at mid-treatment (week 10), at treatment termination (week 20) and at three-month follow-up (week 32) of 225 patients with personality disorders and high severity of depressive symptoms (PD-Hi) and patients with low severity of depressive symptoms (PD-Lo). The assessments focused on symptom (Symptom Checklist-90) and schema severity (Young Schema Questionnaire) and coping styles (Utrecht Coping List). We also measured the rate of symptom remission. The data obtained were subjected to multilevel analysis. Results: Psychiatric symptoms and maladaptive schemas improved in both patient groups. Effect sizes were moderate, and even small for the coping styles. Symptom remission was achieved in the minority of the total sample. Remission in psychiatric symptomatology was seen in more PD-Lo patients at treatment termination. However, the difference in levels of remission between the two patient groups was no longer apparent at follow-up. Conclusion: A short-term form of schema therapy in groups proved to be an effective approach for a broad group of patients with personality disorders. However, the majority of patients did not achieve symptom remission. Trial registration: Not applicable.
... Studies of the effectiveness of schema therapy have described clear results for borderline personality disorders (Giesen-Bloo et al., 2006;Nadort et al., 2009) and promising results for samples of personality disorders (PD), mainly in cluster C . A short version of schema therapy in group settings with a focus on reduction of EMS with cognitive and behaviour treatment techniques for PD (Broersen & van Vreeswijk, 2012) has been repeatedly examined and found to have positive effects on global psychological distress and EMS (Koppers et al., 2019;Renner et al., 2013;van Vreeswijk et al., 2014). However, studies of long-term schema therapy have focused mainly on individual formats while, in recent years, schema therapy has also been adapted as group forms for mental health settings (Jacob & Arntz, 2013). ...
... It found that the comorbid group had more severe psychological distress and personality problems at baseline and poorer treatment outcome. Although several studies have found an association between a reduction in EMS and schema modes on the one hand and symptom reduction at treatment termination and at follow-up on the other (Renner et al., 2013;Schaap et al., 2016;van Vreeswijk et al., 2014), prediction outcome studies of baseline EMS and schema mode levels are scarce. ...
... Effect sizes were slightly better for EMS severity and schema modes than for global psychological distress. On the basis of earlier studies Renner et al., 2013;van Vreeswijk et al., 2014), our first hypothesis was large effect sizes for all measures. In this sample, this was confirmed by the improvement of maladaptive schemas and schema modes. ...
Article
Objective: This naturalistic study examined the outcomes of group schema therapy for patients with personality disorders (PD) and the effect of psychological symptoms, early maladaptive schemas (EMS) and schema modes on outcome. Method: Assessments were made of 194 patients at baseline, during treatment, at treatment termination and at three-month follow-up. We used the Symptom Checklist-General Severity Index (SCL-GSI) to measure the remission-rate of global psychological distress and as a dependent variable in a multilevel model to conduct univariate and multiple variate analyses. Results: The research sample achieved medium symptom reduction (pre–post d = 0.65, 95% CI [0.39–0.91]) and the remission rate was about 30% after 60 sessions. These results remained stable at three-month follow-up (pre-follow-up d = 0.61, 95% CI [0.29–0.94]; 28.9%). Higher baseline scores on the SCL scale interpersonal sensitivity, the EMS defectiveness/shame and all the maladaptive schema modes together predicted improvements in global psychological distress after treatment. Conclusions: A long-term form of group schema therapy proved effective for a broad group of patients with PD. Internalizing symptoms seems predictive for improvement at outcome. Almost a third of the patients achieved remission. There is therefore room for improvement, possibly by increasing dose or intensity in combination with individual sessions.
... The number of participants ranged from 6 to 62 (Mean 26.3; SD 19.8). Five studies were conducted in the Netherlands (Dickhaut & Arntz, 2014;Nadort et al., 2009;Renner et al., 2013;van Vreeswijk et al., 2014;Videler, Rossi, Schoevaars, Van der Feltz-Cornelis, & Van Alphen, 2014), two in Norway (Hoffart, Versland, & Sexton, 2002;Nordahl & Nysaeter, 2005), three in Australia (Cockram, Drummond, & Lee, 2010;George, Thornton, Touyz, Waller, & Beumont, 2004;Skewes, Samson, Simpson, & van Vreeswijk, 2015), one in Scotland (Simpson, Morrow, Vreeswijk, & Reid, 2010), and one in Greece (Malogiannis et al., 2014). Interventions were either individual schema therapy (n = 5), group schema therapy (n = 5), or a combination (n = 2). ...
... Seven studies examined how effective schema therapy was in reducing EMS and in reducing symptoms of personality disorder (PD). Of these, two were case series studies (Dickhaut & Arntz, 2014;Nordahl & Nysaeter, 2005), four were open trials (Renner et al., 2013;Skewes et al., 2015;van Vreeswijk et al., 2014;Videler et al., 2014), and one was an implementation-randomized trial (Nadort et al., 2009). Four of the studies recruited individuals with BPDs, and three of the studies recruited those with other personality disorders, for example Cluster B or Cluster C PD or with PD features (Renner et al., 2013;Skewes et al., 2015;van Vreeswijk et al., 2012). ...
... Of these, two were case series studies (Dickhaut & Arntz, 2014;Nordahl & Nysaeter, 2005), four were open trials (Renner et al., 2013;Skewes et al., 2015;van Vreeswijk et al., 2014;Videler et al., 2014), and one was an implementation-randomized trial (Nadort et al., 2009). Four of the studies recruited individuals with BPDs, and three of the studies recruited those with other personality disorders, for example Cluster B or Cluster C PD or with PD features (Renner et al., 2013;Skewes et al., 2015;van Vreeswijk et al., 2012). Of the seven PD studies, all reported significant reductions in PD symptoms. ...
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Purpose Schema therapy was first applied to individuals with borderline personality disorder (BPD) over 20 years ago, and more recent work has suggested efficacy across a range of disorders. The present review aimed to systematically synthesize evidence for the efficacy and effectiveness of schema therapy in reducing early maladaptive schema (EMS) and improving symptoms as applied to a range of mental health disorders in adults including BPD, other personality disorders, eating disorders, anxiety disorders, and post‐traumatic stress disorder. Methods Studies were identified through electronic searches (EMBASE, PsycINFO, MEDLINE from 1990 to January 2016). Results The search produced 835 titles, of which 12 studies were found to meet inclusion criteria. A significant number of studies of schema therapy treatment were excluded as they failed to include a measure of schema change. The Clinical Trial Assessment Measure was used to rate the methodological quality of studies. Schema change and disorder‐specific symptom change was found in 11 of the 12 studies. Conclusions Schema therapy has demonstrated initial significant results in terms of reducing EMS and improving symptoms for personality disorders, but formal mediation analytical studies are lacking and rigorous evidence for other mental health disorders is currently sparse. Practitioner points First review to investigate whether schema therapy leads to reduced maladaptive schemas and symptoms across mental health disorders. Limited evidence for schema change with schema therapy in borderline personality disorder (BPD), with only three studies conducting correlational analyses. Evidence for schema and symptom change in other mental health disorders is sparse, and so use of schema therapy for disorders other than BPD should be based on service user/patient preference and clinical expertise and/or that the theoretical underpinnings of schema therapy justify the use of it therapeutically. Further work is needed to develop the evidence base for schema therapy for other disorders.
... A number of previous studies support the effectiveness of ST, either provided in a group or an individual format, for treating PD's in adults (Reiss et al. 2014;Bamelis et al. 2013;Farrell et al. 2009;Giesen-Bloo et al. 2006;Hoffart et al. 2002;Nadort et al. 2009;Nordahl and Nysaeter 2005;van Vreeswijk et al. 2014;Zorn et al. 2007). Systematic research on the efficacy of ST in young adults and adolescents is lacking, although there are tentative indications that this population might also benefit from such intervention (Renner et al. 2013). Since personality problems are frequently observed in young people and have been empirically linked to the underlying theoretical concepts of early maladaptive schemas, schema coping styles, and schema modes (e.g., Roelofs et al. 2015b), it seems worthwhile to examine the applicability and effectiveness of ST intervention in an adolescent population. ...
... With respect to change in schema modes, schemas, and schema coping during treatment, more change was observed in schema modes as compared to schemas. A possible explanation for this might be that some items of the schema questionnaire are formulated in a way that they are unlikely to change because these items are referring to experiences in the past (Renner et al. 2013). Further, the finding that schemas are more stable than modes, is in line with previous research demonstrating the stability of schemas over time (Riso et al. 2006;Renner et al. 2013). ...
... A possible explanation for this might be that some items of the schema questionnaire are formulated in a way that they are unlikely to change because these items are referring to experiences in the past (Renner et al. 2013). Further, the finding that schemas are more stable than modes, is in line with previous research demonstrating the stability of schemas over time (Riso et al. 2006;Renner et al. 2013). Modes, in contrast to schemas, are conceptualized as the current state a person is in, therefore by definition a more relevant measure of change. ...
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Personality disorders are complex mental health problems, associated with chronic dysfunction in several life domains. Adolescents suffer from these disorders as well. The present study is a naturalistic case study, investigating whether group schematherapy (GST) can be applied to adolescents with personality disorders or personality disorder traits. Four clinically referred patients were included and completed questionnaires on quality of life, symptoms of psychopathology, schema modes, early maladaptive schemas, and schema coping styles. Patients participated in weekly GST sessions complemented by weekly or 2-weekly individual sessions. The parents of the adolescents participated in a separate parent group. From pre- to post-treatment, results demonstrated improvements for some patients in quality of life and symptoms of psychopathology. Changes in a number of modes and schemas were observed in all patients from pre- to post-therapy. In addition to assessing changes from pre- to post-treatment, the current study investigated the temporal changes in modes during therapy as well. Results demonstrated that maladaptive modes decreased, whereas healthy modes increased for all patients across the course of therapy. The present study provides preliminary support for the applicability of GST for adolescents as well as the effectiveness of GST. It is a starting point for further research on this intervention.
... The findings provided by Bamelis et al. (2014) have shown the effectiveness of ST among patients with cluster C (paranoid, histrionic, narcissistic) personality disorders. In the same vein, the study carried out by Renner et al. (2013) highlighted the beneficial role of ST in treatment of cluster C and B personality disorders. Moreover, a study carried out by Van Vreeswijk, Spinhoven, Eurelings-Bontekoe, &Broensen (2014) showed that group ST reduced symptoms among psychiatric patients, and in particular treatment of the other directedness domain led to better therapy success. ...
... ST is considered as an integrative therapeutic approach (Young et al., 2003). Moreover, this method has already been established its effectiveness in the treatment of personality disorders (Giesen-Bloo et al., 2006;Gude & Hoffart, 2008) especially in the treatment of borderline personality disorders and patients with cluster b and C disorders (Farrell et al., 2009;Nadort et al., 2009;Nysaeter & Nordahl, 2008;Renner et al., 2013) and chronic depressions (Malogiannis et al., 2014). Hence, ST may also be useful for improving patients' abilities to cope with daily hassles and stressful situations. ...
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Abstract Introduction Defense mechanism and early maladaptive schemas are two concepts distorting the perception of reality. Objective The aim of this study was to explore the link between two reality-distorting concepts from two theoretical models: early maladaptive schemas from the cognitive and behavioral model and defense mechanisms based on the psychoanalytic model. Method Two hundred thirty-two non-clinical participants completed the Defense Style Questionnaire and the Young Schema Questionnaire (short version). Then a Bravais Pearson correlation analysis connecting these two concepts, and a multiple regressions analysis using early maladaptive schemas as predictors for defense style mechanisms levels were conducted. Results The results indicate that 2 early maladaptive schema domains (i.e. other-directedness as well as over-vigilance and inhibition) predict the frequency of use of the neurotic defense mechanism, and 3 schema domains (i.e. disconnection and rejection, impaired autonomy and performances as well as impaired limits) predict the frequency of use of the immature defense mechanism. Conclusion To conclude, two psychological concepts based on two different theoretical models (psychoanalytic and cognitive and behavioral therapy) seem to share an important link justifying the use of integrative therapies such as schema therapy.
... Mindfulness has been successfully added previously in treatments of BPD (Linehan, 1993) and is in development for other PDs as well (Sng & Janca, 2016). ST-g has so far shown promising results (Farrell, Shaw, & Webber, 2009;Nenadić, Lamberth, & Reiss, 2017;Renner et al., 2013;Skewes, Samson, Simpson, & van Vreeswijk, 2015;van Vreeswijk, Spinhoven, et al., 2012;Videler, Rossi, Schoevaars, van der Feltz-Cornelis, & van Alphen, 2014). However, as yet, no RCTs with SMBCT have been conducted. ...
... In contrast to other studies on outpatient time-limited schema group therapy in heterogenetic patient groups (Renner et al., 2013;Simpson, Morrow, van Vreeswijk, & Reid, 2010;Skewes et al., 2015;Videler et al., 2014) the SMBCT ϩ TAU condition showed, just as the COMET ϩ TAU condition, low effect sizes. Several explanations might be applicable here. ...
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Waiting lists for psychotherapy for patients with personality disorders are increasing; there is an imbalance between the number of patients seeking help and the amount of therapy available. Thus, there is a need for time-limited treatments that are effective for specific patients and their specific problems. This pilot randomized controlled trial aimed to investigate the effectiveness of two 8-week group modules + treatment as usual (TAU): schema mindfulness-based cognitive therapy (SMBCT) and competitive memory therapy (COMET) with special attention to predictors and mediators of change. Patients (N = 58) were randomized to either SMBCT + TAU or COMET + TAU. The dropout rate was 34%. Time effects were found for both treatments, but neither was more effective than the other, and around 23% showed deterioration after treatment. Explorative analyses suggested that predictors for change were severity of psychological distress and a demanding and/or punitive attitude toward oneself at baseline. Global severity index change in the beginning of the treatment mediated schema changes later on in treatment. SMBCT + TAU and COMET + TAU might be mostly suitable for patients with high levels of symptom severity followed by high scores on parent modes. More research is needed to tailor these time-limited therapies to specific personality problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... As the Schema Mode Inventory (SMI) has not been validated for use with ED populations, statistical power was estimated from previous studies using the SMI with personality disorder samples that reported moderate effects (d = 0.56: [33]). Given a medium effect size, power of .80, ...
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Background: Preliminary studies suggest that both childhood experiences and coping behaviours may be linked to eating disorder symptoms. Methods: In this study maladaptive schema coping modes were investigated as mediators in the relationship between perceived negative parenting and disordered eating. A total of 174 adults with eating and/or body image concerns completed questionnaires measuring parenting experiences, schema modes, and disordered eating behaviours. Results: Perfectionistic Overcontroller, Self-Aggrandiser, Compliant Surrenderer, Detached Protector and Detached SelfSoother coping modes partially explained the variance in the relationships between perceived negative parenting experiences and the behaviours of restricting and compensation (purging and overexercising). Conclusions: Our findings suggest that Overcompensatory, Avoidant and Surrender coping mechanisms all appear to play a role in the maintenance of eating disorder symptoms, and that there are multiple complex relationships between these and Early Maladaptive Schemas that warrant further investigation. Full text available free at: http://rdcu.be/mjFR
... Increasing speed of recovery is of special interest in residential settings where treatment duration is relatively short and dependent on external factors, such as court decisions. Treatment duration may also influence the chance of accomplishing change in trait-like constructs such as EMSs, which have been shown to be quite stable over time (Riso et al., 2006;Renner et al., 2013). Nonetheless, despite the relatively short treatment duration some of our patients showed decreases in relevant EMS domains. ...
Article
This multiple case study examined the feasibility and effectiveness of an innovative residential treatment, based on Schema Therapy (ST), for adolescents with disruptive behaviors and Personality Disorder (PD) traits. We reported case narratives as well as quantitative changes in behavior problems, early maladaptive schemas, and schema modes of four patients. In terms of feasibility, the therapist was able to use the full range of ST techniques (working in the here and now, experiential techniques, and cognitive-behavioral techniques) with all four patients. We trained and coached treatment teams in ST theory and practice, and were partially successful in involving patients’ parents in the ST treatment. Qualitative and quantitative findings showed that patients improved in their behavior problems, early maladaptive schemas, and schema modes. These results support the feasibility of ST for adolescents with disruptive behaviors and PD traits in residential treatment, and provide preliminary evidence of its effectiveness.
... With respect to the concurrent validity of the SCI and SMI in adolescents, meaningful relations were found between schema coping, schema modes, and behavioral problems. This is in line with previous studies that have demonstrated concurrent validity of the SMI and SCI in adults Renner et al., 2013;Rijkeboer & Lobbestael, 2016), and of the SMI-A in adolescents (Roelofs, Muris, & Lobbestael, 2016). ...
Article
This study investigated whether the schema therapy constructs of schema coping and schema modes have validity in adolescents. We examined the validity and reliability of the Schema Coping Inventory (SCI) and an 80-item version of the Schema Mode Inventory (SMI) in a mixed sample of adolescents. Confirmatory factor analyses showed that the first-order factor structures of the SCI and SMI were replicated, but that the hypothesized higher-order models of the SMI were not confirmed. Instead, we proposed an alternative higher-order model of Internalizing, Externalizing, Overachieving, and Healthy modes. In general, the SCI and SMI scales were able to distinguish the clinical sample from the community sample, and meaningful relationships were found between coping styles, schema modes, and behavior problems. In conclusion, our study supports the theorized relationships between schema coping styles, schema modes, and behavior problems in adolescents, and provides initial validation for the SCI and the 80-item SMI in adolescent populations.
... Numerous studies show that group therapy is effective for adolescents and young adults, e.g., adolescents who are deliberately self-harming (Wood, Trainor, Rothwell, Moore, & Harrington, 2001), young adults with social phobia (Piet, Hougaard, Hecksher, & Rosenberg, 2010), and young adults with personality disorders or personality disorder features (Renner et al., 2013). Knowledge is, however, lacking as to which therapeutic factors and processes are important or inhibitory in group therapy for adolescents and young adults, as well as why group therapy can be especially helpful for young people (Kymissis, 2007;Oetzel & Scherer, 2003). ...
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Purpose: The purpose of the study was to examine what was beneficial and what was challenging in a group intervention for young adults based on RENEW principles in a municipal employment centre. RENEW (Rehabilitation for Empowerment, Natural support, Education, and Work) is an education-oriented support model for young people. Method: The eight young adults who participated in the group and three mentors who led the group were interviewed about their experiences with the group, and a workshop was held for staff to validate the themes found in the study. Results: Three themes emerged, one denoted the importance of helpful personal relationships, both between the mentors and the young adults and among the young adults; another denoted how an authentic attitude from the mentors made group exercises inconspicuous as the group members experienced activities in the group as originating from spontaneous, genuine interest rather than the manual-based exercises they were. The last theme conveyed how the group process was challenged by the institutionally regulated compulsory attendance and the mentors’ lack of teamwork resources. Conclusions: The study suggests that meeting young adults authentically and flexibly combining a certain element of self-disclosure with a manual-based group intervention such as RENEW can strengthen relatedness and convey hope, thereby supporting educational rehabilitation.
... Im schematy są silniejsze i bardziej rozległe, tym bardziej nieprawidłowo kształtuje się osobowość, od pojedynczych zachowań, przez rysy osobowości nieprawidłowej (rozumianej jako charakterystyczne dla określonego typu zaburzenia cechy funkcjonowania, jednak nie spełniające wymaganych kryteriów diagnostycznych zaburzenia osobowości) aż po w pełni nieprawidłową osobowość pozwalającą na postawienie diagnozy zaburzenia. Zgodnie zaś z rozumieniem schematów jako genezy formowania nieprawidłowej osobowości, terapia tak wytworzonych i utrwalonych wzorców wymaga pracy opartej przede wszystkim na jakości relacji terapeutycznej, a nie oddziaływań wyłącznie poznawczych [10][11][12]. ...
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Psychiatria i Psychoterapia 2016; tom 12, numer 1: strony 3-24 wersja pierwotna – elektroniczna Wczesne nieadaptacyjne schematy Younga i ich związki z rysami zaburzeń osobowości w populacji nieklinicznej – badania wstępne Young's Early Maladaptive Schemas and their relations to personality disorders' traits in a non-clinical sample – preliminary research Dorota Mącik Katolicki Uniwersytet Lubelski Jana Pawła II, Instytut Psychologii Streszczenie Cel: Celem badań była eksploracja teorii wczesnych nieadaptacyjnych schematów (EMS) Younga w populacji nieklinicznej. Wg Younga deprywacja podstawowych potrzeb w dzieciństwie prowadzi do powstawania specyficznych negatywnych przekonań na własny temat, te zaś stają się podłożem zaburzeń osobowości, lub specyficznych rysów osobowości nieprawidłowej. W badaniu sprawdzono jakie są związki schematów z rysami osobowościowymi u osób niezaburzonych. Metoda: 68 zdrowych osób (bez zaburzeń psychicznych i chorób somatycznych) w wieku 18-53 lat wypełniło 2 kwestionariusze: Kwestionariusz Schematów Younga w wersji skróconej (YSQ-S3) oraz Styl życia Trzebińskiej, badający 10 zaburzeń osobowości w oparciu o kryteria DSM IV-TR. Zastosowano metody analizy korelacji, ANOVA oraz skalowanie wielowymiarowe PROXSCAL. Wyniki: Uzyskano istotne korelacje dla wszystkich typów osobowości ze schematami teoretycznie zgodnymi z przekonaniami rdzennymi dla osobowości w ujęciu poznawczym, co potwierdza teorię Younga. Ponadto, im wyższe jest nasilenie rysów osobowościowych mierzonych kwestionariuszem Styl życia, tym wyższe jest nasilenie schematów. Wyniki skalowania wielowymiarowego wskazują, że wzajemne relacje pomiędzy schematami w przestrzeni dwuwymiarowej są różne, dla różnych układów i nasileń w zakresie zaburzeń osobowości. Wnioski: Badanie pozytywie weryfikuje tezy Younga dotyczące związków patologicznych cech osobowości ze schematami i jest podstawą do dalszej ich weryfikacji w populacji klinicznej, oraz dostosowania protokołów terapii. Jednocześnie może wyjaśniać poczucie dyskomfortu psychicznego w populacji osób zdrowych Summary Objectives: The aim of this study was to verify Young's theory of early maladaptive schemas (EMS) in a non-clinical population. According to Young, deprivation of some of core needs of a child, leads to the growth of specific negative beliefs. Those beliefs become the ground of personality disorders (PD), or specific abnormal personality traits. The study tested what are the relations between schemas and personality disorders' traits in healthy people. Methods: 68 healthy people (without mental disorders and somatic diseases), aged 18-53 years, filled out the 2 questionnaires: Young Schema Questionnaire – Short Form (YSQ-S3) and " Styl życia " by Trzebińska for the measurement of 10 personality disorder based on DSM-IV-TR. Pearson's correlation, ANOVA and multidimensional scaling PROXSCAL were used for the testing. Results: There are significant correlations for all PD scales with schemas. They are theoretically compatible with the core beliefs of PD in cognitive approach, which confirms Young's theory. Moreover, with the increase of the severity of personality traits measured by Styl Życia, severity of schemas growths. The results of the
... Therefore, changes in EMSs were proposed as a mechanism of change in ST (Young et al., 2003). How ever, the evidence suggesting that EMSs drive therapeutic change is poor (Nordahl, Holthe, & Haugum, 2005;Renner et al., 2013;Taylor et al., 2017). Moreover, Renner et al. (2018) recently concluded that the negative core beliefs that lie at the center of EMSs did not predict subsequent changes in symptoms. ...
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Objective: We aimed to empirically test whether schema modes are central to the change process in schema therapy, clarification-oriented psychotherapy, and treatment as usual, i.e., predictive of personality pathology, and global and social-occupational functioning. Method: A multicenter randomized controlled trial was conducted (N = 139 men, N = 181 women) over the course of three years. Repeated assessments of schema modes, personality disorder (PD) severity and functioning (controlled for concurrent PD-pathology) were analyzed using a multilevel autoregressive model. Variables were person-centered to ensure that within-person changes were analyzed. Through a process of backward elimination, the schema modes predictive of the dependent variable (i.e., PD-severity and functioning) at a later point in time were identified while controlling for concurrent dependent variable levels. Bidirectionality was tested by assessing whether dependent variables predicted later schema modes. Results: The Healthy Adult, Vulnerable Child, Impulsive Child, and Avoidant Protector predicted later personality pathology, with no bidirectionality observed for the first two. The Healthy Adult and Self-Aggrandizer predicted functioning at a later point in time, with no bidirectionality for Self-Aggrandizer. There was no moderation by treatment type for PD symptomatology, except for Self-Aggrandizer, which predicted functioning only in schema therapy. Conclusions: The Healthy Adult and Vulnerable Child are central to the change process and appear to reflect common mechanisms of change. The Self-Aggrandizer might reflect a change mechanism specific for schema therapy. Our findings support the recent emphasis on these modes in schema therapy.
... Rees and Pritchard (2015) question the necessity of prolonged treatment duration in AVPD and present the cases of two patients successfully treated in 12 sessions of cognitive therapy. However, many authors argue that it takes more time to achieve structural or emotional changes in AVPD [69,56]. Results show no consistent trend in favor of longer or shorter treatments, and additional empirical research is needed. ...
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This review focuses on recent research on diagnostic aspects, etiology, and treatment of avoidant personality disorder (AVPD). Current studies stress the close relation between AVPD and social anxiety disorder, the influence of genetic factors in the development of AVPD, and the relative stability of symptoms. Treatment approaches should target the pervasive patterns of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Empirical evidence for cognitive-behavior and schema therapy is promising. Few other therapeutic approaches have been developed, but until now, these have only been investigated in case studies. We conclude that AVPD qualifies as a neglected disorder and that more research specifically on avoidant personality disorder symptoms and its treatment is needed.
... Consequently, schema theory forms the theoretical foundation for schema therapy, a promising approach for the treatment of psychological issues that are more chronic and resistant to change, such as personality disorders (Farrell, Shaw, & Webber, 2009;Malogiannis et al., 2014). To date, there have been a number of case series and open trials supporting the efficacy of schema therapy in the reduction of EMSs and psychological symptoms in Clusters B and C personality disorders (Dickhaut & Arntz, 2014;Renner et al., 2013;Skewes, Samson, Simpson, & van Vreeswijk, 2015). In a randomized control trial, 94% of participants were found to no longer meet diagnostic criteria for borderline personality disorder following 8 months of group schema therapy when compared with 16% in the treatment as usual group (Farrell et al., 2009). ...
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Early maladaptive schemas (EMSs) have been hypothesised to be associated with interpersonal problems. Furthermore, a stronger contention is that EMSs impact negatively on, or cause, interpersonal problems. The aims of this meta‐analysis were: (1) to assess the strength of the association between EMSs and interpersonal problems, (2) clarify which EMSs are most strongly associated with interpersonal problems, (3) examine any possible moderators on the relationship between EMSs and interpersonal problems, (4) examine whether any empirical evidence exists supporting a causal relationship between EMSs and interpersonal problems. A comprehensive systematic literature search and meta‐analysis were conducted using the PRISMA guidelines for systematic reviews. A total of 49 empirical studies were reviewed investigating EMSs and interpersonal problems. EMSs were found to have a moderate positive association with interpersonal problems with different EMSs having small to moderate effect sizes. To date there has been limited evidence supporting a causal effect of EMSs on interpersonal problems. Possible limitations and avenues for future research were discussed.
... Their research into the efficacy of ST in a short group format in older adults showed that ST led to a decrease of symptomatic distress, EMS, and schema modes. However, the effects were smaller than in two studies in adults with an average age of 39 (Van Vreeswijk, Spinhoven, Eurelings-Bontekoe, & Broersen, 2012) and 23 (Renner et al., 2013), raising the question how to specifically adapt ST techniques so that they are better molded for older patients? ...
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Schema therapy (ST) is an evidence-based treatment for personality disorders (PDs). The first research into ST with older adults in a short group format demonstrated its applicability for this population, although with lower efficacy than in younger age groups. This raises the question whether ST can be optimized for older adults. Therefore we conducted a mixed quantitative/qualitative case study of individual ST of a 65-year old man with a cluster-C PD, to explore possible adaptations of ST for older adults. We assessed symptomatic distress, early maladaptive schemas, PD diagnosis and the quality of the working alliance. The patient improved on these parameters and no longer met PD-criteria. Five domains of adaptations emerged for possibly enhancing the outcome of ST for older adults: the ST language, the case conceptualization diagram, imagery rescripting, chairwork, and contextualizing to a life span perspective by incorporating wisdom enhancement and reinforcing positive schemas.
... Early maladaptive schemas are considered as central and basic goal in curing long-time personality disorders and personality problems [3]. Schema-based treatment is used by the objective to reduce effects of early maladaptive schemas and to replace negative coping responses and schema moods by healthier ways [4]. ...
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This study aimed to investigate the relation between early maladaptive schemas and checking strategies, has examined 150 women aged between 20 to 30 years. Young schemas questionnaire and coping styles questionnaire are used for collecting information, also pearson correlation coefficient and multiple regression are used for analyzing data. Findings showed that there is a significant negative correlation between abandonment, social isolation, Approval-seeking/ Recognition-seeking, emotional deprivation, subjugation, defectiveness, failure schemas, and problem-focused coping styles, and there is a positive significant correlation between types of schemas and emotion-focused coping styles. Also there is a significant negative correlation between punitiveness schemas and avoidant coping. According to findings of multiple regressions, the only variable which had the predictive power of problem-focused coping styles was defectiveness schema, vulnerability to harm and illness, punitiveness and unrelenting standards schemas have significant role in predicting emotion-focused style, and finally, only the unrelenting standards schema have an affective role in avoidance style predictive model.
... One of the cognitive factors affecting addiction is the scope of schemas, which needs to be considered [9]. It is assumed that drug use is one of the handling strategies used to avoid the adverse effects of spontaneous maladaptive schemas [10]. ...
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Introduction: Drug addiction treatment may be associated with more challenges and problems in women compared with men. Objectives: The present research aimed at determining the impact of group schema therapy on adjusting the early maladaptive schemas in drug-dependent women. Materials and Methods: The present research was an experimental study with a pretest-posttest design and a control group. The statistical population included all of the women with substance abuse disorder who referred to the addiction recovery centers in Rasht from November to December 2019. Using a randomized sampling, 60 individuals were selected and assigned into the experimental and control groups (n=30 for each group) and completed the Young Schema Questionnaire - Short Form Version 3 (YSQ-S3). The experimental group was subjected to the schema therapy, whereas the control group did not receive any intervention. The data were analyzed using a one-way Analysis of Covariance (ANCOVA) and Multivariate Analysis of Covariance (MANCOVA) by SPSS V. 22 software. Results: The results showed that group schema therapy decreased early maladaptive schemas, including disconnection and rejection (P
... In addition, brief schema group therapy forms of 12-20 sessions with an individual treatment have in uncontrolled studies displayed a significant reduction in BPD and general symptoms as well as maladaptive schema modes [25,26]. The brief group form of 20 sessions has also shown a promising effect on mixed personality disorder patients' general symptoms in uncontrolled studies [27,28]. However, insufficient research evidence exists for effectiveness of group schema therapy relative to treatment as usual, or of group format alone in BPD. ...
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Background and objectives: Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). Methods: Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. Results: Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. Limitations: Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. Conclusions: Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.
... In addition to theoretical implications, establishing the status of the evidence on schemas and suicidality has implications for treatment and prevention. Schema Therapy has demonstrated effectiveness in treating disorders often characterized by self-harm and suicidal ideation, such as chronic depression and Bor-derline Personality Disorder ( Bamelis et al., 2014 ;Farrell et al., 2009 ;Giesen-Bloo et al., 2006 ;Hawke and Provencher, 2013 ;Renner et al., 2013 ). Identifying the specific schemas that are most strongly related to suicide-related outcomes could inform suicide risk assessment and identify therapeutic targets. ...
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Background. Understanding the risk factors for suicidality is essential to the prevention of death by suicide and the effective treatment of suicidal ideation and self-harm. The objective of this review was to summarise the evidence on the associations between early maladaptive schemas and suicidal ideation and self-harm. Method. A systematic review and meta-analysis was completed based on the PRISMA statement. Searches were conducted via PubMed, PsycInfo, and CINAHL. Included studies were peer-reviewed and reported on the bivariate association between one or more of the 18 schemas and either suicidal ideation or self-harm behavior. Results. We included 17 studies reporting more than 200 associations. Suicidal ideation demonstrated a large mean correlation with Defectiveness Shame (r = .50 [.43, .57]), moderate correlations with Social Isolation (r =.43 [.34, .50]), Failure (r =.35 [.27, .42]), and Dependence Incompetence (r = .33 [.13, .51]), and small correlations with Subjugation (r = .26, [.13, 38]) and Emotional Inhibition (r = .29 [.13, .44]). Self-harm demonstrated small correlations with Emotional Deprivation (r = .21, [.13, .29]), Social Isolation (r = .29, [.18, .38]), and Emotional Inhibition (r = .19, [.13, .24]). Limitations. Confidence in the findings is limited by high heterogeneity across several analyses and the inability to investigate possible moderators due to the low number of included studies. Conclusions. Believing that one is isolated, unlovable, or incapable is associated with an increased risk of suicidal thoughts. The findings correspond with the risk factors identified by the Interpersonal Theory of Suicide: thwarted belonging and burdensomeness.
... The evidence base for schema therapy (ST) has grown rapidly in recent years, as applied to a wide range of clinical groups (Masley et al., 2011); for ST with groups see Farrell et al. (2009), Simpson et al. (2010), Farrell and Shaw (2012), van Vreeswijk et al. (2012), Renner et al. (2013), Videler et al. (2014). Variations exist between group schema therapy protocols utilized across clinical settings and client groups. ...
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A commentary on Short-term group schema therapy for mixed personality disorders: a pilot study by Simpson,S.G.,Skewes,S.A.,Samson,R.,and van Vreeswijk,M. (2014). Front Psychol.5:1592. doi: 10.3389/fpsyg.2014.01592
... There was some evidence that the condition called borderline personality disorder, which overlaps with antisocial and dangerous personality features, could be treated successfully by dialectical behaviour therapy and transference focused psychotherapy, with some slight evidence that cognitive behaviour therapy might also be effective (American Psychiatric Association, 2001). More recently, there has been additional evidence that schemafocused treatment may be effective (Renner et al., 2013), but the population treated may not all have qualified as severe using present criteria (Tyrer et al., 2015). But all this was peripheral to the main concern about dangerousness. ...
... Aby uniknąć ich doświadczania, podejmuje się różnorodne strategie zachowań, które zmniejszając napięcie, stają się utrwalonymi sposobami reakcji. Young definiuje schemat jako ogólny wzorzec funkcjonowania składający się z emocji, wspomnień i przekonań dotyczących relacji z innymi ludźmi, który został ukształtowany w dzieciństwie, ale był umacniany na kolejnych etapach rozwoju 9 . Schematy w tym ujęciu obejmują nie tylko przekonania, lecz także wspomnienia, sferę emocjonalną oraz doznania cielesne. ...
... prescribing of medicine) and other relevant consultants (e.g., neurologist, internist, and gynecologist), laboratory and imaging. The importance of involvement of the patient' social network and parties affected and if not applicable the establishment of a peer group (e.g., through group therapy) has been shown (Renner et al., 2013). Mental health centers would certainly save time and resources by facilitating collaboration and communication especially when dealing with severely ill mental disease, as relapse rates are high and secondary complications and consequences often result in limited ambulatory possibilities. ...
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Given the tight interconnections proposed between brain and psyche, psychoanalysis was conceptualized as an interdisciplinary theory right from the beginning. The diversification of knowledge performed by different science and technology fields, concerned with the same matter (explaining mind and brain and connecting them), makes this interdisciplinarity even more visible and evident. This challenges the integrative potential lying in psychoanalytic meta-theory.
... In another study, forensic inpatients with psychopathic features showed significant improvement with ST with combined movement therapy and milieu therapy over four years of treatment and three-year follow-up (Chakhssi et al., 2014). Overall, ST is a popular tool for treating antisocial personality and psychopathic features (e.g., Bernstein et al., 2012;Chakhssi et al., 2014) as well as other axis I (e.g., Morvaridi et al., 2019;Simpson et al., 2010) and axis II (e.g., Farrell et al., 2009;Renner et al., 2013) disorders. It seems important to note that the studies mentioned above have used a different version of the SMI which not including forensic modes or used observational methods to assess forensic mode concepts. ...
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The Schema Mode Inventory was the first tool that was developed to assess schema modes (SMI; Young et al., 2007). Recently, the SMI was expanded to also assess forensic modes (Bernstein et al., 2014). The main purpose of the current study was to test The Schema Mode Inventory – Forensics’ (SMI-F) reliability and validity. The sample consists of (n = 1271) volunteer undergraduate students across various universities from Turkey. The sample consisted mostly of females (77.5%). The mean age of the whole sample was 20.43 (SD = 2.16, range = 18-57). In order to test the psychometric properties of the SMI-F, we carried out confirmatory factor analysis, multiple regression analysis, correlational analyses for test-retest, and calculated the correlations and internal reliability coefficients. Overall, the results revealed that the SMI-F has satisfactory levels of reliability and validity and might be useful for research and clinical purposes. In conclusion, the inclusion of the forensic modes in this version makes the inventory more comprehensive in reflecting recent developments in the Schema Therapy Model. It could be possible to assess a wide variety of coping modes and formulate a treatment plan for the general population and forensic patients with the SMI-F.
... Failure to meet these needs causes emotions that are difficult for the child, such as anxiety, anger, shame, or guilt. In an effort to avoid experiencing them, individuals engage in a variety of behavioral and coping strategies that-while reducing tension-also contribute to the perpetuation of the schemas [21]. ...
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Abstract: Aim: There are more non-specific, hence harder to diagnose, symptoms in the picture of male depression. These symptoms are strongly linked to social norms and roles traditionally assigned to men. The aim of this study was to assess the interrelationship of early maladaptive schemas that affect the formation of self-image as a man with indicators of male depression. Materials and methods: The Gender-Sensitive Depression Screening (GSDS-26) by A.M. Möller-Leimkühler and the Early Maladaptive Schema Questionnaire by J. Young (YSQ-S3-PL) were used. A group of 75 men (aged 18 to 50) were qualified to take part in the research. Results: The total score of the GSDS-26 scale and individual indicators of male depression are strongly positively correlated with the severity of all five domains of the YSQ-S3-PL questionnaire. The highest correlation coefficient value was obtained in the following areas: “Disconnection and rejection” (0.741), “Other-directedness” (0.711), and “Overvigilance and inhibition” (0.711). In case of the GSDS-26 total score and the following indicators—Elevated stress, Aggressiveness, Emotional control, Risky behavior, and Classic symptoms of depression—positive statistically significant associations were confirmed with each of the 18 schemas from the YSQ-S3-PL questionnaire. Multiple regression results revealed that the following domains were significant for symptoms typical of male depression: “Disconnection and rejection” and “Impaired autonomy and performance”. The “Impaired limits” area was found to be statistically significant only for symptoms of classic depression. Conclusions: (1) The GSDS-26 scale scores show positive associations with each domain of the YSQ-S3-PL questionnaire. (2) The following areas seem to be more important for atypical depressive symptoms in men: “Disconnection and rejection” and “Impaired autonomy and performance”, while for classic depression: “Impaired limits” was more important. (3) In therapeutic work with male depressive symptoms, it is useful to focus on dominant maladaptive schemas alongside beliefs about stereotypical male roles.
... The primary source of dysfunctional schemas is the inability to meet or inadequately meet one (or more) of the child's basic developmental needs (so-called core needs) [3,4]. Failure to meet these needs causes emotions that are difficult for the child, such as anxiety, anger, shame, or guilt; to avoid experiencing them, individuals engage in a variety of behavioral and coping strategies, which-while reducing tension-also contribute to the perpetuation of certain schemas [5]. Over the past few years, Young's theory of schemas has become a focal point for many studies that have attempted to explain the etiology of numerous psychiatric disorders [6]. ...
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Abstract: Aim: The aim of this study was to assess the interrelationships of Young’s early maladaptive schemas with indicators of specific neural emotional systems conceptualized in Panksepp’s theory in a group of people suffering from depressive disorders. Materials and methods: The Affective Neuroscience Personality Scales (ANPS) v. 2.4. and J. Young’s Early Maladaptive Schema Questionnaire (YSQ-S3-PL) were used. Ninety (90) individuals aged 18–58, including 45 people treated for depression (DD group), were qualified to participate in the experiment. Results: The subjects in the DD group scored statistically significantly lower than the subjects from the control group (CG group) on the three ANPS scale domains, namely SEEKING, PLAY, and ANGER. The subjects with depressive symptoms scored significantly higher in the YSQ-S3-PL questionnaire on two domains of early maladaptive schemas, i.e., “Impaired autonomy and performance” and “Other-directedness”. Regression analysis results indicate that impairment of the emotional SEEKING system explains most of the variability in the following typical domains of depression: “Disconnection and rejection”, “Impaired autonomy and performance”, and “Other-directedness”. For score variability in the domain area of “Impaired limits”, the ANGER system was found to be most significant, and the FEAR system proved the same for “Overvigilance and Inhibition”. Conclusions: 1. Two domains of early maladaptive schemas are significant for the onset of depressive symptoms, namely “Impaired autonomy and performance” and “Other-directedness”, linked to difficulties in engaging in behaviors to meet one’s own needs. 2. Impairment of the neural emotional SEEKING system most significantly explains the variability in depression-typical areas of early maladaptive schemas.
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Ausgangslage: Seit einigen Jahren hat sich in der Schweiz die Entwicklung der IV-Neurenten stabilisiert oder sie hat gar abgenommen. Eine Ausnahme von diesem Trend zeigt sich bei der Altersgruppe der Kinder, Jugendlichen und jungen Erwachsenen: hier ist weiterhin eine Zunahme der Neurenten zu verzeichnen. Besorgniserregend ist auch der Befund, dass viele der Personen im Kindes- oder Jugendalter eine volle IV-Rente erhalten und die Berentung selten wieder verlassen. Für die IV ist es deshalb zentral, wissenschaftlich gesicherte Kenntnisse zur Wirksamkeit von medizinischen und beruflichen Massnahmen für Kinder und Jugendliche mit psychischen Erkrankungen zu erhalten. Fragestellungen: Konkret wurden durch die vorliegende Studie fünf Fragenkomplexe behandelt: 1) Welche diagnostische Verfahren und welche (individuelle oder kombinierte) therapeutischen Methoden sollen in welcher Altersgruppe bei welcher Störung angewendet werden? 2) Gibt es für ausgewählte Störungen bei der interessierenden Zielgruppe national und international anerkannte und auf wissenschaftlicher Evidenz basierte Leitlinien zur Diagnostik und zur Therapie? Zeigen sich Unterschiede zwischen den Leitlinien verschiedener nationaler Fachgesellschaften? 3) Welche (individuellen oder kombinierten) therapeutischen Methoden sind bei der Zielgruppe und bei den spezifischen Störungen sowohl klinisch als auch im Hinblick auf den Schulerfolg sowie die berufliche Integration wirksam? 4) Gibt es optimalen Zeitpunkt für Diagnose und Behandlung bei den zu untersuchenden Krankheiten? 5) Inwieweit bestehen noch Lücken in der Literatur, um die vorangehenden Fragen (1-4) beantworten zu können? Methodisches Vorgehen: Fragenkomplexe 1und 2: allgemeine Literaturrecherche anhand aktueller Lehrbücher und aktuellen veröffentlichten Leitlinien von Fachgesellschaften aus den Fachbereichen Kinder- & Jugendpsychiatrie und Pädiatrie sowie Experteninterviews mit Kinder-und Jugendpsychiatern und Ärzten/Ärztinnen des Regionalärztlichen Dienstes, Fragenkomplex 3 und 4: systematische Literaturrecherche über Datenbanken der wissenschaftlichen Literatur (Medline, PsycInfo, EconLit, ERIC). Ergebnisse: Aufgrund der recherchierten Literatur konnten einige Wissenslücken sowie Themenfelder mit schmaler Befundlage identifiziert werden. Diese betreffen das Wissen: • zu mittel- bis langfristigen Wirkungen von Interventionen auf die soziale Integration und Anpassung (Schulerfolg, Beruf, Bewältigung von Entwicklungsaufgaben) der Kinder und Jugendlichen mit psychischen Störungen; • zur Nachhaltigkeit positiver Therapieeffekte und zu nicht-intendierten (Neben-)Wirkungen oder auch negativer Effekte von Interventionen; • zur Wirksamkeit von verschiedenen Präventionsstrategien psychischer Störungen; • zu geeigneten Interventionen für Kinder im Vorschulalter.
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Achtergrond: Recent is aangetoond dat schemagerichte cognitieve gedragstherapie in groepsverband (SCBT-g) tot verbeteringen leidt in actuele symptomatologie, maladaptieve schema’s en schemamodi. Dit is onderzocht bij zowel volwassenen (gemiddelde leeftijd 38) als jongvolwassenen (gemiddelde leeftijd 22,5 jaar) met persoonlijkheidsstoornissen of kenmerken hiervan. Er is echter nog geen effectonderzoek verricht bij ouderen. Daarom hebben we in een proof-of-conceptstudie verkend of SCBT-g effectief is bij ouderen met kenmerken van een persoonlijkheidsstoornis en recidiverende depressies. Een proof-of-conceptstudie betreft een studie waarin de toepasbaarheid en werkzaamheid van een nieuwe interventie getest wordt in een kleine pilotstudie. Methode: Eenendertig ambulante patiënten, variërend in leeftijd van 60 tot 78 jaar, met kenmerken van een persoonlijkheidsstoornis en/of recidiverende depressies. Primaire uitkomstmaat was actuele symptomatologie (BSI) en intermediërende uitkomstmaten waren maladaptieve schema’s (YSQ) en schemamodi (SMI), gemeten voorafgaand, halverwege en aan het einde van de behandeling. T-toetsen voor afhankelijke steekproeven werden verricht, en Cohen’s d effectmaten berekend. Als proof-of-conceptanalyse werden hiërarchische regressieanalyses met residuale verschilscores gebruikt om te analyseren of vroege procesveranderingen in maladaptieve schema’s latere veranderingen in symptomatologie voorspelden. Resultaten: Het bleek dat SCBT-g leidde tot significante verbetering in alle drie de uitkomstmaten met middelmatige effectgroottes. Veranderingen in de ernst van maladaptieve schema’s van het begin tot het midden van de behandeling voorspelden symptoomverbetering van het midden tot het einde van de behandeling. Conclusie: Onze bevindingen bieden voorlopig bewijs dat SCBT-g via verbeteringen in maladaptieve schema’s leidt tot significante afname van klachten bij ouderen met kenmerken van een persoonlijkheidsstoornis en/of recidiverende depressies. SCBT-g bleek bij ouderen wel iets minder effectief dan bij volwassenen (Van Vreeswijk e.a. 2012) en jongvolwassenen (Renner e.a. 2013). Wellicht dient schematherapie aangepast te worden aan leeftijdsspecifieke aspecten van ouderen om de effectiviteit te vergroten. Een noodzakelijke vervolgstap voor verder onderzoek is een RCT met controleconditie. Voor de GZ-psycholoog met opleiding in schematherapie is deze geprotocolleerde behandelmethode goed toepasbaar in de klinische praktijk.
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Background: Several studies have evaluated the (cost) effectiveness of schema therapy for personality disorders, but little research has been done on the perspectives of patients and therapists. Aim: The present study aims to explore patients' and therapists' perspectives on schema therapy. Method: Qualitative data were collected through in-depth semi-structured interviews with 15 patients and a focus group of 8 therapists. A thematic analysis was performed. Results: Most patients and therapists agreed that helpful aspects in schema therapy were the highly committed therapeutic relationship, the transparent and clear theoretical model, and the specific schema therapy techniques. About unhelpful aspects, several patients and some therapists shared the opinion that 50 sessions was not enough. Furthermore, patients lacked clear advance information about the possibility that they might temporarily experience stronger emotions during therapy and the possibility of having telephone contact outside session hours. They missed practical goals in the later stage of therapy. With regard to imagery, patients experienced time pressure and they missed a proper link between the past and the present. For therapists, it was hard to manage the therapeutic relation, to get used to a new kind of therapy and to keep the treatment focused on personality problems. Conclusions: Patients and therapists found some aspects of the schema therapy protocol helpful. Their views about which aspects are unhelpful and their recommendations need to be taken into consideration when adjusting the protocol and implementing schema therapy.
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There is increasing interest in developing more nuanced methods for managing aggression and violence in long-term psychiatric inpatient settings. However, the dearth of controlled studies has, at times, hampered presentation of viable options. Following the publication of guidelines developed in the California State Hospital forensic system, the authors present a group of 7 cases illustrating different approaches to violence management, including pharmacological, psychotherapeutic, and environmental interventions.
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Here we provide comprehensive guidelines for the assessment and treatment of violence and aggression of various etiologies, including psychotic aggression and impulsive aggression due to schizophrenia, mood disorders, ADHD, or trauma, and predatory aggression due to psychopathy and other personality disorders. These guidelines have been developed from a collection of prescribing recommendations, clinical trial results, and years of clinical experience in treating patients who are persistently violent or aggressive in the California Department of State Hospital System. Many of the recommendations provided in these guidelines employ off-label prescribing practices; thus, sound clinical judgment based on individual patient needs and according to institution formularies must be considered when applying these guidelines in clinical practice.
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Background Improving the quality of care in community settings for people with ‘Complex Emotional Needs’ (CEN—our preferred working term for services for people with a “personality disorder” diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. Methods We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. Results We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people’s lives, peer support, or ways of designing effective services. Conclusions Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.
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Introduction: Obsessive-compulsive personality disorder (OCPD) has a pervasive pattern of preoccupation with orderliness, perfection, and mental and interpersonal control at the expense of flexibility, openness, and efficiency. The aims of the present study were to explore the relationship between OCPD and psychological stress and psychological tests. Methods: We evaluated 63 OCPD patients and 107 healthy controls (HCs). We collected saliva samples from patients and controls before and after a social stress procedure, the Trier Social Stress Test (TSST), to measure the concentrations of salivary alpha-amylase (sAA) and salivary cortisol. The Childhood Trauma Questionnaire (CTQ), Profile of Mood State (POMS), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Social Adaptation Self-Evaluation Scale (SASS), and Depression and Anxiety Cognition Scale (DACS) were administered to patients and HCs. Results: Following TSST exposure, the salivary amylase and cortisol levels were significantly decreased in male patients compared with controls. Additionally, OCPD patients had higher CTQ, POMS, STAI, and BDI scores than HCs and exhibited significantly higher anxiety and depressive states. OCPD patients scored higher on future denial and threat prediction as per the DACS tool. According to a stepwise regression analysis, STAI, POMS, and salivary cortisol responses were independent predictors of OCPD. Conclusions: Our results suggested that attenuated sympathetic and parasympathetic reactivity in male OCPD patients occurs along with attenuated salivary amylase and cortisol responses to the TSST. In addition, there was a significant difference between OCPD patients and HCs in child trauma, mood, anxiety, and cognition. The finding support the modeling role of cortisol (20min) on the relationships between STAI trait and depression among OCPD.
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Multidisciplinary treatment programs for patients with personality disorders (PDs) often include art therapy, but the efficacy of this intervention has hardly been evaluated. The objective of this study is to evaluate the effects of an art therapy intervention on psychological functioning of patients with a PD. In this randomized controlled trial, 57 adult participants diagnosed with a PD cluster B/C (SCID-II) were randomly assigned to either weekly group art therapy (1.5 hours, 10 weeks) or a waiting list group. Outcome measures OQ45, AAQ-II, and SMI were assessed at baseline, at post-test (10 weeks after baseline), and at follow-up (5 weeks after post-test). The results show that art therapy is an effective treatment for PD patients because it not only reduces PD pathology and maladaptive modes but it also helps patients to develop adaptive, positive modes that indicate better mental health and self-regulation.
Article
Background and objectives The underlying mechanisms of symptom change in schema therapy (ST) for chronic major depressive disorder (cMDD) have not been studied. The aim of this study was to explore the impact of two potentially important mechanisms of symptom change, maladaptive schemas (proxied by negative idiosyncratic core-beliefs) and the therapeutic alliance. Methods We drew data from a single-case series of ST for cMDD. Patients with cMDD (N = 20) received on average 78 repeated weekly assessments over a course of up to 65 individual sessions of ST. Focusing on repeated assessments within-individuals, we used mixed regression to test whether change in core-beliefs and therapeutic alliance preceded, followed, or occurred concurrently with change in depressive symptoms. Results Changes in core-beliefs did not precede but were concurrently related to changes in symptoms. Repeated goal and task agreement ratings (specific aspects of alliance) of the same session, completed on separate days, were at least in part associated with concurrent changes in symptoms. Limitations By design this study had a small sample-size and no control group. Conclusions Contrary to what would be expected based on theory, our findings suggest that change in core-beliefs does not precede change in symptoms. Instead, change in these variables occurs concurrently. Moreover, alliance ratings seem to be at least in part colored by changes in current mood state.
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The Young Schema Questionnaire-Short Form (YSQ-SF) is one of the most widely used measures of individual early maladaptive schemas in schema therapy, and this study examined the factor structure and reliability of its Japanese version (YSQ-SF-J). We created a subsample to ensure the samples' mutual independence (N= 248, mean age= 19.75; 121 females). Then, Japanese participants (N= 800) completed the Japanese-translated YSQ-SF. Participants were divided into 2 samples: Sample 1 (n= 700, mean age= 23.05; 350 females); and Sample 2 (n= 100, mean age= 20.27; 50 females) for test-retest reliability. Exploratory and confirmatory factor analyses revealed that the YSQ-SF-J's item-factor structure was identical to the English version. Moreover, the scale showed good internal consistency and test-retest reliability. Results revealed the scale's adequate psychometric properties. Thus, this study provided the first examples of empirical support for the YSQ-SF-J.
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Schema Mode Inventory (SMI) is an instrument developed to measure the most frequent Schema Modes that are present in an individual's life. It is an exploratory questionnaire, used for both therapeutic and research purposes and aims to get an overview of the Schema Modes that a particular patient shows most often. The aim of this research was to carry out a review of the literature on SMI, focusing on validation and use. Through two search strategies, the first is a search for the keyword Schema Mode Inventory and the second is a manual search, we found 253 works in the databases (PubMed, PsycInfo, Google Scholar), belonging to the last 11 years, of which 45 met the inclusion criteria. Of these, 36 proposed to use the SMI to evaluate some psychological theme and 09 sought their validation. Among the psychological themes encountered, Personality Disorder stands out as the most targeted analysis of Schema Modes. Finally, it was observed through the review that with the course of the years, there is a growing use and validation of the instrument in several countries, although no empirical studies have been done in Brazil.
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Purpose The purpose of this study/paper is to describe the implementation of a six-month schema therapy awareness (STA) group. Research supporting individual schema therapy (ST) as an effective intervention for personality disorder is growing steadily within a number of settings including with forensic patients. Alongside individual ST, positive results have been reported for group ST. However, to the best of the authors’ knowledge, no current published research exists with regard to the use of group ST within forensic populations and more specifically within a low secure environment. Design/methodology/approach This paper describes the implementation of a six-month schema therapy awareness (STA) group with individuals situated within a low secure environment. Findings For individuals transitioning into the community from a secure setting, the focus of risk management should attempt to move away from external controls towards more of a reliance on internal factors. In ST, this is achieved by understanding the role of schema modes (and underlying schemas) that are linked to an individual’s offences/risk and developing this understanding into a coherent and accessible formulation for the individual to make changes. Research limitations/implications Further robust research evaluating clinical change is recommended as the next step. Practical implications The group protocol is described along with the challenges and potential solutions experienced during the implementation. This provides an opportunity for other professionals to replicate this approach in the future. Originality/value With regard to group ST within forensic populations, the research is sparse at present and this study focusses on practical application of theory and the challenges of operationalising a STA group.
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Background: This naturalistic study looked at the effect of comorbid depressive symptoms on the outcomes – at treatment termination and three-month follow-up – of Short-Term Schema Cognitive Behavioural Therapy in groups for personality disorders. Methods: We investigated 225 patients with personality disorders and comorbid depressive symptoms (PD-DEP) and patients without comorbidity (PD), focusing on symptom and schema severity and coping styles. We also measured the rate of symptom remission. The data obtained were subjected to multilevel analysis. Results: Psychiatric symptoms and maladaptive schemas improved in both patient groups. Effect sizes were moderate. It proved more difficult to improve coping styles. Symptom remission was achieved in the minority of the total sample There were no differences in outcome between PD and PD-DEP at treatment termination. Psychiatric symptoms were more severe among PD-DEP patients at follow-up. Conclusion: A short-term form of schema therapy in groups proved to be an effective approach for a broad group of patients with personality disorders, however, the majority of patients did not achieve symptom remission. This indicates that this type of short-term group therapy should be considered a valuable first step in a stepped-care model.
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Despite a still reigning therapeutic nihilism, attention for the psychological treatment of personality disorders in older adults has been growing recently. The first empirical studies have been conducted, but their number is still limited, and varies from expert consensus to the first tests of effectiveness of schema therapy and dialectical behavior therapy. Therefore, there is an urgent need for further empirical studies into psychological treatments that have been optimized for older adults on all three treatment levels.
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Introduction Schema therapy (ST) is an efficacious psychotherapy for personality disorders (PDs) in adults. The first empirical support for the effectiveness of ST in older adults with cluster C PDs was provided recently. ST partly focusses on the positive, but there is an increasing awareness of imbalance in the ST community because of the emphasis on negative schemas versus attention to positive schemas. Positive schemas may be important vehicles of therapeutic change in psychotherapy with older people, as is may help strengthen the healthy adult mode, and it might also help change a negative life review. Suggestions were made to increase the efficacy and feasibility of ST in older adults, including adjusting the case conceptualisation, modifying the experiential techniques, making use of the patient's wisdom and reactivating positive schemas. The aim of the current study is to investigate the feasibility and effectiveness of adapted individual ST for older adults. Methods/design A multiple baseline design is used with positive and negative core beliefs as primary outcome measures. Ten older adults (age > 60 years) with cluster C PDs are treated with schema therapy, with weekly sessions during one year. This treatment phase is preceded by a baseline phase varying randomly from 4 to 8 weeks. After treatment, there is a 6-month follow-up phase with monthly booster sessions. Symptomatic distress, schema modes, early maladaptive schemas (EMS) and early adaptive schemas (EAS) are secondary outcome measures. PD will be diagnosed before baseline and after treatment phase. EAS are assessed with the Dutch version of the Young Positive Schema Questionnaire (YPSQ). Discussion To the best of our knowledge, this is the first empirical study in which positive schemas are integrated in ST treatment to examine the efficacy of an adapted form of ST for older adults. This is in line with wider developments supporting the integration of positive schema's into ST. It offers the possibility to improve the effectiveness of ST in older adults. Trial registration The Netherlands National Trial Register. NL8346 Registered 1 February 2020.
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Związek wczesnych nieadaptacyjnych schematów z różnymi przejawami zaburzeń psychicznych znajduje po twierdzenie w prowadzonych ostatnio badaniach empirycznych. Teoria Younga należy do tzw. trzeciej fali terapii poznawczo-behawioralnej. Jej techniki są stosowane przede wszystkim w terapii zaburzeń osobowości. Zaburzenie osobowości borderline (borderline personality disorder-BPD) w ciągu ostatnich 20 lat diagnozowane jest coraz częściej, a przez wielu badaczy i klinicystów nazywane jest ono zaburzeniem osobowości naszych czasów. Z uwagi na fakt, że świadomość występowa nia objawów BPD w powszechnym odbiorze wzrasta, a pacjenci z tym rozpoznaniem coraz częściej oczekują specjalistycznej porady, istotne wydaje się szukanie no wych, dostępnych, ale też skutecznych sposobów po mocy dla tej grupy osób. Coraz większą popularność zyskują techniki terapeutyczne wywodzące się ze wspo mnianej teorii wczesnych nieadaptacyjnych schematów Younga. Celem pracy jest przedstawienie rozumienia objawów zaburzeń osobowości borderline z perspektywy teorii schematów. Słowa kluczowe: wczesne nieadaptacyjne schematy, terapia schematów Younga, osobowość borderline. A b s t r a c t The relationship of early maladaptive schemas with various manifestations of mental disorders is confirmed in recent empirical research. Young's theory belongs to the socalled third wave of cognitive behavioral thera py. Its techniques are used primarily in the treatment of personality disorders. Over the last 20 years, bor derline personality disorder (BPD) has been diagnosed more and more frequently, and by many researchers and clinicians it is called the personality disorder of our time. Due to the fact that the awareness of BPD symptoms in common perception is increasing, and patients with this diagnosis more and more often seek specialist advice, it seems important to look for new, available, but also effective ways of helping this group of people. Therapeutic techniques derived from the aforementioned theory of early maladaptive Young's schemas are gaining more and more popularity. The aim of the study is therefore to present the understanding of symptoms of borderline personality disorder from the perspective of schema theory.
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A first empirical study into group schema therapy in older adults with mood disorders and personality disorder (PD) features has shown that brief group schema therapy has potential to decrease psychological distress and to change early maladaptive schemas (EMS). Effect sizes however were smaller than those found in similar studies in younger adults. Therefore, we set out to adapt the treatment protocol for older adults in order to enhance its feasibility and outcome in this age group. We examined this adapted protocol in 29 older adults (mean age 66 years) with PDs from four Dutch mental health institutes. The primary outcome was symptomatic distress, measured by the Brief Symptom Inventory. Secondary outcomes were measured by the Young Schema Questionnaire, the Schema Mode Inventory, and the short version of the Severity Indices of Personality Problems. Contrary to our expectations, the adapted treatment protocol yielded only a small effect size in our primary outcome, and no significant improvement in EMS, modes and personality functioning. Patients pointed out that they were more aware of their dysfunctional patterns, but maybe they had not been able yet to work on behavioural change due to this schema therapy treatment being too brief. We recommend more intensive treatment for older patients with PDs, as they might benefit from more schema therapy sessions, similar to the treatment dosage in younger PD patients. They might also benefit from a combination of group therapy and individual treatment sessions. Key learning aims (1) How to adapt group schema therapy for older adults. (2) How to explore feasibility and outcome. (3) Treat older personality disorder patients as intensively as younger adults.
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Bij een groep patiënten (n = 88) met persoonlijkheidsstoornissen die deelnamen aan groepsschematherapie op een klinische afdeling in een derdelijns behandelsetting, is de verandering in het algemeen psychologisch functioneren tijdens behandeling en bij follow-up onderzocht. Daarnaast is onderzocht of veranderingen in schemamodi en hechtingstijl tijdens de behandeling samenhangen met het algemeen psychologisch functioneren bij follow-up, gemiddeld 32,6 maanden later. Een intentie-tot-behandelinganalyse laat zien dat er geen significante verbeteringen waren in maladaptieve schemamodi en hechtingstijlen van begin tot eind van de behandeling. De adaptieve schemamodi verbeterden wel significant van begin tot einde behandeling. Aan het einde van de behandeling verbeterde het algemeen psychologisch functioneren significant met een matig tot groot effect, dat standhield bij follow-up. De resultaten ondersteunen het groeiende bewijs dat klinische groepsschematherapie bij kan dragen aan een verbetering in het adaptieve functioneren, ook bij een groep patiënten met persoonlijkheidsstoornissen die onvoldoende profiteerden van eerdere behandelingen.
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Cluster-C personality disorders (PD) can be a challenge for therapists. This paper presents a novel Schema Therapy approach to the treatment of Cluster-C PDs. First an overview of schema mode models of the 3 cluster C PDs is presented, and it is discussed how idiosyncratic case formulations based on schema modes can be made. The most important survival strategies of each disorder (avoidance, control, dependency) are mirrored in the respective coping modes, but also underlying historical factors, represented in child-modes and internalized parental-modes. Next, the main schema therapy interventions, and the ways of dealing with typical clinical problems with these disorders are discussed. First study results demonstrate good applicability of this approach in cluster C PD.
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According to Dutch Law, patients committing severe crimes justifying imprisonment of four years or more who cannot be held (fully) accountable for these acts can be sentenced to compulsory hospitalization in a specialized TBS hospital in the Netherlands. In the current paper, the effects of TBS treatment will be addressed in terms of recidivism numbers after termination of TBS treatment, as well as in behavioral changes that are observed during admission to TBS hospitals. Although these results offer some indirect support suggesting that TBS is effective, no randomized controlled trials had been conducted up until now that could confirm this. In the current study, preliminary results are reported from a multicenter randomized clinical trial on the effectiveness of Schema Therapy (ST) for hospitalized TBS patients with Antisocial, Borderline, Narcissistic, or Paranoid Personality Disorders, including those with high levels of psychopathy. Patients at seven TBS clinics were randomly assigned to receive three years of either ST or Treatment As Usual (TAU), and are being assessed on several outcome variables, such as recidivism risk (HCR-20, START), personality disorder symptoms (SIDP-IV, SNAP), and successful re-integration into the community. A three-year follow-up study will examine actual recidivism. One hundred and two patients are participating in the study. The preliminary findings from the first 30 patients to complete the three-year study suggest that ST is yielding better outcomes than TAU with regard to reducing recidivism risk and promoting re-entry into the community. These findings are not yet statistically significant, and thus need to be interpreted with caution until confirmed in our complete sample and follow up. However, they suggest that ST may be a promising treatment for offenders with personality disorders, including some psychopathic ones.
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J. E. Young’s (1995) Early Maladaptive Schemas (EMS) are assumed to be highly stable and enduring beliefs that are responsible for the persistence and poor treatment response of a variety of clinical problems. EMS are now the basis for a growing number of specialized “schema-focused” treatments. However, the critical assumption that they are stable constructs remains largely unexamined and open to question. This study examined the long-term stability of Young’s EMS in 55 depressed outpatients over a 2.5 to 5-year interval. EMS exhibited moderate to good levels of stability, even after controlling for severity of depression and neuroticism at both time points, and moderate levels of discriminant validity. A comparison of these results with existing literature revealed that the stability and discriminant validity of EMS are quite similar to the stability and discriminant validity of personality disorder features. Additional work is needed to examine the stability of EMS across greater fluctuations in mood and in different clinical populations. Our findings for the stability of EMS may be generalizable to the more general notion of core beliefs. Future work needs to focus on further theoretical development and improved measurement of EMS.
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The present cross-sectional study examined the relations of particular forms of childhood adversity (e.g., emotional maltreatment vs. physical abuse vs. sexual abuse) to specific early maladaptive schema themes (e.g., worthlessness/loss vs. danger) and symptom profiles (i.e., anhedonic vs. anxious). Seventy-six depressed adolescents retrospectively reported on their childhood experiences of emotional maltreatment, physical abuse, and sexual abuse in a contextual semi-structured interview. They were also administered the Young Schema Questionnaire to measure early maladaptive schemas, and the Mood and Anxiety Symptom Questionnaire to measure anhedonic and anxious symptomatology. Consistent with specificity hypotheses, schemas with themes of loss/worthlessness preferentially mediated the relation between childhood adversity and anhedonic symptoms, while schemas with themes of danger preferentially mediated the relation between childhood adversity and anxious symptoms. Sexual abuse was not significantly associated with either depression or anxiety symptoms and, thus, mediation models involving sexual abuse were not tested. Implications for fine-grained models of etiology in depression are discussed.
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Vulnerability has increasingly become the organizing construct around which much research in psychopathology is organized. This is particularly the case for depression, where researchers have begun to focus considerable attention on the variables that may predispose some individuals to this disorder. Much of this attention has been directed toward understanding the origins of these presumed vulnerability processes. In line with this interest, vulnerability origins stemming from schema models, hopelessness models, and attachment theory are discussed, as is the idea of disrupted parent-child interactions in the creation of vulnerability. Within this latter category the link between abuse, maltreatment, cognitive factors andvulnerability is examined. Possible directions for future theory and research in cognitive vulnerability and depression are then discussed.
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Recent research suggests that how information is organized in the mind may be important for determining one’s vulnerability to depression. The purpose of the current study was to examine potential developmental precursors to a depressotypic cognitive organization (i.e., tightly-connected negative schemas and loosely-connected positive schemas) in a sample of young adult men and women (N=91). The relation between childhood maltreatment (i.e., mother emotional maltreatment, father emotional maltreatment, physical abuse, and sexual abuse) and cognitive organization was assessed using a computer task in which participants with different self-reported maltreatment histories plotted a series of cognitive schema contents (e.g., “I am a failure”) on a 2-dimensional grid along the dimensions of self-descriptiveness and valence. As hypothesized, higher levels of mother emotional maltreatment, father emotional maltreatment and physical abuse (but not sexual abuse) were associated with a depressotypic schema organization. Consistent with hypotheses, a depressotypic schema organization mediated the relation between maltreatment and depression, suggesting that the organization of cognitive schemas may help to elucidate why individuals with maltreatment histories are so vulnerable to develop depression.
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Despite international guidelines describing psychotherapy as first choice for people with personality disorders (PDs), well-designed research on the effectiveness and cost-effectiveness of psychotherapy for PD is scarce. Schema therapy (ST) is a specific form of psychological treatment that proved to be effective for borderline PD. Randomized controlled studies on the effectiveness of ST for other PDs are lacking. Another not yet tested new specialized treatment is Clarification Oriented Psychotherapy (COP). The aim of this project is to perform an effectiveness study as well as an economic evaluation study (cost effectiveness as well as cost-utility) comparing ST versus COP versus treatment as usual (TAU). In this study, we focus on avoidant, dependent, obsessive-compulsive, paranoid, histrionic and narcissistic PD. In a multicentered randomized controlled trial, ST, and COP as an extra experimental condition, are compared to TAU. Minimal 300 patients are recruited in 12 mental health institutes throughout the Netherlands, and receive an extensive screening prior to enrolment in the study. When eligible, they are randomly assigned to one of the intervention groups. An economic evaluation and a qualitative research study on patient and therapist perspectives on ST are embedded in this trial. Outcome assessments (both for clinical effectiveness and economic evaluation) take place at 6,12,18,24 and 36 months after start of treatment. Primary outcome is recovery from PD; secondary measures include general psychopathological complaints, social functioning and quality of life. Data for the cost-effectiveness and cost-utility analyses are collected by using a retrospective cost interview. Information on patient and therapist perspectives is gathered using in-depth interviews and focus groups, and focuses on possible helpful and impeding aspects of ST. This trial is the first to compare ST and COP head-to-head with TAU for people with a cluster C, paranoid, histrionic and/or narcissistic PD. By combining clinical effectiveness data with an economic evaluation and with direct information from primary stakeholders, this trial offers a complete and thorough view on ST as a contribution to the improvement of treatment for this PD patient group. Netherlands Trial Register (NTR): NTR566.
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This study presents a new questionnaire to assess schema modes: the Schema Mode Inventory (SMI). First, the construction of the short SMI (118 items) was described. Second, the psychometric properties of this short SMI were assessed. More specifically, its factor structure, internal reliability, inter-correlations between the subscales, test-retest reliability and monotonically increase of the modes were tested. This was done in a sample of N = 863 non-patients, Axis I and Axis II patients. Results indicated a 14-factor structure of the short SMI, acceptable internal consistencies of the 14 subscales (Cronbach alpha's from .79 to .96), adequate test-retest reliability and moderate construct validity. Certain modes were predicted by a combination of the severity of Axis I and II disorders, while other modes were mainly predicted by Axis II pathology. The psychometric results indicate that the short SMI is a valuable measure that can be of use for mode assessment in SFT.
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Previous studies have found that few chronically depressed patients remit with antidepressant medications alone. To determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complete response to an initial medication trial. This trial compared 12 weeks of (1) continued pharmacotherapy and augmentation with cognitive behavioral analysis system of psychotherapy (CBASP), (2) continued pharmacotherapy and augmentation with brief supportive psychotherapy (BSP), and (3) continued optimized pharmacotherapy (MEDS) alone. We hypothesized that adding CBASP would produce higher rates of response and remission than adding BSP or continuing MEDS alone. Eight academic sites. Chronically depressed patients with a current DSM-IV-defined major depressive episode and persistent depressive symptoms for more than 2 years. Phase 1 consisted of open-label, algorithm-guided treatment for 12 weeks based on a history of antidepressant response. Patients not achieving remission received next-step pharmacotherapy options with or without adjunctive psychotherapy (phase 2). Individuals undergoing psychotherapy were randomized to receive either CBASP or BSP stratified by phase 1 response, ie, as nonresponders (NRs) or partial responders (PRs). Proportions of remitters, PRs, and NRs and change on Hamilton Scale for Depression (HAM-D) scores. In all, 808 participants entered phase 1, of which 491 were classified as NRs or PRs and entered phase 2 (200 received CBASP and MEDS, 195 received BSP and MEDS, and 96 received MEDS only). Mean HAM-D scores dropped from 25.9 to 17.7 in NRs and from 15.2 to 9.9 in PRs. No statistically significant differences emerged among the 3 treatment groups in the proportions of phase 2 remission (15.0%), partial response (22.5%), and nonresponse (62.5%) or in changes on HAM-D scores. Although 37.5% of the participants experienced partial response or remitted in phase 2, neither form of adjunctive psychotherapy significantly improved outcomes over that of a flexible, individualized pharmacotherapy regimen alone. A longitudinal assessment of later-emerging benefits is ongoing.
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This study tests the effectiveness of adding an eight-month, thirty-session schema-focused therapy (SFT) group to treatment-as-usual (TAU) individual psychotherapy for borderline personality disorder (BPD). Patients (N=32) were randomly assigned to SFT-TAU and TAU alone. Dropout was 0% SFT, 25% TAU. Significant reductions in BPD symptoms and global severity of psychiatric symptoms, and improved global functioning with large treatment effect sizes were found in the SFT-TAU group. At the end of treatment, 94% of SFT-TAU compared to 16% of TAU no longer met BPD diagnosis criteria (p<.001). This study supports group SFT as an effective treatment for BPD that leads to recovery and improved overall functioning.
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Follow-up data across an 18-month period are presented for 43 adults who had been randomly assigned and had responded to short-term client-centered (CC) and emotion-focused (EFT) therapies for major depression. Long-term effects of these short-term therapies were evaluated using relapse rates, number of asymptomatic or minimally symptomatic weeks, survival times across an 18-month follow-up, and group comparisons on self-report indices at 6- and 18-month follow-up among those clients who responded to the acute treatment phase. EFT treatment showed superior effects across 18 months in terms of less depressive relapse and greater number of asymptomatic or minimally symptomatic weeks, and the probability of maintaining treatment gains was significantly more likely in the EFT treatment than in the CC treatment. In addition, follow-up self-report results demonstrated significantly greater effects for EFT clients on reduction of depression and improvement of self-esteem, and there were trends in favor of EFT, in comparison with CC, on reduction of general symptom distress and interpersonal problems. Maintenance of treatment gains following an empathic relational treatment appears to be enhanced by the addition of specific experiential and gestalt-derived emotion-focused interventions. Clinical and theoretical implications of these findings are presented.
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To compare the course of depression during a 2-year period in adult outpatients (n = 626) with current major depression, dysthymia, and either both current disorders ("double depression") or depressive symptoms with no current depressive disorder. Depressed patients visiting 523 clinicians (mental health specialists and general medical providers) were identified using a two-stage screening procedure including the Diagnostic Interview Schedule. The course of depression was assessed in 2 follow-up years with a structured telephone interview based on the format of the Diagnostic Interview Schedule. Baseline severity of depressive symptoms was greatest in patients with double depression, but initial functional status was poor in those with dysthymia with or without concurrent major depression. Patients with dysthymia had the worst outcomes, those with current major depression alone had intermediate outcomes, and those with subthreshold depressive symptoms had the best outcomes. Even the latter group, however, had a high incidence (25%) of major depressive episode over 2 years. Initial depression severity and level of functional status accounted for more explained variance in outcomes than did type of depressive disorder. The findings emphasize the poor prognosis associated with dysthymia even in the absence of major depression; the prognostic significance of subthreshold depressive symptoms; and the clinical significance of assessing level of severity of symptoms as well as functional status and well-being, regardless of type of depressive disorder.
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Major depressive disorder is associated with considerable morbidity, disability, and risk for suicide. Treatments for depression most commonly include antidepressants, psychotherapy, or the combination. Little is known about predictors of treatment response for depression. In this study, 681 patients with chronic forms of major depression were treated with an antidepressant (nefazodone), Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or the combination. Overall, the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment. Among those with a history of early childhood trauma (loss of parents at an early age, physical or sexual abuse, or neglect), psychotherapy alone was superior to antidepressant monotherapy. Moreover, the combination of psychotherapy and pharmacotherapy was only marginally superior to psychotherapy alone among the childhood abuse cohort. Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma.
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Objective: The authors compared the effectiveness of 50 sessions of schema therapy with clarification-oriented psychotherapy and with treatment as usual among patients with cluster C, paranoid, histrionic, or narcissistic personality disorder. Method: A multicenter randomized controlled trial, with a single-blind parallel design, was conducted between 2006 and 2011 in 12 Dutch mental health institutes. A total of 323 patients with personality disorders were randomly assigned (schema therapy, N=147; treatment as usual, N=135; clarification-oriented psychotherapy, N=41). There were two cohorts of schema therapy therapists, with the first trained primarily with lectures and the second primarily with exercises. The primary outcome was recovery from personality disorder 3 years after treatment started (assessed by blinded interviewers). Secondary outcomes were dropout rates and measures of personality disorder traits, depressive and anxiety disorders, general psychological complaints, general and social functioning, self-ideal discrepancy, and quality of life. Results: A significantly greater proportion of patients recovered in schema therapy compared with treatment as usual and clarification-oriented psychotherapy. Second-cohort schema therapists had better results than first-cohort therapists. Clarification-oriented psychotherapy and treatment as usual did not differ. Findings did not vary with specific personality disorder diagnosis. Dropout was lower in the schema therapy and clarification-oriented psychotherapy conditions. All treatments showed improvements on secondary outcomes. Schema therapy patients had less depressive disorder and higher general and social functioning at follow-up. While interview-based measures demonstrated significant differences between treatments, differences were not found with self-report measures. Conclusions: Schema therapy was superior to treatment as usual on recovery, other interview-based outcomes, and dropout. Exercise-based schema therapy training was superior to lecture-based training.
Chapter
Concluding Thoughts;Dutch Handbook of Schema Therapy;Schema Therapy;Schema Therapists;patients;less distortion;The Gift of Therapy
Article
The history and description of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) is presented. The SCID-II is a clinician-administered semistructured interview for diagnosing the 11 Axis II personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, pins the Appendix category self-defeating personality disorder. The SCID-II is unique in that it was designed with the primary goal of providing a rapid clinical assessment of personality disorders without sacrificing reliability or validity. It can be used in conjunction with a self-report personality questionnaire, which allows the interview to focus only on the Items corresponding to positively endorsed questions on the questionnaire, thus shortening the administration time of the interview.
Article
Until recently few empirically supported treatments for patients with personality disorders were available. Schema Focused Therapy (SFT) has recently shown efficacy in (non-forensic) outpatients with Borderline Personality Disorder, raising the question if it may also be effective in forensic PD patients. For the past two years, we have been collaborating with Dutch forensic hospitals to adapt the SFT approach to meet the challenges posed by this population. In this article, we present our forensic modification of the SFT theoretical model, and make recommendations for the implementation of SFT in forensic clinical practice.
Article
Schema therapy (ST) is an integrative treatment approach to chronic lifelong problems with an established effectiveness for treating personality disorders. This article describes the adaptation of ST to chronic depression by reviewing the literature on the underlying risk factors to chronic depression. A model of chronic depression is presented, describing the interplay between empirically supported risk factors to chronic depression (early adversity, cognitive factors, personality pathology, interpersonal factors). We provide a treatment protocol of ST for chronic depression describing techniques that can be used in ST to target these underlying risk factors. Based on the current body of empirical evidence for the underlying risk factors to chronic depression, ST appears to be a promising new treatment approach to chronic depression, as it directly targets these underlying risk factors.
Article
The Temple-Wisconsin Cognitive Vulnerability to Depression (CVD) project is a two-site, prospective longitudinal study designed to test the etiological hypotheses of two cognitive theories of depression: Hopelessness theory (Abramson, Metalsky, & Alloy, 1989; Alloy, Kelly, Mineka, & Clements, 1990) and Beck's theory (Beck, 1967, 1987). In this article, we provide an overview of the CVD project, including the conceptual background, goals, rationale, and design of the project, as well as a description of the project sample and assessment methods. Separate articles will present empirical findings from the project.
Article
the course and natural history of chronic depression is described and its definition expanded to differentiate chronic major depression, dysthymia, and double depression [having both major depression & dysthymia] / discusses recent data on course, chronicity, recurrence, relapse, and predictors of outcome in patients suffering from chronic depression, dysthymia, and double depression / many of the data come from the National Inst of Mental Health . . . Collaborative Depression Study . . . , a prospective, naturalistic study of over 955 depressed patients who sought treatment at 1 of 5 study sites nationwide [Massachusetts, Chicago, Iowa, New York, and Missouri] / recent data from the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) . . . Mood Disorders Field Trial, which was designed to assess the relationship between major depression, dysthymia, minor depression, and depressive personality disorder, is presented (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Argues that C. B. Ferster (see record 1974-11260-001) failed to recognize some significant clinical subtleties in his functional analysis of depression. Therapists' failure to distinguish symptomatology in depression may be potentially dangerous. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This book discusses schema-focused therapy, an integrative approach . . . to treat characterological patients including borderline, narcissistic, avoidant, dependent, obsessive-compulsive, passive-aggressive, and histrionic personality disorders. . . . [This] model is [an] integration of cognitive behavior therapy with gestalt, object relations, and psychoanalytic approaches. It expands on conventional cognitive behavior therapy by placing more emphasis on the therapeutic relationship, affective experience, and the discussion of early life experiences. In addition to presenting the rationale, theory, and practical techniques of schema-focused therapy, this book includes an extended case example, and revised editions of the Schema Questionnaire, Client's Guide, and schema listings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)