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  • River of Life Method: A Technique for Group Schema Therapy

    Jan Praško
    Marie Ociskova

    The River of Life Method is a novel technique for group schema therapy that uses the metaphor of a river of life to help patients visualize and understand their life story and their schemas. The River of Life Method can enhance the effectiveness and efficiency of group schema therapy by fostering self-awareness, empathy, validation, and change. The workshop is suitable for therapists who are interested in learning more about group schema therapy and the River of Life Method. In this workshop, we will introduce the practical steps and the clinical applications of the River of Life. We will cover the following topics: • The theoretical background and rationale of the River of Life Method • The structure and process of the River of Life Method • The role and skills of the therapists and the helpers in facilitating the River of Life Method • The benefits and challenges of using the River of Life Method in group schema therapy The workshop will also include experiential exercises to illustrate the use of the River of Life Method.

  • Coping Modes in Disguise: Working with ‘Pseudo Vulnerability’.

    Limor Navot
    Susan Simpson

    One of the superpowers of schema therapy is reparenting. It is the depth of warmth, nurturance, and attunement we provide that helps heal our client’s schemas. But what happens when we unwittingly fall into the trap of reparenting a coping mode?

    Some coping modes can present a ‘false’ presentation of vulnerability. They can elicit powerful countertransference dynamics within us and the teams we work with. We can find ourselves with long-term clients who seem stuck, without any real work happening, and with no end point in sight. Other signs may include guilt feelings, an urge to find solutions, to work harder, or to ‘rescue’ our clients from their suffering and despair.

    These modes do not want to be challenged and are very powerful in disarming us from using empathic confrontation techniques. We may find ourselves tip-toeing around due to fears that the client is too fragile or that we are harming them. In this skills class, we will learn how to tell the difference between genuine child modes and pseudo vulnerability modes (among which, Complaining Protector, Attention/recognition seeking, Self-pity/victim, and a new mode: Helpless Surrenderer).

    We will demonstrate the

  • All you need is positive schema therapy: positive schemas and related interventions across the adult life span

    Abstract: **Please click on the speakers to check the individual presentations included in the symposium

    Early maladaptive schemas (EMS) are considered core elements of schema therapy. Early adaptive schemas (EAS) or positive schemas have gained more attention recently. Like EMS, EAS consist of persistent patterns of information processing, thoughts, emotions, memories, and attention preferences. However, these EAS serve positive functions and give rise to adaptive behaviour, and they emerge during childhood, when one’s core emotional needs are adequately met by parents or other primary caregivers. In this symposium we discuss recent research and clinical advances in working with positive schemas. First, Anne-Marie Claassen will discuss the results of a scoping review into EAS and healthy modes in schema therapy. Next, Jenny Broersen will examine the clinical relevance of combining schema therapy with positive schemas and positive interventions for adult outpatients. She will share the findings from two case studies and discuss the outcomes and experiences of adult outpatients. Machteld Ouwens will present the psychometric aspects of the Dutch Young Positive Schema Questionnaire (YPSQ-NL) in a large and representative panel of the Dutch population (N=650, age 18 to 80 years old). Finally, Loes van Donzel will discuss findings of her study into an adapted form of schema therapy that included interventions to reactivate positive schemas in older adults with cluster C personality disorders. She will present quantitative results from a multiple baseline case series design among nine older persons (age > 60 years) with cluster C personality disorder who were treated with modified schema therapy. After follow-up, participants were interviewed about their experiences with this modified schema therapy, and therapists were interviewed in a focus group.
    1. Positive schemas and healthy modes in schema therapy: a scoping reviewAnne-Marie Claasen
    2. Working with positive concepts in schema therapy: what are the experiences of adult outpatients?Jenny Broersen
    3. The Young Positive Schema Questionnaire: psychometric propertiesMachteld Ouwens
    4. Working with positive schemas in schema therapy with older adults: effects and experiencesLoes van Donzel
  • Outdoor Intensive Programme for A Male Veteran With Combat PTSD As Well As Early Childhood Trauma, Post Deployment Trauma And Addiction Issues

    Michael Mo

    This case study examines challenges in working with military veterans who are difficult to engage and hard to experience Healthy Adult, by introducing intensive working and outdoors. The idea of using intensive working allows the client to truly exploring trauma in an unrushed way, which is considered as a quality of a healthy adult. The therapy was also delivered entirely outdoors, which allowed the client to draw upon the power of nature and safety, both of which were important for veterans who appreciate such through their combat training, and again, this further encouraged the establishment and integration of healthy adult in the client in a much efficient way. The study highlights the challenges and successes of the treatment, showing light on effective strategies for managing complex trauma treatment in military veterans that went beyond the traditional PTSD treatment protocols outside Schema Therapy community.


    Complex Post-Traumatic Stress Disorder (CPTSD) that is caused by both combat trauma and early life trauma due to adverse childhood experience (ACEs) has a higher rate in military veterans, particularly men, than general population (Blosnich et al 2014). An early 2000 meta analysis showed that up to 79% of treatment seeking veterans for PTSD in an in patient unit also would have a comorbid personality disorder (Bollinger et al 2000). This makes treatment of PTSD in veterans using standard therapy approaches a complex matter. Traditional treatment protocols all focus on the trauma narratives, with few making references or dedicating appropriate time to address anything outside combat trauma. By using Schema Therapy approach, this would allow the therapists and clients to address the symptoms of PTSD as part of their maladaptive coping mode network. This approach then will allow the client to truly heal from the inside out. However, conventional delivery of therapy, 1-1.5 hours a time, done on a weekly basis, and inside a clinical room, can become an obstacle for veterans seeking help. The culture of veterans: being in a tight unit with others all the time, physical trainings and appreciating outdoors etc demand therapists be creative in creating conditions that will meet such needs. In addition, guild and shame caused by moral injuries can make them feel even more ashamed when they attend therapy, especially at a clinical room, which remind them of being disciplined in the military. Usually, it takes a long time for therapists to gain the trust and later encourage healthy adult within veterans. Veterans have higher drop out rate than general population, and many cited these as the reasons for them to feel less trusting of the process. This case study wished to highlight an alternative to get to the vulnerable child and encourage quicker establishment of healthy adult by giving them what they are looking for in the journey.

    Patient Presentation:

    Mr. A, a 37-year-old male, presented with recurring nightmares, flashbacks, and heightened anxiety, as well as active suicidal thoughts, anger outbursts and addictive behaviours with alcohol and heroine. He reported experiencing several traumatic events during his military service overseas, which led to him being referred to my team, veterans NHS Wales, for treatment. However, upon assessment, he reported a history of family violence perpetrated by both parents towards each other and towards him, as well as exposure to alcohol from a young age (first given alcohol as a toddler by a baby sitter, and later recalled given wine aged 8 by parents. He also suffered from bullying after deployment by senior officers in the military for years, and started to use alcohol and heroine as coping method. At the time of us starting his treatment, he was reported to be actively suicidal as well as displaying destructive behaviours that showed traits of Anti Social Personality Disorder.


    Treatment for Mr. A went beyond conventional CBT, EMDR, CPT, prolonged exposure and narrative exposure, all of which could be delivered within the service. I chose to use Schema Therapy for him due to his complexity and we saw his combat trauma symptoms being part of his maladaptive modes (punitive critic, detached self soother, avoidant protector, anger protector, etc) . I used intensive treatment programme, delivering a course of therapy with initial six 1.5-hour sessions for assessment/education, and followed by 4 days of 8-hour sessions delivered in two of my local national parks, and wrapped up with 2 follow-up sessions to monitor progress. The four 8-hour days were spaced out into weekly appointments, instead of being delivered over four days. The first 8-hour day was three weeks from the last 8-hour day. The delivery of therapy (on each day) consisted of 1 hour of experiential approach (using either imagery rescripting or “standing up chair work” – chair work delivered whilst the client was asked to stand in different positions instead of sitting down, and in vivo Mindfulness practice to draw upon the nature to inspire Healthy Adult) followed by 30 minutes of hiking/climbing whilst I engaged the client for consolidation of learning from the experiential time, allowing the client to use me as external reasoning board to further synthesize healthy adult responses. Outcome: Following the delivery of therapy, a total 40 therapy hours, delivered over 2 months period Mr. A showed significant improvement. He reported a reduction in nightmares, fewer flashbacks, and an increase in sleep quality. His hypervigilance diminished, and he began to engage in social activities. He also stopped taking heroine and drinking alcohol all together (same reduction of symptoms and abstinence of alcohol and drugs reported in his 1 month follow up and 6 months follow up).


    – The use of intensive treatment is not new and is currently gaining recognition around the world. Same as nature based/outdoor therapy sessions being used with veterans suffering from PTSD. However, the combination of both in a structured way is less talked about. This is one of the latest “up and coming” trends in therapy world and I would like to see more Schema Therapists doing so. I believe this helps to improve the healthy adult in the clients and by-pass the avoidant protector earlier.

    – The use of Schema Therapy is effective in treating complex trauma and personality disorders, but on average, it takes a long time for therapists to get pass the detached protector, or to encourage internally established healthy adult (where the significant change happen is when clients start using healthy adults themselves in experiential works). Conventional approach – 1 hour sessions weekly – sometimes can also lead to drop out due to perceived lack of progress or change of personal circumstances.

    – Working with veterans, therapists must be able to identify their cultural needs, instead of approaching the same way as general population, and working with these military culture will enhance their experience. Downside:

    – Not everyone can do this, some do find it too overwhelming, or physically too challenging for them. High demand on therapist’s ability to stay focused on the journey, as there is no way to take notes in the traditional way.

    – Therapy drift: treating this as a day out instead of a day of therapy Conclusion: This case study highlights the successful treatment of CPTSD in a male military veteran using an intensive treatment programme, delivered outdoors, over a period of 2 months. This is just one of a cohort of clients that I have worked with in such way and almost all experience success. Further research is encouraged on this. Furthermore, moving away from conventional trauma treatment approaches, using ST, will help deeper healing in a person, rather than just symptoms.


    Bollinger, A. R., Riggs, D. S., Blake, D. D., & Ruzek, J. I. (2000). Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 13(2), 255-270. Blosnich, J. R., Dichter, M. E., Cerulli, C., Batten, S. V., & Bossarte, R. M. (2014). Disparities in adverse childhood experiences among individuals with a history of military service. JAMA psychiatry, 71(9), 1041-1048.

  • Individual Schema Therapy for Highly Sensitive Patients: Building Resilience Through Differential Susceptibility

    Rachel Samson
    Aoife Durcan

    We will present a comprehensive approach to using Schema Therapy with highly sensitive patients to promote resilience and flourishing. It is estimated that around 30% of the population are highly sensitive. High sensitivity is considered to be a heritable and evolutionarily conserved temperament trait presenting equally in males and females and observed in over 100 species of non-human animals. The scientific term for high sensitivity is sensory processing sensitivity (SPS). Research shows that SPS is a continuous temperament trait with people falling somewhere on the sensitivity continuum between low sensitivity and high sensitivity. High SPS is thought to be a phenotypic marker of a higher susceptibility to environment influence. Highly sensitive people tend to be more aware of information in their environment and process this information on a more complex level than most people, which is believed to affect the way they think, learn, plan, and experience the world. Highly sensitive individuals across species have been found to be more sensitive to their environment.

    Research has shown that in stressful and unsupportive early environments, highly sensitive children may have poorer developmental outcomes and an increased likelihood of experiencing behavioural disturbance and psychological difficulties (e.g., anxiety, depression) in childhood and later life. In contrast, in supportive and highly nurturing early environments, those who are highly sensitive have the capacity to flourish and may have better developmental trajectories than less sensitive individuals (e.g., enhanced emotional wellbeing, greater social competence).

    In addition to addressing maladaptive schemas and modes stemming from unmet needs in childhood, highly sensitive adults can learn to modify both their behaviour and the environment in ways that promote resilience and uncover the “bright side” of differential susceptibility. It has been argued that psychotherapy represents a supportive environment that highly sensitive clients are disproportionately likely to benefit from over and above less sensitive clients.


    The ST model assumes that temperament plays an important role in the acquisition of maladaptive schemas and modes and, consistent with this, updated case conceptualisation forms explicitly invite consideration of temperament in the patient’s presentation. However, in general, it has been argued that too little weight is given to temperament in the context of psychotherapy (Aron 2012). This workshop will demonstrate how schema therapy is uniquely positioned to meet the needs of highly sensitive patients. In this workshop, Schema Therapists will:

    • become familiar with differential susceptible paradigm and how we can leverage client temperament to build resilience;

    • learn how to utilise psychoeducation and temperament counselling to (a) empower patients to understand the physical and emotional needs associated with high sensitivity, and (b) modify the environment in ways that reduce stress and promote resilience;

    • learn how to incorporate the patient’s sensitivity beyond conceptualisation to all aspects of treatment, including cognitive, behavioural, and experiential techniques. Detailed case examples, and video examples of themes, concepts and interventions will be provided. There will be opportunities for discussion and role plays.

    Target audience: Suitable for all levels.

  • From Reparenting to Self-Parenting: Concept, Skills and Pitfalls

    Jeffrey Young repeatedly pointed out the importance of helping the patient become a good parent to themselves. The reparenting relationship aims to develop this healthy self-relationship, which provides safety to the Vulnerable Child by meeting its emotional needs and thus enables the patient to reconnect with their adult side.

    In the workshop we will take a closer look at the modes involved, their attributes, development tasks, and how they relate to one another. A self-parenting depiction will be used in order to illustrate mode interactions, challenges and intervention possibilities. Furthermore, applying a particular parent-child narrative will be suggested as a framework.

    Adequate self-parenting as a goal of therapy will be specified and expanded on by proposing three central areas of responsibility regarding the self-parenting work of the Healthy Adult, which I abbreviate as NEED: (1) Nurturance and Enjoyment: e.g. being a caring and value-oriented parent for the Vulnerable Child in everyday life and evolving a positive, grateful and appreciative “inner family climate”, (2) Emergency care: attention and understanding in the case of schema activation, addressing the Vulnerable Child’s emotions and coping impulses, and (3) Decision making from a good parent’s perspective, keeping in mind adult reasons, but also the needs and “wounds” of the Vulnerable Child, their healing capacity and their actual limits. In addition, we will reflect on ways to strengthen the Vulnerable Child’s confidence in being seen, valued and cared for by the grown up. Frequent challenges will be discussed.

    In regards to our reparenting work as a means to achieve this goal, we will take important individual differences in account, that may lie beyond schemas, but still affect attachment. Even “little” things like a therapist’s warm, soft tone of voice can be soothing for one patient and triggering for another. However, especially the “big” things, such as the limit setting style, can have vastly different effects on clients. Not considering those differences can lead to subtle misunderstandings and even subconscious countertransference. Two cases will be presented and compared, according to the above-mentioned depiction. They will outline frequent differences we should be aware of and take to a conscious level. Moreover, we will reflect on their caregiver’s coping modes and consider the presumed influence on the patient’s early attachment experiences and current attachment problems. We will then derive individual reparenting and self-parenting suggestions from that.

    Participants are invited to reflect on some of their own childhood experiences, relationship patterns and their Vulnerable Child, if they want to. It would be great if you bring a personal picture with you where you are 3 to 6 years old, ideally looking at the camera, the format being big enough to clearly see the child’s eyes.

  • Can Religious Faith Be Incorporated into Schema Therapy to Increase Resilience?

    Arinobu Hori
    Tara Cutland
    Ahmed Mahmoud
    Oksana Martsyniak-Dorosh


    85% of the world’s population is estimated to identify with a religion. However, there can be a disparity between the prevalence of religiosity in a country’s general population and its population of psychologists and psychotherapists. For example, Delaney et al (2007) found that in the USA, 75% of the public but only 35% percent of psychologists surveyed agreed that their approach to life is based on their religion. As additionally, religious and spiritual issues and resources are rarely covered in therapy training, we suggest that it is likely that many therapists do not feel equipped to integrate religious clients’ faith into the therapy they offer. Yet this may be an untapped resource that is highly relevant to many clients; empirical studies now point up the role that religious faith plays in increasing psychological wellbeing and resilience (e.g., Koenig, 2012). Some studies attempt to unpack why this is (e.g. Schwalm et al 2021; Cutland, 2000). Distinctions have also been made in the literature between positive and negative religious coping. One study found that positive religious coping reflects a secure relationship with a transcendent force, a sense of spiritual connectedness with others, and a benevolent worldview (Pargament, 2011). Whilst various elements of faith can be important, based on personal and clinical experience as well as research (e.g., Leman et al 2018), Round Table Discussion’s theistic panellists regard attachment relationship with God as central. However, in Buddhism this is not the case and different mechanisms such as fostering a sense of responsibility and agency may be relevant (see e.g., Laurent et al 2021). Practices such as meditation, gratitude and a sense of belonging in a faith community may also be important, irrespective of the specific faith. Tara, Ahmed, Oksana and Arinobu are experienced in actively incorporating aspects of Christianity (Protestant and Catholic), Islam and Buddhism into Schema Therapy with religious clients. They work in different cultural contexts: the UK, the Middle East (UAE and Egypt), Ukraine and Japan.


    Panellists will share their perspectives on incorporating clients’ faiths into Schema Therapy assessment, formulation and change methods, referring to research findings where relevant. They will describe examples of how faith has strengthened and empowered clients’ Healthy Adult modes and increased resilience through Schema Therapy methods. They will also address how aspects of faith may impede the development of resilience and present in maladaptive schemas and modes. Part-way through the session the audience will be invited to form small groups to discuss and reflect on the topics have been raised. There will then be ample opportunity for the audience to ask questions to address issues and generate further discussion of relevance to them.


    We aim to equip delegates with greater understanding of and ideas regarding how clients’ religious faith can be actively incorporated into Schema Therapy to enhance healthy need-meeting and bolster the Healthy Adult, resulting in increased resilience and schema healing. Delegates will also grow in their awareness and understanding of different cultural contexts and the relevance of these in developing resilience.

  • New Tools and Strategies for Developing Positive Schemas and Modes in Work with Challenging Patients

    George Lockwood

    In this workshop you will learn ways of increasing your effectiveness in developing positive schemas, adaptive child modes and the Healthy Adult Mode in work with complex PTSD and other challenging cases. You will first learn how to expand the scope and depth of your case conceptualization to more fully establish the foundation these adaptive capacities are built upon. You will then learn how to use this understanding to expand a range of strategies, including imagery rescripting, to more directly engage positive child modes and develop positive schemas. This positivity is most fully leveraged within a therapeutic relationship that is drawing upon 8 dimensions of limited reparenting as operationalized in the recently developed Limited Reparenting Inventory (LRI). You will learn what these dimensions are and how to embody them. We will start with an expansion of the assessment of functioning in 5 major life areas included in the current ISST Case Conceptualization Form that includes an additional 6 areas that have strong links to optimal brain functioning and emotional well-being. An overview will be provided of key research findings demonstrating the strength of their impact. Practical guidelines for incorporating them into reparenting will be presented and guidance offered for how to increase your own functioning in each of these areas; a necessary precursor to helping your patients with this. Next a framework and set of tools for a comprehensive assessment of temperament will be provided that includes measures of adult temperament, sensory processing sensitivity and a newly developed measure of retrospective child temperament will be outlined and the ways these inform the development of positive schemas and modes will be discussed. An expansion of the framework for assessing early childhood and adolescence will be provided that helps to identify strengths by clarifying both the ways parents fell short and what they did well. How this is facilitated through the use of the PPSI and YPI-R3, tools to assess adaptive and maladaptive parenting, will be outlined. A set of 8 core emotional needs, a refinement and expansion of the current 5 postulated by Young, will be described, the nature of their empirical support discussed and the ways this refinement helps in developing positive schemas and modes discussed. A framework for the systematic assessment of both negative and positive schemas and the use of the LRI in assessing the quality and strength of the reparenting relationship and in guiding treatment and will be presented. Finally, an overview of the newly emerging frameworks for understanding our most complex mode, the Healthy Adult will be provided and what they tell us about what it is and how to develop it most fully will be discussed and demonstrated. Case examples demonstrating the conceptualization process and the use of these new concepts, tools and frameworks over the course of a full treatment will be presented. This will include video taped examples, experiential exercises, role plays and opportunities for supervised practice of some of the key skills.

  • How bringing your inner child on the stage makes you a better adult – applied improvisation theatre in clinical settings to prompt healthy modes

    In Schematherapy we usually try to challenge the inner critic voices of the patient by highlighting its self-destructive nature, but often adversely face the patient clinging onto the critic modes while demonstrating fear to loose control and furthermore lacking openness and flexibility to try out new and more adaptive behavior. Hence supporting the patients basic need for spontaneity and play is enhancing their capacity to tolerate feelings of discomfort while giving up the feeling of control associated with staying in their old pattern. Improvisation theatre is a multi-functional method to enable the patient to experience healthy modes behavior through “as-if-games” whilst evoking joyfulness as a benefit same time. Basic mindfulness principles that are needed in building up the healty adult modes are also learnt in a playful manner: cognitive flexibility and impulse control are enhancing the autoexecutive functioning, Letting go of judgement and expectations are enhancing the tolerance for frustration and mistakes (which is antagonistic to the inner critic). But also the social and emotional competencies needed for healthy adult behavor in social interactions are trained: being mindful of others whilst being present within oneself enable feelings of cohesiveness and coherence in the patient, subsequently generating self-efficacy and fulfilling the basic need of coherent self. A more contemporary (but not limited to) benefit is the training of an „adaptive mindset“: Patients nowadays feel more and more threatened by a quickly changing world around them both on a personal as well as a geopolitical level. Dealing with this so called “VUCA”-world (VUCA: Our world becomes increasingly Volatile, Uncertain, Complex and Ambiguous) or “BANI”-world (BANI: We perceive our surroundings as increasingly Brittle, inducing Anxiety, Non-linear and Incomprehensible) often activates vulnerable child modes as well as maladaptive coping modes. An “improv-mindset” can help to cope with seemingly overwhelming surroundings by developing and strengthening an healthy adult or healthy parent attitude towards uncertainty, complexity and perceived loss of control.

  • Integrating Voice Dialogue, IFS & Positive Psychology with Schema Therapy for Healthy Modes

    Edward Chan

    Schema Therapy, with its formulation of multiple modes, has in common with some other psychotherapy modalities that view the person as having multiple parts, such as IFS (Internal Family System) (Swartz, R, 2017; 2021) and Voice Dialogue (Stone, H and Stone, S,1998). The modes and Schema in Schema Therapy are mostly considered as maladaptive and need to be rescripted or changed to healthy ones. There is, however, little specification on the healthy mode and schema. The Voice Dialogue model, on the other hand, does not view the parts as maladaptive, and the therapy involves developing an awareness, thereby allowing the client to make a healthy choice of choosing the best part for a given situation. There is also scant specification in the Voice Dialogue model on how this healthy choice of the parts is to be made, and there is an inherent assumption of a healthy “aware ego” to be able to make this choice with increased awareness of the different parts, just as in IFS there is an assumption of a healthy self that can lead the parts or selves towards a healthy outcome. This presentation explores how insights from Positive Psychology such as the Happiness principles expounded by Brooks and Winfrey in: Build the Life you want, The Art and Science of getting Happier. (2023), can be utilised conceptually to facilitate the therapeutic process of Voice Dialogue and Schema Therapy in a modified model whereby all the parts can be validated, accepted, and selected based on the happiness principles for any given situation to facilitate a healthy selection of modes leading to a healthy and happier (ibid.) outcome for clients.

    Target Audience: Intermediate-Advanced level

  • Comparing the efficacy of cognitive-behavioral therapy with the treatment of allegorical schema modes on psychotherapists burnout

    Mohammad Faghanpour Ganji


    Job burnout is one of the psychological problems that threaten therapists. This problem can lead to a decrease in service quality. Cognitive-behavioral therapy and paradigmatic schema mentalities therapy are two intervention methods that have been proposed to deal with job burnout. Both intervention methods have their advantages and limitations. Therefore, comparing the effectiveness of these two methods on job burnout in therapists is necessary and necessary research. Aims: The main purpose of the present study was to compare the effectiveness of treatment of allegorical schema modes with cognitive behavioral therapy on therapists’ job burnout.


    The method of the current research is of semi-experimental type and the statistical population consisted of psychotherapists of therapeutic centers in the 3rd district of Tehran who were engaged in therapeutic work between December 2021 and December 2022. To select the sample size according to the research method, 15 people were selected for each group. In order to evaluate the variables of the research, the job burnout questionnaire of Moslesh and Jackson (1993) was used.


    The findings showed that the F rate of the effect of the treatment of allegorical schema modes was not significant on the variable of emotional exhaustion and sense of success, and it was significant on the variable of depletion. Also, the F rate of the effect of cognitive behavioral therapy on the variable of emotional exhaustion and depletion was not significant, and it was significant on the variable of feeling of success.


    Based on the results of the present study, the effects of treatment methods on burnout scores did not fluctuate much in both and both were equally effective in this variable. It seems that both treatment methods are effective in reducing therapists’ burnout. Therefore, it is expected that policy makers in the field of mental health will invest and promote such approaches to improve the health of psychotherapists.

  • Exploring the ``Parent Mode`` Dynamics in Japanese Clients: Struggles in Externalization, Criticism, and Overcoming Techniques

    Arinobu Hori


    After more than two decades as a psychiatrist in Japan, the author undertook the study of Schema Therapy. While recognizing its effectiveness in Japanese clinical settings, challenges arose when applying the recommended “Mode Model” from Schema Therapy textbooks for certain clients. This study aims to elucidate these challenges and offer potential adjustments for more effective therapeutic interventions.


    Observational analysis was conducted on clients who demonstrated resistance to the standard practices of Schema Therapy. Specifically, the study focused on clients’ responses to the externalization of the “Parent Mode” and their reactions to its negative messages.


    Several clients found it challenging to externalize the punitive and demanding facets of the “Parent Mode,” perceiving the associated negative messages as inherently their thoughts and voices. This was accompanied by significant resistance to distancing and critically examining these messages. Many exhibited what appeared to be manifestations of the Enmeshment Schema, where the Parent and Child Modes were fused, and the Healthy Adult Mode’s function was notably fragile. Furthermore, therapeutic interventions that aimed at promoting differentiation occasionally elicited paranoid-like pushbacks. This phenomenon was thought to be deeply influenced by Japanese societal values, where the concept of individual importance is not yet mature, and there’s a pronounced tendency to prioritize alignment with collective groups and authority.


    To address these client tendencies, a modified approach proved effective. Initially using less confrontational terminology than “Punitive and Demanding Parent Mode” and emphasizing the importance of transitioning from an “all-good” worldview to one accepting the “bad” seemed beneficial. Experiential techniques to strengthen the Healthy Adult Mode that challenge the Parent Mode were used cautiously. This tailored approach underscores the need for flexibility and cultural sensitivity in applying Schema Therapy techniques.

  • The mediation role of self-compassion in the link between early maladaptive schemas and perseverative thinking in depression

    Paweł Holas

    In prior research, it was established that the severity of depressive symptoms is positively correlated with early maladaptive schemas (EMSs) and inversely associated with self-compassion and trait mindfulness in the general population. Additionally, perseverative thinking, manifested as rumination and worrying, has been identified as a transdiagnostic risk factor related to depression. However, there is a limited understanding of the connection between EMSs and perseverative thinking in major depression and the mediating mechanisms of their interaction.

    Therefore, the objective of our current study was to investigate the intricate relationship between EMSs, self-compassion, mindfulness, and perseverative thinking in major depression. To achieve this, we administered questionnaires assessing these variables to 60 depressed women (MDD), diagnosed based on the Mini-International Neuropsychiatric Interview, and to 36 healthy women as control subjects (SC). Moderated mediation analysis, considering group membership (HC or MDD), was performed using Hayes’ Process macro (2018) in model no. 59.

    The findings revealed significant positive associations between EMSs and perseverative thinking, and negative associations with trait mindfulness and self-compassion. Importantly, self-compassion, in contrast to mindfulness, which was found to be insignificant, was identified as a full mediator in the relationship between EMSs and perseverative thinking. These results underscore the importance of incorporating techniques that enhance self-compassion skills in depressed individuals with increased early maladaptive schemas

  • How does culture shape the way we define what is healthy in schema therapy?

    Michelle Neo
    Edward Chan
    John Louis
    Beatrice Ng-Kessler
    Chaiyun Sakulsriprasert
    Duygu Yakin

    The majority of schema therapy research is rooted in Western contexts, resulting in clinical samples that are largely representative of Western populations. In the Delphi consensus study, Pilkington and colleagues (2022) identified the important gaps in research on the schema therapy model with two areas of concern relating to the need to expand research to “people who are from racial and ethnic minorities” and “adapting schema therapy to different cultures.” Currently, there are few papers that have examined schema therapy within Asian populations, however, the existing findings do reflect the universality of both positive and negative schemas when compared across different cultures (Louis et al., 2018) and that with cultural modifications (whilst preserving the integrity of the schema model) it is an appropriate therapy for Asian clients (Mao et al., 2022). Unfortunately, the investigation of schema therapy across Asian demographics remains limited due to challenges such as difficulty in participant recruitment, resource constraints, complexities in the translation of schema terminology, and a shortage of trained schema therapists in the Asian region. This Round Table will tie into the conference theme “How Schema Therapy Empowers Healthy Modes” by exploring the question “How does culture shape the way we define what is healthy in schema therapy?” with an emphasis on the exploration of what healthy schemas and modes can look like in Asian populations (versus non-Asian/Western populations). Our discussion will explore the intersection of schema therapy principles and Asian cultural values including how the definition of “healthy” may present differently in a Western vs. Eastern context, how schemas and modes may present differently across cultures, the potential issues that may arise when culture is not factored in schema formulation and how certain cultural concepts (e.g. filial piety) may pose challenges for shifting coping modes (e.g. compliant surrenderer). Each of our panellists will share their unique thoughts and experiences in their application of schema therapy within Asian populations across both research and clinical settings. References Louis, J. P., Wood, A. M., Lockwood, G., Ho, M. H. R., & Ferguson, E. (2018). Positive clinical psychology and Schema Therapy (ST): The development of the Young Positive Schema Questionnaire (YPSQ) to complement the Young Schema Questionnaire 3 Short Form (YSQ-S3). Psychological Assessment, 30(9), 1199-1213. Mao, A., Brockman, R., Neo, H. L. M., Siu, S. H. C., Liu, X., & Rhodes, P. (2022). A qualitative inquiry into the acceptability of schema therapy in Hong Kong and Singapore: implications for cultural responsiveness in the practice of schema therapy. Clinical Psychologist, 26(3), 341-350. Pilkington, P. D., Younan, R., & Karantzas, G. C. (2023). Identifying the research priorities for schema therapy: A Delphi consensus study. Clinical Psychology & Psychotherapy, 30(2), 344–356.

  • A patient-therapist attempt to deal with affect fobia and transgenerational messages using ST and EMDR

    Michiel van Vreeswijk

    A case of a woman in her thirties with a recurring depression, transgenerational issues, Emotional inhibition, Unrelenting standards, Detached protector, Demanding and Punitive parent (collectively introduced as the Undermining mode) is presented. The patient has had individual and group therapy in the past which has helped her to become depression free when she was discharged. After some time she comes back in need of some more therapy as she does not feel free to live her life as her little child mode would like to live. Some booster sessions with chair techniques are helpful but not enough. As a shared decision it is decided to do an experiment with EMDR in which she is trained by the therapist. She keeps track of how she implements it and both therapist and patient try to refine the process. In this case presentation, in which the patient is actively involved, the patient and I present the intervention based on observation and collected data, share our findings and ideas. We also discuss the process of collaboration to this point of the presentation and how it can be helpful to strengthen the Healthy adult and possible pitfalls.

  • Working with horses in schema therapy: Equine-assisted schema therapy to empower healthy modes

    Alexandra Schosser

    Equine-assisted psychotherapy (EAP) is a form of therapy that incorporates horses to treat human psychological problems in and around an equestrian facility. It is not the same as therapeutic riding or hippotherapy, thus participants do not go on horseback. Instead, the horse(s) are usually unsaddled and free to move closer or farther away from the client, and vice versa. EAP can be an effective supplement to mental health treatment, including schema therapy. The incorporation of animals in mental health treatment has a long history, and animal-assisted psychotherapy can be an evidence-based complementary treatment to traditional psychotherapy. Animals can aid in healing emotional and behavioural conditions. They can provide a source of comfort, consistency and mutual nurturance, giving support to both the mind and the body. Horses can help people with their well-being and nurturing interactions with horses allow humans to practice, among others, emotional regulation, problem-solving skills, social skills and empathy. Horses also sense our emotions and mirror them back, offering people a way to talk about their own emotions without feeling as overwhelmed or judged. EAP can be used for a variety of mental health conditions including depression, PTSD, generalized anxiety disorder, substance abuse, social anxiety disorder, ADHD, or autism. Working with horse(s) can be a helpful supplement in schema therapy, e.g. for emotional activation, diagnostic clarification, mode awareness, developing future prospects, and especially empowering healthy modes. This workshop will introduce into the concept of equine-assisted schema therapy and present techniques (including video demonstrations) to work with horses in a schema therapeutic treatment setting.

  • Schema Therapy and the Transdiagnostic Model

    Leonardo Wainer
    André Kolb
    Jorge Gustavo Azpiroz

    The upcoming symposium is poised to be an exploration into the integration of the transdiagnostic model with Schema Therapy. This event seeks to unravel the complexities of addressing common underlying factors that transcend traditional diagnostic boundaries, offering a fresh perspective on therapeutic interventions for individuals with personality disorders. The symposium will delve into the core principles of Schema Therapy, examining how this modality can effectively address transdiagnostic features present in diverse personality disorders. The presentation will showcase empirical evidence and a teorethical framework of ST and the Transdiagnostic Model. Attendees can expect to gain insights into tailoring interventions that go beyond conventional diagnostic categories, providing a more comprehensive and nuanced approach to treatment. The presenters will discuss the practical implications of transdiagnostic schema work, emphasizing the importance of identifying and modifying maladaptive schemas that cut across different personality disorder presentations. The symposium will offer attendees hands-on experience in applying transdiagnostic principles within the framework of Schema Therapy, fostering a deeper understanding of the therapeutic process. Furthermore, the symposium will encourage a collaborative dialogue among professionals, exploring the challenges and opportunities in transdiagnostic schema-focused work. Discussions will center around adapting traditional therapeutic approaches to better suit the unique needs of individuals with personality disorders, transcending the limitations imposed by strict diagnostic categories. This symposium aims to present a different view on conceptualization and treatment of clients within the ST model. Attendees can anticipate gaining valuable insights and practical tools to enhance their clinical practices, fostering a more integrative and nuanced approach to working with individuals who present with complex and overlapping diagnostic features within the context of Schema Therapy.

  • Strengths Based Schema Therapy (SBST): A new, short-term therapy that rapidly mobilizes the Healthy Adult mode

    David Bernstein
    Erwin Bijlsma

    Schema Therapy is remarkably effective for a broad range of personality disorders (PDs). However, it requires a substantial commitment of time, usually one to three years or more, depending on the severity of the case. In clinical practice, there are quite a few patients with less severe personality and behavior problems who could benefit from shorter-term forms of Schema Therapy. In this workshop, we introduce Strengths-Based Schema Therapy (SBST), a 12-session manualized therapy plus 4 optional booster sessions, that rapidly mobilizes patients’ Healthy Adult mode. It incorporates positive psychology, mindfulness, and experiential techniques to help patients become aware of their dysfunctional modes, and utilize their strengths to get their emotional needs met. The therapy is intended for patients with mild to moderate PDs or traits, along with mood, relationship, or adjustment problems. It was developed by Dr. David Bernstein and piloted with 15 patients at 4mb (“For mind and behavior”), an ambulant treatment center in the Netherlands directed by Mr. Erwin Bijlsma. In a pilot study of N = 3 patients with mild to moderate personality disorders, all three patients showed positive reliable change in early maladaptive schemas, modes, symptom distress, coping, and strengths. SBST uses the visual metaphor of a sailboat, the “Healthy Adult Boat,” based on a concept by Hugo Albert (Albert, 2018, Bernstein et al., 2021), to represent the Healthy Adult on its life’s voyage. The therapy consists of 4 phases: 1) assessment (“Where are you in your life’s voyage?”), 2) problem definition and analysis, and mindful awareness (“Setting your course, experiencing the voyage”), 3) Creating Healthy Adult messages for maladaptive modes (“Braving the stormy seas”), and 4) Building strengths to meet emotional needs (“Coming to Strengths Island”). We incorporate the iModes image-based therapy tools throughout the therapy. In this workshop, we will use case examples, demonstrations, and exercises to show how this strengths focused approach can rapidly mobilize patients to recognize unhealthy patterns, improve coping and symptoms, and get emotional needs met more adequately.

  • Strengthen the Mind Towards Resilience with Buddhist Psychology: How to Cultivate the Healthy Qualities of the Mind and How to Regulate their Antidotes

    Buddhist psychology supports basically four main tasks (efforts, skt. Vīrya) for mental growth: 1) to prevent the initial development of destructive mental states (which have not yet manifested in the psyche), 2) to abandon the destructive mental states that have already manifested, 3) to cultivate constructive mental states (initially create healthy mind resources), and 4) to maintain such constructive mental states (strengthen the healthy mind and subsequently build up resilience by doing so). Much of the Buddhist psychology regarding the treatment of destructive mental states (see 1) and 2) above) has been researched and found their ways into secular therapeutic settings and methods. A key method, the application of mindfulness, is nowadays widespread researched, applied and understood and is the needed basic skill for schematherapy to detect modes (mode awareness). Furthermore the non-judgemental attitude towards the sheer existence of destructive mental states (acceptance) has also found its way into psychotherapy and schematherapy (acceptance of the biographical creation of EMS, and the corresponding modes in the present such as inner critic and a more nuanced approach towards it such as using self-compassion as its antidote and acceptance that the self-destructive critic inner-voices

  • Exploring Unconscious Discrimination in the Therapeutic Encounter - The Gender and Sexuality Special Interest Group Roundtable

    Nicole Manktelow
    Offer Maurer

    This roundtable seeks to explore how discrimination related to gender and sexuality might unconsciously and unwittingly enter into the therapeutic encounter and how we, as schema therapists, can overcome and even harness these realisations in order to promote growth and thriving. As therapists and clients, we are deeply immersed in a society replete with many forms of overt and covert discrimination around gender and sexuality. This likely influences our schemas, modes, and coping styles in subtle ways we may not fully recognise. Our discussion will focus on raising awareness of the insidious effect societal discrimination may have on therapists’ and clients’ inner worlds. We will explore our sensitivities around these topics and examine our ability as therapists to detect the impact of early discrimination on our clients. Key questions include: How attuned are we to gender and sexuality-based discrimination in ourselves and our clients? What discriminations are commonly encountered in working with diverse clients? How might our own unconscious biases affect the therapeutic relationship? What are effective ways to reparent clients affected by discrimination? By shining a light on these unconscious processes, we hope to gain insight into the complex dynamics between gender, sexuality, and schema therapy. The discussion aims to contribute to a greater understanding of these crucial issues so we can enhance our therapeutic approaches to meet all clients’ needs. Together, we can work to counteract societal prejudices and provide the reparative relational experiences clients deeply need

  • Empathic Confrontation: A Live Demonstration / Two Approaches

    Eckhard Roediger
    Wendy Behary

    We may feel sorrow while witnessing the pain and struggle of our clients – but empathy is not sympathy. We may feel compelled to repair, comfort, and heal – but empathy is not compassion. Empathy is the experience of “knowing” that includes and goes beyond intellectual sense-making; a bone-deep, skin-felt, resonance that acts as an important prelude to necessary confrontations in treatment – for pattern breaking, limit setting, as well as fortifying connection. Empathic confrontation is an essential part of the therapy relationship in schema therapy. While many schema therapists transition easily into limited reparenting and rescripting roles, confrontation can often remain a challenge. Yet, we know that to adequately meet unmet needs, we need to effectively confront and bypass rigid coping modes and strident inner critics; to set limits, forge connections to the vulnerable child, and fortify the therapy relationship. In this LIVE demonstration (with an actor playing a narcissistic client), Wendy Behary will share an elaborated version of the conventional empathic confrontation, while Eckhard Roediger will demonstrate a contextual approach.

  • Conceptualizing and assessing the Healthy Adult within the context of schema therapy practice

    This panel discussion will focus on conceptual and practical aspects of the process of assessing a client’s healthy adult functioning in preparation for schema therapy. The Healthy Adult is best thought of as not a single mode, but a suite of healthy capacities or strengths that, when viewed together, characterize how a psychologically mature adult would think, feel and behave towards self and others. The ISST’s 2024 Case Conceptualization Form provides a framework for conceptualizing the Healthy Adult Mode with considerable breadth and depth, using eight broad categories.
    David Edwards will discuss how these categories were arrived at. The nature of mature human functioning has always been of interest and concern within psychology and contributions will be reviewed from Alfred Adler’s community feeling, Carl Roger’s fully functioning person, Abraham Maslow’s self-actualizing personality, and those who have drawn on the traditional concept of wisdom as elaborated, for example, in the Berlin wisdom paradigm of Baltes, Linden and others. Within schema therapy, these perspectives are the foundation of Bernstein’s 16 qualities of the Healthy Adult portrayed in a set of illustrated iModes cards. More recently, the DSM-5 and ICD-11 diagnostic systems, in moving away from classifying personality disorders using a limited set of categories, have identified a range of dimensions of mature and healthy functioning which, taken together, offer a view of mature human functioning which is comprehensive, and evidence-based, and does justice to the complexity of human personality.
    The eight categories for evaluating the Healthy Adult in the latest ISST case conceptualization form offer an attempt to synthesize these capacities into a manageable form for assessment of the Healthy Adult in clients along dimensions that are clinically relevant in that they directly impact case conceptualization and the effectiveness of therapy interventions.
    On the basis of this, Poul Perris will describe a clinical tool for assessing these capacities: “My Healthy Adult Capacities in a specific Life Area/Relationship.” It is based on eight different statements relating to each of the eight categories from the case conceptualization form (64 in all). Based on a development process in which feedback was provided by clients and therapists, he will offer practical guidelines on how to implement this in clinical practice, both in the initial assessment process, and more generally, when conceptualizing the challenges presented by clients whose therapy does not proceed smoothly.
    George Lockwood will draw on his experience in contributing to the development of the Positive Parenting Schema Inventory (PPSI) and the Young Positive Schema Questionnaire (YPSQ) and his clinical use of the PPSI, YPSQ and the International Personality Item Pool-NEO in the case conceptualization process to comment further on this discussion and to highlight the practical aspects of evaluating healthy adult functioning within the schema therapy process.
    Tijana Mirovic will act as discussant, presenting her reaction to the material presented with a focus on the practical implications and challenges for trainers and supervisors.

  • Integrating Schema Therapy and EMDR with Autistic and ADHD Clients

    Liam Spicer

    Research has demonstrated that up to 70% of Autistic and ADHD people are estimated to have a co-occurring mental health condition (e.g., anxiety, depression, anorexia etc., Lai et al., 2019). Autistic and/or ADHD people have also been demonstrated to be at increased risk of experiencing a range of adverse life experiences and subsequent negative life outcomes (El Ayoubi et al., 2021; Schwartz et al., 2023; Rumball et al., 2019). For example, people with ADHD are 3-5 times more likely than non-ADHD peers to report clinically significant PTSD symptoms (Miodus et al., 2021). Furthermore, research has demonstrated that autistic individuals are more likely to experience traumatic events that may not meet the Criteria A for PTSD in the DSM-V such as extreme bullying, grooming, and various restrictive practices. Furthermore, Kerns et al., (2022), demonstrated that some autistic individuals due to social communication differences may not understand that what they have experienced is abuse, or that what has happened to them is “wrong”. Neurodivergent individuals are also shown to be more likely to develop clinically significant mental health challenges after stressful experiences due to underlying vulnerabilities such as a predisposition to anxiety, likelihood of social isolation, and experiences of bullying, demonstrating the interplay between individual differences, adverse childhood experiences, and mental health challenges (Stewart et al., 2020).

    Presentation Focus: When assisting Autistic and ADHD clients in therapy with presenting comorbid mental health concerns, interventions need to be adapted not only to their needs, but also to their neurotype, the unique way they process information, connect with others, and experience the world from a sensory perspective. Increasing awareness on the importance of highly individualized treatment options combining evidence based therapeutic modalities with this population is rapidly growing. Both EMDR and Schema Therapy have shown some preliminary evidence for assisting Autistic and ADHD clients with their mental health challenges (Diest et al., 2022; Fisher et al., 2022, Oshima et al., 2021), however further research is needed. In this presentation, the mental health outcomes and challenges of those who are autistic, and ADHD will be presented demonstrating the increased risk this population is at regarding mental health and the experiences of trauma. The research regarding the Schemas of this population will also be presented to provide some foundational knowledge to clinicians in this area. The focus will then direct to various schema therapy and EMDR based interventions that can be useful in assisting this client group, and the modifications to these interventions that are needed. This will include discussing variations to exercises such as chair work, imagery rescripting, using EMDR for trauma reprocessing, and adjustments to therapeutic delivery and the therapy space to create an attuned relationship with this client group. Discussion will also focus on the importance of needs meeting and limited reparenting with this group and focus on the context of their developmental environment as to why not being identified as being autistic and/or ADHD may have further magnified early needs not being met.

  • Autonomy granting: using patient’s goals to strengthen HA and HC modes

    Jędrzej Kosewski

    The presentation will show how working with BPD patient, suffering from severe trauma and several very strong schemas (mistrust, abandonment, defectiveness, subjugation and enmeshment), use patient’s goals, aspirations and values as a means of strengthening healthy adult and happy child mode. We will discuss how different interventions, aimed at exploring patient’s life vision, can help them engage in treatment, lower the power of enmeshment and subjugation and fulfill the need for autonomy granting. Participant will have a chance to see how concepts from motivational interviewing and other positive-oriented CBT approaches can be integrated into schema therapy framework.

    Points of the discussion:

    1. Autonomy granting – definition

    2. Different types of patient’s goals

    3. HA and HC and patient’s goals

    4. Autonomy granting and its relations with patient’s goals

    5. Intervention that use patient’s goals to strengthen HA and HC modes

  • Schema therapy as a transdiagnostic biopsychosocial treatment perspective for trauma and ADHD

    Nermin Taşkale


    Schema therapy is an integrated model that explains how a person’s emotions, cognitions, and behaviors are shaped to lead to today’s everyday life reactions. It provides an inclusive and rich conceptual framework for psychotherapeutic intervention. Utilizing this framework for trauma is especially informative since trauma is a response to a variety of triggering events including but not limited to accidents, illnesses, types of violence and abuse, natural disasters, terror, political distress, etc. Trauma also leads to emotional reactions such as numb, depressive, anxious, and irritable affect which are linked to a variety of clinical diagnoses. In such a complex situation, it becomes difficult to conceptualize trauma cases in a comprehensible way. So, this hot topic discussion focuses on the suitability and effectiveness of schema therapy as an integrated model in approaching trauma with its immense background. Trauma may be triggered by factors from the immediate environment of the person. It may also be triggered by broader sociopolitical factors surrounding the individual/groups. Triggering events may happen in single or recurrent episodes as in the case of interpersonal violence. However, sometimes a chronic situation such as a chronic mental or physical illness may lead to trauma. Also, people may suffer from a number of different traumatic events (either episodic or chronic) simultaneously. Schema therapy provides a baseline to compile this complex information from a dynamic perspective. It does not focus solely on the triggering events and the types of reactions. Instead, it uncovers how triggering events lead to challenges in meeting emotional needs. Unmet emotional needs lead to surrendering, overcompensating, and/or avoiding behaviors. These various ways of coping provide an inclusive conceptualization for people with traumatic events to understand their mostly multi-diagnostic profiles, one of which is Attention Deficit Hyperactivity Disorder (ADHD).


    I will provide supporting results from academic and field work for these arguments. Firstly, I will mention research on women victims of intimate partner violence to understand the interrelationships between childhood traumas, intimate partner violence victimization, and ADHD. Secondly, I will briefly refer to an individual schema therapy of an ADHD-diagnosed LGBTQ man who experienced childhood political trauma and peer bullying to explain this hot topic’s perspective.


    The review of the relevant literature and sample case studies reveal that a biopsychosocial perspective is informative in understanding the interrelationships between trauma and other diagnoses, i.e. ADHD. Conclusions: ADHD has long been discussed as a hereditary disorder. Medical treatment was the only treatment option for this patient group. However, the importance of behavioral approaches was noticed by practicians to help people manage ADHD symptoms. Yet, the conceptualizations mostly continued following the medical model. Only some recent conceptualizations started to utilize a biopsychosocial model to explain ADHD. They highlight how ADHD may function as a reaction to trauma. The current hot topic discussion favors these recent conceptual developments from a schema therapy perspective.

  • The role of Enmeshment and Undeveloped Self, Subjugation, and Self-sacrifice in childhood trauma and attachment problems: The link with Self-Concept Clarity.

    Cristina Baroncelli

    The link between EMS and a coherent sense of identity has not been investigated yet. This study focuses on the relationship of three specific EMS, Enmeshment and Undeveloped Self, Subjugation, and Self-Sacrifice, their association to developmental trauma and attachment problems, and their link with identity coherence. Self-report questionnaires on these constructs were completed by 360 university students. Path models were fitted to the total scores to test whether the three EMS mediated the association between developmental trauma and attachment problems and self-concept clarity. Developmental trauma was directly related to each of the three EMS, which all mediated the association between trauma and attachment anxiety. Subjugation additionally mediated the relation between trauma and attachment avoidance. Both insecure attachment styles were directly related to self-concept clarity. Attachment anxiety mediated the association between each EMS and self-concept clarity, whereas the effect of subjugation was additionally mediated by attachment avoidance. The results confirmed that developmental trauma is related to insecure attachment styles and to self-concept clarity, and that this relation is mediated by all three EMS. Evidence-based interventions (e.g., EMDR, Schema Therapy, etc.) need to take attachment styles, EMS and self-concept clarity into consideration when working with developmental trauma, making the patient aware of the subtle interconnection between these variables. Key words: Early Maladaptive Schemas, Subjugation, Self-Sacrifice, impaired autonomy, self-concept, self-concept clarity

  • Genome-wide therapygenetic study of an international multicentre RCT on schema therapy for borderline personality disorder

    Alexandra Schosser

    The field of therapygenetics refers to the prediction of psychotherapeutic therapy outcomes from genetic markers. The current study is, to our knowledge, the first therapygenetic study investigating genes predicting treatment response in borderline personality disorder (BPD) on a genome-wide level. We aim to identify genes predicting treatment response to psychotherapeutic treatment (schema therapy vs. treatment as usual) by analysing the genome-wide association study (GWAS) data of the, so far, largest randomized-controlled trial (RCT, 495 participants) on effectiveness of schema therapy in BPD (Arntz et al. 2022). We plan to investigate genes associated with treatment response phenotypes applying a polygenic risk score analysis (PRS) and a gene-set analysis (GSA) approach. PRS is a method which allows an individual’s genetic loading for a trait to be calculated using genome-wide SNP (single nucleotide polymorphism) data and the output of GWAS summary statistics of another study of the same or related phenotype. It can be of clinical use in predicting traits in independent samples, including treatment response. In addition, GSA of pre-defined treatment response candidate genes such as 5-HTTLPR (serotonin transporter polymorphism) and BDNF (brain-derived neurotrophic factor), and subsequent explorative gene-wide single-marker analyses in order to extent the results of the GSA will be performed. The detailed study design and first results of the study will be presented. Identifying reliable associations between blood biomarkers and treatment response to psychotherapeutic treatments would have a major impact on clinical practice and patient care. Patients at high risk for non-response could be identified and obtain alternative treatment at an early stage, potentially enhancing the success rate of psychotherapeutic treatment programs. In addition, knowledge about the processes related to genetic markers will help us to develop better treatments, especially for those that don’t respond well to current treatments.

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