Dr. Nermin Taşkale is a clinical psychologist. She uses Cognitive-Behavioral and Schema Therapy and EMDR with adults and Emotionally-Focused Therapy with couples. She is also a full-time researcher and instructor at Istanbul University. Her research focuses on conflict resolution in intimate relations and violence against women.
Schema therapy as a transdiagnostic biopsychosocial treatment perspective for trauma and ADHD
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.