Evaluation of the Efficacy Evidence of Schema Therapy and Research Agenda
Schema Therapy is an integrative psychotherapeutic model that was developed by Jeffrey Young as an advancement to cognitive-behavioral therapies (Edwards & Arntz, 2012; Young, Klosko, Weishaar, 2008). Schema Therapy was originally developed with the aim of working with individuals with chronic, refractory and personality disorders (Young et al., 2008). Currently, we can see studies that expand this initial focus, such as studies with eating disorders (McIntosh et al., 2016). The therapeutic model has, in recent years, gained greater popularity among clinicians and in trainings. The International Society of Schema Therapy (ISST) has more than 3000 members on five continents. As the approach gains notoriety, it becomes necessary to evaluate the effectiveness of the model and identify for which demands there is evidence where Schema Therapy can and cannot be used. The objective of this presentation is to evaluate most of the research about the effectiveness of the model in its quality and to point out future aims of research.
Personality disorders prescribing guide: how to address to comorbidities of our patients
Personality disorders (PDs) have a prevalence in the general population of 7,8%, and clearly present one of the most important indications for schema therapy. However, like most mental disorders, the presence of comorbid diagnoses is common, with each of the PDs more frequently presenting certain profiles of associated diagnoses. Being clear about which psychopathologies to seek to identify, in addition to assisting in the most appropriate psychotherapeutic management, is also essential to know how to differentiate when the patient needs referral for evaluation of the use of psychotropic drugs and when the patient is only presenting maladaptive coping strategies. Through a review of the literature, using the DSM-5TR to identify main comorbidities, this presentation aims to present tools to help the management of PDs patients through updated guidelines, and search for recent articles on pharmacological management of serious situations in PDs cases.
The Interplay between Schema Therapy and Ketamine for Treatment-Resistant Depression: Case studies
Ketamine, a dissociative anaesthetic, has been used in surgery and pain management since the 1970’s. In the last 20 years, ketamine has received considerable attention by the psychiatric community for its antidepressant and psychedelic properties, and especially for the management of treatment-resistant depression (TRD). In 2021, the Australian Therapeutic Goods Administration (TGA) approved a ketamine intranasal spray known as Spravato for the management of TRD. Research studies examining the use of ketamine for managing TRD have shown some interesting results – rapidly improving mood to the point of remission, increasing positive emotion, reducing suicidal tendencies, and increasing both synaptic connectivity and neuroplasticity. Despite such promising findings, the antidepressant effects of ketamine as a standalone treatment for TRD are temporary (often only lasting from 24hrs to 7 days).
Psychotherapy has been put forward as a means of prolonging the effects of ketamine and make positive use of its dissociative elements. Formal research studies in this area are still in their infancy and have focused on Ketamine Assisted Therapy and the combination of ketamine and Cognitive Behavioural Therapy. However, childhood trauma and attachment injuries are often at the core of TRD, and more durable change requires trauma and attachment informed psychotherapy. Schema Therapy is applicable and effective for TRD, and is a promising candidate for combination with ketamine therapy. Despite this, no studies or case studies so far have examined the interplay between Schema Therapy (ST) and ketamine delivered specifically by subcutaneous means.
This presentation aims to address this gap by:
1) outlining the ketamine treatment protocol for TRD used at the Black Dog Institute in Sydney, Australia,
2) present two compelling case studies showing the positive outcomes achieved using ST and ST techniques with depressed clients receiving concurrent ketamine treatment at the Black Dog Institute,
3) emphasising the need for a biopsychosocial understanding, and treatment of TRD, and, as such,
4) propose an expanded role for ST in a multidisciplinary model of care for this condition.
Assessing partner responsiveness to disconnection and rejection: A new schema therapy-informed measure for couples research and practice.
Objectives/Background.
In adulthood, romantic partners are considered to be a person’s primary attachment figure. Therefore, the relationship that one develops with a romantic partner in adulthood represents an important relational context within which schema-congruent and schema-incongruent experiences can occur. Of particular interest is the extent to which romantic partners can help to mitigate or attenuate an individual’s activation and perpetuation of early maladaptive schemas (EMSs) within the domain considered critical to secure attachment bonds – the disconnection and rejection domain (i.e., schemas of abandonment, mistrust abuse, emotional deprivation, social isolation, and defectiveness shame).However, it remains unclear as to the relationship behaviours that romantic partners engage in that can attenuate the activation of their partner’s EMSs within the disconnection and rejection domain. Indeed, there exists no research that has specifically examined the types of behavioral responses rendered by partners that can address EMS activation. The reasons for this lack of research are varied, but a primary reason relates to issues around assessment. To date there is no measure that evaluates the specific partner behaviours that reflect responses that can soothe or mitigate activation of EMSs. This presentation addresses this gap by reporting on the development and psychometric evaluation of a novel self-report measure of partner behaviours that can help to mitigate or attenuate EMSs in the disconnection rejection domain.
Method
. A large (N~800) general community sample of adults currently in a romantic relationship will complete an online survey. Participants are administered items comprising the partner behaviours measure as well as widely validated measures to examine the convergent and divergent validity of the new measure. These assessments include adult attachment styles, loneliness, partner conflict, partner support and responsiveness, partner relationship quality, sexual satisfaction, and items from the disconnection rejection domain of the YSQ-S3. Confirmatory Factor Analysis will be used to evaluate the structural validity of the newly developed measure. Correlation analyses will be used to evaluate the convergent and divergent validity of the measure.Results and Conclusions
. It is anticipated that this study will provide a psychometrically sound new measure that can be used by clinicians and researchers to evaluate the extent to which a romantic partner engages in behaviour that can attenuate a variety of EMSs associated with the disconnection/rejection schema domain and thereby meet a person’s need to experience a stable, nurturing and secure romantic attachment.Increasing mode awareness whit patients’ home- made videos in Group Schema Therapy
At the University of Turku, we have studied the use of visual material, especially video, as a facilitator of psychotherapy (Koffert et al. 2019). We have named the method VideoTalk (VT). In the method, patients take videos at home in different emotional situations with the therapist’s precise instructions for the next therapy session. Video recording at home is important because when patients are alone, symptoms are more likely to be activated. On the videotape, the patient speaks out the thoughts that come to mind around the theme at present. Next, they watch the video in therapy session and pay attention to their emotional state, their bodily reactions, their tone of voice, their way of thinking and how they talk about the situation that is problematic for them. Patients’ experiences of the work have been positive (Nordström et al. 2021). The Group Schema Therapy (GST) model of program is theoretically consistent with the model and theory of ST as developed by Young and later Farrell & Shaw (Young et al. 2003; Farrell & Shaw 2012). We combined the individual VT treatment program to GST context and run a group with eight BPD patients. Patient videotaped at home their modes which were watched in the group.
Video Talk method is an observational tool in Schema Therapy group for observing modes. Patients videotape their mode states at home according to the treatment program. The aim is making observations from the videotape of patient’s internal experience and understand more the causal impacts of experience. The videos are watched in the group sessions where the patient identifies the schema, coping styles and pattern of emotions and behaviors that results of schema. The video expands the number of the patient’s observations, bringing out the reactions caused by the negative schema, which appear in the video image as bodily changes, making the mode’s harmfulness concrete. The patient must understand the ways in which the schema distorts the way in which he/she sees the world. The Video Talk method provides a platform where to combine observations of hearing, vision, and bodily signals. Link them to cognitions and spoken language on the video. Video gives feedback of the impact of schema which can be used in group discussions to build a Healthy Adult mode. This video-assisted communication between the internal and outside world gives an opportunity to observe how modes are affecting in experiences. It will also socialize group members for new observation from the other group members videos.
Our presentation presents the interventions of VT-model for mode interventions in GST. and preliminary treatment results and discuss the treatment method.
Parallel Process In schema therapy and Supervision
Jan Praško
Ilona Krone
Marie OciskovaThe parallel process is a psychosocial phenomenon where the relationship dynamics between the therapist and the client are repeated in the supervisory relationship between the therapist and the supervisor. The concept of the parallel process can be a useful tool for understanding and solving problems in therapy. However, it can induce supervision drift or block the supervision process.
Objective:
This lecture aims to familiarize the reader with parallel processes in schema therapy supervision and discuss how to manage this phenomenon in supervision.
Method:
The lecture provides an overview of theoretical constructions and empirical studies related to the parallel process. Case vignettes were collected from trainees, training leaders and supervisors to provide real-life examples of how self-reflection and self-experience can enhance the understanding of parallel process in schema therapy training, practice, and supervision.
Results:
Interventions focused on the parallel process within supervision can help understand what is happening in the client-therapist relationship and can help focus on therapeutic and supervisory practices. Schema therapy interventions such as guided discovery, psychoeducation, imagery rescripting, cognitive techniques, role-playing, dialogue of modes, and chairwork might reveal and elaborate the parallel process.
Conclusion:
Supervisors and supervisees should acknowledge and be vigilant about the diverse manifestations of parallel processes and leverage their potential for supervision and therapeutic interventions.
The Healthy Adult Mode; Key Similarities and Differences Between four empirical based models and their Clinical Implications
George Lockwood
David Bernstein
John Louis
Duygu YakinFour major research based approaches to the development of our understanding of the Healthy Adult Mode will be discussed with a focus on the key areas of overlap, differences, possibilities for integration, clinical implications and suggestions for further development. Each had distinctly different starting points. Yakin and Arntz have been exploring the interactions between healthy adults and child modes. Bernstein cast a broad to develop a model drawing on the work of Seligman, Bowlbly, Frankle, Ryan & Deci and the DSM-5 model of healthy functioning, among others. Louis and Lockwood started with 18 positive schemas hypothesized by Lockwood, Perris and Young as the adaptive counterpoints to the 18 early maladaptive schemas. Louis and Lockwood also developed a second model of the healthy adult mode in a nurturing context with their starting point being hypothesized counterpoints to the maladaptive parenting interactions operationalized in the Young Parenting Inventory. Tilling the soil of healthy adult functioning from such distinct yet compelling directions offers the promise of significantly advancing our understanding of this important and complex construct.
Yakin and Arntz’s work involved in-depth qualitative analysis of the interactions between child modes and healthy adults by conducting 45 to 60 minute semi-structured interviews. Three broad themes and 10 subthemes emerged. Bernstien’s personal strengths model consists of four domains and 16 primary factors and has an accompanying scale for clinical use. Louis and Lockwood’s model of healthy adult functioning consists of 14 positive schemas organized into 4 domains and Louis and Lockwood’s model of the healthy adult parent consists of 7 parenting schemas. Each of these two models have an accompanying scale for clinical use. All four of these models are in the midst of ongoing research and updates on recent findings will be provided.
Experimental studies on memory and imagery rescripting
Abstract: **Please click on the speakers to check the individual presentations included in the symposiumImagery rescripting (ImRs) is an effective therapeutic technique aimed at reducing trauma-related emotions and memories. In this symposium, we will present several experimental studies that each explore different aspects underlying ImRs. The first speaker, Marleen Rijkeboer will present a study on generalization of ImRs to related memories. Next, Pauline Dibbets and Maarten Peters will elaborate on the effects of misinformation during rescripting on false memory recollections. During the third presentation, Nicole Geschwind will present a study on the value of added positive emotion in ImRs on trauma-related symptoms. The final presenter, Julie Krans, will compare the generalization of safety after reevaluation of the aversive event (ImRs) or after expectancy violation (extinction). The novel work presented in this symposium tries to unravel fundamental aspects of ImRs and to bring these insights to the clinical field.- Do the effects of ImRs on the target memory generalize to related memories in the emotional memory network?
- Does misinformation during ImR increase false memories?Pauline Dibbets & Maarten J.V. Peters
- Let’s have fun together! Experimental research on the value of an added positive emotion component in Imagery RescriptingNicole GeschwindThe generalisation of safety in imagery rescripting versus extinctionJulie Krans
Working mechanisms of imagery and imagery rescripting
Abstract: **Please click on the speakers to check the individual presentations included in the symposiumThe symposium consists of four presentations highlighting the latest research results on the effectiveness of imagery techniques (primarily imagery rescripting) when compared to EMDR, imaginal exposure or cognitive restructuring. The methodological care with which these studies were conducted made it possible to verify the role of candidate working mechanisms of the imagery treatment, such as prediction error, disruption of memory reconsolidation, image vividness, and image-related beliefs. The conclusions presented at the symposium are based on a variety of different self-report, behavioral and neuronal findings.- The efficacy of incorporating mental imagery in cognitive restructuring techniques on reducing hostility
Jill Lobbestael - Effectiveness and mechanism of imagery techniques. The role of prediction error in imagery rescripting and imaginal exposure
Julia Bączek - Change mechanisms of Imagery Rescripting compared with EMDR
Arnoud Arntz - Imagery rescripting and disruption of memory reconsolidation -psychophysiological and fMRI studyStanisław Karkosz