Schema-focused Cognitive Therapy Research Articles

Comparative Effects of Schema-Focused Cognitive and Self-Exploratory Therapies on Avoidant Personality Disorders among Senior Secondary School Students in Imo State, Nigeria

This study investigated the comparative effects of Schema-focused cognitive therapy and self-exploratory therapy on avoidant personality disorder among Secondary School Students in Imo state. The researcher asked two research questions and formulated two hypotheses to guide the study. The study adopted a quasi-experiment design. The population of the study is 98054. A purposive sampling technique was used to select 48 SSS II students for the study. The instruments for data collection are the Students avoidant personality problem identification rating scale for students and the Students avoidance personality problem checklist for the teachers. Five specialists validated the instrument. The reliability coefficient of 0.76 was obtained using Cronbach Alpha. Data were analysed using mean, standard deviation and ANCOVA F-ratio. The study's findings show that the mean rating scores on avoidant personality disorder of the participants exposed to schema-focused cognitive therapy and self-exploratory therapy in post-treatment and follow-up do not differ significantly. Based on the findings, the researchers recommend that School counsellors should use both schemas-focused cognitive therapy and self-exploratory therapy in the treatment of avoidant personality disorder since they were found to have a significant effect on the condition.

Cognitive Group Therapy Based on Schema-Focused Approach for Reducing Depression in Prisoners Living With HIV.

Depression is one the most common mental disorders in prisons. People living with HIV are more likely to develop psychological difficulties when compared with the general population. This study aims to determine the efficacy of cognitive group therapy based on schema-focused approach in reducing depression in prisoners living with HIV. The design of this study was between-groups (or "independent measures"). It was conducted with pretest, posttest, and waiting list control group. The research population comprised all prisoners living with HIV in a men's prison in Iran. Based on voluntary desire, screening, and inclusion criteria, 42 prisoners living with HIV participated in this study. They were randomly assigned to an experimental group (21 prisoners) and waiting list control group (21 prisoners). The experimental group received 11 sessions of schema-focused cognitive group therapy, while the waiting list control group received the treatment after the completion of the study. The various groups were evaluated in terms of depression. ANCOVA models were employed to test the study hypotheses. Collated results indicated that depression was reduced among prisoners in the experimental group. Schema therapy (ST) could reduce depression among prisoners living with HIV/AIDS.

Cognitive Therapy's Assimilation of Countertransference: a Psychodynamic Perspective

Increasingly, cognitive therapy (CT) authors are paying attention to understanding and managing countertransference reactions. This paper critically discusses the recent assimilation of countertransference theory and technique evident in the literature. It begins by examining the factors responsible for CT's interest in countertransference, before going on to discuss the cognitive conceptualization of countertransference. Case material is used to illustrate parallels between schema‐focused CT and relational psychoanalytic models. However, despite manifest similarities, it is argued that CT's rejection of the dynamic unconscious means that the respective approaches to how countertransference is understood and worked with are essentially incompatible. The psychoanalytic theory of countertransference is underpinned by a model of mind and associated therapeutic stance, the analytic attitude, which differs fundamentally from the therapeutic stance of CT. The paper concludes with a discussion of a published cognitive case study (Ellis, 2001), which is used to illustrate inherent limitations in the cognitive approach to countertransference.

Personality disorders training in an acute psychiatric inpatient setting

An introductory inpatient staff training programme is described, incorporating ideas from schema-focused cognitive therapy, offering nursing staff a psychological framework for understanding and more effectively managing patients with a diagnosis of personality disorder. This training was well received.

Borderline Personality Disorder Across the Life Span

SUMMARY Borderline personality disorder is characterized by affective dysregulation, intense, unstable interpersonal relationships, impulsivity and unstable identity. It overlaps considerably with both PTSD and bipolar spectrum disorders. Research on true late-life BPD is limited, but suggests that some of the core features of BPD including interpersonal difficulties, unstable affect and anger remain relatively unchanged, while impulsivity and identity disturbance decline or change their mode of expression in late life. Diagnosis of BPD in late life requires flexible application of the standard diagnostic criteria as well as a thorough longitudinal history. The etiology of BPD is best explained as a combination of genetic, neurobiological vulnerability combined with childhood trauma, abuse or neglect that leads to dysregulated emotions, distorted cognitions, social skills deficits, and few adaptive coping strategies. Treatment options include pharmacotherapy (especially mood stabilizers, SSRIs and atypical antipsychotics) and psychotherapeutic interventions that focus on distress tolerance, affective regulation, changing distorted beliefs, and introducing new social and relationship problem-solving skills (especially Dialectical Behavior Therapy and Schema Focused Cognitive Therapy). In late-life care environments, such as nursing homes and other residential facilities, staff need to be empowered to set appropriate limits on problematic behavior while maintaining empathy and validating the painful affect patients often experience.

The Pharmacologic and Psychological Treatment of Obsessive—Compulsive Disorder

Obsessive-compulsive disorder (OCD) continues to present a particular challenge to clinicians. As opposed to other anxiety disorders and, to some degree, to depression, the results of therapies, be they pharmacologie or psychological, are at best less than optimal. Indeed, when one reads articles reporting randomized controlled trials, patients are said to be responders when a 35% reduction of symptoms occurs (as if reducing rituals from 6 to 4 hours were clinically meaningful). Moreover, when one takes into account those who drop out of studies because of medication side effects or because of fear in the exposure-response prevention (ERP) studies-often in the 25% to 30% range-and add to those numbers the nonresponders, then we are looking at a 35% to 50% response in about 50% of patients. Additionally, few patients attain full remission-hardly satisfactory outcomes! The one redeeming finding is that most gains achieved by cognitive-behavioural therapy (CBT) seem to be stable. The longest study to date spans 7 years but has few subjects (1). In it, the 41% improvement was maintained (45% at follow-up). Hence the continued effort to develop new strategies. Foa reports an intensive regimen of daily, prolonged exposure sessions (over 2 hours) for 3 weeks (2). The dropout rate was extremely high in the New York site (over 40%), as opposed to the Philadelphia site, which may indicate that in Foa's clinic the cognitive preparation for treatment reduced apprehension and induced better compliance. Dr Foa's comparator to ERP was clomipramine, which we know has a high side effect profile that may explain patient resistance. The ERP therapy was superior to clomipramine alone, and the combination of behaviour therapy and medication did not, in that study, improve outcome. Foa feels that ERP was so powerful that there was little room for the medication to show added improvement. However, in children and adolescents, the combination of CBT and sertraline has been shown to be superior to either treatment alone (3). Another strategy has been to add the components sequentially. For example, Kampman added 12 sessions of CBT to continued treatment with fluoxetine in nonresponders (defined as those showing less than 25% improvement after 12 weeks of medication) (4). There was a 41% improvement rate in these resistant patients. A recent review and 2 case illustrations have outlined in which patients the combinatory approaches may be best indicated (5). In his review in this issue, Abramowitz summarizes the comparative results of CBT and ERP and shows that the indispensable component of the psychological approaches seems to be exposure, even in the soi-disant pure cognitive group (individuals often expose in imagination and indeed, at times, spontaneously in vivo without therapist intervention). Abramowitz also mentions that cognitive therapists have developed strategies that look more deeply into the schemas of patients-a core belief of enhanced responsibility for the patient's own and others' well-being (6), an increased sense of vulnerability (7), and thought-action fusion (IfI think it, it means I want to do it) (8). Integrating ERP, traditional CBT, and schema-focused cognitive therapy has been proposed as a strategy to enhance response in treatment-resistant patients (9). Subtypes identified according to symptoms (such as checking, washing, or symmetry) may also explain some of the differential responses encountered in treatment (10) Augmenting regimens have also been proposed in pharmacology: in Blier's review, he states that the most promising approach seems to employ the atypical antipsychotics. …

Commentary on ‘The value of formulation: A question for debate’

Dr Tracy Thorns (North Dorset Primary Care Trust) and I worked together using schema-focused cognitive therapy (SFCT) for 11 sessions spread over about six months. During this time Tracy, who was being supervised by Gillian Butler, showed me this paper in the context of a discussion about the value of our joint work on formulation. I sent my comments to Gillian Butler as I thought she might be interested to have them. I am happy for my views to be shared with others. I would like these comments to be used in any way that seems appropriate.

Schema-Focused Cognitive Therapy and the Case of Ms. S.

Schema-Focused Cognitive Therapy and the Case of Ms. S.

Practical Psychotherapy: A Current Perspective on the Psychotherapies

Practical Psychotherapy: A Current Perspective on the Psychotherapies

The effect of mood on responses to the Young Schema Questionnaire: Short form

The schema concept has had an important role in both early and more recent accounts of psychopathology. Schemas are underlying cognitive structures that are thought to create vulnerability to disorders, because they act as templates for the perception, encoding, storage, and retrieval of information. Recent approaches to the understanding and treatment of personality disorders give schemas particular prominence, and the concept of early maladaptive schemas forms the cornerstone of Young's (1999) schema-focused cognitive therapy. The aim of this paper is to examine the effect of mood on responses to the Young Schema Questionnaire--short form (YSQ-S; Young, 1998). A sample of 50 non-clinical participants completed the YSQ-S on three different occasions: in neutral mood, and following happy and depressed mood inductions. The results of 30 participants with full data sets showed that emotional deprivation and defectiveness scores increased after the depressed mood induction, whereas entitlement scores increased after the happy mood induction. The results are discussed in relation to cognitive theories of vulnerability to psychopathology, and future directions for research are suggested.

Motivational enhancement and schema-focused cognitive behaviour therapy in the treatment of chronic eating disorders

A day hospital program for the treatment of patients with long-term anorexia nervosa (AN) is described. This program forms part of a comprehensive system of day programs that reflect and incorporate patients' varying degrees of readiness for change and attempt to match patients' readiness for change to the interventions offered in treatment. Preliminary outcome data are presented, showing clinically valuable changes of motivation in this group.

The effect of different components of psychological therapy on people with delusions: five experimental single cases

AbstractThis study is a contribution to the investigation of the active ingredient in psychological therapy for psychosis. Five people with chronic delusions were treated using a single‐case experiment design. The treatment was broken down into components that were administered sequentially. A baseline phase was followed by three different treatment conditions (An A–B–C–D design). The treatments were (1) Solution‐focused Therapy (2) Schema‐focused cognitive therapy (3) Cognitive therapy focused on modification of the delusion. Three of the five clients responded to treatment with a large change in degree of belief in their delusion. Two clients improved during solution‐focused therapy, one client improved during cognitive challenging of the delusion and one client changed during baseline. The implications of this study are discussed. Copyright © 2003 John Wiley & Sons, Ltd.

Schema-focused cognitive therapy for bipolar disorder: reducing vulnerability to relapse through attitudinal change.

Acceptance of, and adaptability to illness, are major determinants of adherence to treatment and functional recovery. This paper addresses the major psychosocial factors associated with bipolar disorder and the role of psychological interventions in symptom management and adaptability to the illness experience. A new model is presented highlighting the role of developmental experiences and temperament in determining reactions to bipolar disorder. The authors propose that by addressing reactions to the illness experiences and effects on self-concept through schema-focused cognitive therapy, functional recovery is more likely to occur among those patients functioning below expectation. A systematic review of the current literature including an Index Medicus/MEDLINE search was conducted, focusing on risk factors, cognitive vulnerabilities and triggers associated with bipolar disorder. Psychological treatments available for the treatment of bipolar disorder are reviewed and details of a novel schema-focused cognitive model for this condition are presented. Traditional models of adaptation to chronic illness are outlined and incorporated into the proposed model. Schema-focused cognitive therapy is proposed as an approach to help patients reduce cognitive vulnerability to relapse in addition to adopting effective mood management strategies. There is a need for psychological treatments which reduce the risks associated with poor functionality in patients with bipolar disorder. Schema-focused cognitive therapy specifically targets the temperament, developmental experiences and cognitive vulnerabilities that determine adjustment to illness. This proposed treatment, combined with pharmacotherapy, may offer new psychotherapeutic options for the future.

Combining Schema-Focused Cognitive Therapy and Psychodrama: A Model for Treating Clients With Personality Disorders

Combining Schema-Focused Cognitive Therapy and Psychodrama: A Model for Treating Clients With Personality Disorders

The role of optimism in the process of schema-focused cognitive therapy of personality problems

The aim of this study was to examine the determinants and effects of optimism in the process of schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week residential program with one symptom-focused and one personality-focused phase. This study examines the role played by optimism during the individual sessions of the second phase, using a time series approach. Decreased patient's belief in his/her primary Early Maladaptive Schema and increased patient-experienced empathy from the therapist in a session predicted increased patient-rated optimism before the subsequent session. Increased patient-rated optimism in turn predicted decreased schema belief and distress and increased insight, empathy, and therapist-rated optimism. The slope of optimism across sessions was related to change in most of the overall outcome measures. There appears to be a positive feedback in the process of schema-focused cognitive therapy between decreased schema belief and increased optimism. In addition, optimism appears to mediate the effects of schema belief and therapist empathy on overall improvement, and to serve as an antecedent to decreased distress and to increased empathy, insight, and therapist's optimism.

Self-understanding, empathy, guided discovery, and schema belief in schema-focused cognitive therapy of personality problems: A process-outcome study.

The aim of this study was to examine the dispositional and/or episodic influences of the process variables of self-understanding, empathy, guided discovery, and convictions about primary early maladaptive schema, which are central concepts in the schema-focused cognitive therapy of personality problems. The sample consisted of 35 patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits who participated in an 11-week inpatient program. Patients, therapists, and an expert observer rated individual therapy sessions. Greater patient-rated self-understanding the first session was related to greater decreases in schema belief and of emotional distress throughout therapy. Greater therapist-rated empathic experience the first session was related to greater decreases in distress throughout therapy. Session-by-session analyses revealed few sequential relationships. However, a greater in-session reduction of schema belief weakly predicted lower level of presessional distress the next session, and vice versa. The study illustrates how to intensively measure and model change in psychotherapy, using both growth curve and time series analyses.

Machiavellianism and Empathy in an Adolescent Residential Psychiatric Population

ABSTRACT This study examined the relationships between two psychopathy-related traits–Machiavellianism and low empathy–and behavior problems in adolescents in residential treatment. Sixty-four youths completed the Children's Machiavellianism Scale, the Interpersonal Reactivity Index, and the Youth Self-Report version of the Child Behavior Checklist. Adolescents high in Machiavellianism reported more externalizing, and especially delinquent, behaviors; more thought problems; and less cognitive empathy than those low in Machiavellianism. Low empathy was related to externalizing diagnoses and to self-reported externalizing behavior. Schema-focused cognitive therapy, role-taking training, and problem-solving skills training are suggested as possible interventions to remediate the cognitive and behavioral dysfunctions characteristic of these youth.

The psychopathology of bulimic women who report childhood sexual abuse: the mediating role of core beliefs.

Although reported sexual abuse in childhood is associated with bulimic behaviors, less is known about the cognitive factors that explain this association. This study examined the potential role of core beliefs as a mediator in the abuse-bulimia link. Sixty-one bulimic women were interviewed regarding any history of childhood sexual abuse and completed measures of bulimic behaviors, dissociation, depression, and core beliefs. The 21 women who reported a history of childhood sexual abuse had significantly higher levels of several core beliefs and greater levels of psychopathology. Different core beliefs acted as mediators in the relationships between sexual abuse and individual symptoms. The findings support the suggestion that schema-focused cognitive therapy may be useful in working with bulimics, particularly if they have been sexually abused in childhood. Further research is needed to determine the role of core beliefs in mediating the impact of other forms of trauma and how traumas relate to other "escape" behaviors.

Case of Silvia: A Schema-Focused Approach

This case study systematically addresses the components and sequence of a Schema-Focused cognitive therapy approach to the assessment, formulation, and treatment of Silvia's anxious and depressive symptoms and enduring life problems. Following a description of the major tools and procedures involved in collecting the evidence that is required to generate a Schema-Focused case conceptualization, a comprehensive formulation of this case is presented as a guide for treatment intervention. A Schema-Focused Therapy approach is then applied to this case, highlighting the four essential strategies—cognitive, experiential, behavioral, and the therapy relationship—used to change Silvia's maladaptive schemas. Adjunctive interventions and potential problems with this therapy approach are also proposed for consideration.

SCHEMA-FOCUSED COGNITIVE THERAPY FOR COMPLEX LONG-STANDING PROBLEMS: A SINGLE CASE STUDY

A single case study of a schema-focused cognitive therapy approach to treatment of a young woman with long-term interpersonal relationship problems and affective instability is described. There have been few accounts of this type of therapy that have incorporated outcome measures. Measures of mood and of schema have been taken throughout treatment and results would appear to offer some support for schema-focused cognitive therapy.