Short-term, manualized schema-focused group therapy for patients with CBT-resistant disorders within primary care: a pilot study with a naturalistic pre-treatment and post-treatment design

The aim of this study was to explore the feasibility and preliminary effectiveness of a short-term, manualized schema therapy group for 77 patients with CBT-resistant mood and/or anxiety and/or personality disorders (PDs) in primary care. The primary focus was on the effects of this treatment on Early Maladaptive Schemas (EMS), schema modes, and psychological well-being. These aspects were assessed pre-and post-treatment treatment using the Young Schema Questionnaire (YSQ), the Schema Mode Inventory version 1.1 (SMI), and the Symptom Questionnaire-48 (SQ-48). The treatment consisted of 16 sessions, incorporating cognitive, behavioral, and experiential techniques. EMS significantly decreased from pre-treatment to post-treatment, as along with maladaptive schema modes. Adaptive modes increased, as did psychological wellbeing. There were no significant differences between the DSM-5 classifications regarding changes in the aforementioned measures, except for the maladaptive modes, where the value of the corrected within-subject effect indicated a significant interaction. Post hoc comparisons were therefore conducted which showed that patients with a mood disorder experienced more positive changes in maladaptive modes compared to patients with anxiety disorders and PDs (p < 0.001). There was no significant difference between those with PDs and those with Anxiety Disorders. Our findings provide preliminary evidence that short-term, manualized schema therapy might be an effective treatment for patients with CBT-resistant mood and/or anxiety and/or PDs in primary care.

Offence Paralleling Schema Modes in Institutional Violence

This study explored emotional patterns in relation to the Offence Paralleling Behavior and the schema mode frameworks. The study retrospectively assesses schema modes in the events prior and during criminal and institutional violent behavior. It draws upon observer-ratings of schema modes by 42 male patients who received mandated clinical care in a forensic hospital in the Netherlands. Wilcoxon Signed Ranked tests showed no differences between events prior crimes and incidents with regard to schema modes that relate to universal childhood needs with the exception of impulsive child mode. States of intoxication were more prevalent prior and during the crimes than during the incidents. Furthermore, modes tended to be less activated during incidents, particularly low self-control, conning and manipulating, and self-aggrandizer modes. It is hoped that criminal justice institutions and their staff would benefit from being more aware of schema mode in order to prevent and deal with incidental violence.

Differentiating authentic versus pseudo vulnerability in therapeutic practice

The importance of empathy and attuned care as key ingredients in therapeutic healing has been widely recognized. However, empathy that is delivered in ways that are misaligned with the client's clinical presentation and emotional states or 'modes' can have the opposite effect, reinforcing unhelpful coping patterns, and hindering recovery. In this theoretical development paper, it is proposed that 'pseudo vulnerability' is an important yet overlooked source of therapeutic impasses, often resulting in unremitting clinical problems, and poor clinical outcomes. A range of commonly occurring pseudo vulnerable presentations are described, including Complaining Protector, Attention/Recognition Seeking, and Self-Pity/Victim, with the addition of a new mode Helpless Surrenderer. Guidance on differentiating pseudo vulnerable modes from each other and from the authentic Vulnerable Child mode are delineated via characteristic clinical presentations and typical therapist countertransference reactions. Methods for managing pseudo vulnerability to facilitate access to underlying authentic vulnerability are described.

Understanding the reparative effects of schema modes: an in-depth analysis of the healthy adult mode

Objectives

Evidence in favor of schema therapy's effectiveness in treating personality disorders is growing. One of the central and recently popular concepts of schema therapy is schema modes [i.e., temporary emotional-cognitive-behavioral states resulting from the activation of early maladaptive schemas (EMSs)]. A key aspect herein is self-reparenting, i.e., a healing relationship between the healthy adult (HA, i.e., compassionate and healthy emotional states, and functional dealing with reality) and the child modes (i.e., representation of fragile and hurt feelings and dysfunctional coping). Through an in-depth qualitative analysis, we aimed to better understand the components of the HA that enable self-reparenting.

Method

Purposive sampling procedures were used to recruit eligible participants (n = 10) with relatively strong HA modes, as determined by high scores on positive affect and satisfaction with life measures and low scores on EMSs and psychopathological symptom measures. Semi-structured 45- to 60-min face-to-face interviews were conducted individually, in which individuals were asked to help the child modes reflected in the pictures. Interviews were then analyzed using deductive thematic analysis in MaxQDA.

Results and discussion

The analysis revealed three superordinate themes comprising of a total of 10 group themes: (1) bonding between HA and the vulnerable child modes ("Bond"); (2) balancing expression and inhibition of adult and child mode emotions ("Balancing"); and (3) opposing demanding and critical voices and maladaptive coping styles ("Battle"). Furthermore, a strong HA mode seems to have a reciprocal relationship with the child modes: the HA gives nurturance and protection to the child modes, and the child modes boost up the HA with spontaneity and happiness. In conclusion, emotional stability and resilience may be highest when HA-child mode interaction happens bidirectionally; when the child modes get reparented by the HA, and the HA is informed by the child modes.

Implementation of a case formulation to reduce restrictive interventions on a psychiatric intensive care unit: quasi-experimental single case evaluation

BACKGROUND

Despite the use of case formulation being encouraged for in-patient psychiatric care, there have been no previous examples and evaluations of this type of work on a psychiatric intensive care unit (PICU).

AIMS

To evaluate whether a schema-informed formulation with a patient diagnosed with emotionally unstable personality disorder (EUPD), autism spectrum disorder (ASD) and mild learning difficulties was effective in reducing the use of restrictive interventions.

METHOD

A biphasic n = 1 quasi-experimental design with an 8-week baseline versus an 8-week intervention phase. The restrictive outcomes measured were use of physical restraint, seclusion, and intramuscular rapid tranquilisation. The formulation was developed through eight one-to-one sessions during the baseline period, and was implemented via six one-to-one sessions during the intervention phase and discussion at the ward reflective practice group. The intervention encouraged better communication of schema modes from the patient and for staff to then respond with bespoke mode support.

RESULTS

Incidents involving need for seclusion, restraint and rapid tranquilisation extinguished.

DISCUSSION

The need for making access to psychological input a routine aspect of the care in PICUs and the necessity for developing a methodologically more robust evidence base for psychological interventions on these wards.

Guilt, Disgust, and Not Just Right Experience Mediate the Effect of Demanding Parent Mode on Obsessive-Compulsive-Disorder-like Tendencies, and Punitive Parent Mode Moderates This Mediation

The main objective of the present study was to examine, in a non-clinical population, the validity of a moderated mediation model for obsessive mental functioning. The research was conducted on a sample of 205 participants. Data were collected using the Psychiatric Screening and Diagnostic Questionnaire, Young's Modes Questionnaire-form SMI-2, Padua Inventory of Obsessive-Compulsive Symptoms, Fear of Guilt Scale in OCD, Disgust Propensity and Sensitivity Scale-Revised, and Not Just Right Experiences Questionnaire-Revised. The results revealed that there is a significant positive, indirect effect of the Demanding Parent mode on OCD-like tendencies, which is completely mediated by fear of guilt, tendency and sensitivity to disgust, and Not Just Right Experiences severity. The Punitive Parent mode moderates only the indirect effect of the Demanding Parent mode mediated by fear of guilt, not the indirect effect mediated by disgust tendency and sensitivity and Not Just Right Experiences severity. Also, the indirect effect of the Demanding Parent mode on obsessive tendencies mediated by fear of guilt is significant only at medium and high values of the Punitive Parent mode, not at low values of the moderator. Our results provide a novel direction targeting the direct therapeutic intervention on demanding and punitive internal dialogue, complementing the classical CBT intervention protocol.

An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization

BACKGROUND

Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals.

METHOD

Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style.

RESULTS

Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother.

CONCLUSION

Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.

Stronger coupling of emotional instability with reward processing in borderline personality disorder is predicted by schema modes

BACKGROUND

Mood instability and risk-taking are hallmarks of borderline personality disorder (BPD). Schema modes are combinations of self-reflective evaluations, negative emotional states, and destructive coping strategies common in BPD. When activated, they can push patients with BPD into emotional turmoil and a dissociative state of mind. Our knowledge of the underlying neurocognitive mechanisms driving these changes is incomplete. We hypothesized that in patients with BPD, affective instability is more influenced by reward expectation, outcomes, and reward prediction errors (RPEs) during risky decision-making than in healthy controls. Additionally, we expected that these alterations would be related to schema modes.

METHODS

Thirty-two patients with BPD and thirty-one healthy controls were recruited. We used an established behavioral paradigm to measure mood fluctuations during risky decision-making. The impact of expectations and RPEs on momentary mood was quantified by a computational model, and its parameters were estimated with hierarchical Bayesian analysis. Model parameters were compared using High-Density Intervals.

RESULTS

We found that model parameters capturing the influence of RPE and Certain Rewards on mood were significantly higher in patients with BPD than in controls. These model parameters correlated significantly with schema modes, but not with depression severity.

CONCLUSIONS

BPD is coupled with altered associations between mood fluctuation and reward processing under uncertainty. Our findings seem to be BPD-specific, as they stand in contrast with the correlates of depressive symptoms. Future studies should establish the clinical utility of these alterations, such as predicting or assessing therapeutic response in BPD.

Borderline Personality Disorder With Versus Without Alcohol Use Disorder: Comparing Impulsivity and Schema Modes

Substance use disorders (SUDs) and borderline personality disorder (BPD) are highly comorbid. In the present study, an attempt was made to understand the differences between BPD and BPD with comorbid SUD (BPD + alcohol use disorder [AUD]), by studying impulsivity and schema modes (i.e., maladaptive moment-to-moment emotional states and coping responses). BPD patients, BPD+AUD patients, and nonpatients (NP) were compared regarding behavioral impulsivity (motor impulsivity, risk taking, delay discounting), and schema modes. The two patient groups displayed greater delay discounting than the NP group. Further, BPD and BPD+AUD groups were different from the NP group regarding all schema modes investigated. However, no differences were found on any of the dependent variables between the two patient groups. It is suggested that although BPD patients are in general more impulsive and have more maladaptive moment-to-moment emotional states and coping responses, BPD patients with and without AUD seem not to be different in this respect.

Schema Modes, Trauma, and Disordered Eating

Maladaptive schema modes may mediate between trauma and disordered eating, however there is little relevant evidence. This study aimed to predict disordered eating from modes, trauma, and age and gender. Also, to re-examine the factor structure of the Schema Mode Inventory for Eating Disorders, using an online cross-sectional survey of 612 volunteer participants aged 18 to 65, recruited from online eating disorder support groups, including people with and without diagnosed eating disorders. Measures were sociodemographic variables, the Schema Mode Inventory for Eating Disorders (Short Form; SMI-ED-SF), the Eating Disorder Examination Questionnaire (EDE-Q), and the Trauma History Questionnaire (THQ). Confirmatory factor analysis produced 16 factors similar to the 16 modes. Differences were that Vulnerable Child, Happy Child, and Healthy Adult appeared as a one factor, that all ED items appeared as one factor, and that Bully & Attack and Self-Aggrandizer modes appeared combined. In stepwise linear regression, EDE-Q scores was predicted by Total maladaptive mode score (37.3% of variance), Total adaptive mode score (1.5%) variance, Vulnerable Child (2.8%), Detached Self-Soother (1.5%). Other modes accounted for 1% or less of variance. Schema modes predicted EDE-Q, but the stable existence of discrete persona-like modes was less clear. Further research should refine the structure of SMI-ED-SF and relate modes to interpersonal traumas.

The influence of maladaptive coping modes, resilience, and job demands on emotional exhaustion in psychologists

Although it is well established that emotion-focused coping is associated with burnout, the schema therapy model may improve the prediction of who is most vulnerable to using emotion-focused coping and what kinds of emotion-focused coping carry the greatest risk of burnout. It is also unknown the extent to which resilience might buffer against maladaptive coping in protecting against burnout. The present study investigated whether maladaptive coping modes would incrementally predict emotional exhaustion (EE) adjusting for resilience and whether resilience might moderate the effect of maladaptive coping on EE. The possible role of maladaptive coping as a mediator of job demands on EE was also explored. Four hundred and forty-three clinical and counselling psychologists completed online measures of job demands, EE, resilience, and maladaptive coping modes. The Detached Protector mode was associated with greater EE after adjusting for resilience. Bully and Attack mode was associated with greater EE when considered separately from other coping modes but associated with decreased EE when considered together. Resilience did not moderate the effect of job demands on EE, or the effect of coping modes on EE, except for Compliant Surrenderer. Coping modes only partially mediated the effect of job demands on EE accounting for 20% or less of its effect. Maladaptive coping modes appear to make independent contributions to the risk of EE and efforts to reduce burnout in psychologists should focus dually on increasing resilience-building practices and decreasing maladaptive coping.

Association of Fatigue Severity With Maladaptive Coping in Multiple Sclerosis: A Data-Driven Psychodynamic Perspective

Fatigue in persons with multiple sclerosis (PwMS) is severely disabling. However, the underlying mechanisms remain incompletely understood. Recent research suggests a link to early childhood adversities and psychological trait variables. In line with these studies, this paper took a psychodynamic perspective on MS-fatigue. It was hypothesized that fatigue could represent a manifestation of maladaptive coping with intense emotions. The schema therapeutic mode model served as a theoretical and empirically validated framework, linking psychodynamic theory and empirical research methods. The study was based on a data set of N = 571 PwMS that has also served as the basis for another publication. Data was collected online. The Schema Mode Inventory was used to quantify regulatory strategies to cope with emotionally stressful experiences. In addition, depressive symptoms (Beck's Depression Inventory - FastScreen), physical disability (Patient Determined Disease Steps), alexithymia (Toronto Alexithymia Scale-26), adverse childhood experiences (Childhood Trauma Questionnaire), and self-reported fatigue (Fatigue Scale for Motor and Cognitive Functions) were assessed. Latent profile analysis revealed three distinct groups of PwMS, based on their coping mode profiles: (1) PwMS with low maladaptive coping, (2) PwMS with avoidant/submissive coping styles, and (3) PwMS with avoidant/overcompensatory coping styles. Multivariate comparisons showed no significant difference in physical disability across the three groups. However, heightened levels of self-reported fatigue and depression symptoms occurred in PwMS with maladaptive coping styles. A path model uncovered that self-reported fatigue was robustly related to physical disability (β = 0.33) and detached/avoidant coping (Detached Protector; β = 0.34). There was no specific relation between any of the maladaptive coping modes and depression symptoms. Detached/avoidant coping was in turn predicted by childhood emotional abuse and neglect. The results indicate that childhood adversity and detached/avoidant coping styles may be associated with variability in MS-fatigue severity: PwMS that resort to detached/avoidant coping in response to negative emotions also tend to report heightened levels of fatigue, although they do not differ in their perceived disability from PwMS with low levels of fatigue and maladaptive coping. A link between MS-fatigue and the psychodynamic traumatic conversion model is discussed. The implications of these findings for therapeutic interventions require further study.

The mediating role of externalising and healthy schema modes in the relationship between early maladaptive schemata and overt behaviours in adolescent boys with offending behaviours, and a comparison of their early schemata with those of typically developing boys

BACKGROUND

Evidence-based treatments in routine clinical practice often fail to achieve or sustain amelioration of severe behaviour problems in adolescents. Better understanding of mechanisms underlying such severe behaviour problems could improve treatments. Underlying schemata and schema modes may play an important role.

AIMS

To compare early maladaptive schemata, schema modes and behaviour problems in adolescent boys showing disruptive and offending behaviours with those in typically developing boys. We hypothesised a relationship between disconnection and rejection schemata on the one hand and behaviour problems (including offending) on the other in adolescent boys with disruptive behaviour disorders. We also hypothesised that this offending group would differ significantly from typically developing boys on these measures and that schema modes would mediate relationships between schemata and overt behaviours.

METHOD

In this cross-sectional study, fifty-five 12-19-year-old boys with disruptive behaviour disorders referred to an in- or out-patient clinic were matched to fifty-five typically developing boys from a previously generated school sample. Group differences on self-reported schema related measures and externalising behaviour measures were compared using t-tests. Mediation analyses were performed to assess the mediating role of schema modes in the relation between schemata and behaviour.

RESULTS

Boys diagnosed with disruptive behaviour disorders and engaging in offending behaviours had higher scores on externalising modes and lower scores on healthy modes than the typically developing boys. There were no differences between these groups, however, in disconnection and rejection schemata. In the offending behaviour group, externalising modes mediated the relationship between disconnection and rejection schemata and externalising behaviours while healthy modes mediated a relationship between these schemata and overt prosocial behaviours.

IMPLICATIONS

The potential impact of healthy modes has not previously been shown in studies of schemata in young offenders. Our findings suggest that treatments for adolescents with severe behaviour problems should not only target maladaptive schemata and dysfunctional modes, but seek also to boost healthy modes.

Evaluating schema modes and cognitive distortions in borderline personality disorder: A mixed-method approach

OBJECTIVES

Cognitive processes, such as schema modes and cognitive distortions, may play a role in the genesis and maintenance of affective, interpersonal, and behavioral difficulties in individuals with Borderline Personality Disorder (BPD). This study aimed at exploring the schema modes and cognitive distortions in individuals with BPD.

METHODS

Using a mixed-method approach, 30 individuals with BPD and 30 healthy participants were assessed on the Borderline Personality Questionnaire, the Schema Mode Inventory, the Cognitive Distortions Scale, and a semi-structured interview schedule.

RESULTS

The BPD group had higher scores than the control group on all the maladaptive schema modes and cognitive distortions subscales. The child modes were the commonest and were also the strongest correlate of BPD symptomatology. Qualitative analysis of the content of the semi-structured interview also corroborated these findings.

CONCLUSIONS

There could be many schema modes and cognitive distortions operating behind the diverse psychopathology seen in BPD.

The network structure of schema modes

A fundamental question in psychotherapy is whether interventions should target client problems (i.e., problem-focused approaches) or client strengths (i.e., strength-focused approaches). In this study, we first propose to address this question from a network perspective on schema modes (i.e., healthy or dysfunctional patterns of co-occurring emotions, cognitions, and behaviours). From this perspective, schema modes mutually influence each other (e.g., healthy modes reduce dysfunctional modes). Recent evidence suggests that changes in modes that are strongly associated to other modes (i.e., central modes) could be associated with greater treatment effects. We therefore suggest research should investigate the relative centrality of healthy and dysfunctional modes. To make an exploratory start, we investigated the cross-sectional network structure of schema modes in a clinical (comprising individuals diagnosed with paranoid, narcissistic, histrionic, and Cluster C personality disorders) and non-clinical sample. Results showed that, in both samples, the Healthy Adult was significantly less central than several dysfunctional modes (e.g., Undisciplined Child and Abandoned and Abused Child). Although our study cannot draw causal conclusions, this finding could suggest that weakening dysfunctional modes (compared to strengthening the Healthy Adult) might be more effective in decreasing other dysfunctional modes. Our study further indicates that several schema modes are negatively associated, which could suggest that decreasing one might increase another. Finally, the Healthy Adult was among the modes that most strongly discriminated between clinical and non-clinical individuals. Longitudinal and experimental research into the network structure of schema modes is required to further clarify the relative influence of schema modes.

A trait emotional intelligence perspective on schema modes

Schema modes (or modes) are a key concept in the theory underlying schema therapy. Modes have rarely been related to established models of personality traits. The present study thus investigates the associations between trait emotional intelligence (TEI) and 14 modes, and tests a global TEI-mode factors-general psychological distress mediation model. The study draws on self-report data from 173 inpatients from a German clinic for psychosomatic medicine. Global TEI correlated positively with both healthy modes (happy child and healthy adult) and negatively with 10 maladaptive modes. When modes were regressed on the four TEI factors, six (emotionality), five (well-being), four (sociability), and four (self-control) significant partial effects on 10 modes emerged. In the parallel mediation model, the mode factors internalization and compulsivity fully mediated the global TEI-general psychological distress link. Implications of the results for the integration of modes with traits in general and with TEI in particular as well as implications of low TEI as a transdiagnostic feature of personality malfunctioning are discussed.

Patient-Reported ICD-11 Personality Disorder Severity and DSM-5 Level of Personality Functioning

This study evaluated the Standardized Assessment of Severity of Personality Disorder (SASPD) proposed for ICD-11 and the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF) developed for DSM-5 Section III and their relationships with external correlates. We used a clinical sample (N = 150; 33% women) of 65 psychiatric outpatients and 85 incarcerated addicts, who self-reported the SASPD and the LPFS-BF. We conducted correlation and regression analyses in order to determine the relative associations of these two measures with relevant external criteria. SASPD predominantly captured externalizing and other-related problems (e.g., potential harm to others), whereas LPFS-BF predominantly captured internalizing and self-related problems (e.g., identity and distress). Generally, LPFS-BF explained more variance of the external criteria relative to SASPD. The findings seem to reflect that the ICD-11 oriented SASPD emphasizes interpersonal and aggressive features, whereas the DSM-5-oriented LPFS-BF emphasizes self-pathology and distress. More conclusive findings warrant interview-rated personality functioning.

Turkish adaptation of the Short Schema Mode Inventory

The purpose of the current study is to present the psychometric properties of the Short Schema Mode Inventory in the Turkish culture. The study sample comprised 1,287 participants, including both clinical and nonclinical participants. The age of the participants ranged between 18 and 48 years. The construct validity of the scale was tested using confirmatory factor analysis. The internal (Cronbach's alpha) and test-retest reliability coefficients were used to examine the reliability of the scale. Discriminant validity was investigated by comparing the nonclinical and clinical participants. Concurrent validity was tested via the Splitting Scale. The results of the study showed that the tested model had good data-model fit statistics. Additionally, the reliability analyses revealed that the scales had good internal and test-retest reliability coefficients. A significant association was found between the subscales of the Schema Mode Inventory. Furthermore, the scores of the clinical participants were significantly higher compared with the scores of the nonclinical participants for the maladaptive schema modes. Nonetheless, the participants in the nonclinical group had significantly higher levels of the healthy schema modes than individuals in the clinical group. The results of this study demonstrated that the Schema Mode Inventory was a reliable and valid instrument to measure schema modes in the Turkish population.

Schema in older adults: does the schema mode model apply?

BACKGROUND

The relevance of schema theory to psychopathology, in particular personality disorder, in younger adults is established. Investigations into the relevance of schema theory to older adults, however, is highly limited.

AIMS

To consider the relationship of schema modes to psychopathology in older adults and establish whether maladaptive schema modes are associated with unmet needs and that this relationship is mediated by the healthy adult mode of responding in this population.

METHOD

One hundred and four older adults were recruited from an established database. Participants completed questionnaires assessing psychopathology, schema modes (YAMI: Young-Atkinson Mode Inventory) and basic psychological needs (BPNS: Basic Psychological Needs Scale - autonomy, competence and relatedness). Ninety-four responses were included after applying exclusion criteria.

RESULTS

The healthy adult schema mode was found to be associated with reduced psychopathology, and maladaptive child modes (angry and vulnerable child) to increased psychopathology. The healthy adult schema mode mediated the relationship between maladaptive child modes and needs satisfaction.

CONCLUSIONS

As predicted by schema theory, the presence of one of the maladaptive child modes makes it difficult for an older individual to have their needs met, but the presence of healthy adult mode works to support this process.

Young Schema Questionnaire - Short Form Version 3 (YSQ-S3): Preliminary validation in older adults

OBJECTIVES

The aim of the current study was to establish the reliability and validity of one of the most used schema questionnaires, Young Schema Questionnaire Short Form Version 3 (YSQ-S3) in older adults.

METHOD

104 participants aged 60-84 years were recruited. They were administered a battery of questionnaires, including the YSQ-S3, Young-Atkinson Mode Inventory (YAMI), Germans (Personality) Screener, the Geriatric Depression Scale (GDS), The Geriatric Anxiety Inventory (GAI) and the Basic Psychological Needs Scale (BPNS). The YSQ-S3 was completed a second time by 83 participants a median of 12 days later.

RESULTS

Satisfactory internal consistency reliability was found for 13 of the 18 early maladaptive schemas (EMS) of the YSQ-S3. Test-retest reliability was satisfactory for 17 of 18 EMS. Convergent validity was evident from significant correlations between the EMS of the YSQ-S3 and the vulnerable child and angry child schema modes from the YAMI. Congruent validity was evident from correlations of the majority of the EMS with the GDS, the GAI, German's (Personality) Screener and the BPNS measure.

CONCLUSIONS

By and large the YSQ-S3 demonstrates internal and test re-test reliability in as well as congruent and convergent validity, in older adults. This suggests the YSQ-S3 may be of use in work establishing the utility of schema therapy in this population, and that schema therapy with older people warrants further exploration. Notwithstanding this some re-development of some EMS items appears to be required for the YSQ-S3 to be more relevant to older people.

The role of aggression-related early maladaptive schemas and schema modes in aggression in a prisoner sample

Contemporary social-cognitive aggression theory and extant empirical research highlights the relationship between certain Early Maladaptive Schemas (EMSs) and aggression in offenders. To date, the related construct of schema modes, which presents a comprehensive and integrated schema unit, has received scant empirical attention. Furthermore, EMSs and schema modes have yet to be examined concurrently with respect to aggressive behavior. This study examined associations between EMSs, schema modes, and aggression in an offender sample. Two hundred and eight adult male prisoners completed self-report psychological tests measuring their histories of aggression, EMSs, and schema modes. Regression analyses revealed that EMSs were significantly associated with aggression but did not account for a unique portion of variance once the effects of schema modes were taken into account. Three schema modes, Enraged Child, Impulsive Child, and Bully and Attack, significantly predicted aggression. These findings support the proposition that schema modes characterized by escalating states of anger, rage, and impulsivity characterize aggressive offenders. In this regard, we call attention to the need to include schema modes in contemporary social-cognitive aggression theories, and suggest that systematic assessment and treatment of schema modes has the potential to enhance outcomes with violent offenders.

Does schema therapy change schemas and symptoms? A systematic review across mental health disorders

PURPOSE

Schema therapy was first applied to individuals with borderline personality disorder (BPD) over 20 years ago, and more recent work has suggested efficacy across a range of disorders. The present review aimed to systematically synthesize evidence for the efficacy and effectiveness of schema therapy in reducing early maladaptive schema (EMS) and improving symptoms as applied to a range of mental health disorders in adults including BPD, other personality disorders, eating disorders, anxiety disorders, and post-traumatic stress disorder.

METHODS

Studies were identified through electronic searches (EMBASE, PsycINFO, MEDLINE from 1990 to January 2016).

RESULTS

The search produced 835 titles, of which 12 studies were found to meet inclusion criteria. A significant number of studies of schema therapy treatment were excluded as they failed to include a measure of schema change. The Clinical Trial Assessment Measure was used to rate the methodological quality of studies. Schema change and disorder-specific symptom change was found in 11 of the 12 studies.

CONCLUSIONS

Schema therapy has demonstrated initial significant results in terms of reducing EMS and improving symptoms for personality disorders, but formal mediation analytical studies are lacking and rigorous evidence for other mental health disorders is currently sparse.

PRACTITIONER POINTS

First review to investigate whether schema therapy leads to reduced maladaptive schemas and symptoms across mental health disorders. Limited evidence for schema change with schema therapy in borderline personality disorder (BPD), with only three studies conducting correlational analyses. Evidence for schema and symptom change in other mental health disorders is sparse, and so use of schema therapy for disorders other than BPD should be based on service user/patient preference and clinical expertise and/or that the theoretical underpinnings of schema therapy justify the use of it therapeutically. Further work is needed to develop the evidence base for schema therapy for other disorders.