SUMMARY:

While large-scale randomised clinical trials have demonstrated the efficacy of schema therapy (ST) for borderline personality disorder (BPD) and other PDs, current studies are expanding to assess its usefulness for other disorders and particular treatment settings. This symposium intends to focus on novel empirical research on mode work techniques and implementation of schema therapy for different in- and out-patient groups. The first talk (A. Werner et al.) will focus the relation of self-criticism and the “inner critic” in BPD, depression, and healthy controls, comparing cognitive restructuring, distraction and chair work as practical interventions. The second talk (Tolgou et al.) will then present data on imagery rescripting in cancer patients with depression, and will link these findings to clinical practice. Finally, we will also present (Nenadic et al.) data from a pilot study implementing group ST (GST) with a modified Farrell/Shaw model in BPD and mixed PD acute-psychiatric inpatients showing short-term improvement of symptoms after 12-15 sessions, as well as a meta-analysis of GST studies underlining its effectiveness in clinical settings. Altogether, we aim to link these empirical data with recommendations and discussions on clinical implementations of optimised treatment delivery in different in- and out-patient settings.

Chairperson: Igor Nenadic

1. Lending an ear to the “inner critic” – verbal self-criticism and resilience to it. How self-criticism differs in clinical and non-clinical samples by Antonia Werner

Extreme self-criticism is often a relevant symptom in depression and borderline personality disorder (Köhling et al., 2015). Therefore it might be seen as a risk factor for developing and maintaining these mental disorders (Gilbert & Irons, 2004). The present study investigates two main issues: first it examines how differences in the participants’ self-criticism are connected to resourceful personality traits that might buffer against harsh selfcriticism; second an experimental evaluation of intervention techniques after self-criticism takes place. Participants are healthy female and male students as well as inpatients diagnosed with depressive disorders or borderline personality disorder. Using established psychological questionnaires dispositional self-esteem, self-compassion, coping strategies, trait resilience and hope are assessed prior to a negative emotion induction. Participants are then asked to represent their “inner critic” in one chair and verbalize what their inner critic would now say to them. Afterwards participants are randomized into four different intervention groups (naturalistic control, distraction, cognitive restructuring and chair technique group). The verbal data of the “inner critic” undergo a qualitative content analysis (Mayring, 2002) to identify differences on the individual and the group level. Preliminary results regarding differences in the “inner critic” of clinical and non-clinical samples and possible connections to resilience factors will be discussed. Additionally our study focuses on the effectiveness of different intervention strategies.

Additional speakers: Ana Nanette Tibubos, Sonja Rohrmann, Neele Reiss

2. Imagery rescripting for health related fears in cancer patients by Theano Tolgou

Imagery rescripting (ImRS) as a therapeutic intervention is already being applied to several psychiatric disorders. For depression following cancer, it is assumed that ImRs contributes to the reduction of distress associated with negative intrusive imagery. Yet, only single-case studies exist and there is little knowledge about the impact of ImRS on health related fears in cancer patients. In the presented study ImRs is being compared to a progressive muscle relaxation condition. After a diagnostic interview, 20 patients with lung cancer and intrusions are randomly allocated to one of the conditions. Over a period of six weekly sessions patients activate negative mental images in order to modify them and to produce and experience a positive outcome. Progressive muscle relaxation exercises are also held in six weekly sessions. A diagnostic investigation as well as a follow-up three and six months after the interventions are planned. The content and degree of psychological parameters such as intrusive imagery, health related fears, depressive symptoms, distress and contentment are assessed. It is hypothesized that ImRs reduces the degree of psychological parameters and changes the quality of intrusive images. Preliminary results of the study will be presented and implications for clinical practice will be discussed.

Additional speakers: Daniel Berthold, Ulf Sibelius, Sonja Rohrmann, Neele Reiss

3. Group schema therapy (GST): results of a pilot study in psychiatric in-patients and a meta-analysis of GST studies / Igor Nenadic

Group schema therapy (GST) has shown very promising results in several studies, demonstrating considerable effect sizes for in-patient and out-patient treatment. Here, we present findings from a pilot study implementing an abbreviated GST programme based on the Farrell/Shaw GST model in a) borderline personality disorder (BPD), and b) a mixed cluster B / cluster C personality disorder group. We evaluated pre- and post-treatment self-report of schema modes (using the SMI) and early maladaptive schemas (YSQ-3), as well as overall symptoms (brief symptom check list, BSCL-53-S), patient satisfaction (ZUF-8) and group climate and coherence (GCQ-S). We found significant reduction of symptoms (p<0.029), and trend-level improvement for schema mode activation (p=0.054), but not maladaptive schemas (p=0.291). Effect sizes of Cohen’s d=0.857 for symptoms and d=0.693 for maladaptive schema mode reduction were similar to previous GST trials in out-patient settings. Our findings provide first evidence that GST (based on the Farrell & Shaw model) can be implemented and adapted for use in short-term in-patient (sub)acute settings, and might lead to short-term symptom improvement and possibly also improvement of schema mode activation. Longer interventions might be necessary to achieve enduring schema changes. Additionally, in a meta-analysis we conducted on available GST studies, we found considerable effect sizes, underlining the potentially large impact GST can have on treatment outcomes in BPD and potentially other personality disorders. These new findings underline the increasing evidence base for GST in the delivery of effective therapy for severe disorders.

Additional speakers: Sina Lamberth, Neele Reiss