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Hot Topics: Session 2

Schema Therapy vs. CBT in Psychiatric Rehabilitation of (Chronic) Depression

by: Alexandra Schosser


Early Maladaptive Schemas (EMS) play a causal role in the development of later psychopathology including depression severity and episodes of major depression. The current study examines schemas and modes in depression phenotypes (chronic vs. non-chronic depression, with vs. without co-morbidity) in an ambulant psychiatric rehabilitation setting in Vienna, Austria. The therapy programme under investigation was based on either cognitive behavioural psychotherapy (CBT) or schema therapy (ST).


Treatment was performed as standardised 6-weeks multi-professional rehabilitation programme, based on either CBT or ST. Questionnaire-based surveys were performed at time of admission, at discharge, and 6 and 12 months after discharge. Among others, patients filled in the Young Schema Questionnaire (YSQ-S3 dt), the Schema Mode Inventory (SMI v1), and the Beck-Depression Inventory (BDI-II).


A total of 1,913 patients were included, of those 1,406 (73.50%) were diagnosed with a depressive disorder (59.60% with a diagnosis of depression with comorbidity, 27.45% a diagnosis of chronic depression without comorbidity, and 12.94% of non-chronic depression without comorbidity.

Depression (BDI-II) scores significantly decreased from admission to discharge (p<0.001) in all groups of patients.

The highest schema scores at admission were found for patients suffering from chronic depression with comorbidity (multivariate analysis of variance p<0.001). Schemas were shown to be stable traits when investigating the influence of BDI-II scores on the YSQ scores. Modes in chronic depression significantly differed from modes in non-chronic depression as well (p<0.001).

Comparing ST (n=156) vs. CBT (n=348), both groups showed significant improvement with regard to BDI-II, with higher effect sizes of ST in the subgroup of chronic depression.


Chronically depressed, especially those with comorbidities, were shown to have significantly higher EMS scores than non-chronic courses of disease. As for treatment response, we found higher effect sizes of ST as compared to CBT in chronic depression.


1,2,3Alexandra Schosser, 2Daniela Fischer-Hansal, 2Gabriele Riedl, 2Birgit Senft

1 Sigmund Freud Private University, Vienna, Austria

2Zentren für seelische Gesundheit, BBRZ-Med, Vienna, Austria

3 Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

4 Arbeitsgemeinschaft für Verhaltensmodifikation, Paris-Lodron-Straße 32, 6020 Salzburg, Austria

About the Presenter:

Alexandra Schosser

I am medical specialist in psychiatry, as well as psychotherapist and supervisor in CBT and Schema Therapy. I have been medical director of an ambulant psychiatric rehabilitation clinics in Vienna(Austria)since 2013 (“Zentren für seelische Gesundheit Wien”, BBRZ-Med). In addition to my clinical work, I have been working in research and teaching at the Department of Psychiatry and Psychotherapy of the Medical University Vienna since 2001, with a major focus on psychiatric genetics of affective disorders, and since 2013 onpsychiatric rehabilitation and psychotherapy research. Since 2016 I am member of the ISST Training & Certification committee, and I am current science and research co-ordinator of the ISST executive board

Why Schema Therapy?

Schema therapy has been extensively researched to effectively treat a wide variety of typically treatment resistant conditions, including Borderline Personality Disorder and Narcissistic Personality Disorder. Read our summary of the latest research comparing the dramatic results of schema therapy compared to other standard models of psychotherapy.

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