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SYMPOSIUM 3 | DAY 1: 10.30 AM -12.00 PM

Creating Positive Change in the Lives of Our Clients Using Technology: Which Elements of Schema Therapy Can Be Offered Online?

by Sally Skewes, Alp Karaosmanoglu, Gitta Jacob, Eva Fassbinder, and Michiel van Vreeswijk

Chair: Sally Skewes


As the therapeutic landscape changes alongside advances in technology, therapists will have access to increasingly innovative ways of connecting with their clients and contributing to client wellbeing, enhancing therapy outcomes. By integrating eHealth programs into Schema Therapy, the transfer of Schema Therapy experiences from the therapy room to the everyday lives of our clients can be promoted as support can be provided in the moment through technology. Technology has the potential to solve some of the issues related to decreasing session allowances across the world, long waiting lists and other difficulties accessing Schema Therapy. This symposium addresses the development and effectiveness of eHealth programs designed specifically for Schema Therapy to create positive change in the lives of our clients. We will explore the following questions; 1. Is it helpful to provide clients with eHealth tools to gain a deeper understanding of relevant basic core needs, schemas and modes? 2. Which clients benefit from eHealth programs? 3. What elements should be incorporated in eHealth programs to contribute positively to the change process as an adjunct to face to face therapy? Growing evidence indicates that specialised eHealth tools can be integrated into Schema Therapy with positive outcomes that hold great promise. This symposium brings together therapists from Germany, Turkey, Australia and the Netherlands working with specialised eHealth programs who will present the programs they are developing and preliminary results for a variety of disorders including BPD and mixed PD. Karaosmanoglu will present the production process and effectiveness studies of a self-help app. Jacob and Fassbinder will present Priovi, which is a Schema Therapy based online program for patients with Borderline Personality Disorder. Skewes and van Vreeswijk will present Secure Nest, which is an eHealth tool designed for Schema Therapy.

Segment 1

Presenter: Alp Karaosmanoglu

Mobile technologies and artificial intelligence are being used increasingly in our daily lives. We can get help from our mobile phones through applications (apps) to call a taxi or find a restaurant nearby. These apps even calculate the time of our trip or the time for the taxi to arrive. There are so many apps on the market for helping us to meet our daily needs. Mental health professionals are also beginning to use these mobile facilities in their practice. There are many apps for automation of clinical work, helping the therapy process with online questionnaires and homework monitoring, and also providing therapy techniques for self-help. 

In this presentation the production process and the effectiveness studies of a self-help app will be introduced. Based on a simple ‘thought record form’ of Cognitive Behavioral Therapy, this self-help app is being used for nearly ten thousand distressing events by three thousand users since the year it was developed, 2002. 

With the developments in the mobile technologies and the experience gained with these recorded triggering events, thoughts and behaviors, this app is programmed to “understand” what the user is working on. Like real psychotherapy, it helps the user to distinguish emotion from thought, thought from behavior, etc. With the aid of an online schema questionnaire, the schemas of the user are extracted and this information is used during a session to build a rationale about the triggered schema(s) with the distressing event that the user is working on. 

Within the presentation some questions will try to be fulfilled: 

- Is this self-help app really helpful? 

- Does the understanding ability of the app increase the effectiveness? 

- What is the additive effect of the schema-focused techniques to basic CBT techniques used in this app?

Segment 2

Presenters: Gitta Jacob & Eva Fassbinder

Online-treatment hold promise for the treatment of mental disorders. So far, very few applications for people with BPD have been developed and investigated. Main concerns against the use of automatized tools are related to the complexity of the disorder and the high need of BPD patients for personal contact. Thus we conducted a pilot study to investigate whether a complex automatized program is feasible and potentially helpful in BPD. Priovi is a fully automatized online-program tailored to the needs and emotions of the patient user. Users "chat" with priovi; psychoeducation and psychological techniques are offered within this dialogue. Priovi is designed to be used for approx. 6 months and contains information, psychoeducation, exercises, audios, illustrations etc. 

In a pilot study, 14 patients used priovi in addition to individual treatment. Our main question was whether patients would like to work with priovi and whether we could detect risks related to the use of priovi. 

In sum, patients made good progress in their treatment and no averse events were reported. In qualitative interviews regarding the patients' relationship with priovi, they reported an overall positive attitude and found priovi very helpful. We found that patients who got their first specific BPD treatment had much better benefit than patients with prior treatments in their history. 

Currently the first RCT with priovi as add-on to standard care is running. First experiences will be reported.

Segment 3

Presenters: Sally Skewes & Michiel van Vreeswijk

The recent development of eHealth tools for Schema Therapy provides therapists with innovative ways to transfer corrective emotional experiences in the therapy room to the everyday lives of our clients. A growing body of research indicates that eHealth tools provide therapists with avenues to enhance connection between sessions, strengthen one’s understanding of therapy material, encourage self-reflection, and provide access to therapeutic support 24/7. Such tools hold promise for enhancing therapeutic outcomes for a range of mental health difficulties. 

Conversely, concerns exist around whether the essential experiential elements of Schema Therapy can be applied using eHealth and whether the needs of those with complex disorders can be met. Secure Nest is an eHealth tool which places a special emphasis on each user’s unique combination of schemas, modes and relevant core needs. 

Consistent with the Schema Therapy model, the case conceptualisation drives the individually tailored educational information and therapeutic techniques that are offered to the user in a flexible way. Secure Nest provides a collaborative workspace for therapists to support their clients; connecting them together on the platform. Therapists have the opportunity to upload personalised exercises, information, audio-recordings and images tailored to the needs and feelings of clients, and to comment on mode diaries and communicate with clients between sessions. 

In our qualitative pilot study, a therapist focus group and individual client interviews were conducted to explore the subjective impact of and satisfaction with Secure Nest as an adjunct to face-to-face Schema Therapy in a small sample of therapists and clients. Thematic analysis of client interview transcripts revealed that overall Secure Nest added value to Schema Therapy and clients reported positive experiences. Challenges included disclosing sensitive information and schemas being triggered by response time. The first multiple single case series study exploring a group format of Secure Nest in addition to group schema therapy is in development. Initial experiences will be presented.

About the Presenters:

Sally Skewes

Sally Skewes is a Clinical Psychologist who shares her time working in both government and private settings with clients with complex psychological presentations. Sally is certified as a Schema Therapist and Supervisor with the International Society of Schema Therapy (ISST); and co-founder of SecureNest.org, an innovative eHealth tool designed specifically for Schema Therapy. Sally has co-authored book chapters and articles on Schema Therapy, and has presented workshops on Schema Therapy and eHealth. Sally trains psychologists and psychiatrists in Australia.

Hasan Alp Karaosmanoğlu

Psychiatrist, Founder of PsikoNET Psychiatry and Training Center

Advanced Certified Schema Therapist, Supervisor, and Trainer

Hasan Alp Karaosmanoğlu works as a psychiatrist and a psychotherapist in Istanbul. He is the writer of the book Oops, Something Bad Will Happen -The Pincer of Worry: Anxiety and Conscience. He continues his ISST-approved training and certification programs in Turkey and abroad. 

Michiel van Vreeswijk

Michiel van Vreeswijk is a Clinical Psychologist, certified as a Schema Therapist and Supervisor with the ISST. He is a certified CBT practitioner and supervisor, and is CEO of Gkracht Psychomedisch Centrum BV in the Netherlands. Michiel has written, edited and authored several books, chapters and articles on Schema Therapy, including editing, and writing several chapters in The Handbook of Schema Therapy, Theory, Research, and Practice (Wiley-Blackwell,2012).

Gitta Jacob

Gitta Jacob, Ph.D., licensed CBT therapist, ISST approved schema therapist and supervisor, member of the founding board of the ISST. Gitta has participated in the RCT investigating effectiveness of schema therapy as a group treatment for BPD (PI Arntz, Farrell), and has written, together with Arnoud Arntz, the book "Schema Therapy in Practice", which has been published in about 10 languages so far. Since 2013, she works in Hamburg at GAIA, a public health company with a focus on development and research in therapeutic software. Gitta is scientifically affiliated with the University Clinic of Lübeck.

Eva Fassbinder

Eva Fassbinder works as assistant medical director at the Department of Psychiatry and Psychotherapy, Lübeck University. She is co-leader of the outpatient center at Lübeck University and her main efforts lie in the implementation and dissemination of outpatient psychotherapy programs. Main research interests: schema therapy and other third wave psychotherapies, group psychotherapy, personality disorders, posttraumatic stress disorders, depression, emotion regulation and online psychotherapy.

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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