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SYMPOSIUM 12 | DAY 2: 10.45 AM - 12.15 PM

Broadening Our Understanding of Schema Modes Across Disorders: Theory and Evidence 

by Duygu Yak, Richard Vuijk, Sandra Raabe, and Martine Daniels

Chair: Duygu Yak

Recent developments on the schema therapy model, with a specific focus on schema modes, displayed the effectiveness of schema therapy across a variety of disorders. Although schema modes are theoretically recognized as transdiagnostic factors that facilitate recovery, there is still lack of empirical evidence identifying the relationship between early maladaptive schemas and schema modes across different psychopathological problems. In this symposium, promising lines of research are introduced to provide information on this problem. The first talk identifies a schema mode model to specify the mechanism of change in schema therapy from a schema mode perspective for global severity of personality pathology. The second talk focuses on treatment of personality disorder comorbidity in adults with autism spectrum disorder by identifying the related early maladaptive schemas and schema mode structure. The third talk discusses the effects of Imagery Rescripting for patients with complex PTSD related to childhood abuse on schema modes, emotion regulation, and interpersonal functioning. The last talk compares the effectiveness of Imagery Rescripting and EMDR on schema modes while treating childhood trauma-related PTSD. Together, we aim to connect empirical data on different schema therapy settings across disorders and discuss clinical implications of schema modes.

Segment 1

Title: Mechanisms of change in schema therapy for personality pathology : A schema mode model

Presenter: Duygu Yakın

In recent years, schema therapy is recognized as an evidence-based treatment for people with personality disorders. However, an evidence-based explanation for the mechanism of change in schema modes has not been specified yet. The present study aims to identify a schema mode model to formulate the change in the global severity of the personality pathology during schema therapy. The data were collected from 12 Dutch mental health institutes as a part of a multicenter randomized controlled trial of schema therapy conducted by Bamelis and colleagues (2014). Multilevel autoregressive model with restricted maximum likelihood estimator was utilized in order to explore cross-lagged associations between schema modes and personality psychopathology scores over subsequent measurements at baseline, 6, 12, 18, 24 and 36 months. 

Two principal hypotheses were tested. First, maladaptive SM manifestations are positively associated with later severity of personality disorder. Second, Healthy Adult schema mode manifestations are negatively associated with later severity of personality disorder. Results revealed that The Vulnerable Child, Impulsive Child, Avoidant Protector and the Healthy Adult at a previous time point of the measurement are predictive of later global severity of personality psychopathology during treatment.

Segment 2

Title: Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder: Protocol of a multiple-baseline case series study testing cognitive-behavioral and experiential interventions

Presenter: Richard Vuijk

Background: To our knowledge treatment of personality disorder (PD) comorbidity in adults with ASD is understudied and is still in its infancy. This study investigates the effectiveness of schema therapy for PD-psychopathology in adult patients with both ASD and PD. 

Methods/Design: Twelve adult individuals (age > 18 years) with ASD and at least one PD are given a treatment protocol consisting of 30 weekly offered sessions. A concurrent multiple baseline design is used with baseline varying from 4 to 9 weeks, after which weekly supportive sessions varying from 1 to 6 weeks start with the study therapist. After baseline and 1 to 6 supportive sessions, a 5-week exploration phase follows with weekly sessions during which current and past functioning, psychological symptoms, and schema modes are explored, and information about the treatment is given. This is followed by 15 weekly sessions with cognitive-behavioral interventions and 15 weekly sessions with experiential interventions: patients are vice versa and randomly assigned to the interventions. 

Finally, there is a 10-month follow-up phase with monthly booster sessions. Participants are randomly assigned to baseline length, and report weekly during treatment and monthly at follow-up on Belief Strength of negative core beliefs, and fill out SMI, SCL-90 and SRS-A 7 times during screening procedure (i.e. before baseline), after supportive sessions, after exploration, after cognitive and behavioral interventions, after experiential interventions, and after 5- and 10- month follow-up. The SCID-II is administered during screening procedure, at 5- and at 10-month follow-up.

Segment 3

Title: Imagery Rescripting versus STAIR/Imagery Rescripting for PTSD related to Childhood Abuse: A Randomized Controlled Trial

Presenter: Sandra Raabe

PTSD related to childhood abuse is often characterized by a complex presentation of symptoms, both in the areas of PTSD and in the areas of selfview- and others, emotion regulation, interpersonal functioning, and dissociation. The symptom overlap with personality disorders is high. In a recent randomized controlled trial we tested whether Imagery Rescripting (ImRs) is a helpful technique for processing childhood trauma and reducing PTSD-symptoms when administered as a stand-alone treatment. 

We examined two main questions: 

1) what is the efficacy of Imagery Rescripting (ImRs) as stand-alone treatment for patients with complex PTSD related to childhood abuse

2) does the addition of a skills training in emotion and interpersonal regulation (STAIR) as a preparatory phase prior to the ImRs-treatment phase enhance the treatment effect for PTSD-symptoms. 

This presentation provides data on a comparison of ImRs as stand-alone treatment compared to the sequential treatment (STAIR/ImRs) and to a waitlist control group. Data consist of single-blind obtained interview-based measures for PTSD, and self-report measures for PTSD-symptoms, schema-modes, emotion regulation, and interpersonal functioning.

Segment 4

Title: Imagery Rescripting (ImRs) vs. Eye Movement Desensitization and Reprocessing (EMDR) for PTSD related to Childhood Abuse: effectiveness on the Schema Modes

Presenter: Martine Daniels

Many patients suffering from PTSD related to Childhood Abuse also suffer from comorbid personality pathology. It is therefore preferable that the treatment of the PTSD is also effective in reducing these comorbid problems. In a multicenter Randomised Controlled Trial on the effectiveness of ImRs vs. EMDR as treatment for PTSD related to Childhood Abuse, this additional study examines two main questions: 

1) Is ImRs more effective than EMDR in the reduction of dysfunctional Schema Modes/enhancement of functional Schema Modes of childhood-trauma related PTSD? 

2) To what extent is the effectiveness on the Schema Modes independent of the effectiveness on the PTSD? This presentation provides data on a comparison between 12 sessions of ImRs and 12 sessions of EMDR. Data consist of single-blind obtained interview-based measures for PTSD and self-report measures of Schema Modes (pre-, post treatment and 8 weeks follow-up, N=70).

About the presenters:

Duygu Yakın

Duygu Yakın  is a postdoctoral researcher in the department of Clinical Psychology at the University of Amsterdam with an affiliation at the Istanbul Arel University. Her work is centered on early maladaptive schemas, schema modes, emotion regulation and personality disorders. She also practices as a researcher/psychotherapist at i-psy Haarlem, a center which provides psychotherapy from an intercultural perspective.

Richard Vuijk

Richard Vuijk is clinical psychologist at Sarr Expertise center Autism Rotterdam, The Netherlands. Richard has worked extensively with adults with autism spectrum disorder. His research and publications address personality, psychotherapy (schema therapy) and diagnostic assessment of individuals with ASD. Richard is active in the training of psychiatrists and psychologists to diagnose and treat ASD and related disorders. In the Netherlands he published the Netherlands Interview  for Diagnostic assessment Autism spectrum disorder in adults (NIDA).

Sandra Raabe

Sandra Raabe is a lecturer/PhD-student at the department of Clinical Psychology at the University of Amsterdam. Her research focuses on the application of Imagery Rescripting as treatment technique for complex PTSD related to childhood trauma. In addition, she works as a therapist at the Sinai Centre, a department of Arkin Institute of Mental Health offering specialized trauma-focused treatments.

Martine Daniëls

Martine Daniëls is a clinical psychologist in training at Mental Health Service Organization GGZ Noord-Holland Noord and works at the SFT-Department of Arkin in Amsterdam. As schema therapist and cognitive behaviour therapist, she is specialised in treatment of patients with PTSD, Personality Disorders and Bipolar Disorders. She was co-author of the Dutch Bipolar disorder treatment guidelines 2015. In recent years, she was connected as researcher to the IREM study (Imagery Rescripting vs. Eye Movement Desensitization and Reprocessing as treatment of childhood-trauma related PTSD in adults). This study was conducted at, inter alia, Mental Health Service Organisation GGZ Noord-Holland Noord.

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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