General Abstract:

Schema Therapy for Depression - Treating Symptoms and Healing Schemas?

This symposium is aimed at evaluating the use of schema therapy in recurrent, chronic and comorbid depression from a scientific perspective. Originally formulated as a transdiagnostic approach for patients with personality disorders, Schema Therapy is constantly extending its clinical use towards the treatment of Axis-I disorders and we want to present a rationale why ST might work for depressive disorders. The speakers will present recent data from four large clinical trials in order to accumulate empirical evidence for the effectiveness of schema therapy in the treatment of depression on a symptom and schema level. Clinical and research implications will be discussed based on the presented data. We will also point out how schema therapy can be integrated into inpatient settings and adapted to shorter time frames.

Talk 1: Martin Rein will give a short introduction into the empiric foundations of the schema theoretic rationale and presents results of the OPTIMA study - a randomized controlled trial comparing schema therapy and cognitive behavior therapy for depressed patients in an inpatient setting.
Talk 2: Alexandra Schosser will complement this symposium with clinical data from more than 1400 patients treated with a standardized short time, 6-week or 20-weeks CBT or ST protocol in an outpatient setting and gather further evidence for the effectiveness of ST in affective disorders.

Talk 3: To evaluate the effect of short timed schema interventions Eckhard Roediger presents data from 448 patients treated in a 4- week inpatient schema based program of a Psychosomatic Clinic under naturalistic conditions.

Talk 4: Marit Kool will present preliminary data on the psychotherapy dosage (PSYDOS-) trial- a randomized controlled trial comparing two dosages (25 vs 50 sessions) of psychotherapy for patients with co-occurring depression and personality disorders. Schema Therapy and Short-term Psychodynamic Supportive Psychotherapy are presented as promising options to effectively treat depression that is interwoven with long-standing personality patterns.

Talk 5: Silke Bramer-Ugur will share her one-year experience from a pilot-project in an inpatient unit where schema therapy is applied to patients suffering from mood disorders and severe neurosis complicated by personality traits. The talk provides suggestions how schema therapy can be effectively integrated in an inpatient setting in regard to the clinical practices in Germany.

Presentation 1

Title: 

schema Therapy for Patients with Major Depression - Results from a Randomized Controlled Trial Comparing Schema Therapy and Cognitive Behavior Therapy in an Inpatient Setting (OPTIMA trial)

Presenter's Name:

Martin Rein

General Abstract for Presentation 1:

Schema Therapy for Patients with Major Depression - Results from a Randomized Controlled Trial Comparing Schema Therapy and

Cognitive Behavior Therapy in an Inpatient Setting (OPTIMA trial)

Martin Rein, Nils Kappelmann, Samy Egli, Katharina Rek, Julia Fietz, Johannes Kopf-Beck Max-Planck-Institut for Psychiatry, Munich, Germany

Introduction:
Originally designed as a transdiagnostic approach for patients with personality disorders, Schema Therapy is constantly extending its clinical use towards the treatment of Axis-I disorders. In contrast to its growing clinical popularity in these fields there is still a need for of empirical support. We conducted a randomized controlled trial evaluating the effectiveness of Schema Therapy in the treatment of depression (OPTIMA).

Methods:
Moderate to severely ill depressed patients with either acute or chronic depression were treated for 7 weeks in an inpatient and day- clinic setting in our institute. All participants (N=150) were randomly assigned to either schema therapy, cognitive behavior therapy or individual supportive therapy as an active control. They received a standardized protocol with 2 individual and 2 group-sessions per week. Treatment blind assessment of depression severity was performed before and after treatment using the Becks-Depressions- Inventory II (BDI-II) and the Montgomery-Åsberg Depression Rating Scale (MADRS). Additionally early maladaptive schemas (EMS) were assessed pre/post treatment with the Young schema questionnaire (YSQ-S3).

Results:
We found a significant reduction in depression scores (BDI-II, MADRS, p<0.001) over all three treatment conditions after 7 weeks of an intense standardized inpatient protocol. Schema load as measured by the Young schema questionnaire also declined in all three groups after treatment with treatment specific differences.

Conclusions:
Schema therapy and cognitive behaviour therapy are both effective treatments in severely depressed inpatients even when applied in a short termed manner. There might be treatment specific differences regarding the effect on underlying vulnerability factors as represented by EMS. Potential clinical implications will be discussed in the presentation.

Presentation 2

Title: 

Schema Therapy versus Cognitive Behavioural Psychotherapy in a 6-weeks and 20-weeks ambulant rehabilitation programme

Presenter's Name: 

Alexandra Schosser

General Abstract for Presentation 2:

Schema Therapy versus Cognitive Behavioural Psychotherapy in a 6-weeks and 20-weeks ambulant rehabilitation programme 1,2Alexandra Schosser, 1Daniela Fischer-Hansal, 1Gabriele Riedl, 1Nicole Pritz, 1Susanne Dür, 1Christoph Teufl, 1Anna Hülsmann, 1Andreas Affenzeller, 1Birgit Senft

Introduction:
In Austria, the majority of patients treated in psychiatric rehabilitation clinics suffer from affective and/or anxiety disorders, with a high proportion of chronic courses of disease. The current study investigates group and individual schema therapy (ST) versus cognitive behavioural psychotherapy (CBT) in a 6-weeks and a 20-weeks ambulant rehabilitation setting in Vienna, Austria.
Methods:
Treatment was performed as standardised 6-weeks or 20-weeks multi-professional rehabilitation programme, based on either CBT or ST. Questionnaire-based surveys were performed at time of admission and at discharge. Patients also filled in the Young Schema Questionnaire (YSQ-S3 dt) and the Schema Mode Inventory (SMI v1).
Results:
In the 6-weeks programme, 1,062 patients were assigned either to ST (n=177) or CBT (n=885). The majority of patients suffered from affective (80.5%) or anxiety disorder (12.2%), with a high proportion of chronic axis-I symptomatology (79.3%). We found a significant reduction in depression scores (BDI-II, p<0.001) in both groups, however with larger effect size in the ST group. We found hardly any changes in YSQ and SMI scores.
We assigned 393 patients either to ST (n=80) or CBT (n=313) in the 20-weeks programme. The majority of patients suffered from affective (71.5%) and/or anxiety disorder (17.3%), with a higher proportion of chronic axis-I symptomatology in the ST (95%) than in the CBT groups (82.4%). Again, we found a significant reduction in depression scores (BDI-II, p<0.001) in both groups, with larger effect size in the ST group. In the ST groups, we further found changes in YSQ (significant changes in schema domains 1-4; significant reduction in 7 schemas) and SMI (significant reduction in 5 modes) scores.
Conclusion:
We conclude that although both CBT and ST were highly effective, the effect sizes were higher in patients treated with ST. Moreover, time factor seems to be essential in treating the underlying vulnerability as represented by EMS.

Presentation 3

Title: 

Results from a 4-week inpatient schema based program of a Psychosomatic Clinic under naturalistic conditions.

Presenter's Name: 

Eckhard Roediger

General Abstract for Presentation 3:

Schema therapy has primarily been developed in out-patient treatment setting and gained first evidence base there, while research on in-patient treatment setting is still hard to find. The clinical study presented here indicates strong effects in a 4-week inpatient schema based program of a Psychosomatic Clinic under naturalistic conditions. Especially depression symptoms of the 448 patients in the PHQ decreased with an effect size of d = 1.0.

Presentation 4

Title: 

Applying schema therapy in specialized inpatient and day clinic units – treatment concept of LVR Klinikum Düsseldorf, hospital of Heinrich-Heine-University

Presenter's Name: 

Silke Bramer-Ugur

General Abstract for Presentation 4:

A proportion of psychiatric inpatients with mood disorders does not improve satisfyingly during and after usual hospital treatment, which is defined by the national guidelines in Germany (Guidance Manual and Rules for Guideline Development) and treatment settings defined by staffing ratios based on the Psychiatry Personal Act (Psychiatrie Personalverordnung). However psychiatric inpatient units hardly match the recommended number of physicians and the treatment mostly amounts to a combined pharmacological, unspecified and cogntive-behavioral treatment. There is an increasing body evidence indicating that Schematherapy ist one of the most efficatious treatments of dysfunctional cognitions and interpersonal interactions. These conditions mostly complicate the course of mood disorders. In a pilot project the Department of Psychiatry of the University Clinics of Dusseldorf has established an inpatients unit were Schematherapy is applied to patients suffering from mood disorders, and severe neurosis complicated by personality traits. One year of clinical experience now suggests a higher rate of complete remissions and less relapses. The approach seems superior to standard treatment which is in accordance with guidelines. Further research based on randomized and controlled trials is needed to prove its efficacy and determine the staffing ratios in the wake of imminent changes in the Psychiatry Personal Act.

About the Presenters:

Arnoud Arntz

Arnoud Arntz is professor of Clinical Psychology at the University of Amsterdam, the Netherlands, with an affiliation at Maastricht University, the Netherlands. His main research interests lie in the fields of PTSD and personality disorders, both applied and fundamental. He also practices as a psychotherapist at PsyQ in Amsterdam, where he treats patients with trauma and personality disorders. Together with Adam Radomsky he was editor of the Journal of Behavior Therapy and Experimental Psychiatry.

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

Eckhard Roediger
Coming Soon

Martin Rein

Martin Rein (MD), born 1977, psychiatrist and psychotherapist. Supervisor in cognitive behavioural therapy and advanced schema therapist, supervisor and trainer. Father of 2 children and currently living in munich. After medical training at the universities of Hamburg and Heidelberg, clinical fellow in neurology at the university clinics in Heidelberg. Consecutively clinical training in psychiatry and psychotherapy at the Max-Planck-Institute of Psychiatry in Munich. Consultant psychiatrist and head of the outpatient clinic and the psychotherapy ward for the last 3 years. As a member of the IST-M in Munich workshops and lectures with a focus on schema therapy for depression. In addition to the clinical work, research activity with a major focus on psychotherapeutic treatment of affective disorders.

Silke Bramer-Ugur
Coming Soon

Marit Kool
Coming Soon