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: 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 2: 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 3: Marit Kool will present the main outcome data of the psychotherapy dosage (PSYDOS-) trial- a randomized controlled trial comparing two dosages of psychotherapy (25 vs 50 sessions) 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 4: Samy Egli will present the Schema Therapy for Depression – Results of an RCT in an Inpatient and Day Clinic Setting (OPTIMA Trial).

Talk 5: Martin Rein will present Evaluating the role of maladaptive personality traits in schema therapy and cognitive behaviour therapy for depression – results from the randomized controlled OPTIMA therapy study

Presentation 1

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 1:

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 2

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 2:

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 3

Title: Main outcome data of the psychotherapy dosage (PSYDOS-)

Presenter's Name: Marit Kool

General Abstract for Presentation 3:

Integrated treatments provide a conceptual framework to understand and treat the underlying vulnerability in personality in order to improve outcome in depression. Since higher psychotherapy dosages could improve outcome, we compared 50 individual sessions in one year with 25 sessions.

In this pragmatic, double randomized, clinical trial (PSYDOS), 246 patients were randomly assigned to 25 or 50 sessions of either Schema Therapy (ST) or Short-term Psychoanalytic Supportive Psychotherapy (SPSP), stratified by depression severity. The primary outcome was depression severity (BDI-II) over time in the intention-to-treat sample.

A significant effect of psychotherapy dosage was found on depression severity over time in favour of 50 sessions. The estimated mean difference on the BDI at end of treatment was 6.03, with a between-group effect-size of d=0·70 (95% CI: 0·40-0·99). No differences were found over time between SPSP and ST. The 50-session-condition also resulted in better personality outcomes.

This is the first study to compare psychotherapy dosages directly in depressed patients with PD. A higher psychotherapy dosage should be considered for this comorbid group as it treats both depression and underlying vulnerability in personality better and could therefore lead to less recurrence, additional treatment and costs. Long-term effects (including an assessment of cost-effectiveness) should be studied further, as well as working mechanisms.

Presentation 4

Title: Schema Therapy for Depression – Results of an RCT in an Inpatient and Day Clinic Setting (OPTIMA Trial)

Presenter's Name: Samy Egli

General Abstract for Presentation 4:

Background: There is evidence from randomized controlled trials for the efficacy of Schema Therapy in outpatient settings for patients, for instance, with personality disorders or depression. To the best of our knowledge, there is no such evidence for an inpatient and day clinic setting with a much shorter treatment duration.

Methods: We conducted a randomized controlled trial comparing Schema Therapy vs. Cognitive Behavioral Therapy vs. individual supportive therapy in N = 294 patients with depression in an inpatient and day clinic setting for a treatment duration of 7 weeks. The primary outcome was the BDI-II.

Results: Schema Therapy showed a strong pre to post effect size of Cohen’s d = 1.4. Schema Therapy did not show a clinically relevant difference and can be considered as not inferior to Cognitive Behavioral Therapy. However, Schema Therapy was also not significantly better than individual supportive therapy.

Conclusions: To the best of our knowledge this is the first trial that documents the non-inferiority of Schema Therapy compared to the Cognitive Behavioral Therapy in an inpatient and day clinic setting for patients with depression within a short treatment duration of only 7 weeks.

Presentation 5

Title: Evaluating the role of maladaptive personality traits in schema therapy and cognitive behaviour therapy for depression – results from the randomized controlled OPTIMA therapy study

Presenter's Name: Martin Rein

General Abstract for Presentation 5:

Objective: We analysed Data from the OPTIMA Study - an RCT for the treatment of depression comparing Schema Therapy (ST), Cognitive Behavioural Therapy (CBT) and Individual Supportive Therapy (IST) in an inpatient setting. In our study we investigated the influence of personality pathology as a potential moderator or predictor for differential treatment response (ST vs CBT) in depressed patients and its change during treatment.

Method: We included 193 depressed inpatients receiving a seven-week course of either ST or CBT. Latent change score models were applied to test changes of depression and maladaptive traits over treatment. EffecteliteR was used to test the prescriptive potential of personality pathology for ST or CBT allocation.

Results: Maladaptive traits did not predict changes in depressive symptomatology at post-treatment, or vice versa. In addition inter-individual differences in maladaptive traits at baseline were not predictive of favorable treatment allocation choices. However, four out of five maladaptive traits decreased over treatment independent of treatment with ST or CBT.

Conclusions: Contrary to our expectations these results did not suggest new treatment targets or allocation choices in depression, although several limitations ask for replication.

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
Eckhard Roediger (MD), born 1959, Neurologist, Psychiatrist and Psychotherapist. Trained in psychodynamic and Cognitive-Behavior therapy. Formerly Director of a Psychosomatic Department of a clinic in Berlin (GER), since 2007 working in Private Practice and Director of the Schema Therapy Training Center in Frankfurt (GER). Past-president and honorary member of the ISST. Working on the conceptual background of ST and its integration into CBT, Couples therapy and integrating Mindfulness and ACT into ST.

Marit Kool

Marit Kool is a clinical psychologist-psychotherapist in the Netherlands, specialised in Schema Therapy. She works at the NPI (part of Arkin GGZ), a specialised centre in personality disorders in Amsterdam. Besides her clinical work, she is conducting an RCT as part of her PHD-programme.

Samy Egli, M.Sc.

Samy Egli is a M.Sc. in Applied Cognitive Psychology at the University of Zurich in 2004, after a year in research at Harvard Medical School affiliated McLean Hospital, Boston, USA in 2001. Ph.D. in cognitive psychology and psychopathology, with a research stay at the Ludwig-Maximilians-University in Munich in 2008. Master of Advanced Studies and Certification in psychotherapy with a cognitive behavioral and interpersonal focus at the Klaus-Grawe-Institute for Psychological Therapy, Zurich and the University of Basel in 2012. After six years as a clinical psychotherapist and deputy Head of Psychology at the Schloessli-Clinic near Zurich until 2014, starting in 2015 as Head of Psychology at the Max-Planck-Institute of Psychiatry, Munich, Germany. Currently working in the continuous establishment of a method-integrative psychotherapy in clinical psychiatry, research and training with a focus in and passion for Schema Therapy in individual and group- in- and outpatient settings.

Martin Rein

Coming soon...