Abstract:

Introduction : Early adverse life events have been hypothesized to be a etiologically relevant to Early Maladaptive Schemas (EMS) which give rise to depression. Trauma focused treatments (TFT) appear effective in decreasing distress associated with memories that result in Post-traumatic Stress Disorder. The aim of this study was to evaluate the effectiveness of a TFT that targets memories related to EMS for patients with depression.

Methods: A randomized controlled trial was conducted with 49 participants recruited from a 10-day outpatient group program.  All participants showed symptoms of depression and were allocated to treatment as usual (TAU); three additional individual trauma focused sessions; or three additional individual cognitive behavioural therapy (CBT) sessions. Participants were assessed with regards to depression diagnosis and related symptoms.

Results: For participants with a major depressive episode, the addition of TFT significantly increased the likelihood of remission when compared to TAU, or additional CBT sessions.  While no significant treatment difference was noted in depressive symptom change post-treatment, six weeks after treatment those who received an adjunct treatment were more likely to maintain treatment gains than those who received TAU.  Furthermore, at 12 week follow-up, participants who received a TFT for their EMS memories reported significantly fewer depressive symptoms than those who received additional CBT as assessed by a blind independent rater.

Conclusions: While differences in outcomes were minimal immediately post-treatment, differences among treatment groups increased over time.  Thus, as few as three additional TFT sessions on EMS memories impacts positively on symptom change for people completing a group program for treatment of depression.  A recent meta-analysis we conducted indicated that trauma focused treatments result in significant reductions in depression scores and that the effect sizes were large. However, most of these involve EMDR, limiting the generalizability of the conclusions to other trauma focused approaches such as imagery rescripting.   

About the Presenter:

Chris Lee

Associate Professor Christopher Lee works in private practice and has an adjunct appointment at the University of Western Australia. He is a certified trainer by both the international society of schema therapists and the EMDR international association. He conducts therapist training workshops on schema therapy and trauma treatments throughout Australia and overseas. He has published research on personality disorders, the assessment of schemas, and PTSD. He has received two International Society for Traumatic Stress Studies and EMDRIA awards for research excellence the first in 1999 and the most recent in 2019. In 2009 he also received the Inaugural Francine Shapiro award for research excellence conferred by the European EMDRIA. He was the 2011 recipient of the Australian Psychological Society’s Ian Campbell memorial award for contributions as a scientist-practitioner to Clinical Psychology in Australia. He is currently a principle investigator in two international multi-centred randomized controlled trials, one in treating complex PTSD and the other using schema therapy for Borderline Personality Disorder. A recent picture is attached as is a brief CV relevant to the topic.