Introduction:

Early Maladaptive Schemas (EMS) play a causal role in the development of later psychopathology including depression severity and episodes of major depression. The current study examines schemas and modes in depression phenotypes (chronic vs. non-chronic depression, with vs. without co-morbidity) in an ambulant psychiatric rehabilitation setting in Vienna, Austria. The therapy programme under investigation was based on either cognitive behavioural psychotherapy (CBT) or schema therapy (ST).

Methods:

Treatment was performed as standardised 6-weeks multi-professional rehabilitation programme, based on either CBT or ST. Questionnaire-based surveys were performed at time of admission, at discharge, and 6 and 12 months after discharge. Among others, patients filled in the Young Schema Questionnaire (YSQ-S3 dt), the Schema Mode Inventory (SMI v1), and the Beck-Depression Inventory (BDI-II).

Results:

A total of 1,913 patients were included, of those 1,406 (73.50%) were diagnosed with a depressive disorder (59.60% with a diagnosis of depression with comorbidity, 27.45% a diagnosis of chronic depression without comorbidity, and 12.94% of non-chronic depression without comorbidity.

Depression (BDI-II) scores significantly decreased from admission to discharge (p<0.001) in all groups of patients.

The highest schema scores at admission were found for patients suffering from chronic depression with comorbidity (multivariate analysis of variance p<0.001). Schemas were shown to be stable traits when investigating the influence of BDI-II scores on the YSQ scores. Modes in chronic depression significantly differed from modes in non-chronic depression as well (p<0.001).

Comparing ST (n=156) vs. CBT (n=348), both groups showed significant improvement with regard to BDI-II, with higher effect sizes of ST in the subgroup of chronic depression.

Conclusion:

Chronically depressed, especially those with comorbidities, were shown to have significantly higher EMS scores than non-chronic courses of disease. As for treatment response, we found higher effect sizes of ST as compared to CBT in chronic depression.

Authors:

^1,2,3Alexandra Schosser, ²Daniela Fischer-Hansal, ²Gabriele Riedl, ²Birgit Senft

¹ Sigmund Freud Private University, Vienna, Austria

²Zentren für seelische Gesundheit, BBRZ-Med, Vienna, Austria

³ Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria

⁴ Arbeitsgemeinschaft für Verhaltensmodifikation, Paris-Lodron-Straße 32, 6020 Salzburg, Austria

About the Presenter:

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