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New Developments in Schema Therapy  Part 2

by Michiel Boog, Marjolein Van Wijk-Herbrink, & Richard Vuijk

General Abstract
In the second part, also encompassing 4 presentations, studies into the effectiveness of applications of ST for various disorders –other than primary personality disorders- are discussed. Alcohol Use Disorder and comorbid Borderline Personality Disorder: the rational, study design, and subsequent data are presented of a multiple baseline case series study into ST for this specific group of patients. Adolescents with externalizing behavior problems: the theoretical framework, feasibility, and effects of ST for adolescents with severe behavior problems in court-mandated, secure residential youth care are presented. Dissociative Identity Disorder (DID; Rijkeboer & Huntjens): it is explained why the mode model nicely fits with the nature of DID pathology, and how regular ST was adapted to suit the treatment of DID. Autism spectrum disorders with comorbid personality disorders (Vuijck & Arntz): the rational of ST for adults with both ASD and PD is provided. Next, results of a concurrent MBCS trial into the effectiveness of ST for this specific group of patients are discussed. In the end there is a critical discussion on the application of ST for other complex disorders, led by Rob Brockman

Presentation 1

Title: Schema therapy for Borderline Personality Disorder and Alcohol Use Disorder 

Presenter's Name: Dr. Michiel Boog 

This study was designed to find out whether there are indications for the effectiveness of Schema Therapy for patients with borderline personality disorder (BPD) and alcohol use disorder (AUD). AUD and BPD form a prevalent comorbidity: about 20% of AUD patients has a comorbid BPD; 50% of BPD patients suffers from a comorbid AUD (Guy, Newton‐Howes, Ford, Williman, & Foulds, 2018; Verheul, van den Brink, & Hartgers, 1995). Integrative treatments for BPD and AUD are largely lacking (Fridell & Hesse, 2006).
Methods The study was designed as a case series design study with multiple baseline. Twenty patients with BPD and AUD received on average 80 sessions of individual therapy. After a baseline of treament-as-usual, Schema Therapy was applied. Every therapy session was preceded by an assessment of BPD symptoms and a urine test, to check abstinence.
Results & Conclusion Results supporting the effectiveness of ST were found. AUD and BPD symptoms decreased, especially when experiential techniques were used. Details of the results will be presented and clinical relevance will be discussed.
Fridell, M., & Hesse, M. (2006). Psychiatric severity and mortality in substance abusers: a 15-year follow-up of drug users. Addictive Behaviors, 31(4), 559-565. Guy, N., Newton‐Howes, G., Ford, H., Williman, J., & Foulds, J. (2018). The prevalence of comorbid alcohol use disorder in the presence of personality disorder: Systematic review and explanatory modelling. Personality and mental health.
Verheul, R., van den Brink, W., & Hartgers, C. (1995). Prevalence of Personality Disorders among Alcoholics and Drug Addicts: An Overview. European Addiction Research, 1(4), 166-177.

Presentation 2

Title: Schema Therapy in adolescents with externalizing behavior problems: Bridging theory and practice

Presenter's Name: dr. Marjolein van Wijk-Herbrink

Adverse childhood experiences, such as harsh parenting and rejection by peers, may cause adolescents to view the word as a hostile place, and to develop externalizing behavior problems. Such hostility beliefs and behavior problems may be reinforced by the punitive reactions they elicit in others, sustaining negative interaction cycles and impacting personality development. Schema Therapy may help to prevent the development of even more chronic patterns of disfunctional or antisocial behaviors in this adolescent population. For the past couple of years, we have been investigating the theoretic framework, feasibility, and effects of Schema Therapy for adolescents, specifically for adolescents with severe behavior problems in court-mandated, secure residential youth care. In this presentation, I will explain how the central constructs of Schema Therapy can be meaningfully linked to behavior problems (both internalizing and externalizing behaviors) based on cross-sectional and experimental research studies, and I will present the design of a randomized controlled trial in which the effects of Schema Therapy are compared to care as usual in a secure residential treatment center for adolescents. In this study, Schema Therapy is offered in the form of individual therapy and, moreover, its’ key principles and techniques are also integrated in the 24-hour group climate. At the time of the ISST conference, we might be able to present some preliminary findings of this study.

Presentation 3

Title: Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder: results of a concurrent multiple-baseline case series study

Presenter's Name: Richard Vuyck

Richard Vuijk, Mathijs Deen, Hilde Geurts, & Arnoud Arntz

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.
Results: At the ISST Inspire 2020 Conference Copenhagen first results will be presented.

About the Presenters:

Michiel Boog:

Michiel Boog, PhD is clinical psychologist and is a certified advanced level schema therapist (Dutch society of ST) who works at Antes in the Netherlands. He is an expert in the treatment of patients with a substance use disorder. Michiel Boog has worked closely together with Hannie van Genderen and Arnoud Arntz on the development of a schema therapy program for patients with a substance use disorder.

Marjolein Van Wijk-Herbrink:

Marjolein van Wijk-Herbrink is a Dutch schema therapist who obtained her PhD in Schema Therapy with adolescents with severe behavior problems. She works in court-mandated, secure residential care, where she applies individual schema therapy, and trains and coaches youth care workers to work with Schema Therapy based principles and techniques. She is a member of the executive board of the Dutch Schema Therapy association.

Richard Vuijk:

Richard Vuijk is clinical psychologist at Sarr Autism Rotterdam, a health care institute for patients with autism spectrum disorders in Rotterdam, the Netherlands. His focus is treating mental health problems in adults with autism spectrum disorders. His research and publications adress the assessment, personality and treatment of individuals with autism spectrum disorders. He is active in the training of psychologists and psychiatrist on diagnosing and treating autism and personality pathology in adults. He developed the NIDA (Nederlands Interview ten behoeve van Autismespectrumstoornis bij volwassenen – Netherlands Interview for Diagnostic assessment of Autism spectrum disorder in adults).

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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