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Double Symposium: New Developments in Schema Therapy Part 1

by Chris Lee, Arnoud Arntz, Duygu Yakin, & Eshkol Rafaeli


Introduction to Double Symposium: Schema therapy (ST) is an effective treatment for personality disorders, leading to significant improvement of functioning in most patients, and even to full recovery in more than half of the patients. ST is disseminated rapidly over the world. Apparently, the model is well recognized and the treatment appears to be effective in many cultures. Therefore, interesting issues are: e.g., what are important process factors that predict change in ST? Can a cross-cultural taxonomy of schema modes be developed? And can optimal personalized ST courses be distinguished? Furthermore, although ST was originally developed for the treatment of personality disorders, it is also increasingly applied to treat other ‘complex’ disorders. Is this a wise thing to do? This double symposium focusses on these new developments and insights in ST.

Introduction to Part 1 In the first part there are 4 presentations mainly dealing with theoretical and process issues. First, a model is presented (Arntz & Rijkeboer) for an extended taxonomy of maladaptive schema modes that is applicable across cultures, and is to be tested in 27 countries worldwide. Hereafter, results are presented on a study into a newly developed inventory measuring different aspects of the healthy adult (Yakin). Furthermore, in order to move our understanding of treatment closer towards personalized psychotherapy, distinct individual treatment processes and courses are presented (Kopf-Beck, Egli, & Rek), based on data of a large-scale RCT investigating the effectiveness of schema therapy and other psychotherapies for depression. Next, in line with this personalized approach, preliminary findings are presented (Rafaeli & Lazarus) from two pilots in which an experience sampling method was used, frequently assessing schema modes as individuals go about their daily lives, in order to capture each individual’s schema modes' fluctuations and functional relationships. Finally, there is a critical discussion of the aforementioned developments in theory and practice, led by Chris Lee.

Segment 1

Title: Theoretical model for an extended taxonomy of schema modes that is applicable across cultures

Presenters: Arnoud Arntz

The last decades Schema Therapy (ST) has become popular around the world. The model of psychopathology that underlies ST is based on the assumption that when basic emotional needs are insufficiently met in childhood, there is an increased chance that maladaptive schemas develop that can underlie personality pathology. Furthermore, the theory states that when such early maladaptive schemas are triggered, the individual can switch into a specific emotional-cognitive-behavioral state (called schema mode), depending on how the individual copes with the schema activation. Young proposed three maladaptive ways of coping with schema activation: surrender (where the activated schema rules the state of the person); avoidance (where avoidant strategies rule the person); and overcompensation (where believing that the opposite of the schema is true rules the person). An international workgroup is devising a new questionnaire to assess the most important schema modes, which will be validated internationally - so that from scratch on the instrument will be reliable and valid across cultures.

This presentation offers an overview of the project, which started with a fundamental reconsideration of the basic emotional needs of children and adults, and a strict application of Young's theory of coping with schema activation. Based on Dweck's analysis of fundamental needs it is argued that an important need has been overlooked in ST: that is the need of a coherent self- and world view. Also, the international workgroup felt that the need for justice was overlooked. The resulting schemas and schema modes will be discussed, and specific attention will be paid to the confusion so far between temperament and ways of coping with schema activation.

Segment 2

Title: Understanding the reparative effects of schema modes: An in-depth analysis of the healthy adult.

Presenter: Duygu Yakin

Objective. The healthy adult mode (HA) is an essential factor that contributes to symptom recovery in schema therapy. We aimed to provide an in-depth analysis of the HA to understand and assess its crucial components better. Method. In the first study, purposive sampling procedures were used to recruit eligible participants (N = 10 out of 250) with relatively strong HA. Semi-structured interviews lasting approximately 45 minutes were conducted with each participant individually. The interviews were analyzed using deductive thematic analysis in MaxQDA. Based on the results of the first study, a quantitative measurement tool was developed to assess HA. In the second study, the factor structure of the HA scale was tested (N = 114 men, N = 358 women) via bi-factor analysis in R. Results. Deductive thematic analysis revealed three superordinate themes. The first theme reflects the ability to take care of the needs of the vulnerable child. The second theme reflects the ability to regulate emotions and set limits for the angry and impulsive child modes. Finally, the third theme reflects the resilience that enables the individual to oppose the maladaptive parent and coping modes. These themes were confirmed quantitatively in the second study with an additional fourth theme, which is identified to reflect the core essence of the HA. Conclusions. Defining the essential features of the HA within the framework of a systematic model, enriched with a qualitative perspective, helps illuminate how the HA mode provides emotional stability and increases resilience, working as a mechanism of change.

Segment 3

Title: Using Experience Sampling to Assess Prevalent Schema Modes

Presenters: Eshkol Rafaeli

Schema modes - the predominant schemas, emotional states, and coping reactions activated at a particular time – are central to the conceptualization and treatment of clients in ST. However, though modes are by definition transitory and dynamic, current assessment tools are cross-sectional. These tools may be limited in capturing individuals' schema modes; fluctuations and functional relationships as they are blind to the crucial dynamics that occur within clients, over time. The present work introduces preliminary findings from two pilot studies assessing schema modes repeatedly as individuals go about their daily lives. For this purpose, we designed the Momentary Schema Modes Questionnaire (MSMQ), adapted from the short form of the Schema Mode Inventory (SMI).

The MSMQ is a 35-item self-report questionnaire assessing the present moment activation of eleven schema-modes. In Study 1, fifty university students completed the MSMQ 3 times daily for a period of 10 consecutive days. In Study 2, fifty university students completed a slightly revised version of the MSMQ 4 times daily for a period of 14 consecutive days. Additionally, participants completed the short form of the SMI. Reliability and construct validity of the MSMQ were assessed, as well as the stability of the correlations structure across the two studies. Internal consistency for all the schema modes was adequate. Correlations between the respective SMI and MSMQ schema modes were moderate (mean r=0.42, ranging between 0.23 and 0.54).

The MSMQ provides a glimpse into individuals’ dynamic mode profiles, without reliance on retrospection. It also permits a direct assessment of mode transitions. These findings point to the potential benefits of assessing schema modes as they occur in individuals’ daily lives rather than retrospectively. The presented time-series data serves as the basis for more sophisticated analytic techniques, such as dynamic factor analysis and dynamic network analysis, which would help identify central causal agents (i.e., modes) in clients' psychological difficulties.

About the Presenters:

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.

Arnoud Arntz

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.

His research focuses on psychological processes underlying personality disorders (PDs), especially borderline personality disorder (BPD), and anxiety disorders, especially PTSD; and their treatment. Using the approach of experimental psychopathology he tested psychological theories of anxiety disorders and PDs and contributed to the development of their psychological treatment. In developing and testing psychological theories and treatments he aims to connect basic research and clinical work. He is perhaps best known for his contributions to the development of Schema Therapy and Imagery Rescripting. He was project leader of the multicenter RCT that compared schema therapy (ST) to Transference Focused Psychotherapy as treatments of Borderline PD, and of another multicenter RCT that compared ST to treatment as usual (TAU) and CCT for 6 other PDs. Currently he is PI of an international RCT comparing working mechanisms of Imagery Rescripting and EMDR for PTSD that originated from childhood traumas, and together with Dr Joan Farrell PI of the international RCT that compares group-ST to TAU for Borderline PD. Professor Arntz also chairs a Dutch-German collaborative study investigating basic brain and cognitive processes in BPD and their change during treatment, which is associated with the international RCT on group-ST.

Duygu Yakin

Duygu Yakın is a psychotherapist specialized in personality disorders at PsyQ Amsterdam. She has a Ph.D. in clinical psychology and worked as a postdoctoral researcher with Arnoud Arntz at the University of Amsterdam. Her research is centered on the schema modes, mechanisms of change in therapy, self-compassion, and personality disorders.

Eshkol Rafaeli

a professor of clinical psychology and the former director of clinical training in the psychology department and neuroscience center at Bar-Ilan University, Israel, where he directs the Affect and Relationships Lab. Prior to joining BIU, the lab and Eshkol were at Barnard College, Columbia University, where Eshkol continues to serve as a research scientist. Eshkol and his students study two key components of daily life – our affect and our relationships. In projects funded by the NIMH, ISF, BSF, the Templeton Foundation, the Hope & Optimism Initiative, and others, they’ve been examining the nature and structure of moods and emotions in the daily lives of both distressed and non-distressed individuals and couples. they look at the attempts partners make to make sense of each other’s thoughts, feelings, and needs, as well as at the interplay of good (supportive) and bad (hindering) actions that happen in the life of any couple. They also conduct psychotherapy/intervention studies, and are interested in the process and outcome of such interventions. He is a co-founder of the Israeli Institute for Schema Therapy, the co-author (together with David Bernstein and Jeffrey Young) of the 2010 Routledge book on Distinctive Features of Schema Therapy, and he continues to be very interested in using, teaching, supervising and researching this approach. 

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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