Does schema therapy change schemas and symptoms? A systematic review across mental health disorders

Abstract

PurposeSchema therapy was first applied to individuals with borderline personality disorder (BPD) over 20 years ago, and more recent work has suggested efficacy across a range of disorders. The present review aimed to systematically synthesize evidence for the efficacy and effectiveness of schema therapy in reducing early maladaptive schema (EMS) and improving symptoms as applied to a range of mental health disorders in adults including BPD, other personality disorders, eating disorders, anxiety disorders, and post‐traumatic stress disorder.MethodsStudies were identified through electronic searches (EMBASE, PsycINFO, MEDLINE from 1990 to January 2016).ResultsThe search produced 835 titles, of which 12 studies were found to meet inclusion criteria. A significant number of studies of schema therapy treatment were excluded as they failed to include a measure of schema change. The Clinical Trial Assessment Measure was used to rate the methodological quality of studies. Schema change and disorder‐specific symptom change was found in 11 of the 12 studies.ConclusionsSchema therapy has demonstrated initial significant results in terms of reducing EMS and improving symptoms for personality disorders, but formal mediation analytical studies are lacking and rigorous evidence for other mental health disorders is currently sparse.Practitioner points First review to investigate whether schema therapy leads to reduced maladaptive schemas and symptoms across mental health disorders.Limited evidence for schema change with schema therapy in borderline personality disorder (BPD), with only three studies conducting correlational analyses.Evidence for schema and symptom change in other mental health disorders is sparse, and so use of schema therapy for disorders other than BPD should be based on service user/patient preference and clinical expertise and/or that the theoretical underpinnings of schema therapy justify the use of it therapeutically.Further work is needed to develop the evidence base for schema therapy for other disorders.

Early maladaptive schemas in chronically depressed patients: A preliminary investigation

“…Given that the schema model emphasises altering EMSs as a key mechanism for change in therapy, the relief in EMSs should be expected as an outcome of treatment. A recent systematic review (Taylor, Bee, & Haddock, 2016) found that overall there is only limited evidence that EMSs change during schema therapy, as the majority of studies have not included assessment of EMSs as a treatment outcome. Furthermore, one study found that schema therapy results in similar symptomatic relief in MDD patients to that in traditional cognitive-behavioural therapy (Carter et al, 2013), and that other forms of psychotherapy might be beneficial in altering EMSs (Halford, Bernoth-Doolan, & Eadie, 2002;Wegener, Alfter, Geiser, Liedtke, & Conrad, 2013).…”

Psychometric Properties of the German Version of the Young Positive Schema Questionnaire (YPSQ) in the General Population and Psychiatric Patients

“…Since EMS are highly theoretical constructs it is important to develop instruments for their systematic assessment such as the Young Schema Questionnaire (YSQ; Schmidt, Joiner, Young, Telch, 1995). Since the development of the YSQ as a measure of EMS, a growing number of studies have signified their relevance for a range of clinical disorders with a great emphasis on chronic mental disorders (Lobbestael & Arntz, 2012;Taylor, Bee, & Haddock, 2017). This practical relevance could potentially be advanced by balancing the pathological constructs of EMS with concrete strength-focussed concepts emphasizing the fulfilment of needs (Lockwood & Perris, 2012;Seligman & Csikszentmihalyi, 2014).…”

Positive schemas in schema therapy with older adults: clinical implications and research suggestions

“…Activated EMS strongly influence how people perceive themselves and others through mechanisms of selective attention, encoding of stimuli and selective retrieval of schema-associated information (Arntz and Lobbestael, 2018). Schema therapy has been found to reduce EMS while also improving symptoms for personality disorders (Taylor et al, 2017), and in chronic depression (Renner et al, 2018). However, sound mediation-analytical studies have not been conducted yet, and evidence for other mental health disorders than personality disorders and depression is sparse (Taylor et al, 2017).…”