Effectiveness of Schema Therapy in Clinical Disorders: A Systematic Review

Öz

Given that schema therapy was an efficacious method in the treatment of personality disorders, studies on the applicability of this method in a wider clinical spectrum were initiated. Following, clinical applications and studies have shown that schema therapy-based interventions have a healing power on symptoms in clinical diagnoses such as depression, anxiety disorders and post-traumatic stress disorder (PTSD). The aim of this study is to systematically compile research findings examining the effectiveness of schema therapy on clinical disorders through randomized clinical trials. For this purpose, Google Scholar, PsycARTICLES, PubMed, ProQuest, Scopus, Web of Science and Wiley Online Library electronic databases were searched. When the inclusion criteria were applied to the studies obtained, nine eligible studies were finally included. The studies included covers clinical disorders such as depression, anxiety disorders, PTSD, obsessive-compulsive disorder (OCD), and eating disorders. The findings of the studies generally reveal that Schema therapy-based interventions are effective methods in reducing the symptoms of these disorders. However, the effectiveness of schema therapy has generally been examined in comparison with other therapy methods such as cognitive behavioral therapy (CBT), and some studies have observed that applications based on both schools are similarly effective. However, despite the limited findings, schema therapy yields positive results even in short-term applications. Thus, schema therapy can be considered as an important alternative in the treatment of clinical disorders with presence of symptoms.

Anahtar Kelimeler

• schema therapy
• Axis I disorders
• randomized controlled trials

Klinik Bozukluklarda Şema Terapinin Etkinliği: Sistematik Bir Derleme

Öz

Şema terapinin kişilik bozukluklarının tedavisinde etkin bir yöntem olduğu anlaşıldıktan sonra bu yöntemin daha geniş bir klinik yelpazede uygulanabilirliği üzerine incelemeler başlamıştır. Buradan hareketle yürütülen klinik uygulamalar ve çalışmalarda, depresyon, anksiyete bozuklukları ve travma ve stresörle ilişkili bozukluklar (TSSB) gibi klinik bozukluklarda da şema terapi temelli müdahalelerin belirtiler üzerinde iyileştirici gücü olduğu ortaya koyulmuştur. Bu çalışmanın amacı, şema terapinin klinik bozukluklar üzerindeki etkinliğini seçkisiz kontrollü çalışmalarla inceleyen araştırma bulgularını sistematik bir şekilde derlemektir. Bu amaçla, Google Akademik, PsycARTICLES, PubMed, ProQuest, Scopus, Web of Science ve Wiley Online Library elektronik veri tabanları taranmıştır. Tarama sonucunda elde edilen çalışmalara dahil etme kriterleri uygulandığında dokuz makaleye ulaşılmıştır. Değerlendirmeye alınan çalışmalar, depresyon, anksiyete bozuklukları, TSSB, obsesif-kompulsif bozukluk ve ilişkili bozukluklar (OKB) ve beslenme ve yeme bozuklukları gibi klinik bozuklukları kapsayacak şekilde çeşitlilik göstermektedir. Araştırmaların bulguları, genel olarak şema terapi temelli müdahalelerin bu bozukluklarda belirtileri azaltmada etkili bir yöntem olduğunu ortaya koymaktadır. Bununla birlikte, şema terapinin etkinliği, genellikle bilişsel davranışçı terapi gibi diğer terapi yöntemleriyle karşılaştırmalı olarak ele alınmış ve bazı çalışmalarda her iki ekol temelli uygulamaların benzer derecede etkili olduğu gözlenmiştir. Ancak kısıtlı bulgulara rağmen şema terapinin kısa süreli uygulamalarda dahi olumlu sonuçlar verdiği ve özellikle uzun vadeli etkiler açısından umut vadettiği vurgulanmaktadır. Derlenen bulgular, şema terapinin belirgin belirtilerle seyreden klinik bozukluklara yönelik tedavilerde önemli bir alternatif olarak değerlendirilebileceğini önermektedir.

Anahtar Kelimeler

• şema terapi
• Eksen I bozukluklar
• seçkisiz kontrollü çalışmalar

Kaynakça

1. APA (2000) Diagnostic and Statistical Manual of Mental Disorders, fourth ed. (DSM-IV-TR). Washington DC, American Psychiatric Association.
2. APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). Washington DC, American Psychiatric Association.
3. Arntz A, Van Genderen H (2020) Schema Therapy for Borderline Personality Disorder, 2nd
4. ed. Hoboken, NJ, Wiley.
5. Arntz A, Jacob G (2012) Schema Therapy in Practice: An Introductory Guide to the Schema Mode Approach. Hoboken, NJ, Wiley.
6. Assmann N, Schaich A, Arntz A, Wagner T, Herzog P, Alvarez-Fischer D et al. (2024) The effectiveness of dialectical behavior therapy compared to schema therapy for borderline personality disorder: A randomized clinical trial. Psychother Psychosom, 93:249-263.
7. Bach B, Lockwood G, Young JE (2018) A new look at the schema therapy model: Organization and role of early maladaptive schemas. Behav Cogn Psychother, 46:621-633.
8. Balje AE, Greeven A, Deen M, Van Giezen AE, Arntz A, Spinhoven P (2024) Group schema

9. therapy versus group cognitive behavioral therapy for patients with social anxiety disorder and comorbid avoidant personality disorder: a randomized controlled trial. J Anxiety Disord, 104:102860.
10. Bamelis LL, Evers SM, Spinhoven P, Arntz A (2014) Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. Am J Psychiatry, 171:305-322.
11. Bär A, Bär HE, Rijkeboer MM, Lobbestael J (2023) Early maladaptive schemas and schema modes in clinical disorders: A systematic review. Psychol Psychother, 96:716-747.
12. Boog M, Visser MC, Clarijs L, Franken IH, Arntz A (2024) One‐year follow‐up: schema therapy for patients with borderline personality disorder and comorbid alcohol use disorder. Clin Psychol Psychother, 31:e3040.
13. Carter JD, McIntosh VV, Jordan J, Porter RJ, Frampton CM, Joyce PR (2013) Psychotherapy for depression: A randomized clinical trial comparing schema therapy and cognitive behavior therapy. J Affect Disord, 151:500-505.
14. Cockram DM, Drummond PD, Lee CW (2010) Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clin Psychol Psychother, 17:165-182.
15. Çapar-Taşkesen T, Inozu M (2024) Duygu düzenleme stratejilerinin obsesif kompulsif bozukluk ile ilişkisi: Deneysel bir çalışma. Klinik Psikoloji Dergisi, 8:18-33.
16. Emmelkamp PM, Meyerbröker K (2025) Psychotherapies for the treatment of personality disorders: the state of the art. Curr Opin in Psychiatry, 38:66-71.
17. Farrell JM, Shaw IA (2012) Group Schema Therapy for Borderline Personality Disorder: A Step-by-Step Treatment Manual with Patient Workbook, 2nd ed. Chichester, West Sussex, Wiley-Blackwell.
18. Grazka A, Strzelecki D (2023) Early maladaptive schemas and schema modes among people with histories of suicidality and the possibility of a universal pattern: A systematic review. Brain Sci, 13:1216.
19. Halvorsen M, Wang CE, Eisemann M, Waterloo K (2010) Dysfunctional attitudes and early maladaptive schemas as predictors of depression: A 9-year follow-up study. Cogn Ther Res, 34:368-379.
20. Hawke LD, Provencher MD (2011) Schema theory and schema therapy in mood and anxiety disorders: A review. J Cogn Psychother, 25:257-276.
21. Jalali F, Hasani A, Hashemi SF, Kimiaei SA, Babaei A (2019) Cognitive group therapy based on schema-focused approach for reducing depression in prisoners living with HIV. Int J Offender Ther Comp Criminol, 63:276-288.
22. Karbasdehi ER, Abolghasem A, Karbasdehi FR (2018) The effectiveness of schema therapy integrated with rehabilitation on cognitive emotion regulation and existential anxiety in patients with congestive heart failure. J Contemp Psychother, 48:233-239.
23. Kessler RC, Chiu WT, Demler O, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry, 62:617-627.
24. Kool M, Van H, Arntz A, Bartak A, Peen J, Dil L et al. (2024) Dosage effects of psychodynamic and schema therapy in people with comorbid depression and personality disorder: Four-arm pragmatic randomised controlled trial. Br J Psychiatry, 225:274-281.
25. Kopf-Beck J, Müller CL, Tamm J, Fietz J, Rek, N, Just L et al. (2024) Effectiveness of schema therapy versus cognitive behavioral therapy versus supportive therapy for depression in inpatient and day clinic settings: A randomized clinical trial. Psychother Psychosom, 93:24-35.
26. Lian AEZ, Chooi WT, Bono SA (2024) The development and the effectiveness of schema therapy on Malaysian female young adults who experienced continuous trauma and post-traumatic stress disorder. Eur J Trauma Dissociation, 8:100427.
27. Masley SA, Gillanders DT, Simpson SG, Taylor MA (2012) A systematic review of the evidence base for schema therapy. Cogn Behav Ther, 41:185-202.
28. McIntosh VV, Jordan J, Carter JD, Frampton CM, McKenzie JM, Latner JD et al. (2016) Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy. Psychiatry Res, 240:412-420.
29. Mohammadi F, Moradi O (2016) Comparison of the effectiveness of schema therapy and neuro-linguistic programming on reducing anxiety and improving social functioning in patients with generalized anxiety disorder (GAD). International Journal of Philosophy and Social-Psychological Sciences, 2:56-66.
30. Nordahl HM, Holthe H, Haugum JA (2005) Early maladaptive schemas in patients with or without personality disorders: Does schema modification predict symptomatic relief? Clin Psychol Psychother, 12:142-149.
31. Peeters N, Van Passel B, Krans J (2022) The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda. Br J Clin Psychol, 61:579-597.
32. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. (2021) The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372:71.
33. Podea D, Suciu R, Suciu C, Ardelean M (2009) An update on the cognitive behavior therapy of obsessive compulsive disorder in adults. J Evid Based Psychother, 9:221-233.
34. Rek K, Kappelmann N, Zimmermann J, Rein M, Egli S, Kopf-Beck J (2023) Evaluating the role of maladaptive personality traits in schema therapy and cognitive behavioural therapy for depression. Psychol Med, 53:4405-4414.
35. Renner F, Arntz A, Peeters FP, Lobbestael J, Huibers MJ (2016) Schema therapy for chronic depression: Results of a multiple single case series. J Behav Ther Exp Psychiatry, 51:66-73.
36. Sij ZD, Manshaee G, Hasanabadi H, Nadi MA (2018) The effects of schema therapy on emotional self-awareness, vulnerability, and obsessive symptoms among patients with obsessive-compulsive disorder. Modern Care J, 15:e69656.
37. Simpson SG, Morrow E, van Vreeswijk M, Reid C (2010) Group schema therapy for eating disorders: A pilot study. Front Psychol, 1:182.
38. Stefan S, Stroian P, Fodor L, Matu S, Nechita D, Boldea I et al. (2023) An online contextual schema therapy workshop for social anxiety symptoms: a randomized controlled trial. J Contextual Behav Sci, 29:67-75.
39. Stroian PI (2021) Emotional needs and schematic functioning in depression: A narrative review. J Evid Based Psychother, 21:21-36.
40. Tariq A, Quayle E, Lawrie SM, Reid C, Chan SWY (2021) Relationship between early maladaptive schemas and depression in adolescence and young adulthood: A meta analysis. J Affect Disord, 295:1462-1473.
41. Taylor CD, Bee P, Haddock G (2017) Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychol Psychother, 90:456-479.
42. Thiel N, Jacob GA, Tuschen-Caffier B, Herbst N, Kuelz AK, Hertenstein E et al. (2016) Schema therapy augmented exposure and response prevention in patients with obsessive-compulsive disorder: Feasibility and efficacy of a pilot study. J Behav Ther Exp Psychiatry, 52:59-67.
43. Verhaak L, Ter Heide JJ (2024) Group schema therapy for refugees with treatment‐resistant PTSD and personality pathology. Case Rep Psychiatry, 2024:8552659.
44. Wang Q, Zhang L, Zhang J, Ye Z, Li P, Wang F et al. (2021). Prevalence of comorbid personality disorder in psychotic and non-psychotic disorders. Front Psychiatry, 12: 800047.
45. Young JE, Klosko JS, Weishaar ME (2003) Schema Therapy: A Practitioner’s Guide. New York, Guilford Press.