Aim: Schema therapy is becoming an increasingly popular psychological model for working with individuals who have a variety of mental health and personality difficulties. The aim of this review is to look at the current evidence base for schema therapy and highlight directions for further research. Method: A systematic search of the literature was conducted up until January 2011. All studies that had clinically tested the efficacy of schema therapy as described by Jeffrey Young (Young, 1994; Young et al., 2003) were considered. These studies underwent detailed quality assessments based on Scottish Intercollegiate Guidelines Network (SIGN-50) culminating in twelve studies being included in the review. Results: The culminative message (both from the popularity of this model and the medium to large effect sizes) is of a theory which has already demonstrated clinically effective outcomes in a small number of studies and which would benefit from ongoing research and development with complex client groups. Recommendations: It is imperative that psychological practice be guided by high quality research that demonstrates efficacious, evidence based interventions. It is therefore recommended that researchers and clinicians working with schema therapy seek to build on these positive outcomes and further demonstrate the clinical effectiveness of this model through ongoing research.

Many eating disordered patients fail to respond to traditional cognitive behaviour therapy. As a result it has been suggested that further research needs to be completed to determine the cognitive processes and mechanisms that underpin these disorders. This research aims to empirically test Young’s Schema Mode concept (Young et al., 2003) within the eating disordered population and determine the relationship between schema modes and early maladaptive schemata, experience of invalidation of emotion during childhood and symptoms of anxiety and depression. In total 15 patients from an outpatient eating disorders service and 28 non patient controls completed the Schema Mode Inventory, The Young Schema Questionnaire, the Hospital Anxiety and Depression Scale, The Invalidating Childhood Environment Scale, and measures of eating disordered pathology. Non parametric analyses were completed to determine the differences between the two groups. The relationship between all measures was determined using correlation analyses. The eating disordered group were significantly more dysfunctional than the control group across all schema modes and early maladaptive schemata. Both groups did not display uniformity in their dysfunctional schema modes. The eating disordered group had raised scores in the detached self soother, the compliant surrender and the vulnerable child mode, whereas the control group had lower scores in the detached protector and the vulnerable child modes. The measure if eating pathology was not associated with the total score on any questionnaire measure. This research indicates that the schema mode concept may be a useful addition to the schema model of eating disorders.

Abstract Borderline personality disorder (BPD) is a common mental disorder involving a substantial decrease in functional ability, self-destructive behavior and extensive burden on the health care system. This study project aimed to create a well-structured and easily applicable treatment model for patients with severe BPD. The effectiveness of the treatment model was evaluated in a randomized controlled trial. The study group consisted of 71 patients with a mean age of 32 years. During the intervention period (1 Aug 2010 - 31 Jul 2011) 24 patients received new treatment (Community Treatment by Experts, CTBE) while 47 patients received treatment as usual (TAU). Patients in the CTBE group had 40 individual therapy sessions and 40 psychoeducational group sessions, where they were taught the key concepts of schema therapy (ST). Requirements for the therapists providing individual therapy were as follows: willingness to treat patients with BPD, commitment to weekly individual sessions with patients and commitment to participation fortnightly in a CTBE supervision consultation group, but no former psychotherapy training was required. Psychiatric treatment of the TAU group was variable. Changes in BPD symptoms, health-related quality of life, early maladaptive schemas and schema modes were measured at the beginning and at the end of the one-year intervention. At the end of the year there were 20 patients (83%) in the CTBE group and 33 patients (70%) in the TAU group. After the intervention the patients in the CTBE group had less self-destructive behavior, impulsivity, and paranoid ideation or dissociative symptoms than patients in the TAU group, which means the CTBE treatment model was able to reduce the most serious symptoms of BPD. It is possible that the reduction in self-destructive behavior of CTBE patients is linked to the fact that certain early maladaptive schemas, such as rejection, mistrust and social isolation, decreased during the intervention. Similar changes were not seen in the TAU group patients. The study showed the CTBE treatment to be more efficient than TAU treatment. In addition, the CTBE model is applicable to public mental health services using existing professionals. / Tiivistelmä Epävakaa persoonallisuus on tavallinen mielenterveyden häiriö, johon liittyy huomattavaa toimintakyvyn alenemista, itsetuhoisuutta ja runsasta terveyspalvelujen käyttöä. Tässä tutkimusprojektissa luotiin Oulun kaupungin mielenterveyspalveluihin uusi hoitomalli vaikeaoireisille epävakaasta persoonallisuudesta kärsiville potilaille. Hoitomallin tehokkuutta arvioitiin satunnaistetulla kontrolloidulla tutkimuksella. Tutkimusjoukon muodosti 71 potilasta, keski-iältään 32 vuotta. Interventiovuoden ajan (1.8.2010–31.7.2011) 24 potilasta sai uuden hoitomallin mukaista hoitoa (ns. hoitomalliryhmä) ja 47 potilasta tavanomaista psykiatrista hoitoa (ns. verrokkiryhmä). Hoitomalliryhmän potilaat kävivät vuoden aikana viikoittain yksilöhoidossa (40 käyntiä) ja psykoedukatiivisessa ryhmässä (40 istuntoa), jossa potilaille mm. opetettiin skeematerapian keskeisiä käsitteitä. Yksilöhoidon toteuttaneilta työntekijöiltä ei edellytetty psykoterapiakoulutusta. Sen sijaan heiltä edellytettiin kiinnostusta epävakaan persoonallisuuden hoitoa kohtaan sekä halua sitoutua interventiovuoden ajaksi viikoittaisiin yksilötapaamisiin ja kahden viikon välein kokoontuvaan työnohjaustyyppiseen konsultaatioryhmään. Tavanomainen psykiatrinen hoito oli vaihtelevaa. Interventiovuoden alussa ja lopussa mitattiin epävakaan persoonallisuushäiriön oireita, terveyteen liittyvää elämänlaatua sekä varhaisia haitallisia skeemoja (tunnelukkoja) ja skeemamoodeja (minätiloja). Interventiovuoden päätyttyä hoitomalliryhmässä oli jäljellä 20 potilasta (83 %) ja verrokkiryhmässä 33 potilasta (70 %). Hoitomalliryhmän potilailla oli interventiovuoden jälkeen vähemmän itsetuhoisuutta, impulsiivisuutta ja paranoidisia ajatuksia tai dissosiatiivisia oireita kuin verrokkiryhmän potilailla, eli hoitomallilla pystyttiin vähentämään kaikkein vakavimpia epävakaaseen persoonallisuushäiriöön liittyviä oireita. On mahdollista, että itsetuhoisuuden väheneminen hoitomalliryhmässä liittyy siihen, että tietyt haitalliset skeemat, kuten hylkäämisen, epäluottamuksen ja sosiaalisen eristäytymisen skeemat, lievenivät hoidon aikana. Tavanomaista psykiatrista hoitoa saaneilla potilailla ei tapahtunut vastaavia muutoksia. Tutkimusprojekti osoitti, että hoitomallin mukainen epävakaan persoonallisuuden hoito on tehokkaampaa kuin tavanomainen psykiatrinen hoito. Lisäksi hoitomalli on sovellettavissa julkisen sektorin psykiatriseen palvelujärjestelmään ja käytettävissä oleviin henkilökuntaresursseihin.