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Schema Therapy empirical evidence base

Schema Therapy has shown an expanding evidence base which has evolved over twenty years during which time treatments have been operationalised, manualised and evaluated through RCTs. Empirical research indicates that Schema Therapy is effective for borderline personality disorder and Cluster C presentations.  Other studies have demonstrated that Schema Therapy can be successful in treating individuals with Axis I presentations including chronic depression and eating disorders. 

Due to the broadening evidence base, Schema Therapy is gaining increasing recognition and appeal for practitioners working in a range of settings. For those starting out in Schema Therapy, we recommend the following list:

 

Introductory recommended reading

  • Arntz, A. & Jacob, G. (2012). Schema therapy in practice: An introductory guide to the schema mode approach. Chichester: Wiley-Blackwell.

  • Arntz, A. & van Gendered, H.  (2009). Schema therapy for borderline personality disorder. New York: Wiley.

  • Bakos, D. S., Gallo, A. E., & Wainer, R. (2015). Systematic review of the clinical effectiveness of schema therapy. Contemp Behav Health Care, doi: 10.15761/CBHC.1000104

  • Masley, S. A., Gillanders, D. T., Simpson, S. G., & Taylor, M. A. (2012). A systematic review of the evidence base for schema therapy. Cognitive Behaviour Therapy, 41(3), 185-202.

  • Young, J. E. & Klosko, J. S. (1998). Reinventing your life. New York: Penguin. 

  • Young, J. E., Klosko, J. S. & Weishaar, M.E. (2003). Schema therapy: A practitioner’s guide. New York: Guildford.

 

Further reading:

 

  • Arjan C. Videler, Rita J. J. Van Royen, Sylvia M. J. Heijnen-Kohl, Gina Rossi, Sebastiaan P. J. Van Alphen, and Christina M. Van der Feltz-Cornelis (2017). Adapting Schema Therapy for Personality Disorders in Older Adults. International Journal of Cognitive Therapy: 10 (1): 62-78. https://doi.org/10.1521/ijct.2017.10.1.62

  • Arntz, A. (2011). Imagery rescripting for personality disorders. Cognitive and Behavioral Practice, 18, 466–481. doi:10.1016/j.cbpra.2011.04.006Pugh, M. (2017) Pull Up a Chair. The Psychologist. 30, 42-47.

  • Arntz, A. Stupar-Rutemfrans, S., Bloo, J. & van Dyck. (2015) Prediction of treatment discontinuation and recovery from BPD: Results from an RCT comparing Schema Therapy and Transference Focused Psychotherapy. Behavior research and therapy, 74, 60-71.

  • Arntz, A. (2016) Imagery Rescripting for Personality Disorders: Healing Early Maladaptive Schemas, in Working with Emotion in Cognitive-Behavioral Therapy Techniques for Clinical Practice, McKay, D. & Thoma, N. (Eds), Guildford, New York.

  • Bakos, D.S., Gallo, A.E. & Wainer, R. (2015). Systematic review of the clinical effectiveness of schema therapy. Contemp Behav Health Care, 1.  doi: 10.15761/CBHC.1000104

  • Bamelis, L., Evers, S., Spinhoven, P., & Arntz, A. (2014) Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. The American Journal of Psychiatry, 17(3), 305-322.

  • Bernstein, D., Arntz, A. & de Vos, M. (2007) Schema Focused Therapy in Forensic Settings: Theoretical Model and Recommendations for Best Clinical Practice. International Journal of Forensic Mental Health, 6(2), 169-183.

  • Bernstein, D.P., Nijman, H., Karos, K., Keulen-de Vos, M., de Vogel, V., & Lucker, T. (2012). Schema Therapy for forensic patients with personality disorders: Design and preliminary findings of multicenter randomized clinical trial in the Netherlands. International Journal of Forensic Mental Health, 11,312-324.

  • Brockman, R. N., & Calvert, F. L. (2016). Imagery Rescripting for PTSD and Personality Disorders: Theory and Application. Journal of Contemporary Psychotherapy, 1-8.

  • Brown, J., Selth, S., Stretton, A., Simpson, S. (2016). Do dysfunctional coping modes mediate the relationship between perceived parenting style and disordered eating behaviours?Journal of Eating Disorders 4(27):1-10. DOI: 10.1186/s40337-016-0123-1

  • Carter, J., McIntosh, V., Jordan, J., Porter, R., Frampton, C. & Joyce, P. (2013). Psychotherapy for depression: a randomized clinical trial comparing schema therapy and cognitive behavior therapy. Journal of Affective Disorders, 151(2), 500-505.doi: 10.1016/j.jad.2013.06.034.

  • Chakhssi, F., Kersten, T., de Ruiter, C., & Bernstein, D.P. (2014). Treating the untreatable: A single case study of a psychopathic patient treated with Schema Therapy. Psychotherapy. Psychotherapy (Chic), 51(3):447-61. doi: 10.1037/a0035773

  • Cockram, D., Drummond, P. & Lee, C. (2010). Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clinical Psychology and Psychotherapy, 17,165-182.

  • Dickhaut, V. & Arntz, A. (2014). Combined group and individual schema therapy for borderline personality disorder: A pilot study. J. Behav. Ther. & Exp. Psychiat. 45,242e251

  • Edwards, D. J. A. (2017). An interpretative phenomenological analysis of schema modes in a single case of anorexia nervosa: Part 1 - Background, method and Child and Parent modes. Indo-Pacific Journal of Phenomenology, 17 (1), 1-13.  doi: 10.1080/20797222.2017.1326728

  • Edwards, D. J. A. (2017). An interpretative phenomenological analysis of schema modes in a single case of anorexia nervosa: Part 2 - Coping modes, Healthy Adult mode, superordinate themes and implications for research and practice. Indo-Pacific Journal of Phenomenology, 17 (1), 1-12.  doi: 10.1080/20797222.2017.1326730

  • Farrell, J.M., Shaw, I.A., Webber, M.A. (2009) A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry. 40, 317-328.

  • Farrell, J., Shaw, I., Webber, M. (2009). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial. J Behav Ther Exp Psychiatry, 40(2), 317-28. doi: 10.1016/j.jbtep.2009.01.002. Epub 2009 Jan 14.

  • Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M. & Arntz, A. (2006) Outpatient psychotherapy for borderline personality disorder: Randomised trial of schema-focused therapy versus transference-focused psychotherapy Archives of General Psychiatry, 63(6)649-658.

  • Gojani, P.J., Masjedi, M. Khaleghipour, S. & Behzadi, E. (2017) Effects of Schema Therapy and Mindfulness on the Maladaptive Schemas Hold by the Psoriasis Patients with the Psychopathology Symptoms. Adv Biomed Res. 6: 4.

  • Gude, T. & Hoffart, H. (2008). Change in interpersonal problems after cognitive agoraphobia and schema focused therapy versus psychodynamic treatment as usual of inpatients with agoraphobia and Cluster C personality disorders. Scandinavian Journal of Psychology, 49,195-199.

  • Hodge, L. & Simpson, S. (2016). Speaking the Unspeakable: Artistic expression in Eating Disorder Research and Schema Therapy. The Arts in Psychotherapy.50, 1-8. doi:10.1016/j.aip.2016.05.005

  • Hopwood, C. & Thomas, K. (2014). Schema therapy is an effective treatment for avoidant, dependent and obsessive-compulsive personality disorders. Evid Based Ment Health;17(3):90-1. doi: 10.1136/eb-2014-101858.

  • Jacob, G., Arntz, A. (2013). Schema Therapy for Personality Disorders – A Review. International Journal of Cognitive Therapy, 6(2),171-185.

  • Keith, L., Gillanders, D. & Simpson, S. (2009). An exploration of the main sources of shame in an eating disordered population. Clinical Psychology & Psychotherapy, 16, 317-327.

  • Khatamsaz, B., Forouzandeh, E., Ghaderi, D. (2017). Effectiveness of schema therapy on marital satisfaction and marital relationship quality in married women. Int J Educ Psychol Res; 3:11-16

  • Malogiannis, I., Arntz, A., Spiropoulou, A., Aggeli, A., Karveli, S., Tsartsara, E., Vlavianou, M., Pehlivanidis, A., Papadimitriou, G. & Zervas, I. (2014). Schema Therapy for patients with chronic depression. A single case series study. Journal of Behavior Therapy and Experimental Psychiatry, 45,319-329.

  • Masley, S., Gillanders, D., Simpson, S. & Taylor, M. (2012). A Systematic Review of the Evidence Base for Schema Therapy. Cognitive behaviour therapy, 41(3), 185-202. doi:10.1080/16506073.2011.614274

  • McIntosh, V. V., Jordan, J., Carter, J. D., Frampton, C. M., McKenzie, J. M., Latner, J. D., & Joyce, P. R. (2016). Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural erapy, and schema therapy. Psychiatry research, 240, 412-420.

  • Nadort, M., Arntz, A., Smit, J.H., Giesen-Bloo, J., Eikelenboom, M., Spinhoven, P., van Asselt, T., Wensing, M. & van Dyck, R. (2009). Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial. Behaviour Research and Therapy, 47(11), 961-973.

  • Nadort, M., van Dyck, R., Smit, J.H., Giesen-Bloo, J., Eikelenboom, M., Wensing, M., Spinhoven, P., Dirksen, C., Bleecke, J., van Milligen, B. & van Vreeswijk, M. (2009). Three preparatory studies for promoting implementation of outpatient schema therapy for borderline personality disorder in general mental health care. Behaviour Research and Therapy, 47(11), 938-945.

  • Porter, R.J., Bourke, C., Carter, J.D., Douglas, K.M., McIntosh, V.V.W., Jordan, J., Joyce, P.R. and Frampton, C.M.A. (2016). No change in neuropsychological dysfunction or emotional processing during treatment of major depression with cognitive–behaviour therapy or schema therapy. Psychological medicine,46(02), 393-404.

  • Pugh, M. (2015). A narrative review of schemas and schema therapy outcomes in the eating disorders. Clinical Psychology Review, 39, 30-41.

  • Renner, F., Arntz, A., Leeuw, I., & Huibers, M. (2013). Treatment for chronic depression using schema therapy. Clinical Psychology: Science and Practice, 20(2),166-180.

  • Renner, F., Arntz, A., Peeters, F. P., Lobbestael, J., & Huibers, M. J. (2016). Schema therapy for chronic depression: Results of a multiple single case series. Journal of behavior therapy and experimental psychiatry, 51, 66-73.

  • Seavey, A., & Moore, T. M. (2012). Schema-Focused Therapy for Major Depressive Disorder and Personality Disorder: A Case Study. Clinical Case Studies, 11(6), 457-473.

  • Sempertegui, G.A., Karreman, A., Arntz, A. & Bekker, M. (2012). Schema therapy for borderline personality disorder: a comprehensive review of its empirical foundations, effectiveness and implementation possibilities. Clinical Psychology Review, 33(3),426-447.

  • Skewes, S., Samson, R., Simpson, S. & van Vreeswijk, M. (2014). Short-term group schema therapy for mixed personality disorders: A pilot studyFrontiers in Psychology, 5, 1592. doi:10.3389/fpsyg.2014.01592

  • Simpson, S., Morrow, E., van Vreeswijk, M. & Reid, C., (2010). Group schema therapy for eating disorders: A pilot study. Frontiers in Psychology in Clinical Settings, 1, 182.

  • Simpson, S. & Slowey, L. (2011). Video Therapy for Atypical Eating Disorder and Obesity: A Case Study Clinical Practice and Epidemiology in Mental Health, 7(1), 38-43. doi:10.2174/1745017901107010038

  • Simpson, S. (2012). Schema Therapy for Eating Disorders: a case study illustration of the Mode Approach. In van Vreeswijk, M., Broersen, J. & Nadort, M. (Eds.) The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research and Practice. Oxford, UK: Wiley-Blackwell. Pp145-171.

  • Simpson, S., Skewes, S., van Vreeswijk, M. & Samson, R. (2015). Commentary: Short-term group schema therapy for mixed personality disorders: An introduction to the treatment protocol. Frontiers in Psychology, 6 (Article 609), 1-3. doi:10.3389/fpsyg.2015.00609

  • Talbot, D., Smith, E., Tomkins, A., Brockman, R., Simpson, S. Schema modes in eating disorders compared to a community sample. Journal of Eating Disorders. 3(1), 1. doi:10.1186/s40337-015-0082-y

  • Taylor, C. D. J., Bee, P. and Haddock, G. (2016), Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychol Psychother Theory Res Pract. doi:10.1111/papt.12112

  • Ten Napel-Schut, M, Abma, T., Bamelis, L. & Arntz, A. (2011). Personality disorder patients’ perspectives on the introduction of imagery within schema therapy: a qualitative study of patients’ experiences. Cognitive and Behavioral Practice, 18, 482–490. doi:10.1016/j.cbpra.2011.04.005

  • Van Asselt, A. D. I., Dirksen, C. D., Arntz, A., Giesen-Bloo, J. H., van Dyck, R., Spinhoven, P., et al. (2008). Outpatient psychotherapy for borderline personality disorder: cost effectiveness of schema-focused therapy versus transference focused psychotherapy. Br. J. Psychiatry 192, 450–457. doi: 10.1192/bjp.bp.106.033597

  • Van Vreeswijk M. F., Spinhoven P., Eurelings-Bontekoe E. H. M., Broersen J. (2012). Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short term schema cognitive-behavioural group therapy: a naturalistic pre-post treatment design in an outpatient clinic. Clin. Psychol. Psychother. 21, 29–38 doi:10.1002/cpp.1813

  • Vuijka, R. & Arntz, A. (2017) Schema therapy as treatment for adults with autism spectrum disorder and comorbid personality disorder: Protocol of a multiple-baseline case series study testing cognitive-behavioral and experiential interventions, Contemproary Clinical Trials Communications, 5, 80 -85. https://doi.org/10.1016/j.conctc.2017.01.001

  • Weertman, A. & Arntz, A., (2007). Effectiveness of treatment of childhood memories in cognitive therapy for personality disorders: a controlled study contrasting methods focusing on the present and methods focusing on childhood memories. Behavior Research and Therapy, 45, 2133-2143.

Self-Help Books 

  • Behary, W. (2013).  Disarming the narcissist: Surviving and thriving with the self-absorbed. New Harbinger.

  • Louis, J. & Louis, K. (2015). Good Enough Parenting: An in-depth perspective on meeting core emotional needs and avoiding exasperation. NY: Morgan James.

  • Stevens, B. & Roediger, E. (2016). Breaking negative relationship patterns: a schema therapy self-help and support book. Chichester: Wiley-Blackwell.

  • Stevens, B. (2017). Hidden Learning: The Way we are wired for intimacy. Fremantle: Vivid Publishing.

  • Young, J.E. & Klosko, J.S. (1993). Reinventing Your Life. New York: Plume.