Schema therapy

Meet the patient

A 34-year-old software engineer has been referred because three courses of CBT "didn't stick". She is competent, chronically single, and convinced — at a level she cannot argue with — that she is defective and that anyone who got close would discover the flaw and leave. She cancels dates at the last minute, works late to avoid intimacy, and cuts herself after the rare evening she lets someone in.^[1][7]

The registrar's note says "treatment-resistant depression". The examiner's question is sharper: what is the characterological driver that brief CBT never touched, and what therapy is built for it? That is schema therapy's reason to exist.^[1][10]

References14ShowHide

1. [1]Giesen-Bloo J, van Dyck R, Spinhoven P, et al. Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy Arch Gen Psychiatry, 2006.PMID 16754838
2. [2]van Asselt AD, Dirksen CD, Arntz A, et al. Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy Br J Psychiatry, 2008.PMID 18515897
3. [3]Farrell JM, Shaw IA, Webber MA A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized controlled trial J Behav Ther Exp Psychiatry, 2009.PMID 19176222
4. [4]Nadort M, Arntz A, Smit JH, et al. Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial Behav Res Ther, 2009.PMID 19698939
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7. [7]Bamelis LL, Evers SM, Spinhoven P, Arntz A Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders Am J Psychiatry, 2014.PMID 24322378
8. [8]Bamelis LL, Arntz A, Wetzelaer P, et al. Economic evaluation of schema therapy and clarification-oriented psychotherapy for personality disorders: a multicenter, randomized controlled trial J Clin Psychiatry, 2015.PMID 26579561
9. [9]Cristea IA, Gentili C, Cotet CD, et al. Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis JAMA Psychiatry, 2017.PMID 28249086
10. [10]Tan YM, Lee CW, Averbeck LE, et al. Schema therapy for borderline personality disorder: A qualitative study of patients' perceptions PLoS One, 2018.PMID 30462650
11. [11]Storebø OJ, Stoffers-Winterling JM, Völlm BA, et al. Psychological therapies for people with borderline personality disorder Cochrane Database Syst Rev, 2020.PMID 32368793
12. [12]Stoffers-Winterling JM, Storebø OJ, Kongerslev MT, et al. Psychotherapies for borderline personality disorder: a focused systematic review and meta-analysis Br J Psychiatry, 2022.PMID 35088687
13. [13]Arntz A, Jacob GA, Lee CW, et al. Effectiveness of Predominantly Group Schema Therapy and Combined Individual and Group Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial JAMA Psychiatry, 2022.PMID 35234828
14. [14]Assmann N, Schaich A, Arntz A, et al. The Effectiveness of Dialectical Behavior Therapy Compared to Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial Psychother Psychosom, 2024.PMID 38986457