Hostname: page-component-6d856f89d9-5pczc Total loading time: 0 Render date: 2024-07-16T06:40:44.919Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of Self-Help Schema Therapy on Psychological Distress and Early Maladaptive Schemas: A Randomised Controlled Trial

Published online by Cambridge University Press:  04 March 2015

Margaret Priemer ,
France Talbot  and
Douglas J. French
Margaret Priemer
Affiliation:
Université de Moncton, Moncton, New Brunswick, Canada
France Talbot*
Affiliation:
Université de Moncton, Moncton, New Brunswick, Canada
Douglas J. French
Affiliation:
Université de Moncton, Moncton, New Brunswick, Canada
*
Address for correspondence: France Talbot, PhD, LPsych, Associate Professor of Psychology, School of Psychology, Université de Moncton, 18 Antonine-Maillet Avenue, Moncton, NB, Canada, E1A 3E9. E-mail: france.talbot@umoncton.ca
Get access

Abstract

Self-help cognitive behaviour therapy has been found helpful in treating anxiety and depression. Recent evidence suggests that self-help schema therapy may represent another treatment alternative. The present study aimed to provide a preliminary assessment of the efficacy of self-help schema therapy on psychological distress and early maladaptive schemas (EMSs) using a 6-week treatment protocol with minimal email contact. Method: Participants were recruited from the general population and randomly assigned to self-help schema therapy (n = 32) or a waitlist (n = 32). Intent-to-treat analyses and study completer analyses were conducted using repeated-measures analyses of variance (time × group). Results: Intent-to-treat analyses revealed that treatment produced a marginal improvement in distress, but no change in EMSs. Among study completers (n = 34), self-help schema therapy yielded large reductions in distress scores on the Outcome Questionnaire-45.2 (partial eta squared = .16). Compared to the waitlist, self-help schema therapy also produced a moderate decrease in EMSs (partial eta squared = .10). The majority of study completers showed reliable clinical change in distress and reported high levels of satisfaction with the intervention. Conclusion: Self-help schema therapy may be an effective treatment for those individuals who persist in treatment. Self-help schema therapy has the potential to help a large number of individuals who may not otherwise have access to services. More research is needed to determine variables associated with treatment adherence and successful outcome.

Keywords

self-helpschema therapydistressschemasanxietydepression
Type
Standard Papers
Information
Behaviour Change , Volume 32 , Issue 1 , April 2015 , pp. 59 - 73
Copyright
Copyright © The Author(s) 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrews, G., Cuijpers, P., Craske, M.G., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS ONE, 5, e13196. doi:10.1371/journal.pone.0013196CrossRefGoogle ScholarPubMed
Atalay, H., Atalay, F., & Bağdaçiçek, S. (2011). Effect of short-term antidepressant treatment on early maladaptive schemas in patients with major depressive and panic disorder. International Journal of Psychiatry in Clinical Practice, 15, 97–105. doi:10.3109/13651501.2010.549234CrossRefGoogle ScholarPubMed
Bamelis, L., Evers, S., Spinhoven, P., & Arntz, A. (2013). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 305–322. doi:10.1176/appi.ajp.2013.12040518CrossRefGoogle Scholar
Bebbington, P.E., & Nayani, T. (1995). The Psychosis Screening Questionnaire. International Journal of Methods in Psychiatric Research, 5, 11–19.Google Scholar
Bilich, L.L., Deane, F.P., Phipps, A.B., Barisic, M., & Gould, G. (2008). Effectiveness of bibliotherapy for depression with varying levels of telephone helpline support. Clinical Psychology and Psychotherapy, 15, 61–74. doi:10.1002/cpp.562CrossRefGoogle ScholarPubMed
Bludworth, J.L., Tracey, T.J.G., & Glidden-Tracey, C. (2010). The bilevel structure of the Outcome Questionnaire-45. Psychological Assessment, 22, 350–355. doi:10.1037/a0019187CrossRefGoogle ScholarPubMed
Callahan, J.L., & Hynan, M.T. (2005). Models of psychotherapy outcome: Are they applicable in training clinics? Psychological Services, 2, 65–69. doi:10.1037/1541-1559.2.1.65CrossRefGoogle Scholar
Carter, J.D., Luty, S.E., McKenzie, J.M., Mulder, R.T., Frampton, C.M., & Joyce, P.R. (2011). Patient predictors of response to cognitive behaviour therapy and interpersonal therapy in a randomized clinical trial for depression. Journal of Affective Disorders, 128, 252–261. doi:10.1016/j.jad.2010.07.002CrossRefGoogle Scholar
Carter, J.D., McIntosh, V.V., Jordan, J., Porter, R.J., Frampton, C.M., & Joyce, P.R. (2013). Psychotherapy for depression: A randomized clinical trial comparing schema therapy and cognitive behaviour therapy. Journal of Affective Disorders, 151, 500–505. doi:10.1016/j.jad.2013.06.034CrossRefGoogle Scholar
Carter, J.C., Olmsted, M.P., Kaplan, A.S., McCabe, R.E., Mills, J.S., & Aimée, A. (2003). Self-help for bulimia nervosa: A randomized controlled trial. American Journal of Psychiatry, 160, 973–978. doi:10.1176/appi.ajp.160.5.973CrossRefGoogle ScholarPubMed
Cockram, D.M., Drummond, P.D., & Lee, C.W. (2010). Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clinical Psychology & Psychotherapy, 17, 165–182. doi:http://dx.doi.org/10.1002/cpp.690CrossRefGoogle ScholarPubMed
Coull, G., & Morris, P.G. (2011). The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review. Psychological Medicine, 41, 2239–2252. http://dx.doi.org/10.1017/S0033291711000900CrossRefGoogle ScholarPubMed
Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders?: A systematic review and meta-analysis of comparative outcome studies. Psychological Medicine, 40, 1943–1957. http://dx.doi.org/10.1017/S0033291710000772CrossRefGoogle ScholarPubMed
Danoff, N.L., Kemper, K.J., & Sherry, B. (1994). Risk factors for dropping out of a parenting education program. Child Abuse and Neglect, 18, 599–606.CrossRefGoogle ScholarPubMed
Enns, M.W., Cox, B.J., Afifi, T.O., De Graaf, R., Ten Have, M., & Sareen, J. (2006). Childhood adversities and risk for suicidal ideation and attempts: A longitudinal population-based study. Psychological Medicine, 36, 1769–1778. doi:10.1017/S0033291706008646CrossRefGoogle ScholarPubMed
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. http://dx.doi.org/10.1016/j.jbtep.2009.01.002CrossRefGoogle ScholarPubMed
Fitzsimmons, K., Gallagher, S., Blayone, S., Chan, D., Leaitch, W., Veals, N., & Wilkinson, N. (2008). The Young Schema Questionnaire in group therapy: A client-focused approach. Social Work in Mental Health, 7, 176–185. doi:10.1080/15332980802072538CrossRefGoogle Scholar
Foroushani, P.S., Schneider, J., & Assareh, N. (2011). Meta-review of the effectiveness of computerised CBT in treating depression. BMC Psychiatry, 11, 131. doi:10.1186/1471-244X-11-131CrossRefGoogle ScholarPubMed
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., . . . Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy versus transference-focused therapy. Archives of General Psychiatry, 63, 619–658. doi:10.1001/archpsyc.63.6.649.CrossRefGoogle Scholar
Haby, M.M., Donnelly, M., Corry, J., & Vos, T. (2006) Cognitive behavioural therapy for depression, panic disorder and generalized anxiety disorder: A meta-regression of factors that may predict outcome. Australian and New Zealand Journal of Psychiatry, 40, 9–19. doi:10.1111/j.1440-1614.2006.01736.x.CrossRefGoogle ScholarPubMed
Hawke, L.D., & Provencher, M.D. (2011). Schema theory and schema therapy in mood and anxiety disorders: A review. Journal of Cognitive Psychotherapy: An International Quarterly, 25, 257–276. doi: 10.1891/0889-8391.25.4.257CrossRefGoogle Scholar
Halvorsen, M., Wang, C. E., Eisemann, M., & Waterloo, K. (2010). Dysfunctional attitudes and early maladaptive schemas as predictors of depression: A 9-year follow-up study. Cognitive Therapy and Research, 34, 368–379. http://dx.doi.org/10.1007/s10608-009-9259-5CrossRefGoogle Scholar
Jacobson, N.S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.CrossRefGoogle ScholarPubMed
Kriston, L., Schäfer, J., von Wolff, A., Härter, M., & Hölzel, L.P. (2012). The latent factor structure of Young's early maladaptive schemas: Are schemas organized into domains? Journal of Clinical Psychology, 68, 684–698. doi:10.1002/jclp.21846CrossRefGoogle ScholarPubMed
Lambert, M.J., Hansen, N.B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G. & Reisinger, C. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ-45.2). Wilmington, DL: American Professional Credentialing Services.Google Scholar
Lambert, M.J., Morton, J.J., Hatfield, D., Harmon, C., Hamilton, S., Reid, R.C., . . . Burlingame, G.M. (2004). Administration and scoring manual for the OQ-45.2. Salt Lake City, UT: American Professional Credentialing Services, L.L.C.Google Scholar
Lewis, C., Pearce, J., & Bisson, J.I. (2012). Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: Systematic review. The British Journal of Psychiatry, 200, 15–21.CrossRefGoogle ScholarPubMed
McGlashan, T.H., Grilo, C.M., Sanislo, C.A., Ralevski, E., Morey, L.C., Gunderson, J.G., . . . Pagano, M. (2005). Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: Toward a hybrid model of Axis II disorders. American Journal of Psychiatry, 162, 883–889. doi: 10.1176/appi.ajp.162.5.883CrossRefGoogle Scholar
Melville, K.M., Casey, L.M., & Kavanaugh, D.J. (2010). Dropout from Internet based treatment for psychological disorders. British Journal of Clinical Psychology, 49, 455–471. doi: 10.1348/014466509´472138CrossRefGoogle ScholarPubMed
Mitchell, J.E., Agras, S., Crow, S., Halmi, K., Fairburn, C.G., Bryson, M.S., . . . Kraemer, H. (2011). Stepped care and cognitive behavioral therapy for bulimia nervosa: A randomised trial. The British Journal of Psychiatry, 198, 391–397. doi:10.1192/bjp.bp.110.082172CrossRefGoogle ScholarPubMed
Mond, J., Myers, T., Crosby, R., Hay, P., & Mitchell, J. (2010). Bulimic eating disorders in primary care: Hidden morbidity still? Journal of Clinical Psychology in Medical Settings, 17, 56–63. doi:10.1007//s10880-009-9180-9CrossRefGoogle ScholarPubMed
Morey, L.C., Shea, M.T., Markowitz, J.C., Stout, R.L., Hopwood, C.J., Gunderson, J.G., . . . Skodol, A.E. (2010). State effects of major depression on the assessment of personality and personality disorder. American Journal of Psychiatry, 167, 528–535. doi:10.1176/appi.ajp.2009.09071023CrossRefGoogle ScholarPubMed
Mueller, R.M., Lambert, M.J., & Burlingame, G.M. (1998). Construct validity of the Outcome Questionnaire: A confirmatory factor analysis. Journal of Personality Assessment, 70, 248–262.CrossRefGoogle Scholar
Nadort, M., Arntz, A., Smit, J.H., Giesen-Bloo, J., Eikelenboom, M., Spinoven, P., . . . 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, 961–973. doi:10.1016/j.brat.2009.07.013CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE). (2009). Depression treatment and management of depression in adults including adults with a chronic physical health problem. London, England: Author. Retrieved from http://www.nice.org.uk/nicemedia/live/12329/45890/45890.pdfGoogle Scholar
National Institute for Health and Clinical Excellence (NICE). (2011). Generalized anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care. London, England: Author. Retrieved from http://www.nice.org.uk/nicemedia/live/13314/52601/52601.pdfGoogle Scholar
Newman, M.G., Szkodny, L.E., Llera, S.J., & Przeworski, A. (2011). A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: Is human contact necessary for therapeutic efficacy? Clinical Psychology Review, 31, 89–103. doi:10.1016/j.cpr.2010.09.008CrossRefGoogle Scholar
Nordahl, H.M., Holthe, H., & Haugum, J.A. (2005). Early maladaptive schemas in patients with or without personality disorders: Does schema modification predict symptomatic relief? Clinical Psychology and Psychotherapy, 12, 142–149. doi:10.1002/cpp.430CrossRefGoogle Scholar
Nordin, S., Carlbring, P., Cuijpers, P., & Andersson, G., (2010). Expanding the limits of bibliotherapy for panic disorder: Randomized trial of self-help without support but with a clear deadline. Behavior Therapy, 41, 267–276. doi:10.1016/j.beth.2009.06.001CrossRefGoogle ScholarPubMed
Priemer, M., & Talbot, F. (2013). Guided self-administered CBT compares favorably to gold standard therapist administered CBT and shows unique benefits over traditional treatment. Behaviour Change, 30, 227–240. doi:http://dx.doi.org/10.1017/bec.2013.22CrossRefGoogle Scholar
Rush, A.J. (1982). Inventory of Depressive Symptomatology – Self-Report –Canada/English. Retrieved from http://www.ids-qids.org/translations/english/IDS-SREnglish-Canada.pdfGoogle Scholar
Rush, A.J., Gullion, C.M., Basco, M.R., Jarrett, R.B., & Trivedi, M.H. (1996). The Inventory of Depressive Symptomatology (IDS): Psychometric properties. Psychological Medicine, 26, 477–86. doi:10.1017/S0033291700035558CrossRefGoogle ScholarPubMed
Salmoiraghi, A., & Sambhi, R (2010). Early termination of cognitive behavioural interventions: Literature review. The Psychiatric Bulletin, 34, 529–532. doi:10.1192/pb.bp.110.030775Google Scholar
Stopa, L., Thorne, P., Waters, A., & Preston, J. (2001). Are the short and long forms of the Young Schema Questionnaire comparable and how well does each version predict psychopathology scores? Journal of Cognitive Psychotherapy, 15, 253–272.CrossRefGoogle Scholar
Sullivan, G.M., & Feinn, R. (2012). Using effect size — or why the p value is not enough. Journal of Graduate Medical Education, 4, 279–282. doi:http://dx.doi.org/10.4300/JGME-D-12-00156.1CrossRefGoogle ScholarPubMed
Talbot, F. (2012). Client contact in self-help therapy for anxiety and depression: Necessary but can take a variety of forms beside therapist contact. Behaviour Change, 29, 63–76. doi:http://dx.doi.org/10.1017/bec.2012.4CrossRefGoogle Scholar
Titov, N., Dear, B.F., Johnston, L., Lorian, C., Zou, J., Wootton, B., . . . Rapee, R.M. (2013). Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: Randomized controlled trial. PLoS ONE, 8, e62873. doi:10.1371/journal.pone.0062873CrossRefGoogle Scholar
Tough, S.C., Siever, J.E., & Johnston, D.W. (2007). Retaining women in a prenatal care randomized controlled trial in Canada: Implications for program planning. BMC Public Health, 7, 148. doi:10.1186/1471-2458-7-148CrossRefGoogle Scholar
van't Hof, E., Cuijpers, P., & Stein, D.J. (2009). Self-help and internet-guided interventions in depression and anxiety disorders: A systematic review of meta-analyses. CNS Sprectrums, 14, 34–40. Retrieved from http://www.cnsspectrums.com/aspx/articledetail.aspx?articleid=2031CrossRefGoogle ScholarPubMed
Waller, G., Meyer, C., & Ohanian, V. (2001). Psychometric properties of the long and short versions of the Young Schema-Questionnaire: Core beliefs among bulimic and comparison women. Cognitive Therapy and Research, 25, 137–147. doi:10.1023/A:1026487018110CrossRefGoogle Scholar
Young, J. (2005). The Young Schema Questionnaire-Short Form (YSQ-S3). New York, NY: ST Institute.Google Scholar
Young, J.E., & Klosko, J.S. (1994). Reinventing your life: The breakthrough program to end negative behavior . . . and feel great again. New York: Plume.Google Scholar
Young, J.E., Klosko, J.S., & Weishaar, M. (2003). Schema therapy: A practitioner's guide. New York: Guilford Press.Google Scholar