Can Schema Therapy Help Treatment-Resistant Anxiety and OCD Patients?

What you need to know

• Schema therapy combined with cognitive behavioral therapy (CBT) may help improve symptoms in patients with treatment-resistant anxiety disorders and obsessive-compulsive disorder (OCD).
• Improvement in symptoms was strongly correlated with improvement in early maladaptive schemas and schema modes.
• The severity of schemas and schema modes before treatment did not predict treatment outcomes, suggesting that even patients with severe schemas may benefit from this approach.

Understanding Treatment Resistance in Anxiety and OCD

Anxiety disorders and obsessive-compulsive disorder (OCD) can be challenging to treat. Even after receiving standard treatments like medication and cognitive behavioral therapy (CBT), about half of patients continue to struggle with significant symptoms. This situation is known as treatment resistance.

Researchers believe that one reason for treatment resistance might be the presence of deeply ingrained patterns of thoughts, emotions, and behaviors that developed early in life. These patterns are called early maladaptive schemas (EMS) and schema modes.

What are Early Maladaptive Schemas and Schema Modes?

Early maladaptive schemas are persistent, self-defeating patterns that develop during childhood or adolescence. They consist of memories, emotions, thoughts, and bodily sensations about oneself and relationships with others. For example, a person might have a schema of “abandonment,” always fearing that close relationships will end.

Schema modes are the moment-to-moment emotional states and coping responses that occur when these schemas are activated. For instance, when the “abandonment” schema is triggered, a person might enter a “vulnerable child” mode, feeling helpless and scared, or a “detached protector” mode, emotionally shutting down to avoid pain.

Schema Therapy: A New Approach for Treatment-Resistant Anxiety and OCD

Schema therapy is a form of psychotherapy that specifically targets early maladaptive schemas and unhealthy schema modes. It combines elements from cognitive behavioral therapy, attachment theory, and other therapeutic approaches. While schema therapy has shown promise in treating personality disorders, researchers are now exploring its potential for helping patients with treatment-resistant anxiety and OCD.

The Study: Combining Schema Therapy with CBT

This research paper reports on a pilot study that examined the effects of combining schema therapy with cognitive behavioral therapy in an intensive day-treatment program for patients with treatment-resistant anxiety disorders and OCD.

The Participants

The study included 27 patients who had not improved after at least one previous course of CBT for their anxiety or OCD. Most patients (89%) had additional mental health diagnoses, such as mood disorders or personality disorders. On average, they had already tried 6.4 previous treatments.

The Treatment

Patients received an intensive day-treatment program that combined schema therapy and CBT. The average treatment duration was about 37 weeks, with 11.5 hours of therapy per week. This approach allowed for more in-depth work on both symptoms and underlying schemas.

What Was Measured

The researchers assessed several aspects before and after treatment:

1. General psychological symptoms
2. OCD symptoms (for those with OCD)
3. Early maladaptive schemas
4. Schema modes (both unhealthy and healthy)

Key Findings

1. Overall Improvement in Symptoms and Schemas

After treatment, patients showed significant improvements in:

• General psychological symptoms
• Early maladaptive schemas
• Unhealthy schema modes
• Healthy schema modes

For patients with OCD, there was a 45% reduction in OCD symptoms on average, although this wasn’t statistically significant due to the small number of OCD patients in the study.

2. Strong Connection Between Symptom Improvement and Schema Change

One of the most interesting findings was that improvements in general psychological symptoms were strongly correlated with improvements in early maladaptive schemas and schema modes. This suggests that as patients’ deeply held beliefs and emotional patterns changed, their anxiety and OCD symptoms also improved.

3. Pre-treatment Schema Severity Didn’t Predict Outcomes

Importantly, the severity of schemas and schema modes before treatment did not predict how much patients’ symptoms would improve. This is encouraging because it suggests that even patients with very strong maladaptive schemas might benefit from this treatment approach.

What This Means for Patients and Families

These findings offer hope for individuals who have struggled with anxiety or OCD despite trying standard treatments. Here are some key takeaways:

1. If you or a loved one hasn’t responded well to traditional CBT or medication for anxiety or OCD, it doesn’t mean you can’t improve. There may be underlying schemas that need to be addressed.

2. Intensive treatment that combines schema therapy with CBT could be a helpful option for treatment-resistant cases. This approach targets both symptoms and deeper patterns of thinking and feeling.

3. Even if you feel like your anxiety or OCD is rooted in very strong, longstanding beliefs or patterns, this doesn’t necessarily mean you won’t benefit from treatment. The study found that pre-treatment schema severity didn’t predict outcomes.

4. Improvement might involve not just reducing symptoms, but also changing how you view yourself and relate to others on a fundamental level.

Limitations and Future Research

It’s important to note that this was a small pilot study without a control group, so we can’t be certain that the improvements were due to the treatment alone. Additionally, the treatment was provided as a package, so it’s unclear which specific elements were most helpful.

More research is needed to confirm these findings and compare this approach to other intensive treatments for anxiety and OCD. However, these initial results are promising and suggest that combining schema therapy with CBT could be a valuable option for those who haven’t found relief through standard treatments.

Conclusions

• Schema therapy combined with CBT in an intensive day-treatment program shows promise for treating resistant anxiety disorders and OCD.
• Improvements in symptoms were closely linked to changes in underlying schemas and coping modes.
• The severity of maladaptive schemas before treatment didn’t prevent improvement, suggesting this approach might help even those with deeply ingrained patterns.

For individuals and families struggling with treatment-resistant anxiety or OCD, these findings offer a new avenue of hope. While more research is needed, this study suggests that addressing underlying schemas alongside traditional CBT techniques could lead to meaningful improvements, even for those who haven’t responded well to previous treatments.