ADAA 2018

WASHINGTON – Therapy targeting early maladaptive schemas can reduce the severity of PTSD symptoms and improve the quality of life for patients, according to data presented at the annual conference of the Anxiety and Depression Association of America.

Change in early maladaptive schemas correlated with a 13%-20% variation in PTSD symptom severity among patients tested, which points to the efficacy of incorporating schema-based interventions in trauma-focused therapies, said Karina T. Loyo, of Marquette University, Milwaukee.

Early maladaptive schemas, broad worldviews that develop in childhood, can lead to unhealthy, pervasive expectations in adulthood that directly inhibit PTSD treatment, according to Ms. Loyo. “We can see with how early maladaptive schemas developed early on can influence how an individual interprets a traumatic event,” she said.

To test whether early maladaptive schemas can predict symptom reduction and life improvement beyond trauma-related cognitions, Ms. Loyo and her colleagues gave 120 PTSD patients an early maladaptive schemas questionnaire, a quality of life questionnaire, as well as the Posttraumatic Cognitions Inventory.

Using a regression model, investigators found the Posttraumatic Cognitions Inventory and schema questionnaire predicted quality of life fairly accurately. This was especially true of the schema questionnaire, which predicted 20% more variance in quality of life scores, Ms. Loyo said.

“This suggests that schema-focused therapy [SFT] is related to PTSD symptom severity reduction,” Ms. Loyo said. “This has clinical implications as far as how we integrate schema-based interventions in trauma-focused areas.”

These schema-based treatments can be used to change a patient’s thoughts on their disorder, as well as gather information. For example, a patient exhibiting the early maladaptive schema of mistrust from abuse might be suspicious of others based on childhood experiences of being used or taken advantage of by others. This can lead to alienation from others, which in turn, would affect the patient’s quality of life after their traumatic experience.

Using SFT, clinicians can talk through and identify the possible intentions of those in the patient’s life to reinforce the notion that the people in their life might be both imperfect yet trustworthy, Ms. Loyo said.

SFT can also be used to address childhood trauma that caused a patient’s development of early maladaptive schemas. This kind of work can build trust between the clinician and the patient – and make subsequent treatments more effective.

Unlike a typical trauma narrative, SFT focuses on increasing awareness of patients’ emotions before the trauma occurred and how they felt while addressing the moment the trauma occurred. In addition, SFT uses a slightly different form of imagery scripting in an effort to acknowledge patients’ pain and direct them in a more constructive direction to channel those emotions into rebuilding values such as trust.

Ms. Loyo reported no financial disclosures.

[email protected]

SOURCE: Loyo KT et al. ADAA 2018.

WASHINGTON – Therapy targeting early maladaptive schemas can reduce the severity of PTSD symptoms and improve the quality of life for patients, according to data presented at the annual conference of the Anxiety and Depression Association of America.

Change in early maladaptive schemas correlated with a 13%-20% variation in PTSD symptom severity among patients tested, which points to the efficacy of incorporating schema-based interventions in trauma-focused therapies, said Karina T. Loyo, of Marquette University, Milwaukee.

Early maladaptive schemas, broad worldviews that develop in childhood, can lead to unhealthy, pervasive expectations in adulthood that directly inhibit PTSD treatment, according to Ms. Loyo. “We can see with how early maladaptive schemas developed early on can influence how an individual interprets a traumatic event,” she said.

To test whether early maladaptive schemas can predict symptom reduction and life improvement beyond trauma-related cognitions, Ms. Loyo and her colleagues gave 120 PTSD patients an early maladaptive schemas questionnaire, a quality of life questionnaire, as well as the Posttraumatic Cognitions Inventory.

Using a regression model, investigators found the Posttraumatic Cognitions Inventory and schema questionnaire predicted quality of life fairly accurately. This was especially true of the schema questionnaire, which predicted 20% more variance in quality of life scores, Ms. Loyo said.

“This suggests that schema-focused therapy [SFT] is related to PTSD symptom severity reduction,” Ms. Loyo said. “This has clinical implications as far as how we integrate schema-based interventions in trauma-focused areas.”

These schema-based treatments can be used to change a patient’s thoughts on their disorder, as well as gather information. For example, a patient exhibiting the early maladaptive schema of mistrust from abuse might be suspicious of others based on childhood experiences of being used or taken advantage of by others. This can lead to alienation from others, which in turn, would affect the patient’s quality of life after their traumatic experience.

Using SFT, clinicians can talk through and identify the possible intentions of those in the patient’s life to reinforce the notion that the people in their life might be both imperfect yet trustworthy, Ms. Loyo said.

SFT can also be used to address childhood trauma that caused a patient’s development of early maladaptive schemas. This kind of work can build trust between the clinician and the patient – and make subsequent treatments more effective.

Unlike a typical trauma narrative, SFT focuses on increasing awareness of patients’ emotions before the trauma occurred and how they felt while addressing the moment the trauma occurred. In addition, SFT uses a slightly different form of imagery scripting in an effort to acknowledge patients’ pain and direct them in a more constructive direction to channel those emotions into rebuilding values such as trust.

Ms. Loyo reported no financial disclosures.

[email protected]

SOURCE: Loyo KT et al. ADAA 2018.

WASHINGTON – Therapy targeting early maladaptive schemas can reduce the severity of PTSD symptoms and improve the quality of life for patients, according to data presented at the annual conference of the Anxiety and Depression Association of America.

Change in early maladaptive schemas correlated with a 13%-20% variation in PTSD symptom severity among patients tested, which points to the efficacy of incorporating schema-based interventions in trauma-focused therapies, said Karina T. Loyo, of Marquette University, Milwaukee.

Early maladaptive schemas, broad worldviews that develop in childhood, can lead to unhealthy, pervasive expectations in adulthood that directly inhibit PTSD treatment, according to Ms. Loyo. “We can see with how early maladaptive schemas developed early on can influence how an individual interprets a traumatic event,” she said.

To test whether early maladaptive schemas can predict symptom reduction and life improvement beyond trauma-related cognitions, Ms. Loyo and her colleagues gave 120 PTSD patients an early maladaptive schemas questionnaire, a quality of life questionnaire, as well as the Posttraumatic Cognitions Inventory.

Using a regression model, investigators found the Posttraumatic Cognitions Inventory and schema questionnaire predicted quality of life fairly accurately. This was especially true of the schema questionnaire, which predicted 20% more variance in quality of life scores, Ms. Loyo said.

“This suggests that schema-focused therapy [SFT] is related to PTSD symptom severity reduction,” Ms. Loyo said. “This has clinical implications as far as how we integrate schema-based interventions in trauma-focused areas.”

These schema-based treatments can be used to change a patient’s thoughts on their disorder, as well as gather information. For example, a patient exhibiting the early maladaptive schema of mistrust from abuse might be suspicious of others based on childhood experiences of being used or taken advantage of by others. This can lead to alienation from others, which in turn, would affect the patient’s quality of life after their traumatic experience.

Using SFT, clinicians can talk through and identify the possible intentions of those in the patient’s life to reinforce the notion that the people in their life might be both imperfect yet trustworthy, Ms. Loyo said.

SFT can also be used to address childhood trauma that caused a patient’s development of early maladaptive schemas. This kind of work can build trust between the clinician and the patient – and make subsequent treatments more effective.

Unlike a typical trauma narrative, SFT focuses on increasing awareness of patients’ emotions before the trauma occurred and how they felt while addressing the moment the trauma occurred. In addition, SFT uses a slightly different form of imagery scripting in an effort to acknowledge patients’ pain and direct them in a more constructive direction to channel those emotions into rebuilding values such as trust.

Ms. Loyo reported no financial disclosures.

[email protected]

SOURCE: Loyo KT et al. ADAA 2018.

WASHINGTON – Successfully treating patients who have treatment-resistant depression (TRD) means leaving acute intervention behind and adopting more chronic remediation techniques, Scott T. Aaronson, MD, said at the annual conference of the Anxiety and Depression Association of America.

“We need to change the paradigm; most of the research is looking at a 6- to 12-week outcome measure,” said Dr. Aaronson, director of the clinical research program at Sheppard Pratt Health System, Baltimore. “These are folks who have been depressed for most of their adult lives, and we don’t tend to take a longer-term perspective when looking at this.”

Treatment-resistant depression, Dr. Aaronson said, can be conceptualized as two levels. The first is failure of two agents or treatments, and the second is a failure of four or more agents – including electroconvulsive therapy. In light of those levels, Dr. Aaronson suggests approaching depression as one would cancer, with different stages of failure determining payment for more expensive treatments.

Courtesy Dr. Scott T. Aaronson

Before planning how best to handle treatment-resistant depression, it is important for psychiatrists to understand its complexity, and address the issues associated with current psychiatric diagnoses, Dr. Aaronson said.

Diagnoses now are based purely on phenomenological analysis rather than biological analysis, he said. “Basically, it’s a room full of people getting together to decide what the diagnostic criteria are,” Dr. Aaronson said. “It’s eminence-based medicine, not evidence-based medicine.”

This approach creates a large gray area in which diagnoses can fall, making it more difficult to distinguish between bipolar and unipolar depression, as well as tough to distinguish psychotic and nonpsychotic illnesses.

If a patient displayed mood instability, for example, but not enough to fit the criteria of bipolar disorder, this scenario would present a dilemma for psychiatrists unable to diagnose the patient as bipolar and unconvinced that it would help to treat the patient as only being depressed, according to an example from Dr. Aaronson.

[email protected]

WASHINGTON – Successfully treating patients who have treatment-resistant depression (TRD) means leaving acute intervention behind and adopting more chronic remediation techniques, Scott T. Aaronson, MD, said at the annual conference of the Anxiety and Depression Association of America.

“We need to change the paradigm; most of the research is looking at a 6- to 12-week outcome measure,” said Dr. Aaronson, director of the clinical research program at Sheppard Pratt Health System, Baltimore. “These are folks who have been depressed for most of their adult lives, and we don’t tend to take a longer-term perspective when looking at this.”

Treatment-resistant depression, Dr. Aaronson said, can be conceptualized as two levels. The first is failure of two agents or treatments, and the second is a failure of four or more agents – including electroconvulsive therapy. In light of those levels, Dr. Aaronson suggests approaching depression as one would cancer, with different stages of failure determining payment for more expensive treatments.

Courtesy Dr. Scott T. Aaronson

Before planning how best to handle treatment-resistant depression, it is important for psychiatrists to understand its complexity, and address the issues associated with current psychiatric diagnoses, Dr. Aaronson said.

Diagnoses now are based purely on phenomenological analysis rather than biological analysis, he said. “Basically, it’s a room full of people getting together to decide what the diagnostic criteria are,” Dr. Aaronson said. “It’s eminence-based medicine, not evidence-based medicine.”

This approach creates a large gray area in which diagnoses can fall, making it more difficult to distinguish between bipolar and unipolar depression, as well as tough to distinguish psychotic and nonpsychotic illnesses.

If a patient displayed mood instability, for example, but not enough to fit the criteria of bipolar disorder, this scenario would present a dilemma for psychiatrists unable to diagnose the patient as bipolar and unconvinced that it would help to treat the patient as only being depressed, according to an example from Dr. Aaronson.

[email protected]

WASHINGTON – Successfully treating patients who have treatment-resistant depression (TRD) means leaving acute intervention behind and adopting more chronic remediation techniques, Scott T. Aaronson, MD, said at the annual conference of the Anxiety and Depression Association of America.

“We need to change the paradigm; most of the research is looking at a 6- to 12-week outcome measure,” said Dr. Aaronson, director of the clinical research program at Sheppard Pratt Health System, Baltimore. “These are folks who have been depressed for most of their adult lives, and we don’t tend to take a longer-term perspective when looking at this.”

Treatment-resistant depression, Dr. Aaronson said, can be conceptualized as two levels. The first is failure of two agents or treatments, and the second is a failure of four or more agents – including electroconvulsive therapy. In light of those levels, Dr. Aaronson suggests approaching depression as one would cancer, with different stages of failure determining payment for more expensive treatments.

Courtesy Dr. Scott T. Aaronson

Before planning how best to handle treatment-resistant depression, it is important for psychiatrists to understand its complexity, and address the issues associated with current psychiatric diagnoses, Dr. Aaronson said.

Diagnoses now are based purely on phenomenological analysis rather than biological analysis, he said. “Basically, it’s a room full of people getting together to decide what the diagnostic criteria are,” Dr. Aaronson said. “It’s eminence-based medicine, not evidence-based medicine.”

This approach creates a large gray area in which diagnoses can fall, making it more difficult to distinguish between bipolar and unipolar depression, as well as tough to distinguish psychotic and nonpsychotic illnesses.

If a patient displayed mood instability, for example, but not enough to fit the criteria of bipolar disorder, this scenario would present a dilemma for psychiatrists unable to diagnose the patient as bipolar and unconvinced that it would help to treat the patient as only being depressed, according to an example from Dr. Aaronson.

[email protected]

WASHINGTON – Using schema therapy as an adjunct for substance use disorder might help fill the gaps in traditional cognitive-behavioral therapy, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Schema therapy, developed for treatment-resistant diagnoses, allows clinicians to challenge cognitive distortions and negative coping styles that develop during childhood or adolescence. As an extension of the cognitive-behavioral therapy (CBT) model of Aaron T. Beck, MD, schema therapy can target substance use disorder (SUD) psychiatric comorbidities like PTSD and antisocial personality disorder – which are present in more than 50% of SUD patients, said presenter Katharine D. Wojcik, of the University of British Columbia, Vancouver.

“The combination of a dual diagnosis makes the traditional 12-step addiction therapy less effective,” said Ms. Wojcik, a doctoral candidate at the university. “Additionally, traditional treatment approaches have been found to be ineffective against comorbid mental health and substance use disorders.”

To investigate the effects of schema therapy, Ms. Wojcik collected data on more than 100 residents of a treatment program for patients with addictions and mental illness. The patients took the Young Schema Questionnaire 3 so the investigators could assess the presence and extent of early maladaptive schemas. The patients, mostly white females, participated in the schema therapy protocol for 30 days.

Medication management, a 12-step program, individual sessions, and a CBT intervention – including prolonged exposure, behavior activation, and schema therapy – were incorporated to target their multiple diagnoses, Ms. Wojcik said.

In the initial assessments, the investigators found that self-sacrifice, unrelenting standards, and insufficient self-control were the most common schema among the subject group, with notably elevated levels of disconnection, rejection, overvigilance, and inhibition.

After the assessments, patients and clinicians sat down to discuss the schema clinicians found present. If patients bought into the report, they began self-monitoring through daily activities such as journaling.

Ms. Wojcik and her colleagues said those self-monitoring practices will help change patients’ schema. But such practices were not the only tool in the program aimed at sparking these changes, patients worked with clinicians on cognitive strategies as well. Addressing core beliefs, schema bias, schema activation formulation, and schema rules and assumptions were a few of the strategies implemented by clinicians.

“We also work on schema challenging, which means [when] in session with a client, as a clinician you are able to say: ‘I wonder if this schema is coming up for you right now,’ or ‘Are you noticing any schemas as we’re talking about this?’ ” Ms. Wojcik said. “Since there is such a high comorbidity, a lot of times it does come down to these experiences that they’ve had that tie into trauma history.”

After the end of their stay, patients were given a reassessment and then shown the results to see how they had progressed. The reassessment did show some subtle changes, but the short length of the program hindered any patients from seeing complete deescalation of their schema, Ms. Wojcik said.

She discussed the case of a 30-year-old woman with diagnoses of SUD, PTSD, and bipolar disorder – and an extensive treatment history. Therapists found that the combination of traditional and CBT helped significantly with the patient’s elevated abandonment schema.

“We were able to have her close her eyes and walk through not only what it was like when that schema developed, but also have her talk about what were the things that went unmet in that situation that caused this to happen,” Ms. Wojcik said. “She successfully completed her treatment with us, noticed a lot of her schema had decreased in elevation, and expressed pride that she had done this.”

Ms. Wojcik and her colleagues reported no relevant financial disclosures.

[email protected]

SOURCE: Wojcik KD et al. ADAA 2018, Abstract 173C.

WASHINGTON – Using schema therapy as an adjunct for substance use disorder might help fill the gaps in traditional cognitive-behavioral therapy, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Schema therapy, developed for treatment-resistant diagnoses, allows clinicians to challenge cognitive distortions and negative coping styles that develop during childhood or adolescence. As an extension of the cognitive-behavioral therapy (CBT) model of Aaron T. Beck, MD, schema therapy can target substance use disorder (SUD) psychiatric comorbidities like PTSD and antisocial personality disorder – which are present in more than 50% of SUD patients, said presenter Katharine D. Wojcik, of the University of British Columbia, Vancouver.

“The combination of a dual diagnosis makes the traditional 12-step addiction therapy less effective,” said Ms. Wojcik, a doctoral candidate at the university. “Additionally, traditional treatment approaches have been found to be ineffective against comorbid mental health and substance use disorders.”

To investigate the effects of schema therapy, Ms. Wojcik collected data on more than 100 residents of a treatment program for patients with addictions and mental illness. The patients took the Young Schema Questionnaire 3 so the investigators could assess the presence and extent of early maladaptive schemas. The patients, mostly white females, participated in the schema therapy protocol for 30 days.

Medication management, a 12-step program, individual sessions, and a CBT intervention – including prolonged exposure, behavior activation, and schema therapy – were incorporated to target their multiple diagnoses, Ms. Wojcik said.

In the initial assessments, the investigators found that self-sacrifice, unrelenting standards, and insufficient self-control were the most common schema among the subject group, with notably elevated levels of disconnection, rejection, overvigilance, and inhibition.

After the assessments, patients and clinicians sat down to discuss the schema clinicians found present. If patients bought into the report, they began self-monitoring through daily activities such as journaling.

Ms. Wojcik and her colleagues said those self-monitoring practices will help change patients’ schema. But such practices were not the only tool in the program aimed at sparking these changes, patients worked with clinicians on cognitive strategies as well. Addressing core beliefs, schema bias, schema activation formulation, and schema rules and assumptions were a few of the strategies implemented by clinicians.

“We also work on schema challenging, which means [when] in session with a client, as a clinician you are able to say: ‘I wonder if this schema is coming up for you right now,’ or ‘Are you noticing any schemas as we’re talking about this?’ ” Ms. Wojcik said. “Since there is such a high comorbidity, a lot of times it does come down to these experiences that they’ve had that tie into trauma history.”

After the end of their stay, patients were given a reassessment and then shown the results to see how they had progressed. The reassessment did show some subtle changes, but the short length of the program hindered any patients from seeing complete deescalation of their schema, Ms. Wojcik said.

She discussed the case of a 30-year-old woman with diagnoses of SUD, PTSD, and bipolar disorder – and an extensive treatment history. Therapists found that the combination of traditional and CBT helped significantly with the patient’s elevated abandonment schema.

“We were able to have her close her eyes and walk through not only what it was like when that schema developed, but also have her talk about what were the things that went unmet in that situation that caused this to happen,” Ms. Wojcik said. “She successfully completed her treatment with us, noticed a lot of her schema had decreased in elevation, and expressed pride that she had done this.”

Ms. Wojcik and her colleagues reported no relevant financial disclosures.

[email protected]

SOURCE: Wojcik KD et al. ADAA 2018, Abstract 173C.

WASHINGTON – Using schema therapy as an adjunct for substance use disorder might help fill the gaps in traditional cognitive-behavioral therapy, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Schema therapy, developed for treatment-resistant diagnoses, allows clinicians to challenge cognitive distortions and negative coping styles that develop during childhood or adolescence. As an extension of the cognitive-behavioral therapy (CBT) model of Aaron T. Beck, MD, schema therapy can target substance use disorder (SUD) psychiatric comorbidities like PTSD and antisocial personality disorder – which are present in more than 50% of SUD patients, said presenter Katharine D. Wojcik, of the University of British Columbia, Vancouver.

“The combination of a dual diagnosis makes the traditional 12-step addiction therapy less effective,” said Ms. Wojcik, a doctoral candidate at the university. “Additionally, traditional treatment approaches have been found to be ineffective against comorbid mental health and substance use disorders.”

To investigate the effects of schema therapy, Ms. Wojcik collected data on more than 100 residents of a treatment program for patients with addictions and mental illness. The patients took the Young Schema Questionnaire 3 so the investigators could assess the presence and extent of early maladaptive schemas. The patients, mostly white females, participated in the schema therapy protocol for 30 days.

Medication management, a 12-step program, individual sessions, and a CBT intervention – including prolonged exposure, behavior activation, and schema therapy – were incorporated to target their multiple diagnoses, Ms. Wojcik said.

In the initial assessments, the investigators found that self-sacrifice, unrelenting standards, and insufficient self-control were the most common schema among the subject group, with notably elevated levels of disconnection, rejection, overvigilance, and inhibition.

After the assessments, patients and clinicians sat down to discuss the schema clinicians found present. If patients bought into the report, they began self-monitoring through daily activities such as journaling.

Ms. Wojcik and her colleagues said those self-monitoring practices will help change patients’ schema. But such practices were not the only tool in the program aimed at sparking these changes, patients worked with clinicians on cognitive strategies as well. Addressing core beliefs, schema bias, schema activation formulation, and schema rules and assumptions were a few of the strategies implemented by clinicians.

“We also work on schema challenging, which means [when] in session with a client, as a clinician you are able to say: ‘I wonder if this schema is coming up for you right now,’ or ‘Are you noticing any schemas as we’re talking about this?’ ” Ms. Wojcik said. “Since there is such a high comorbidity, a lot of times it does come down to these experiences that they’ve had that tie into trauma history.”

After the end of their stay, patients were given a reassessment and then shown the results to see how they had progressed. The reassessment did show some subtle changes, but the short length of the program hindered any patients from seeing complete deescalation of their schema, Ms. Wojcik said.

She discussed the case of a 30-year-old woman with diagnoses of SUD, PTSD, and bipolar disorder – and an extensive treatment history. Therapists found that the combination of traditional and CBT helped significantly with the patient’s elevated abandonment schema.

“We were able to have her close her eyes and walk through not only what it was like when that schema developed, but also have her talk about what were the things that went unmet in that situation that caused this to happen,” Ms. Wojcik said. “She successfully completed her treatment with us, noticed a lot of her schema had decreased in elevation, and expressed pride that she had done this.”

Ms. Wojcik and her colleagues reported no relevant financial disclosures.

[email protected]

SOURCE: Wojcik KD et al. ADAA 2018, Abstract 173C.

WASHINGTON – Trauma-Informed Parenting Skills for Resource Parents, a new intervention program, might be an answer to addressing trauma symptoms in foster homes, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Rates of trauma exposure range from 80% to 93% in child welfare populations. In light of those statistics, foster parents are left to deal with the effects of traumatic stress symptoms without proper preparation or tools. Trauma-Informed Parenting Skills for Resource Parents targets different aspects of the way in which trauma can affect both the foster child and other members of the family.

[email protected]

WASHINGTON – Trauma-Informed Parenting Skills for Resource Parents, a new intervention program, might be an answer to addressing trauma symptoms in foster homes, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Rates of trauma exposure range from 80% to 93% in child welfare populations. In light of those statistics, foster parents are left to deal with the effects of traumatic stress symptoms without proper preparation or tools. Trauma-Informed Parenting Skills for Resource Parents targets different aspects of the way in which trauma can affect both the foster child and other members of the family.

[email protected]

WASHINGTON – Trauma-Informed Parenting Skills for Resource Parents, a new intervention program, might be an answer to addressing trauma symptoms in foster homes, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Rates of trauma exposure range from 80% to 93% in child welfare populations. In light of those statistics, foster parents are left to deal with the effects of traumatic stress symptoms without proper preparation or tools. Trauma-Informed Parenting Skills for Resource Parents targets different aspects of the way in which trauma can affect both the foster child and other members of the family.

[email protected]