The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda.

OBJECTIVES: We reviewed the evidence regarding the effectiveness of schema therapy for anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). METHODS: This systematic review followed the recommendation of the PRISMA guidelines. A database search (PsycINFO, MEDLINE, EMBASE, WEB OF SCIENCE, and Academic Search Ultimate) was conducted to identify eligible studies up until 2 April 2021. The search included the keywords ('schema therap*' or 'schema group therap*' or 'schema mode therap*' or 'schema focused' or 'young's model') and ('anxiety disorder*' or 'anxiety-related disorder*' or 'agoraphobia' or 'health anxiety' or 'phobi*' or 'panic disorder' or 'obsessive compulsive disorder' or 'OCD' or 'posttraumatic stress' or 'post traumatic stress' or 'PTSD' or 'hypochondria' or 'axis 1'). Included studies were appraised on methodological quality according to the Psychotherapy Outcome study Methodology Rating Form. RESULTS: We identified 41 studies that were eligible based on the topic. However, only six (comprising 316 anxiety, OCD, and PTSD patients) could be included despite lenient methodological inclusion/exclusion criteria. Results showed that schema therapy can lead to beneficial effects in disorder-specific symptoms and early maladaptive schemas. Yet, we also uncovered substantial methodological limitations in most studies. CONCLUSIONS: Schema therapy is a promising treatment for anxiety, OCD, and PTSD. Yet, there is a systematic problem in the quality of research despite growing clinical interest and application. We therefore concluded with a research agenda presenting recommendations for future research that will be crucial for building a solid evidence-base for schema therapy in chronic anxiety, OCD, and PTSD. PRACTITIONER POINTS: A systematic review on the effectiveness of schema therapy for anxiety disorders, OCD, and PTSD. Preliminary but limited evidence that schema therapy leads to beneficial effects in disorder-specific symptoms. Preliminary but limited evidence that schema therapy leads to beneficial effects in early maladaptive schemas in anxiety, OCD, and PTSD. More research of higher methodological quality is needed to provide more conclusive empirical support for the use of schema therapy for anxiety, OCD, and PTSD.

Schema therapy with exposure and response prevention for the treatment of chronic anxiety with comorbid personality disorder.

BACKGROUND AND OBJECTIVES: A considerable group of patients with anxiety disorders do not respond to guideline CBT treatment, possibly due to comorbid personality disorder (PD) traits. Schema therapy (ST) is an integrative treatment for personality disorders, and preliminary evidence suggests that it also affects anxiety. The present study examined the effects of a combination treatment ('SCHerp': ST + exposure and response prevention) in a non-responsive outpatient group suffering from chronic anxiety and comorbid cluster C personality disorder. METHODS: Psychological malfunction (n = 42), and adaptive and maladaptive schema modes (n = 49) were assessed pre- and post-treatment. RESULTS: Patients showed statistically significant decreases in psychological malfunction and maladaptive modes, and significant increases in adaptive modes from pre- to post-treatment. Changes in modes were correlated with changes in psychological malfunction. LIMITATIONS: No control group or follow-up measurements were included. CONCLUSIONS: The combination of ST and exposure with response prevention may be a viable avenue for research and treatment for this subpopulation. However, further research is needed to confirm and enhance effectiveness and identify working mechanisms of SCHerp. PRACTITIONER POINTS: The SCHerp programme combines schema therapy with exposure and response prevention to tackle chronic anxiety in patients with comorbid personality disorder SCHerp significantly reduced psychological malfunction and maladaptive modes, and increased adaptive modes Changes in schema modes correlated with changes in psychological malfunction, suggesting that schema modes are an appropriate treatment target in this population No active control group was included so no therapy-specific factors can be determined at this stage.

Common neural and transcriptional correlates of inhibitory control underlie emotion regulation and memory control.

Inhibitory control is crucial for regulating emotions and may also enable memory control. However, evidence for their shared neurobiological correlates is limited. Here, we report meta-analyses of neuroimaging studies on emotion regulation, or memory control and link neural commonalities to transcriptional commonalities using the Allen Human Brain Atlas (AHBA). Based on 95 functional magnetic resonance imaging studies, we reveal a role of the right inferior parietal lobule embedded in a frontal-parietal-insular network during emotion regulation and memory control, which is similarly recruited during response inhibition. These co-activation patterns also overlap with the networks associated with 'inhibition', 'cognitive control' and 'working memory' when consulting the Neurosynth. Using the AHBA, we demonstrate that emotion regulation- and memory control-related brain activity patterns are associated with transcriptional profiles of a specific set of 'inhibition-related' genes. Gene ontology enrichment analysis of these 'inhibition-related' genes reveal associations with the neuronal transmission and risk for major psychiatric disorders as well as seizures and alcoholic dependence. In summary, this study identified a neural network and a set of genes associated with inhibitory control across emotion regulation and memory control. These findings facilitate our understanding of the neurobiological correlates of inhibitory control and may contribute to the development of brain stimulation and pharmacological interventions.