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Adding CBT to substance use treatment can change schema.

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 133 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 and her colleagues reported no relevant financial disclosures.

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

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Author:Zimmerman, Eli
Publication:Clinical Psychiatry News
Date:May 1, 2018
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