S3HT1/5 - Hot Topics
Tracks
Track 5
Innovation
| Saturday, June 1, 2024 |
| 2:00 PM - 3:30 PM |
Overview
Hot Topics
Details
If the presenter suggests breaking into groups then you should access the Breakout Foyer HERE
Integrating Schema Therapy and EMDR with Autistic and ADHD Clients
Liam Spicer
Research has demonstrated that up to 70% of Autistic and ADHD people are estimated to have a co-occurring mental health condition (e.g., anxiety, depression, anorexia etc., Lai et al., 2019). Autistic and/or ADHD people have also been demonstrated to be at increased risk of experiencing a range of adverse life experiences and subsequent negative life outcomes (El Ayoubi et al., 2021; Schwartz et al., 2023; Rumball et al., 2019). For example, people with ADHD are 3-5 times more likely than non-ADHD peers to report clinically significant PTSD symptoms (Miodus et al., 2021). Furthermore, research has demonstrated that autistic individuals are more likely to experience traumatic events that may not meet the Criteria A for PTSD in the DSM-V such as extreme bullying, grooming, and various restrictive practices. Furthermore, Kerns et al., (2022), demonstrated that some autistic individuals due to social communication differences may not understand that what they have experienced is abuse, or that what has happened to them is “wrong”. Neurodivergent individuals are also shown to be more likely to develop clinically significant mental health challenges after stressful experiences due to underlying vulnerabilities such as a predisposition to anxiety, likelihood of social isolation, and experiences of bullying, demonstrating the interplay between individual differences, adverse childhood experiences, and mental health challenges (Stewart et al., 2020).
Presentation Focus:
When assisting Autistic and ADHD clients in therapy with presenting comorbid mental health concerns, interventions need to be adapted not only to their needs, but also to their neurotype, the unique way they process information, connect with others, and experience the world from a sensory perspective. Increasing awareness on the importance of highly individualized treatment options combining evidence based therapeutic modalities with this population is rapidly growing. Both EMDR and Schema Therapy have shown some preliminary evidence for assisting Autistic and ADHD clients with their mental health challenges (Diest et al., 2022; Fisher et al., 2022, Oshima et al., 2021), however further research is needed. In this presentation, the mental health outcomes and challenges of those who are autistic, and ADHD will be presented demonstrating the increased risk this population is at regarding mental health and the experiences of trauma. The research regarding the Schemas of this population will also be presented to provide some foundational knowledge to clinicians in this area. The focus will then direct to various schema therapy and EMDR based interventions that can be useful in assisting this client group, and the modifications to these interventions that are needed. This will include discussing variations to exercises such as chair work, imagery rescripting, using EMDR for trauma reprocessing, and adjustments to therapeutic delivery and the therapy space to create an attuned relationship with this client group. Discussion will also focus on the importance of needs meeting and limited reparenting with this group and focus on the context of their developmental environment as to why not being identified as being autistic and/or ADHD may have further magnified early needs not being met.
Autonomy granting: using patient’s goals to strengthen HA and HC modes
Jędrzej Kosewski
The presentation will show how working with BPD patient, suffering from severe trauma and several very strong schemas (mistrust, abandonment, defectiveness, subjugation and enmeshment), use patient's goals, aspirations and values as a means of strengthening healthy adult and happy child mode. We will discuss how different interventions, aimed at exploring patient's life vision, can help them engage in treatment, lower the power of enmeshment and subjugation and fulfill the need for autonomy granting. Participant will have a chance to see how concepts from motivational interviewing and other positive-oriented CBT approaches can be integrated into schema therapy framework.
Points of the discussion:
1. Autonomy granting – definition
2. Different types of patient’s goals
3. HA and HC and patient’s goals
4. Autonomy granting and its relations with patient’s goals
5. Intervention that use patient’s goals to strengthen HA and HC modes
Schema therapy as a transdiagnostic biopsychosocial treatment perspective for trauma and ADHD
Nermin Taşkale
Objective: Schema therapy is an integrated model that explains how a person's emotions, cognitions, and behaviors are shaped to lead to today's everyday life reactions. It provides an inclusive and rich conceptual framework for psychotherapeutic intervention. Utilizing this framework for trauma is especially informative since trauma is a response to a variety of triggering events including but not limited to accidents, illnesses, types of violence and abuse, natural disasters, terror, political distress, etc. Trauma also leads to emotional reactions such as numb, depressive, anxious, and irritable affect which are linked to a variety of clinical diagnoses. In such a complex situation, it becomes difficult to conceptualize trauma cases in a comprehensible way. So, this hot topic discussion focuses on the suitability and effectiveness of schema therapy as an integrated model in approaching trauma with its immense background.
Trauma may be triggered by factors from the immediate environment of the person. It may also be triggered by broader sociopolitical factors surrounding the individual/groups. Triggering events may happen in single or recurrent episodes as in the case of interpersonal violence. However, sometimes a chronic situation such as a chronic mental or physical illness may lead to trauma. Also, people may suffer from a number of different traumatic events (either episodic or chronic) simultaneously.
Schema therapy provides a baseline to compile this complex information from a dynamic perspective. It does not focus solely on the triggering events and the types of reactions. Instead, it uncovers how triggering events lead to challenges in meeting emotional needs. Unmet emotional needs lead to surrendering, overcompensating, and/or avoiding behaviors. These various ways of coping provide an inclusive conceptualization for people with traumatic events to understand their mostly multi-diagnostic profiles, one of which is Attention Deficit Hyperactivity Disorder (ADHD). Method: I will provide supporting results from academic and field work for these arguments. Firstly, I will mention research on women victims of intimate partner violence to understand the interrelationships between childhood traumas, intimate partner violence victimization, and ADHD. Secondly, I will briefly refer to an individual schema therapy of an ADHD-diagnosed LGBTQ man who experienced childhood political trauma and peer bullying to explain this hot topic's perspective.
Results: The review of the relevant literature and sample case studies reveal that a biopsychosocial perspective is informative in understanding the interrelationships between trauma and other diagnoses, i.e. ADHD.
Conclusions: ADHD has long been discussed as a hereditary disorder. Medical treatment was the only treatment option for this patient group. However, the importance of behavioral approaches was noticed by practicians to help people manage ADHD symptoms. Yet, the conceptualizations mostly continued following the medical model. Only some recent conceptualizations started to utilize a biopsychosocial model to explain ADHD. They highlight how ADHD may function as a reaction to trauma. The current hot topic discussion favors these recent conceptual developments from a schema therapy perspective.
The role of Enmeshment and Undeveloped Self, Subjugation, and Self-sacrifice in childhood trauma and attachment problems: The link with Self-Concept Clarity.
Cristina Baroncelli
The link between EMS and a coherent sense of identity has not been investigated yet. This study focuses on the relationship of three specific EMS, Enmeshment and Undeveloped Self, Subjugation, and Self-Sacrifice, their association to developmental trauma and attachment problems, and their link with identity coherence. Self-report questionnaires on these constructs were completed by 360 university students. Path models were fitted to the total scores to test whether the three EMS mediated the association between developmental trauma and attachment problems and self-concept clarity.
Developmental trauma was directly related to each of the three EMS, which all mediated the association between trauma and attachment anxiety. Subjugation additionally mediated the relation between trauma and attachment avoidance. Both insecure attachment styles were directly related to self-concept clarity. Attachment anxiety mediated the association between each EMS and self-concept clarity, whereas the effect of subjugation was additionally mediated by attachment avoidance. The results confirmed that developmental trauma is related to insecure attachment styles and to self-concept clarity, and that this relation is mediated by all three EMS. Evidence-based interventions (e.g., EMDR, Schema Therapy, etc.) need to take attachment styles, EMS and self-concept clarity into consideration when working with developmental trauma, making the patient aware of the subtle interconnection between these variables.
Key words: Early Maladaptive Schemas, Subjugation, Self-Sacrifice, impaired autonomy, self-concept, self-concept clarity
Genome-wide therapygenetic study of an international multicentre RCT on schema therapy for borderline personality disorder
Alexandra Schosser
The field of therapygenetics refers to the prediction of psychotherapeutic therapy outcomes from genetic markers. The current study is, to our knowledge, the first therapygenetic study investigating genes predicting treatment response in borderline personality disorder (BPD) on a genome-wide level.
We aim to identify genes predicting treatment response to psychotherapeutic treatment (schema therapy vs. treatment as usual) by analysing the genome-wide association study (GWAS) data of the, so far, largest randomized-controlled trial (RCT, 495 participants) on effectiveness of schema therapy in BPD (Arntz et al. 2022).
We plan to investigate genes associated with treatment response phenotypes applying a polygenic risk score analysis (PRS) and a gene-set analysis (GSA) approach. PRS is a method which allows an individual’s genetic loading for a trait to be calculated using genome-wide SNP (single nucleotide polymorphism) data and the output of GWAS summary statistics of another study of the same or related phenotype. It can be of clinical use in predicting traits in independent samples, including treatment response. In addition, GSA of pre-defined treatment response candidate genes such as 5-HTTLPR (serotonin transporter polymorphism) and BDNF (brain-derived neurotrophic factor), and subsequent explorative gene-wide single-marker analyses in order to extent the results of the GSA will be performed. The detailed study design and first results of the study will be presented. Identifying reliable associations between blood biomarkers and treatment response to psychotherapeutic treatments would have a major impact on clinical practice and patient care. Patients at high risk for non-response could be identified and obtain alternative treatment at an early stage, potentially enhancing the success rate of psychotherapeutic treatment programs. In addition, knowledge about the processes related to genetic markers will help us to develop better treatments, especially for those that don’t respond well to current treatments.
Integrating Schema Therapy and EMDR with Autistic and ADHD Clients
Liam Spicer
Research has demonstrated that up to 70% of Autistic and ADHD people are estimated to have a co-occurring mental health condition (e.g., anxiety, depression, anorexia etc., Lai et al., 2019). Autistic and/or ADHD people have also been demonstrated to be at increased risk of experiencing a range of adverse life experiences and subsequent negative life outcomes (El Ayoubi et al., 2021; Schwartz et al., 2023; Rumball et al., 2019). For example, people with ADHD are 3-5 times more likely than non-ADHD peers to report clinically significant PTSD symptoms (Miodus et al., 2021). Furthermore, research has demonstrated that autistic individuals are more likely to experience traumatic events that may not meet the Criteria A for PTSD in the DSM-V such as extreme bullying, grooming, and various restrictive practices. Furthermore, Kerns et al., (2022), demonstrated that some autistic individuals due to social communication differences may not understand that what they have experienced is abuse, or that what has happened to them is “wrong”. Neurodivergent individuals are also shown to be more likely to develop clinically significant mental health challenges after stressful experiences due to underlying vulnerabilities such as a predisposition to anxiety, likelihood of social isolation, and experiences of bullying, demonstrating the interplay between individual differences, adverse childhood experiences, and mental health challenges (Stewart et al., 2020).
Presentation Focus:
When assisting Autistic and ADHD clients in therapy with presenting comorbid mental health concerns, interventions need to be adapted not only to their needs, but also to their neurotype, the unique way they process information, connect with others, and experience the world from a sensory perspective. Increasing awareness on the importance of highly individualized treatment options combining evidence based therapeutic modalities with this population is rapidly growing. Both EMDR and Schema Therapy have shown some preliminary evidence for assisting Autistic and ADHD clients with their mental health challenges (Diest et al., 2022; Fisher et al., 2022, Oshima et al., 2021), however further research is needed. In this presentation, the mental health outcomes and challenges of those who are autistic, and ADHD will be presented demonstrating the increased risk this population is at regarding mental health and the experiences of trauma. The research regarding the Schemas of this population will also be presented to provide some foundational knowledge to clinicians in this area. The focus will then direct to various schema therapy and EMDR based interventions that can be useful in assisting this client group, and the modifications to these interventions that are needed. This will include discussing variations to exercises such as chair work, imagery rescripting, using EMDR for trauma reprocessing, and adjustments to therapeutic delivery and the therapy space to create an attuned relationship with this client group. Discussion will also focus on the importance of needs meeting and limited reparenting with this group and focus on the context of their developmental environment as to why not being identified as being autistic and/or ADHD may have further magnified early needs not being met.
Autonomy granting: using patient’s goals to strengthen HA and HC modes
Jędrzej Kosewski
The presentation will show how working with BPD patient, suffering from severe trauma and several very strong schemas (mistrust, abandonment, defectiveness, subjugation and enmeshment), use patient's goals, aspirations and values as a means of strengthening healthy adult and happy child mode. We will discuss how different interventions, aimed at exploring patient's life vision, can help them engage in treatment, lower the power of enmeshment and subjugation and fulfill the need for autonomy granting. Participant will have a chance to see how concepts from motivational interviewing and other positive-oriented CBT approaches can be integrated into schema therapy framework.
Points of the discussion:
1. Autonomy granting – definition
2. Different types of patient’s goals
3. HA and HC and patient’s goals
4. Autonomy granting and its relations with patient’s goals
5. Intervention that use patient’s goals to strengthen HA and HC modes
Schema therapy as a transdiagnostic biopsychosocial treatment perspective for trauma and ADHD
Nermin Taşkale
Objective: Schema therapy is an integrated model that explains how a person's emotions, cognitions, and behaviors are shaped to lead to today's everyday life reactions. It provides an inclusive and rich conceptual framework for psychotherapeutic intervention. Utilizing this framework for trauma is especially informative since trauma is a response to a variety of triggering events including but not limited to accidents, illnesses, types of violence and abuse, natural disasters, terror, political distress, etc. Trauma also leads to emotional reactions such as numb, depressive, anxious, and irritable affect which are linked to a variety of clinical diagnoses. In such a complex situation, it becomes difficult to conceptualize trauma cases in a comprehensible way. So, this hot topic discussion focuses on the suitability and effectiveness of schema therapy as an integrated model in approaching trauma with its immense background.
Trauma may be triggered by factors from the immediate environment of the person. It may also be triggered by broader sociopolitical factors surrounding the individual/groups. Triggering events may happen in single or recurrent episodes as in the case of interpersonal violence. However, sometimes a chronic situation such as a chronic mental or physical illness may lead to trauma. Also, people may suffer from a number of different traumatic events (either episodic or chronic) simultaneously.
Schema therapy provides a baseline to compile this complex information from a dynamic perspective. It does not focus solely on the triggering events and the types of reactions. Instead, it uncovers how triggering events lead to challenges in meeting emotional needs. Unmet emotional needs lead to surrendering, overcompensating, and/or avoiding behaviors. These various ways of coping provide an inclusive conceptualization for people with traumatic events to understand their mostly multi-diagnostic profiles, one of which is Attention Deficit Hyperactivity Disorder (ADHD). Method: I will provide supporting results from academic and field work for these arguments. Firstly, I will mention research on women victims of intimate partner violence to understand the interrelationships between childhood traumas, intimate partner violence victimization, and ADHD. Secondly, I will briefly refer to an individual schema therapy of an ADHD-diagnosed LGBTQ man who experienced childhood political trauma and peer bullying to explain this hot topic's perspective.
Results: The review of the relevant literature and sample case studies reveal that a biopsychosocial perspective is informative in understanding the interrelationships between trauma and other diagnoses, i.e. ADHD.
Conclusions: ADHD has long been discussed as a hereditary disorder. Medical treatment was the only treatment option for this patient group. However, the importance of behavioral approaches was noticed by practicians to help people manage ADHD symptoms. Yet, the conceptualizations mostly continued following the medical model. Only some recent conceptualizations started to utilize a biopsychosocial model to explain ADHD. They highlight how ADHD may function as a reaction to trauma. The current hot topic discussion favors these recent conceptual developments from a schema therapy perspective.
The role of Enmeshment and Undeveloped Self, Subjugation, and Self-sacrifice in childhood trauma and attachment problems: The link with Self-Concept Clarity.
Cristina Baroncelli
The link between EMS and a coherent sense of identity has not been investigated yet. This study focuses on the relationship of three specific EMS, Enmeshment and Undeveloped Self, Subjugation, and Self-Sacrifice, their association to developmental trauma and attachment problems, and their link with identity coherence. Self-report questionnaires on these constructs were completed by 360 university students. Path models were fitted to the total scores to test whether the three EMS mediated the association between developmental trauma and attachment problems and self-concept clarity.
Developmental trauma was directly related to each of the three EMS, which all mediated the association between trauma and attachment anxiety. Subjugation additionally mediated the relation between trauma and attachment avoidance. Both insecure attachment styles were directly related to self-concept clarity. Attachment anxiety mediated the association between each EMS and self-concept clarity, whereas the effect of subjugation was additionally mediated by attachment avoidance. The results confirmed that developmental trauma is related to insecure attachment styles and to self-concept clarity, and that this relation is mediated by all three EMS. Evidence-based interventions (e.g., EMDR, Schema Therapy, etc.) need to take attachment styles, EMS and self-concept clarity into consideration when working with developmental trauma, making the patient aware of the subtle interconnection between these variables.
Key words: Early Maladaptive Schemas, Subjugation, Self-Sacrifice, impaired autonomy, self-concept, self-concept clarity
Genome-wide therapygenetic study of an international multicentre RCT on schema therapy for borderline personality disorder
Alexandra Schosser
The field of therapygenetics refers to the prediction of psychotherapeutic therapy outcomes from genetic markers. The current study is, to our knowledge, the first therapygenetic study investigating genes predicting treatment response in borderline personality disorder (BPD) on a genome-wide level.
We aim to identify genes predicting treatment response to psychotherapeutic treatment (schema therapy vs. treatment as usual) by analysing the genome-wide association study (GWAS) data of the, so far, largest randomized-controlled trial (RCT, 495 participants) on effectiveness of schema therapy in BPD (Arntz et al. 2022).
We plan to investigate genes associated with treatment response phenotypes applying a polygenic risk score analysis (PRS) and a gene-set analysis (GSA) approach. PRS is a method which allows an individual’s genetic loading for a trait to be calculated using genome-wide SNP (single nucleotide polymorphism) data and the output of GWAS summary statistics of another study of the same or related phenotype. It can be of clinical use in predicting traits in independent samples, including treatment response. In addition, GSA of pre-defined treatment response candidate genes such as 5-HTTLPR (serotonin transporter polymorphism) and BDNF (brain-derived neurotrophic factor), and subsequent explorative gene-wide single-marker analyses in order to extent the results of the GSA will be performed. The detailed study design and first results of the study will be presented. Identifying reliable associations between blood biomarkers and treatment response to psychotherapeutic treatments would have a major impact on clinical practice and patient care. Patients at high risk for non-response could be identified and obtain alternative treatment at an early stage, potentially enhancing the success rate of psychotherapeutic treatment programs. In addition, knowledge about the processes related to genetic markers will help us to develop better treatments, especially for those that don’t respond well to current treatments.
Speaker
Alexandra Schosser
Faculty Of Medicine, Sigmund Freud University
Genome-wide therapygenetic study of an international multicentre RCT on schema therapy for borderline personality disorder
Biography
I have been member of the ISST Executive Board for several years since 2015/2016, and, after being elected as Vice President of the current EB, I followed Jeff Conway as President of the EB after his resignation in January 2024.
I am medical specialist in psychiatry, as well as psychotherapist and trainer/supervisor in CBT and Schema Therapy. Besides being head of the Institute for Schema Therapy in Vienna, I am holding a professorship at the Sigmund Freud Private University Vienna since 2021. After being medical director of an ambulant psychiatric rehabilitation clinics in Vienna for many years, since 2022 I am also responsible for the organization unit including the professorships in psychiatry, neurology, ophthalmology and otolaryngology at the Faculty for Medicine of the Sigmund Freud Private University Vienna. My major research focus has been psychiatric genetics since 2001, in addition to psychiatric rehabilitation and psychotherapy research since 2013.
Liam Spicer
Emdr Integrative, Curtin University, University Of Tasmania
Integrating Schema Therapy and EMDR with Autistic and ADHD Clients
Biography
Liam Spicer is a Psychologist, Academic and Researcher based in Tasmania, Australia. He is an EMDR Consultant and Training Facilitator, and works in private practice with children, adolescents, and adults. Liam is actively involved in both training and research in the areas of trauma, grief, suicide, alexithymia, neurodivergence, EMDR, and schema therapy. He recently contributed to the International Handbook of Child and Adolescent Grief and has published in peer reviewed journal articles. He has published in the area of Schema Therapy and has is the lead researcher/author on two current projects including a qualitative exploration of schema therapists confidence and the impact on their therapeutic work, and the schemas and modes of neurodivergent individuals. Liam’s current PHD at Curtin University, Perth is focused on the use of Schema Therapy for Prolonged Grief. This involves exploring the schemas and modes in those with prolonged grief, interviewing schema therapy and grief experts to inform the development of a schema therapy for grief intervention, and also testing a schema therapy for prolonged grief intervention through a case series design. Liam has recently published in the ISST bulletin on the application of Schema Therapy for Prolonged Grief. He has presented at various national conferences and events, and he currently holds a position at the University of Tasmania teaching clinical psychology skills to students.
Mr Jędrzej Kosewski
Director
Nowoczesna Terapia Schematu
Autonomy granting: using patient’s goals to strengthen HA and HC modes
Biography
Jędrzej Kosewski is a certified schema therapist and supervisor/trainer. For over 10 years he has been teaching on CBT and schema therapy. He worked in Anxiety Disorders Ward (with policemen and jail officers) for several years. Currently he has a private practice and runs his Schema Training Program organized by Nowoczesna Terapia Schematu.
Dr. Nermin Taskale
Assistant Professor
Istanbul University
Schema therapy as a transdiagnostic biopsychosocial treatment perspective for trauma and ADHD
Biography
Dr. Nermin Taşkale is a clinical psychologist. She uses Cognitive-Behavioral and Schema Therapy and EMDR with adults and Emotionally-Focused Therapy with couples. She is also a full-time researcher and instructor at Istanbul University. Her research focuses on conflict resolution in intimate relations and violence against women.
Miss Cristina Baroncelli
Psychologist
Tilburg University
The role of Enmeshment and Undeveloped Self, Subjugation, and Self-sacrifice in childhood trauma and attachment problems: The link with Self-Concept Clarity.
Biography
ISST Advanced Schema Therapist and Supervisor, EMDR Therapist, working in The Netherlands, The Hague with expats with developmental trauma, in different languages (Dutch, English, Italian, Spanish). PhD Candidate at Department of Medical and Clinical Psychology - Tilburg University.
