Mindfulness and Schema Therapy

A Practical Guide

Michiel van Vreeswijk, Jenny Broersen, Ger Schurink

• Publisher: Wiley-Blackwell
• Year: 2014
• Print ISBN: 9781118753170, 9781118753187
• eBook ISBN: 9781118753156
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Mindfulness and Schema Therapy presents an eight-session + two follow up sessions protocol for schema mindfulness for therapists and their patients.

 

• Represents the first book to integrate the theory of schema therapy with the techniques of mindfulness
• Enhances schema therapy with techniques drawn from mindfulness-based cognitive therapy (MBCT) - a unique integration of two of the most popular treatment approaches in clinical psychology today.
• Merges two of the hottest topics in contemporary clinical psychology and psychotherapy
• Offers a practical guide for training and practice, with detailed coverage of theory followed by dedicated sections for therapists and patients
• Features a variety of exercises enabling readers to immediately implement the protocol
• Written by authors with expertise and experience in both schema therapy and mindfulness
• Includes a Foreword by Mark Williams, renowned for his contribution to the development of MBCT

Part I
Theoretical Background

1
Introduction

Patients with personality problems are often affected by excessive emotion or, conversely, a lack of affect. Schema Therapy is about linking emotions with the triggering of schemas and modes. Through the use of cognitive-behavioral therapy techniques, experiential therapy, and interpersonal practices like limited reparenting, patients learn how to assign new meaning to their emotions and approach them in new ways. Increasingly, Schema Therapy is beginning to include mindfulness techniques in its therapeutic toolbox (e.g. see Van Genderen & Arntz, 2009; Van Vreeswijk, Broersen, & Nadort, 2012; Young, Klosko, & Weishaar, 2003). These techniques are deemed experiential in form. To date, training protocols for mindfulness in Schema Therapy have not yet been established, but the techniques to be involved in such training have been implemented in treatment with a variety of psychiatric disorders, with considerable success.

This protocol contains clear guidelines for providing mindfulness training to patients struggling with schemas and modes. Central to this practice is the development of attention skills. Patients are encouraged to practice observing the operation of schemas and modes, and to notice their automatic effects on behavior. Rather than attempting to change how they work, training focuses on cultivating awareness of schemas and modes. Additional areas of attention include the monitoring of emotions, physical sensations, and schema-coping mechanisms.

The protocol lays out a comprehensive program consisting of eight sessions and two follow-up sessions. It is presumed that training will be offered in a group setting, but it can be applied just as easily on an individual basis. At the following website, http://www.mfvanvreeswijk.com, patients can buy mindfulness exercises (audio files), like the ones in this book. We consider these required listening, as experience has shown the training to be more effective when participants practice on their own, outside of the group meetings.

For some patients this protocol will run concurrently with existing (Schema) therapy. Others may not yet have commenced treatment, in which case the development of schema and mode awareness will better prepare them for therapy. Certain individuals will no longer require treatment subsequent to participation in mindfulness training. This may be the case with patients who report relatively mild levels of distress or show limited motivation for treatment.

This book employs the term participant as well as patient. A conscious decision was made to use the term participant in chapters describing the mindfulness training protocol, and the term patient in others. This designation is based on the functional distinction between patients, who sign up for training, and participants, who engage in training. For the same reasons, the term therapist is replaced with trainer in chapters dealing with the protocol.

We will not delve into any in-depth discussions of the personality disorders and Schema Therapy literature, as these topics have already enjoyed thorough coverage in other books (e.g., van Vreeswijk, Broersen, & Nadort, 2012). Nor shall we consider the subject of group dynamics. Suffice it to say that experience in group-based therapy and training in personality disorders is vital for those planning to apply this material in group settings. We also recommend training in mindfulness-based cognitive therapy and the book Mindfulness-Based Cognitive Therapy for Depression, by Segal, Williams, and Teasdale (2002).

The creation of this protocol was motivated by positive experience with the application of mindfulness techniques in Schema Therapy, even in cases of profound personality disorder. A pre-post study and a randomized controlled trial are currently in progress, and the results will be described in forthcoming articles.

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Prior to attending “Training Mindfulness and Schema Therapy,” Chantal frequently showed up at the polyclinic or crisis center following a sudden relationship breakup or impulsive self-injury.

During the initial training sessions, Chantal comments on how bored she is with the program. It’s not yielding results fast enough for her. The trainers suggest that Chantal practice renewing her focus, moment by moment, on whatever feelings, thoughts, or impulses to act may occur, and to resist her tendency to react. Over the course of the training, the number of crises she reports subsides; during the follow-up period, there are barely any. Although she did not practice all of the material consistently, Chantal now considers the training to have been of great value. She has become more aware of the operation of her schemas and modes and how these put her on automatic pilot. By learning how to recognize and identify schema/mode patterns, she is developing a greater capacity for mindful decision making, reducing the amount of automatic, impulsive behavior.

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2
Schema Therapy

Schema Therapy is an integrative system of psychotherapy for people with personality problems and/or enduring Axis I disorders. Developed by Dr. Jeffrey Young (Young, Klosko, & Weishaar, 2003), it incorporates theories and techniques derived from cognitive-behavioral therapy, interpersonal psychotherapy, Gestalt therapy, psychodynamic therapy, and attachment theory (for a detailed description of relevant theory, practice, and research, see Van Genderen & Arntz, 2009; Van Vreeswijk, Broersen, & Nadort, 2012; Young et al., 2003).

Schema and Mode Definitions

Schema Therapy utilizes the concepts of schemas and modes. Schemas are considered to represent the way people perceive themselves, others, and the world around them. They are constructed out of sensory perceptions, emotions, and actions etched into memory during previous experiences, especially in childhood (Arntz, Van Genderen, & Wijts, 2006; Rijkeboer, Van Genderen, & Arntz, 2007; Young et al., 2003).

While schemas are seen as trait features of personality, modes refer to state features. Modes are a combination of the schemas and behaviors—adaptive or maladaptive—that are present at any particular moment (Lobbestael, Van Vreeswijk, & Arntz, 2007; Young et al., 2003). Modes can also be seen as the moods in which individuals may dwell for short or longer periods of time, and can alternate or change at the drop of a hat.

Nineteen schemas and twenty modes have been established so far (for an overview, see Table 2.1; for a description of schemas and modes, see the patient folder in Appendix II-B). Schemas can be evaluated using the Schema Questionnaire (YSQ-2; Schmidt, Joiner, Young, & Telch, 1995), and modes can be identified using the Schema-Mode Inventory (SMI-1; Young et al., 2007).

Table 2.1 Schemas and modes

Source: van Vreeswijk, Broersen, and Nadort, 2012. Reproduced with permission of Wiley.

Nineteen schemas	Twenty modes
Emotional Deprivation	Vulnerable Child
Abandonment/Instability	Angry Child
Mistrust and/or Abuse	Enraged Child
Social Isolation/Alienation	Impulsive Child
Defectiveness/Shame	Undisciplined Child
Social Undesirability	Happy Child
Failure	Compliant Surrender
Dependence/Incompetence	Detached Protector
Vulnerability to Harm and Illness	Detached Self-soother
Enmeshment/Undeveloped Self	Self-Aggrandizer
Subjugation	Bully and Attack
Self-Sacrifice	Punitive Parent
Approval Seeking^a	Demanding Parent
Emotional Inhibition	Healthy Adult
Unrelenting Standards/Hypocritical	Angry Protector^b
Negativity and Pessimism^a	Obsessive Over-Controller^b
Punitiveness^a	Paranoid^b
Entitlement/Grandiosity	Conning and Manipulative^b
Insufficient Self-Control/Self-Discipline	Predator^b
	Attention-seeker^b

^aThese schemas are not yet identifiable using the Schema Questionnaire (YSQ).

^bThese modes have not (yet) been added to the Schema Mode Inventory (SMI-1).

Schemas and modes are maintained through various schema coping behaviors, from which three distinct coping styles can be discerned: schema avoidance, schema compensation, and schema surrender. These are defined as follows.

Schema avoidance

The individual attempts to stay out of situations that might trigger the schema, or seeks distractions, in order to avoid thinking about the schema and experiencing related feelings. For instance, someone with the Abandonment/Instability schema will be slow to form attachments with others, because interpersonal bonds entail the possibility of being deserted at a later stage. Such an individual will also try to avoid situations that remind him of past abandonment, so that the feelings connected to those memories remain at bay.

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Example—Schema avoidance

Bram has suffered many losses in his life. Shortly after his parents’ divorce at age five, Bram’s mother died of breast cancer. His father soon developed a new relationship, often leaving Bram alone with the babysitter. Bram initiated treatment after his girlfriend unexpectedly left him. After three months of treatment, his female therapist announces an upcoming six-week vacation. Bram does not show up at the following appointment. He misses the next few sessions, without notifying his therapist. Her phone calls go unanswered, until one day, just before her vacation, she receives an email. Bram writes that he may contact her afterwards, but that, for now, the treatment is causing him too much stress.

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Schema compensation

The individual demonstrates the opposite behavior in order to resist the schema. Instead of striving for perfection, someone with the Unrelenting Standards/Hypocritical schema might get sloppy and impulsive, perhaps claiming to enjoy chaos.

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Example—Schema compensation

Erica is unfailingly conscientious. Others even find her too conscientious. When Erica finds herself repeatedly hitting a wall at work, reacting to her colleagues’ seeming incompetence with increased annoyance, she signs up for therapy. While preparing a case conceptualization, it becomes apparent that Erica holds herself and others to exceedingly high standards. This is one of the reasons for her problems at work. The therapist suspects that additional schemas may be involved, which he suggests they investigate. Because Erica is eager to get results, she announces her recovery to the company physician and returns to w...

Table of contents

• Cover
• Title page
• Copyright page
• About the Authors
• Foreword
• Acknowledgments
• Part I: Theoretical Background
• Part II: Training Manual
• Part III: Participant Workbook
• Part IV: List of Audio Files
• Bibliography
• Index
• End User License Agreement