SCHEMA THERAPY FOR CHRONIC DEPRESSION

Schema therapy, developed by Young, can be used with pa- tients who present with recurrent depressive episodes, an early age of onset (before age 20)

of depression, early life trauma or adverse family relations (loss of parent in childhood, sexual, physical and/or verbal abuse, neglect, and overprotection), comorbid personality dis- order(s), and a large number of EMSs, particularly in the domains of Impaired Autonomy and Over- vigilance. Young has written extensively about the schema therapy approach. Young and Klosko have published a self-help book for patients to guide them.

Beck and colleagues have noted that

schemas are difficult to alter. They are held firmly in place by behavioral, cognitive, and affective ele- ments. The therapeutic approach must take a tri- partite approach. To take a strictly cognitive ap- proach and try to argue patients out of their distortions will not work. Having the patients abreact within the session to fantasies or recollec- tions will not be successful by itself. A therapeutic program that addresses all three areas is essential. A patient’s cognitive distortions serve as signposts that point to the schema.

As a result, schema therapy is significantly dif- ferent from traditional CBT. It places more em- phasis on early developmental patterns and ori- gins, long-term interpersonal difficulties, the patient–therapist relationship, and emotive or experiential exercises.