Does schema therapy change schemas and symptoms? A systematic review across mental health disorders

Purpose: Schema therapy was first applied to individuals with borderline personality disorder over 20 years ago, and more recent work has suggested efficacy across a range of disorders. The present review aimed to systematically synthesise evidence for the efficacy and effectiveness of schema therapy in reducing early maladaptive schema and improving symptoms as applied to a range of mental health disorders in adults including borderline personality disorder, other personality disorders, eating disorders, anxiety disorders and post-traumatic stress disorder. Methods: Studies were identified through electronic searches (EMBASE, PsycINFO, MEDLINE from 1990 to January 2016). Results: The search produced 835 titles, of which 12 studies were found to meet inclusion criteria. A significant number of studies of schema therapy treatment were excluded as they failed to include a measure of schema change. The Clinical Trial Assessment Measure (CTAM) was used to rate the methodological quality of studies. Schema change and disorder specific symptom change was found in 11 of the 12 studies. Conclusions: Schema therapy has demonstrated initial significant results in terms of reducing early maladaptive schema and improving symptoms for personality disorders, but formal mediation analytical studies are lacking and rigorous evidence for other mental health disorders is currently sparse.