A schema therapy approach to the treatment of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a complex condition often influenced by personality characteristics and comorbidity with other psychiatric disorders. More recent understandings of PTSD have suggested that schemas play a role in the development and maintenance of this condition. Schema therapy (ST) was developed to address more characterological disturbances in chronic disorders. It is an integrative approach for treatment that incorporates practices from other therapeutic orientations. The purpose of this article is to describe some key components of ST and how these can be applied to the treatment of patients with more chronic or complex forms of PTSD. These components include formulating a patients' symptom presentation in terms of their early maladaptive schemas (EMSs) and modes. The assessment of EMS, in particular, takes into account a patients' developmental history and how it has impacted their response to a trauma. In addition, emotion-oriented and experiential techniques are key interventions in ST. Finally, ST has a unique perspective on the therapy relationship, which has been described as "limited reparenting." A case study will be used to demonstrate how these components of ST were effective for intervention where previous techniques had failed. The article concludes with some of the research that supports these components of ST. Specific recommendations are made for future research.