The effectiveness of a short-term schema focused group therapy on persistent anxiety and depressive symptoms: A Single Case Experimental Design

Around 50% of clients with anxiety and/or depressive symptoms do not benefit
sufficiently from the first-choice treatment. There is no suitable alternative
for this group of clients. There is a high level of comorbidity between anxiety
and depression. A transdiagnostic approach, which focuses on maintaining
factors of anxiety and depressive symptoms, is interesting in this regard. One
of the hypotheses about maintaining factors is that there are underlying
personality features that impede recovery. Schema therapy has proven to be an
effective therapy for people with personality disorders. There are initial
indications that schema therapy is also effective in the treatment of anxiety
and depressive symptoms. A short-term schema group has been developed within
GGZ-NHN, which is expected to benefit clients with persistent anxiety and
depressive symptoms, but has not yet been studied.

In the present study we aim to investigate the effectiveness of short-term
schema group therapy (protocol of de Jager and Burger) on (1) persistent
anxiety and depressive symptoms, and (2) dysfunctional schemas, experiential
avoidance and the mode of the healthy adult. .

We will use a Single Case Experimental Design (SCED). SCED is an experimental
design that tests the effect of an intervention with a small number of
participants, using repeated measures over different phases. In this study, 10
participants will be assessed during four different phases.

There are two intervention phases. The first concerns the pre-treatment phase,
which consists of five online sessions and three face-to-face sessions with one
of the group therapists. Pre-treatment includes psychoeducation about schema
therapy and an individual case conceptualization for illustration purposes,
showing how schemas and schema modes are characteristic of this specific client.
The second interventione phase is the short term schema group therapy. The SFGT
consists of 17 weekly group sessions. The SFGT is a structured therapy format
based on the protocol written by De Jager and Burger (2022). The group sessions
are divided into four phases, each focused on a different category of schema
modes.
Unlike previously investigated short-term schema group therapies, which were
mainly cognitive in nature, this protocol has an experiential approach. The
goal of the intervention is that it leads to less maladaptive coping, less
punitiveness towards oneself and an increase in the healthy adult mode in which
there is more contact and compassion for one's own vulnerability.

Participants will complete questionnaires in addition to their participation in
the intervention. The assessment of anxiety and depressive symptoms will take
place twice a week for 37-40 weeks, and will take a few minutes each time. Once
every two weeks the assessment is more extensive and will take around 8
minutes. Beyond that, there are five larger measurement moments, before
baseline, before start of pre-treatment, before start of group treatment, after
completion of group treatment and after three months of follow-up. These
measurement moments will take an estimated 40-45 minutes.
Although every effort is made to make the assessment procedure as easy and
accessible as possible for the participants, the design with repeated measures
does ask the participant to rate their symptoms twice a week. These assessments
vary between short and fast, and somewhat more extensive. Constantly dwelling
on the things that bother you can be confrontational for participants.