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London iCAAD 2019 - Mark Dempster - SCHEMA THERAPY TO TREAT ADDICTION

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This presentation will trace the history of Schema Therapy and its relevance in the treatment of addiction. Early Maladaptive Schemas often spring from emotional needs that were not met during childhood or adolescence.

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London iCAAD 2019 - Mark Dempster - SCHEMA THERAPY TO TREAT ADDICTION

  1. 1. ORIGINS Initially introduced to treat personality disorders ( Jeffrey Young) The Term Schema comes from Cognitive Psychology Schema are deeply entrenched ideas about ourselves and the world, learned early in life Schemas are central to our sense of self. Schemas provide us with a sense of security therefore we can cling to it even when it hurts us. They are comfortable and predictable hence why it can feel so difficult to change. These early maladaptive schemas, which result in substantial distress, are gradually being documented as important vulnerabilities for substance abuse Is addiction a personality disorder? Definition of a personality disorder – Self destructive, life long patterns that bring individuals tremendous unhappiness. These individuals can have long- term problems with living, in addition to symptoms such as depression and anxiety
  2. 2. HOW SCHEMAS RELATE TO ADDICTION When treating addiction we treat the outward symptoms i.e. Drugs, alcohol, sex, gambling, food, sugar, internet, gaming etc, however we must treat the inward symptoms (the underlying schemas or controlling beliefs) Another word used commonly instead of schemas, is lifetraps Lifetrap (Schema therapy) is an outgrowth of cognitive therapy developed by beck 1960s, many aspects of cognitive therapy are included in Schema therapy Although cognitive therapy is invaluable, it is not sufficient to change lifelong patterns thus the development of schema therapy Schema therapy is a combination of CBT, psychoanalytical and experiential techniques Most clients suffering from outward facing addictions have certain core schemas (traps) that are reflected in many symptom areas
  3. 3. DIAGNOSIS Addressing these core schemas can have a beneficial effect that reverberate throughout many areas of the individuals life The client can often use language that indicates he/she is stuck in a schema (trap) ‘I have always been this way’, ‘I have always had this problem’. Schemas being hard to change are supported by cognitive behavioral , and emotional elements. It determines how we feel, think, act and relate to others Lifetraps are usually developed as children as appropriate adaptions to the immediate family environment. These patterns were realistic as a child, the problem comes when we repeat these patterns when they no longer serve a useful purpose. One of the key factors that contribute to the development of lifetraps is temperament. Temperament is inborn, it is our emotional make up. The way we are wired to respond to events. Like other inborn traits temperament varies
  4. 4. THE FOUR MAIN CONCEPTS Early maladaptive schemas – Core patterns of behavior that we tend to repeatedly use throughout our lives Schema Domain – Relate to the emotional needs of a child, if these needs are not met in childhood, unhealthy schemas develop, which then results in unhealthy behavior Coping Styles – Are the way we adapt to schemas and early life experiences. These are often unhealthy and tend to maintain or worsen the problem Schema Modes – Are emotional states that we all use from time to time. They sometime lie dormant for a long time being activated by certain triggers. While we can be in a dominant state for some time we can flip over into other modes
  5. 5. CHILD MODES Vulnerable child – feel lonely, sad, misunderstood, unsupported, defective, deprived Angry Child – Feels intensely angry, enraged, infuriated, frustrated, needs not being met Impulsive undisciplined child – acts on non core desires or impulses in a selfish r uncontrolled manner, difficulty delaying short term gratification, often feels intensely angry, enraged when impulses are not met, appears spoiled Happy Child – Feels loved, fulfilled , protected, nurtured, worthwhile, understood, accepted, praised
  6. 6. MALADAPTIVE COPING MODES Compliant Surrender – Acts in a passive, subservient, submissive, self – seeking or self- deprecating around others out of fear of conflict or rejection Detached Protector – Cuts off needs and feelings, detaches emotionally from people and rejects their help, feels withdrawn, distracted, disconnected, depersonalised, empty or bored, persues distracting, self soothing or self- stimulating activities in a compulsive way or to excess, may adopt a cynical, aloof or pessimistic stance to avoid investing in people or activities Over- Compensator – feels and acts in an inordinately grandious, aggressive, dominant, competitive, arrogant, haughtly, manipulative, exploitative, attention seeking or status - seeking way. These feelings and behavior are developed as an compensation or gratification for a core unmet need
  7. 7. MALADAPTIVE PARENT MODES Punitive Parent – Feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing or abusive towards self (e.g. self mutilation) or others. This mode refers to the style of which rules are enforced rather than the nature of the rules Demanding Parent – feels that the right way to be is to be perfect or achieve to a very high level, to keep everything in order, to strive for high status, to be humble, to put others needs ahead of ones own, or to be efficient or avoid wasting time. The person feels that it is wrong to express one feelings or to act spontanously. This mode refers to the nature of the internalized high standards and strict rules, rather than the style with which these rules are enforced Healthy Adult – Nurtures, validates and affirms the vulnerable child mode, sets limits for the angry and impulsive child modes, promotes and supports the healthy child mode, combats and eventually replaces the maladaptive parent modes, neutralizes or moderates the maladaptive parent modes. This mode also performs healthy adult functioning such as parenting, taking responsibility and committing, persues healthy adult activities such as sex, intellectual, aesthetic, cultural interests, health interest. This mode is the goal of full recovery from addiction
  8. 8. THE BENEFITS Therapy must address all of these elements. Change in only one or two realms will be less effective Clients suffering from addiction often don’t arrive at their own solutions, contrary to the approach of some therapies ( non – directive, Rogerian) Schema therapy is a directive approach
  9. 9. THE SCHEMAS (LIFETRAPS) There is often two different groups of Schema definitions that are referred too – One group considers 18 in total individual schemas, however I have used the questionaire within the self- help book by Jeffrey Young (Reinventing your Life) which defines 11 core schemas Abandonment Mistrust and Abuse Vulnerability Dependence Emotional Deprivation Social Exclusion
  10. 10. CONTINUED SCHEMAS Defectiveness Failure Subjugation Unrelenting Standards Entitlement The full 18 include Enmeshment, Self-Sacrifice, Approval-seeking, Insufficient self-control, Emotional Inhibition, Negativity/Pessimism, Punitiveness
  11. 11. DIAGNOSING SCHEMAS (LIFETRAP) We use a sequence of questions to diagnose each Schema Total of 10 questions per schema There is a marking scale from 1-6 for each question. 1- being completely untrue of me, 6 – being this describes me perfectly Once the individual schemas are identified we then begin to examine the origins of the schema
  12. 12. THE SOLUTION We identify the impact the Schema has in work, personal and intimate relationships Identify the danger signals in relationships Identifying the key characteristics of the Schema (lifetrap) Provide information on how to change the Schema (lifetrap) Provide encouragement, reinforcing the benefits, ensuring ongoing support to client in continuing actively to work on changing the schemas (lifetrap) It is increasingly recognized that family members, such as parents, play an integral role in the treatment of substance abuse . This has resulted in family-focused interventions becoming common components of substance abuse treatment programs. In addition, recent research has begun to examine the underlying risk factors for substance abuse, such as early maladaptive schemas, among substance abusers and their family members

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