Adding CBT to substance use treatment may increase success

WASHINGTON – Using schema therapy as an adjunct for substance use disorder might help fill the gaps in traditional cognitive-behavioral therapy, according to a presentation at the annual conference of the Anxiety and Depression Association of America.

Schema therapy, developed for treatment-resistant diagnoses, allows clinicians to challenge cognitive distortions and negative coping styles that develop during childhood or adolescence. As an extension of the cognitive-behavioral therapy (CBT) model of Aaron T. Beck, MD, schema therapy can target substance use disorder (SUD) psychiatric comorbidities like PTSD and antisocial personality disorder – which are present in more than 50% of SUD patients, said presenter Katharine D. Wojcik, of the University of British Columbia, Vancouver.

“The combination of a dual diagnosis makes the traditional 12-step addiction therapy less effective,” said Ms. Wojcik, a doctoral candidate at the university. “Additionally, traditional treatment approaches have been found to be ineffective against comorbid mental health and substance use disorders.”

To investigate the effects of schema therapy, Ms. Wojcik collected data on more than 100 residents of a treatment program for patients with addictions and mental illness. The patients took the Young Schema Questionnaire 3 so the investigators could assess the presence and extent of early maladaptive schemas. The patients, mostly white females, participated in the schema therapy protocol for 30 days.

Medication management, a 12-step program, individual sessions, and a CBT intervention – including prolonged exposure, behavior activation, and schema therapy – were incorporated to target their multiple diagnoses, Ms. Wojcik said.

In the initial assessments, the investigators found that self-sacrifice, unrelenting standards, and insufficient self-control were the most common schema among the subject group, with notably elevated levels of disconnection, rejection, overvigilance, and inhibition.

After the assessments, patients and clinicians sat down to discuss the schema clinicians found present. If patients bought into the report, they began self-monitoring through daily activities such as journaling.