Ms. Wojcik and her colleagues said those self-monitoring practices will help change patients’ schema. But such practices were not the only tool in the program aimed at sparking these changes, patients worked with clinicians on cognitive strategies as well. Addressing core beliefs, schema bias, schema activation formulation, and schema rules and assumptions were a few of the strategies implemented by clinicians.
“We also work on schema challenging, which means [when] in session with a client, as a clinician you are able to say: ‘I wonder if this schema is coming up for you right now,’ or ‘Are you noticing any schemas as we’re talking about this?’ ” Ms. Wojcik said. “Since there is such a high comorbidity, a lot of times it does come down to these experiences that they’ve had that tie into trauma history.”
After the end of their stay, patients were given a reassessment and then shown the results to see how they had progressed. The reassessment did show some subtle changes, but the short length of the program hindered any patients from seeing complete deescalation of their schema, Ms. Wojcik said.
She discussed the case of a 30-year-old woman with diagnoses of SUD, PTSD, and bipolar disorder – and an extensive treatment history. Therapists found that the combination of traditional and CBT helped significantly with the patient’s elevated abandonment schema.