Schema-therapeutic exposure for treatment resistant anxiety and obsessive-compulsive disorders: A multiple baseline case series design study

Exposure is effective for patients with anxiety disorders or obsessive-compulsive disorders (OCD). Yet, a significant minority does not recover with current guideline treatments due to comorbid personality disorder symptoms. For these patients, no further guideline treatments exist. Schema therapy (ST) is an evidence-based treatment for personality disorders and integrating ST and exposure could provide a solution. We tested a new schema-therapeutic exposure treatment in patients with treatment-resistant anxiety or OCD. Using the latest methodological and statistical insights in a well-powered single-case experimental design (SCED; N = 6), we administered weekly measures of psychological malfunctioning, anxiety/OCD symptoms, and schema modes over the course of treatment (29–32 weeks). Schema-therapeutic exposure was effective for 33.33 % of our sample, with improvement on all or most outcome measures. Another 33.33 % demonstrated partial improvements, and 33.33 % remained stable. Given the historical chronicity of symptoms in our sample, these effects are highly encouraging. Secondary findings showed that changes in schema modes did not precede changes in anxiety/OCD symptoms or psychological malfunctioning, and that 66.66 % of the sample continued to improve in the second half of the treatment. Future research is wanted to unravel the interactive and additive effects of schema-therapeutic exposure to further optimize treatment.