@2024 Afarand., IRAN
ISSN: 2008-2630 Iranian Journal of War & Public Health 2015;7(3):147-155
ISSN: 2008-2630 Iranian Journal of War & Public Health 2015;7(3):147-155
Effectiveness of Emotional Schema Therapy on Cognitive Emotion Regulation Strategies of Combat-Related Post Traumatic Stress Disorder Veterans
ARTICLE INFO
Article Type
Descriptive & Survey StudyAuthors
Naderi Y. (*)Moradi A.R. (1)
Hasani J. (2)
Noohi S. (3)
(*) Psychiatry & Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
(1) “Cognitive Sciences Institute” and “Psychology Department, Psychology Faculty", Kharazmi University, Tehran, Iran
(2) Psychology Department, Psychology & Education Faculty, Kharazmi University, Tehran, Iran
(3) “Behavioral Sciences Research Center” and “Psychology Department, Medical Faculty”, Baqiyatallah University of Medical Sciences, Tehran, Iran
Correspondence
Article History
Received: May 4, 2015Accepted: June 21, 2015
ePublished: August 25, 2015
ABSTRACT
Aims
One of the consequences of exposure to the ravages of war is Post-Traumatic Stress Disorder. Variety of treatments has presented to help these patients. The target of this paper was to study the effectiveness of emotional schema therapy on cognitive emotion regulation strategies of combat-related post-traumatic stress disorder veterans.
Materials & Methods In this experimental study with single subject multiple based line method, 6 post-traumatic stress disorder patients were selected through available sampling, matched together and then divided into 3 groups (emotional schema therapy combined with medications, cognitive behavioral therapy combined with medications & medications). Tools of the study were Leahy Emotional Schema Scale (LESS) and the Short Form of Cognitive Emotion Regulation Questionnaire (CERQ-18) and the Persian versions of the Impact of Event Scale-Revise (IES-R). Data analysis was done by indexes of effect size, Cohen’s d, process changes, slope and interpretation of ups & downs in charts.
Findings Scores of patients who received emotional schema therapy decreased in negative emotional schema (rumination, guilt, uncontrollability) and scores of some positive emotional schema (higher values, acceptance, comprehensibility, and consensus) were increased. In addition, emotional schema therapy increased the scores of some adaptive cognitive emotion regulation strategies (especially acceptance) and decreased some maladaptive cognitive emotion regulation strategies (self-blaming, rumination, catastrophizing).
Conclusion Emotional schema therapy that directly targets the basic mechanisms of treatment of Post-Traumatic Stress Disorder is appropriate choice for treatment of this disorder.
Materials & Methods In this experimental study with single subject multiple based line method, 6 post-traumatic stress disorder patients were selected through available sampling, matched together and then divided into 3 groups (emotional schema therapy combined with medications, cognitive behavioral therapy combined with medications & medications). Tools of the study were Leahy Emotional Schema Scale (LESS) and the Short Form of Cognitive Emotion Regulation Questionnaire (CERQ-18) and the Persian versions of the Impact of Event Scale-Revise (IES-R). Data analysis was done by indexes of effect size, Cohen’s d, process changes, slope and interpretation of ups & downs in charts.
Findings Scores of patients who received emotional schema therapy decreased in negative emotional schema (rumination, guilt, uncontrollability) and scores of some positive emotional schema (higher values, acceptance, comprehensibility, and consensus) were increased. In addition, emotional schema therapy increased the scores of some adaptive cognitive emotion regulation strategies (especially acceptance) and decreased some maladaptive cognitive emotion regulation strategies (self-blaming, rumination, catastrophizing).
Conclusion Emotional schema therapy that directly targets the basic mechanisms of treatment of Post-Traumatic Stress Disorder is appropriate choice for treatment of this disorder.
Keywords:
Stress Disorder, Post-Traumatic,
Cognitive-Behavior Therapy ,
Cognitive Emotion Regulation Strategies ,
Emotional Schemas ,
CITATION LINKS
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[16]Leahy RL. Emotional schema therapy: A bridge over troubled waters. In: Herbert JD, Forman EM. Acceptance and Mindfulness in Cognitive Behavior Therapy: Understanding and Applying the New Therapies. New York: Wiley & Sons; 2011. pp. 109-31.
[17]Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change. 2nd edition. New York: Guilford Press; 2011.
[18]Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A. Optimizing inhibitory learning during exposure therapy. Behav Res Ther. 2008;46(1):5-27.
[19]Thompson BL, Waltz J. Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. J Anxiety Disord. 2010;24(4):409-15.
[20]Khanzadah M, Edrisi F, Muhammadkhani Sh, Sa’idian M. Factor Structure and Psychometric Properties of Emotional Schema Scale. J Clin Psychol. 2013;11(3):91-117. [Persian]
[21]Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Personal Individ Differ. 2001;30(8):1311-27.
[22]Hasani J. The Psychometric Properties of the Cognitive Emotion Regulation Questionnaire (CERQ). J Clin Psycol. 2010;2(3):73-84. [Persian]
[23]Beck AT, Steer RA, Brown G. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation; 1996.
[24]Weiss DS, Marmar CR. The impact of event scale-revised (IES-R). Assessing psychological trauma and PTSD. New York: Guilford Press; 1997. p. 168.
[25]Moradi AR, Herlihy J, Yasseri G, Shahraray M, Turner S, Dalgleish T. Specificity of episodic and semantic aspects of autobiographical memory in relation to symptoms of posttraumatic stress disorder (PTSD). Acta Psychol (Amst). 2008;127(3):645-53.
[26]Silberstein LR, Tirch D, Leahy RL, McGinn L. Mindfulness, psychological flexibility and emotional schemas. Int J Cognitive Ther. 2012;5(4):406-19.
[27]Shepherd L, Wild J. Emotion regulation, physiological arousal and PTSD symptoms in trauma-exposed individuals. J Behav Ther Exp Psychiatry. 2014;45(3):360-7.
[28]Wisco BE, Sloan DM, Marx BP. Cognitive emotion regulation and written exposure therapy for posttraumatic stress disorder. Clin Psychol Sci. 2013. Available from: http://cpx.sagepub.com/content/early/2013/05/13/2167702613486630.
[29]Cloitre M, Koenen KC, Cohen LR, Han H. Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. J Consult Clin Psychol. 2002;70(5):1067-74.
[30]Dugas MJ, Ladouceur R. Treatment of GAD. Targeting intolerance of uncertainty in two types of worry. Behav Modif. 2000;24(5):635-57.
[2]Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214-27.
[3]Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007;(3):CD003388.
[4]Leahy RL. A model of emotional schemas. Cognitive Behav Pract. 2002;9(3):177-90.
[5]Leahy RL. Emotional schemas and resistance to change in anxiety disorders. Cognitive Behav Pract. 2007;14(1):36-45.
[6]Leahy RL, Tirch DD, Napolitano LA. Emotion regulation in psychotherapy: A practitioner's guide. New York: Guilford Press; 2011.
[7]Vogel PA, Stiles TC, Götestam KG. Adding cognitive therapy elements to exposure therapy for obsessive compulsive disorder: A controlled study. Behav Cognitive Psychotherapy. 2004;32(3):275-90.
[8]Foa EB, Kozak MJ. Emotional processing of fear: Exposure to corrective information. Psychol Bull. 1986;99(1):20-35.
[9]Hasani J, Naderi Y, Ramazanzadeh F, Pourabbass A. The role of the emotional intelligence and emotional schema in womenn’s marital satisfaction. Fam Res. 2014;9(4):489-506.
[10]Cloitre M, Miranda R, Stovall-McClough KC, Han H. Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behav Therapy. 2005;36(2):119-24.
[11]Frewen PA, Lanius RA. Toward a psychobiology of posttraumatic self-dysregulation. Ann NY Acad Sci. 2006;1071(1):110-24.
[12]Litz BT, Orsillo SM, Kaloupek D, Weathers F. Emotional processing in posttraumatic stress disorder. J Abnorm Psychol. 2000;109(1):26-39.
[13]Barlow DH, Allen LB, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205-30.
[14]Van der Kolk BA. The complexity of adaptation to trauma: Self-regulation, stimulus discrimination, and characterological development. New York: Guilford Press; 1996. pp. 182-213.
[15]Tirch DD, Leahy RL, Silberstein LR, Melwani PS. Emotional schemas, psychological flexibility, and anxiety: the role of flexible response patterns to anxious arousal. Int J Cognitive Ther. 2012;5(4):380-91.
[16]Leahy RL. Emotional schema therapy: A bridge over troubled waters. In: Herbert JD, Forman EM. Acceptance and Mindfulness in Cognitive Behavior Therapy: Understanding and Applying the New Therapies. New York: Wiley & Sons; 2011. pp. 109-31.
[17]Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: The process and practice of mindful change. 2nd edition. New York: Guilford Press; 2011.
[18]Craske MG, Kircanski K, Zelikowsky M, Mystkowski J, Chowdhury N, Baker A. Optimizing inhibitory learning during exposure therapy. Behav Res Ther. 2008;46(1):5-27.
[19]Thompson BL, Waltz J. Mindfulness and experiential avoidance as predictors of posttraumatic stress disorder avoidance symptom severity. J Anxiety Disord. 2010;24(4):409-15.
[20]Khanzadah M, Edrisi F, Muhammadkhani Sh, Sa’idian M. Factor Structure and Psychometric Properties of Emotional Schema Scale. J Clin Psychol. 2013;11(3):91-117. [Persian]
[21]Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive emotion regulation and emotional problems. Personal Individ Differ. 2001;30(8):1311-27.
[22]Hasani J. The Psychometric Properties of the Cognitive Emotion Regulation Questionnaire (CERQ). J Clin Psycol. 2010;2(3):73-84. [Persian]
[23]Beck AT, Steer RA, Brown G. Manual for the Beck depression inventory-II. San Antonio, TX: Psychological Corporation; 1996.
[24]Weiss DS, Marmar CR. The impact of event scale-revised (IES-R). Assessing psychological trauma and PTSD. New York: Guilford Press; 1997. p. 168.
[25]Moradi AR, Herlihy J, Yasseri G, Shahraray M, Turner S, Dalgleish T. Specificity of episodic and semantic aspects of autobiographical memory in relation to symptoms of posttraumatic stress disorder (PTSD). Acta Psychol (Amst). 2008;127(3):645-53.
[26]Silberstein LR, Tirch D, Leahy RL, McGinn L. Mindfulness, psychological flexibility and emotional schemas. Int J Cognitive Ther. 2012;5(4):406-19.
[27]Shepherd L, Wild J. Emotion regulation, physiological arousal and PTSD symptoms in trauma-exposed individuals. J Behav Ther Exp Psychiatry. 2014;45(3):360-7.
[28]Wisco BE, Sloan DM, Marx BP. Cognitive emotion regulation and written exposure therapy for posttraumatic stress disorder. Clin Psychol Sci. 2013. Available from: http://cpx.sagepub.com/content/early/2013/05/13/2167702613486630.
[29]Cloitre M, Koenen KC, Cohen LR, Han H. Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. J Consult Clin Psychol. 2002;70(5):1067-74.
[30]Dugas MJ, Ladouceur R. Treatment of GAD. Targeting intolerance of uncertainty in two types of worry. Behav Modif. 2000;24(5):635-57.