Do schema modes predict outcome of cognitive behavioural therapy in patients with obsessive-compulsive disorder and anxiety disorders?

OBJECTIVES Cognitive behavioural therapy (CBT) is the psychological treatment of choice for patients with obsessive-compulsive disorder (OCD) or an anxiety disorder. However, a substantial group (30-40%) does not profit sufficiently. Predictors of outcome inform us about how to adapt interventions for this group. Specifically, schema modes might affect CBT outcome; yet, research into the relation between schema modes and CBT outcome for anxiety disorders and OCD is very limited. In this study, it was investigated whether adaptive and maladaptive schema modes predict CBT outcome controlling for symptom levels at the start of treatment.

METHODS Pre-treatment maladaptive and adaptive schema modes and pre- and post-treatment psychological distress were assessed in 100 patients (60 women and 40 men with a mean age of 32.49 years) diagnosed with OCD (n = 56) or an anxiety disorder (n = 44) receiving CBT. Regression analyses were conducted to assess the unique predictive value of adaptive and maladaptive schema modes in addition to pre-treatment levels of psychological distress.

RESULTS Pre-treatment maladaptive modes (specifically maladaptive child modes) significantly predicted psychological distress after CBT with small effect sizes. Higher pre-treatment adaptive modes were associated with better CBT response, although this effect was not robust.

CONCLUSIONS Given the small effect size, our study does not yield strong evidence that schema modes influence CBT outcome for patients with OCD or anxiety disorders. Given that this is the first study testing this effect, our findings need to be replicated, preferably in disorder-specific samples.