Deliberate self-harm in a clinical sample: the impact of schema modes, parental bonding and perceived stress
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Introduction: Deliberate self-harm is being increasingly recognised as a behaviour with significant clinical importance. Yet, there remains uncertainty regarding which forms of psychological therapy are most effective for its treatment. Schema Therapy is an integrative psychotherapy blending elements of cognitive behaviour therapy, object relations and gestalt therapy into a unified approach for the treatment of individuals with complex and chronic psychological conditions. The current thesis aimed to provide a better understanding of the Schema Therapy model and its association with deliberate self-harm. Systematic Review: Despite the increasing evidence base for the efficacy of Schema Therapy, less is known about the evidence for its theoretical underpinnings. To address this gap in the literature a systematic review was undertaken to explore the following question: How empirically supported is the theoretical underpinning of Schema Therapy? In a systematic search of the literature conducted until 01 June 2012, studies based on cross-sectional, longitudinal, intervention, meditational and experimental designs were considered. These studies underwent detailed quality analysis culminating in 19 articles being included in the current review. Overall these studies indicate that many of the key theoretical assumptions in Schema Therapy are supported by the literature. Empirical Study: Schema Therapy has recently been expanded to include the ‘schema mode’ concept, with a number of researchers highlighting an association between particular schema modes and a number of chronic psychological conditions. Although the schema mode model allows a method for understanding moment-to-moment emotional states it has not previously been explored in relation to deliberate self-harm. The current project aimed to explore the relationship between these variables and their association with early experiences of parental bonding and current levels of perceived stress. 70 psychiatric outpatients with a history of deliberate self-harm completed a number of measures including the Deliberate Self-Harm Inventory, Schema Mode Inventory, Parental Bonding Instrument and Perceived Stress Scale. Results revealed significant associations between deliberate self-harm, maladaptive schema modes, perceived stress and patterns of parental care. Maladaptive schema modes significantly mediated the relationship between parental care and deliberate self-harm. The Punitive Parent and Angry Child modes were significant mediators in this relationship. Conclusion: Results from the systematic review support the notion that Schema Therapy has a good theoretical underpinning. The empirical study also supports Schema Therapy by highlighting the meditational role of maladaptive schema modes in the relationship between low parental care in childhood and deliberate self-harm in adulthood. These findings provide further support for the Schema Therapy model and suggest that individuals with deliberate self-harm may benefit from this treatment.