[Behavior and cognitive therapies focused on The Young Personality Disorders Schemas: a pilot study of 14 cases]

Personality disorders are very frequent in the general population, and especially in psychiatric patients. Various types of psychotherapy are proposed to treat these disorders, directly or not, but some specific cognitive-behavioural therapies (CBT) have been developed for all personality disorders or some of them such as borderline personality disorder. Among the most known models, one can quote Beck, Young and Linehan's approaches. Young therapies are based on the concept of "early maladaptive schemas", and associate cognitive-behavioural techniques and a very specific work on emotions. The procedure consists in, initially, identifying the cognitive schemas involved in the current disorders, as well as their sources in childhood, in particular through memories of traumatic or emotionally disturbing events. The techniques used to modify these early maladaptive schemas include emotional catharsis and corrective emotional experience methods (eg re-parenting).

We carried out an exploratory and naturalistic study of the effects of this schemas therapy among 14 adult out-patients (12 women and 2 men) suffering of personality disorders according to DSM IV criteria. The majority of the disorders belonged to the clusters C (50%) and B (42.9%). The early maladaptive schemas, according to Young's classification, were especially those of the types "distrust/neglect" (35.7%), "neglect feeling" (21.4%) and "subjugation" (21.4%).

The mean duration of the therapies was 13 month, with 26.2 consultations per subject. The primary efficacy criterion selected was the Social Adaptation Scale (SAS-SR, Weissman) score, showing a significant improvement at the end of the therapy (21.3 versus 27.9; p=0.003). This favourable evolution was confirmed by the other scales used, assessing anxious, depressive and general psychopathology symptomatology.

As a conclusion, -schemas therapies represent a rich and complete psychotherapeutic approach, in particular for personality disorders. Further controlled studies on their efficacy and on the factors associated to a good response are necessary.