Hoorcollege 2 Woensdag 2 april 2025
In 70% in deze verhalen is cannabis een factor. Hij gebruikte het als zelfmedicatie.
Trauma-focused therapy in Psychosis
Trauma is very prevalent in people with psychosis, PTSD plays a role as well. This is why it
makes sense to offer them trauma-focused therapy.
With a psychose you have hallucinations. Most common is auditory this is actually a very
common experience amongst people. Often they are very positive but they can also be very
negative. Then we also have delusions which are beliefs that basically arent true, to put it
concrete. Delusions are often fear-based.
Psychosis/schizophrenia/psychotic disorders. There is so much stigma around schizofrenia,
even though most studies are about schizophrenia the lecturer names it psychosis.
schizofrenia is psychosis with a longer worse outcome, this is how you can look at it.
Psychosis develops
- Genes
- Problems during pregnancy and birth
- Discrimination
- Bullying
- Living in a city
- Smoking weed
- Trauma (the biggest factor)
o Interpersonal trauma mainly
o Trauma experienced in childhood
.
If you experienced a traumatic event as a child your chance to develop psychosis is 3 times
bigger.
Standard implication question is ‘did you experience trauma?’
Trauma-related mechanisms in psychosis
- Emotion regulation
o Avoidance/surpression
§ Can be pathways to psychosis
- Episodic memory
o Flashbacks, nightmares, intrusive memories, decontextualised intrusions
, - Schematic beliefs
o Having negative beliefs about yourself/others/world around you.
Hypervigilance is a symptom of ADHD. You are afraid/dont feel safe, came from a nonsafe
background, overlaps with paranoia. People hear the voices of their parents that abused them.
They say the same thing as when they were a child, now is this a flashback or a ‘voice?’ She
thinks its both.
TFT’S = Trauma Focused Therapy
- Prolonged Exposure (PE)
o Voor het emotieregulatie mechanisme
- EMDR
o Voor het episodische geheugen mechanisme
- Cognitive restructuring (CR)
o Voor de schematic beliefs mechanisme
It makes sense to provide these therapies. We have thought for long time that speaking about
trauma (for people with Psychoses) was a really bad thing to do. Because they were too
vulnerable etc.
People with psychosis would be excluded from trauma-focused therapy. Not anymore
fortunately. We actually know how ptsd is to be treated, it is one of the best treatable DSM
diagnosis. We know these methods are really effective.
Prolonged exposure therapy
- We behandelen het eigenlijk als een fobia de traumatische herinnering/ervaring
- Relive the traumatic event in detail
o Learn that you will not go mad or go out of yourself out of anxiety or fear
Sometimes voices they hear will tell them not to speak about the trauma, that they are not
allowed to speak about it and this you have to adress as a therapist.
Om TFT goed toe te passen voor psychose:
- Address psychosis symptoms & their relation to trauma
- Include in psycho-education
- Work on psychosis related traumas
- Address voices, paranoid ideas, or other psychosis related experiences that might
make
it difficult to come to therapy sessions or talk about trauma
Symptom exacerbation during therapy – common reaction to trauma therapy:
acknowledge & guide. Besides that, standard trauma-therapy protocols!
Findings are that TFTS’S in psychosis are
- Effective; safe; have neutral to positive side effects; cost-effective
,Lecture 3
What is Schema Therapy?
Schema Therapy is a form of psychotherapy designed to help clients:
• Understand the origin and function of recurring negative behavior patterns.
• Grasp how early childhood experiences influence current thoughts, emotions, and
behaviors.
• Learn to recognize emotional needs and address them in healthier ways.
• Develop healthier beliefs and coping strategies.
Schema Therapy combines elements from:
• Cognitive Behavioral Therapy (CBT)
• Attachment Theory
• Gestalt Therapy
• Psychodynamic Therapy
• Transactional Analysis
• Psychodrama
Goals of Schema Therapy (SFT)
1. Adressing negative patterns
Identifying and changing dysfunctional schemas developed from early life
experiences.
2. Promoting healthier thinking
Cognitive restructuring of dysfunctional beliefs.
3. Enhancing emotion regulation
Learning to manage emotions (including triggers for addiction or impulsivity).
4. Fulfilling basic emotional needs
Helping clients identify unmet needs from the past and find healthy ways to meet them
in the present.
5. Improving relationships
Changing interpersonal patterns based on schemas to build more stable, healthy
relationships.
Who is Schema Therapy for?
• People with personality disorders (DSM-5).
• Individuals with chronic or recurring problems who have not responded adequately to
previous treatments.
Requirements
• some insight into one’s own emotions and behavior
• ability to mentalize, and tolerate emotional pain.
• Clinical syndrome is treated first or does not interfere
• Long-term treatment (1 to 3 years); not suitable for those seeking quick results.
, Five Basic Needs Core Concepts in Schema Therapy
1. Safety and connection
2. Expression of emotions
3. Autonomy
4. Realistic boundaries/limits
5. Spontaneity and play
Development of Schemas
When these needs are unmet in childhood, maladaptive
schemas develop.
18 Schemas across 5 Domains:
1. Disconnection and Rejection
Abandonment, abuse, emotional deprivation, shame, social isolation
2. Impaired Autonomy and Performance
Dependence, vulnerability, failure
3. Impaired Limits
Poor self-control, entitlement
4. Other-Directedness
Subjugation, self-sacrifice, approval-seeking
5. Overvigilance and Inhibition
Pessimism, emotional inhibition, perfectionism, punitiveness
Coping Styles When Schemas Are Triggered (ipv fight-
flight-freeze)
• Overcompensation: Acting as if the schema doesn’t
exist
• Avoidance: Emotional distancing or distraction
• Surrender: Fully submitting to the schema
Mode Model: ‘Dynamics of Internal Voices’
Modes represent parts of the personality that become active in
response to different situations.
Key Modes:
• Dysfunctional Parent Modes: Punitive, demanding
• Maladaptive Child Modes: Vulnerable, angry, impulsive
• Coping Modes: Detached, submissive, overcompensating
• Healthy Modes: Healthy adult, happy child
Schema Therapy Mode Model
In 70% in deze verhalen is cannabis een factor. Hij gebruikte het als zelfmedicatie.
Trauma-focused therapy in Psychosis
Trauma is very prevalent in people with psychosis, PTSD plays a role as well. This is why it
makes sense to offer them trauma-focused therapy.
With a psychose you have hallucinations. Most common is auditory this is actually a very
common experience amongst people. Often they are very positive but they can also be very
negative. Then we also have delusions which are beliefs that basically arent true, to put it
concrete. Delusions are often fear-based.
Psychosis/schizophrenia/psychotic disorders. There is so much stigma around schizofrenia,
even though most studies are about schizophrenia the lecturer names it psychosis.
schizofrenia is psychosis with a longer worse outcome, this is how you can look at it.
Psychosis develops
- Genes
- Problems during pregnancy and birth
- Discrimination
- Bullying
- Living in a city
- Smoking weed
- Trauma (the biggest factor)
o Interpersonal trauma mainly
o Trauma experienced in childhood
.
If you experienced a traumatic event as a child your chance to develop psychosis is 3 times
bigger.
Standard implication question is ‘did you experience trauma?’
Trauma-related mechanisms in psychosis
- Emotion regulation
o Avoidance/surpression
§ Can be pathways to psychosis
- Episodic memory
o Flashbacks, nightmares, intrusive memories, decontextualised intrusions
, - Schematic beliefs
o Having negative beliefs about yourself/others/world around you.
Hypervigilance is a symptom of ADHD. You are afraid/dont feel safe, came from a nonsafe
background, overlaps with paranoia. People hear the voices of their parents that abused them.
They say the same thing as when they were a child, now is this a flashback or a ‘voice?’ She
thinks its both.
TFT’S = Trauma Focused Therapy
- Prolonged Exposure (PE)
o Voor het emotieregulatie mechanisme
- EMDR
o Voor het episodische geheugen mechanisme
- Cognitive restructuring (CR)
o Voor de schematic beliefs mechanisme
It makes sense to provide these therapies. We have thought for long time that speaking about
trauma (for people with Psychoses) was a really bad thing to do. Because they were too
vulnerable etc.
People with psychosis would be excluded from trauma-focused therapy. Not anymore
fortunately. We actually know how ptsd is to be treated, it is one of the best treatable DSM
diagnosis. We know these methods are really effective.
Prolonged exposure therapy
- We behandelen het eigenlijk als een fobia de traumatische herinnering/ervaring
- Relive the traumatic event in detail
o Learn that you will not go mad or go out of yourself out of anxiety or fear
Sometimes voices they hear will tell them not to speak about the trauma, that they are not
allowed to speak about it and this you have to adress as a therapist.
Om TFT goed toe te passen voor psychose:
- Address psychosis symptoms & their relation to trauma
- Include in psycho-education
- Work on psychosis related traumas
- Address voices, paranoid ideas, or other psychosis related experiences that might
make
it difficult to come to therapy sessions or talk about trauma
Symptom exacerbation during therapy – common reaction to trauma therapy:
acknowledge & guide. Besides that, standard trauma-therapy protocols!
Findings are that TFTS’S in psychosis are
- Effective; safe; have neutral to positive side effects; cost-effective
,Lecture 3
What is Schema Therapy?
Schema Therapy is a form of psychotherapy designed to help clients:
• Understand the origin and function of recurring negative behavior patterns.
• Grasp how early childhood experiences influence current thoughts, emotions, and
behaviors.
• Learn to recognize emotional needs and address them in healthier ways.
• Develop healthier beliefs and coping strategies.
Schema Therapy combines elements from:
• Cognitive Behavioral Therapy (CBT)
• Attachment Theory
• Gestalt Therapy
• Psychodynamic Therapy
• Transactional Analysis
• Psychodrama
Goals of Schema Therapy (SFT)
1. Adressing negative patterns
Identifying and changing dysfunctional schemas developed from early life
experiences.
2. Promoting healthier thinking
Cognitive restructuring of dysfunctional beliefs.
3. Enhancing emotion regulation
Learning to manage emotions (including triggers for addiction or impulsivity).
4. Fulfilling basic emotional needs
Helping clients identify unmet needs from the past and find healthy ways to meet them
in the present.
5. Improving relationships
Changing interpersonal patterns based on schemas to build more stable, healthy
relationships.
Who is Schema Therapy for?
• People with personality disorders (DSM-5).
• Individuals with chronic or recurring problems who have not responded adequately to
previous treatments.
Requirements
• some insight into one’s own emotions and behavior
• ability to mentalize, and tolerate emotional pain.
• Clinical syndrome is treated first or does not interfere
• Long-term treatment (1 to 3 years); not suitable for those seeking quick results.
, Five Basic Needs Core Concepts in Schema Therapy
1. Safety and connection
2. Expression of emotions
3. Autonomy
4. Realistic boundaries/limits
5. Spontaneity and play
Development of Schemas
When these needs are unmet in childhood, maladaptive
schemas develop.
18 Schemas across 5 Domains:
1. Disconnection and Rejection
Abandonment, abuse, emotional deprivation, shame, social isolation
2. Impaired Autonomy and Performance
Dependence, vulnerability, failure
3. Impaired Limits
Poor self-control, entitlement
4. Other-Directedness
Subjugation, self-sacrifice, approval-seeking
5. Overvigilance and Inhibition
Pessimism, emotional inhibition, perfectionism, punitiveness
Coping Styles When Schemas Are Triggered (ipv fight-
flight-freeze)
• Overcompensation: Acting as if the schema doesn’t
exist
• Avoidance: Emotional distancing or distraction
• Surrender: Fully submitting to the schema
Mode Model: ‘Dynamics of Internal Voices’
Modes represent parts of the personality that become active in
response to different situations.
Key Modes:
• Dysfunctional Parent Modes: Punitive, demanding
• Maladaptive Child Modes: Vulnerable, angry, impulsive
• Coping Modes: Detached, submissive, overcompensating
• Healthy Modes: Healthy adult, happy child
Schema Therapy Mode Model
