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Schema Therapy — MRCPsych Paper B MCQ

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ModeratePsychotherapySchema TherapyMRCPsych Paper B

A patient with recurrent depression describes abrupt shifts into a frightened, needy state or a harsh, self-attacking state when relationships feel insecure. The therapist links these self-states to unmet emotional needs in childhood. Treatment includes imagery rescripting, chair dialogues and a warm but professionally bounded therapeutic relationship intended to provide a corrective developmental experience. Which therapeutic modality is being used?

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Correct answer: C — Schema therapy

C. Schema therapy links current difficulties and shifting self-states or “modes” to unmet childhood emotional needs. Imagery rescripting, chair dialogues and a bounded corrective relationship—often termed limited reparenting—are characteristic techniques. Standard CBT primarily modifies current cognitions and behaviours and does not characteristically use schema modes or limited reparenting. DBT prioritises skills in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Mentalisation-based therapy aims to improve understanding of one’s own and others’ mental states, particularly during attachment-related arousal. Cognitive analytic therapy maps reciprocal roles and repeating procedures, commonly using a written reformulation and sequential diagrammatic reformulation. The developmental mode formulation plus experiential and relational techniques therefore uniquely indicates schema therapy.

Reference: Fassbinder E, Schweiger U, Martius D, Brand-de Wilde O, Arntz A. Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy. Frontiers in Psychology. 2016;7:1373. https://pubmed.ncbi.nlm.nih.gov/27683567/