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Klinik für Psychiatrie und Psychotherapie

Research group Külz

"Schema therapy and early maladaptive schemas (EMS) in patients with obsessive-compulsive disorder (OCD)"

Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) alone or in combination with selective serotonin reuptake inhibitors is the first line treatment for patients with OCD. However, approximately 30 to 50% of the patients show no treatment response measured by an improvement of OC symptoms of at least 35% and suffer from a chronic course. Those findings indicate the necessity for further research. Jeffrey Young developed schema therapy to treat patients with chronic psychological disorders when CBT has been unsuccessful. Schema therapy integrates aspects of other theoretical schools into a richer, unified conceptual treatment model.

In a first step, early maladaptive schemas (EMS), schema modes and traumatic childhood experiences were investigated in a sample of 70 OCD, 43 eating disorder (ED) and 38 chronic pain disorder (CPD) patients. EMS were found to be more substantial in OCD than in ED and CPD, in particular schemas related to the frustrated basic need of autonomy. While the CPD group was the least affected patient group regarding EMS and schema modes, the opposite was observed for traumatic childhood experiences.

In a second step, the predictive value of EMS and schema modes in the treatment outcome of OCD was examined. Regression analyses indicated that higher scores on the Emotional Inhibition and the Failure EMS were related to negative outcome. Higher scores on schema modes, other EMS or traumatisation had no influence on treatment outcome.

In a third step, a specific schema therapy approach was developed for OCD patients not responding to standard CBT with ERP. A pilot study in the inpatient setting recently showed that schema therapy is feasible for OCD. Patients who were still symptomatic after CBT with ERP participated in a 12-week treatment of schema therapy in combination with ERP. Preliminary findings of our pilot study suggested that the program might be effective in reducing OCD symptoms.

Project Members

  • Prof. Ulrich Voderholzer (PI)
  • Dipl. Psych. Nicola Thiel

  • Dr. Anne Katrin Külz
  • Dipl. Psych. Nirmal Herbst
  • Dr. Ellen Gross
  • Dipl. Psych. Elisabeth Hertenstein


  • PD Dr. Gitta Jacob, Freiburg
  • Prof. Almut Zeeck, Freiburg
  • Prof. Carl Eduard Scheidt, Freiburg

Selected publications

  • Knauss E, Stelzer N, Jacob G (2012). Treating OCD with the Schema-Mode-Model. In: Michiel van Vreeswijk, Jenny Broersen, Marjon Nardort (Ed.). The Wiley-Blackwell Handbook of Schema Therapy: Theory, Research and Practice. John Wiley u. Sons. West Sussex.

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