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Integrating Schema Therapy with Kleinman's Cultural Explanatory Model: A Case Study

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Abstract

This case report describes a therapeutic approach that was used with an Egyptian female client who sought treatment for persistent depressive disorder at an outpatient clinic in Cairo, Egypt. This approach was based on an integration of schema therapy, which examined the developmental origins of early maladaptive schemas acquired by individuals with depression, with Kleinman’s cultural explanatory model, which emphasized the cultural meaning given to the cause, severity, and prognosis of this disorder. As shown in the case report, early maladaptive schemas adopted by the client were understood in their cultural and religious contexts, and this cultural understanding enhanced therapeutic connection and effectiveness.

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Data Availability

N/A.

Abbreviations

EMS:

Early maladaptive schemas

CBT:

Cognitive behavioral therapy

WHO:

World health organization

References

  • Afifi, M. (2006). Depression in adolescents: Gender differences in Oman and Egypt. Eastern Mediterranean Health Journal, 12, 61–71.

    CAS  PubMed  Google Scholar 

  • Al Omari, O., Al Sabei, S., Al Rawajfah, O., Abu Sharour, L., Aljohani, K., Alomari, K., ... & Alhalaiqa, F. (2020). Prevalence and predictors of depression, anxiety, and stress among youth at the time of COVID-19: an online cross-sectional multicountry study. Depression research and treatment

  • Aly, R., Ramy, H., & Rathod, S. (2020). The practice and research of cognitive behavioural therapy in Egypt: A review of the current status. The Cognitive Behaviour Therapist, 13, 1–13. https://doi.org/10.1017/S1754470X20000082

    Article  Google Scholar 

  • Bamelis, L. L., Evers, S. M., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 305–322. https://doi.org/10.1176/appi.ajp.2013.12040518

    Article  PubMed  Google Scholar 

  • Bazzoui, W., & Al-Issa, I. (1966). Psychiatry in Iraq. British Journal of Psychiatry, 112, 827–832. https://doi.org/10.1192/bjp.112.489.827

    Article  CAS  Google Scholar 

  • Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-IA and-II in psychiatric outpatients. Journal of Personality Assessment, 67, 588–597.

    Article  CAS  PubMed  Google Scholar 

  • Benazon, N. R., & Coyne, J. C. (2000). Living with a depressed spouse. Journal of Family Psychology, 14, 71–79. https://doi.org/10.1037/0893-3200.14.1.71

    Article  CAS  PubMed  Google Scholar 

  • Beshai, S., Clark, C. M., & Dobson, K. S. (2012). Conceptual and pragmatic considerations in the use of cognitive-behavioral therapy with Muslim clients. Cognitive Therapy and Research, 37, 197–206. https://doi.org/10.1007/s10608-012-9450-y

    Article  Google Scholar 

  • Beshai, S., Dobson, K. S., Adel, A., & Hanna, N. (2016). A cross-cultural study of the cognitive model of depression: Cognitive experiences converge between Egypt and Canada. PLoS ONE, 11, e0150699. https://doi.org/10.1371/journal.pone.0150699

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Carter, J. S., & Garber, J. (2011). Predictors of the first onset of a major depressive episode and changes in depressive symptoms across adolescence: stress and negative cognitions. Journal of Abnormal Psychology, 120, 779–796. https://doi.org/10.1037/a0025441

    Article  PubMed  Google Scholar 

  • Chen, K. H., Tam, W. C. C., & Chang, K. (2019). Early maladaptive schemas, depression severity, and risk factors for persistent depressive disorder: a cross-sectional study. East Asian Archives of Psychiatry, 29, 112–117.

    Article  CAS  PubMed  Google Scholar 

  • Durisko, Z., Mulsant, B. H., & Andrews, P. W. (2015). An adaptationist perspective on the etiology of depression. Journal of Affective Disorders, 172, 315–323.

    Article  PubMed  Google Scholar 

  • El-Gilany, A. H., Elkhawaga, G. O., & Sarraf, B. B. (2018). Depression and its associated factors among elderly: A community-based study in Egypt. Archives of Gerontology and Geriatrics, 77, 103–107. https://doi.org/10.1016/j.archger.2018.04.011

    Article  PubMed  Google Scholar 

  • El-Islam, M. F. (1969). Depression and guilt: A study at an Arab psychiatric clinic. Social Psychiatry, 4, 56–58. https://doi.org/10.1007/bf00582782

    Article  Google Scholar 

  • Flink, N., Honkalampi, K., Lehto, S. M., Viinamäki, H., Koivumaa-honkanen, H., Valkonen-Korhonen, M., & Lindeman, S. (2019). Early maladaptive schemas in chronically depressed patients: A preliminary investigation. Clinical Psychologist, 23, 15–25. https://doi.org/10.1111/cp.12151

    Article  Google Scholar 

  • Friedmann, J. S., Lumley, M. N., & Lerman, B. (2015). Cognitive schemas as longitudinal predictors of self-reported adolescent depressive symptoms and resilience. Cognitive Behaviour Therapy, 45, 32–48. https://doi.org/10.1080/16506073.2015.1100212

    Article  PubMed  Google Scholar 

  • Habib, D., & Seif El Din, A. (2007). Effectiveness of cognitive behaviour therapy in school children with depressive symptoms in Alexandria, Egypt. EMHJ-Eastern Mediterranean Health Journal, 13, 615–624.

    CAS  Google Scholar 

  • Halvorsen, M., Wang, C. E., Eisemann, M., & Waterloo, K. (2010). Dysfunctional attitudes and early maladaptive schemas as predictors of depression: A 9-year follow-up study. Cognitive Therapy and Research, 34, 368–379. https://doi.org/10.1007/s10608-009-9259-5

    Article  Google Scholar 

  • Hawke, L. D., & Provencher, M. D. (2011). Schema theory and schema therapy in mood and anxiety disorders: A review. Journal of Cognitive Psychotherapy, 25, 257–276. https://doi.org/10.1891/0889-8391.25.4.257

    Article  Google Scholar 

  • Hawke, L. D., & Provencher, M. D. (2012). Early maladaptive schemas among patients diagnosed with bipolar disorder. Journal of Affective Disorders, 136, 803–811. https://doi.org/10.1016/j.jad.2011.09.036

  • Ingram, R. E., Atchley, R. A., & Segal, Z. (2011). Vulnerability to depression: From cognitive neuroscience to prevention and treatment. New York, NY: Guilford Press.

  • Jia, H., & Lubetkin, E. I. (2017). Incremental decreases in quality-adjusted life years (QALY) associated with higher levels of depressive symptoms for U.S. Adults aged 65 years and older. Health and Quality of Life Outcomes, 15, 1–9. https://doi.org/10.1186/s12955-016-0582-8

    Article  Google Scholar 

  • Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. Journal of Clinical Psychiatry, 62, 22–30. https://doi.org/10.1177/1363461508089769

    Article  PubMed  Google Scholar 

  • Kleinman, A. M. (1977). Depression, somatization and the “new cross-cultural psychiatry.” Social Science & Medicine, 11, 3–9. https://doi.org/10.1016/0037-7856(77)90138-x

    Article  CAS  Google Scholar 

  • Kleinman, A. (1980). Patients and healers in the context of culture. University of California Press.

    Book  Google Scholar 

  • Kleinman, A., Eisenberg, L., & Good, B. (2006). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Focus, 4, 140–149. https://doi.org/10.1176/foc.4.1.140

    Article  Google Scholar 

  • Kleinman, A., & Seeman, D. (2000). Personal experience of illness. In G. L. Albrecht, R. Fitzpatrick, & S. C. Scrimshaw (Eds.), Handbook of social studies in health and medicine (pp. 230–242). Sage.

    Chapter  Google Scholar 

  • Krishnan, V., & Nestler, E. J. (2008). The molecular neurobiology of depression. Nature, 455(7215), 894–902. https://doi.org/10.1038/nature07455

    Article  ADS  CAS  Google Scholar 

  • Landrine, H., & Klonoff, E. A. (1992). Culture and health-related schema. Health Psychology, 11, 267–276.

    Article  CAS  PubMed  Google Scholar 

  • Lasch, K. E., Hassan, M., Endicott, J., et al. (2012). Development and content validity of a patient reported outcomes measure to assess symptoms of major depressive disorder. BMC Psychiatry, 12, 12–34.

    Article  Google Scholar 

  • Marsella, A. J., & White, G. M. (1982). Cultural conceptions of mental health and therapy. Reidel.

    Book  Google Scholar 

  • Mercan, N., Bulut, M., & Yüksel, Ç. (2021). Investigation of the relatedness of cognitive distortions with emotional expression, anxiety, and depression. Current Psychology, 42, 2176–2185.

    Article  Google Scholar 

  • McTernan, W. P., Dollard, M. F., & LaMontagne, A. D. (2013). Depression in the workplace: An economic cost analysis of depression-related productivity loss attributable to job strain and bullying. Work & Stress, 27, 321–338.

    Article  Google Scholar 

  • Ozyurt, S. S. (2013). The selective integration of Muslim immigrant women in the United States: Explaining Islam’s paradoxical impact. Journal of Ethnic and Migration Studies, 39, 1617–1637.

    Article  Google Scholar 

  • Riso, L., Maddux, R., & Santorelli, N. (2007). Early maladaptive schemas in chronic depression. Washington, DC, US: American Psychological Association.

  • Sadoski, M., Paivio, A., & Goetz, E. T. (1991). Commentary: A critique of schema theory in reading and a dual coding alternative. Reading Research Quarterly, 26, 463–485. https://doi.org/10.2307/747898

    Article  Google Scholar 

  • Saveanu, R. V., & Nemeroff, C. B. (2012). Etiology of depression: genetic and environmental factors. Psychiatric Clinics, 35, 51–71. https://doi.org/10.1016/j.psc.2011.12.001

    Article  PubMed  Google Scholar 

  • Scull, N. C. (2015). Forgiveness, revenge, and adherence to Islam as moderators for psychological wellbeing and depression among survivors of the 1990 Iraqi invasion of Kuwait. Journal of Muslim Mental Health, 9, 41–64. https://doi.org/10.3998/jmmh.10381607.0009.103

    Article  Google Scholar 

  • Shorey, R. C., Elmquist, J., Anderson, S., & Stuart, G. L. (2015). The relationship between early maladaptive schemas, depression, and generalized anxiety among adults seeking residential treatment for substance use disorders. Journal of Psychoactive Drugs, 47, 230–238.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse (4th ed.). New York, NY: John Wiley & Sons.

    Google Scholar 

  • Teyber, E., & Teyber, F. (2010). Interpersonal process in therapy: An integrative model. Cengage Learning.

  • Thimm, J. C. (2013). Early maladaptive schemas and interpersonal problems: A circumplex analysis of the YSQ-SF. International Journal of Psychology and Psychological Therapy, 13, 113–124.

    Google Scholar 

  • Tobah, S. (2017). Constructing mental illness: Comparing discourses on mental health, illness, and depression by Muslim leaders with those found in consumer health materials. Journal of Muslim Mental Health, 11, 47–66. https://doi.org/10.3998/jmmh.10381607.0011.203

    Article  Google Scholar 

  • Wang, G., & Chen, Y.-N. (2010). Collectivism, relations, and Chinese communication. Chinese Journal of Communication, 3, 1–9.

    Article  ADS  Google Scholar 

  • World Health Organization (2018). Depression. Retrieved from http://www.who.int/news-room/fact-sheets/detail/depression

  • World Health Organization (2017). Depression and other common mental disorders. Global health estimates. Retrieved from https://apps.who.int/iris/handle/10665/254610

  • Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.

    Google Scholar 

  • Young, J. E., & Brown, G. (2003). Young Schema Questionnaire—Long form 3. Sarasota, FL: Professional Resource Exchange.

  • Young, J. E., Klosko, J. S., & Weishaar, M. E. (2006). Schema therapy: A practitioner’s guide. New York, NY: Guilford Press.

    Google Scholar 

  • Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Marino, M. F., Lewis, R. E., Williams, A. A., & Khera, G. S. (2000). Biparental failure in the childhood experiences of borderline patients. Journal of Personality Disorders, 14, 264–273.

    Article  CAS  PubMed  Google Scholar 

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All authors contributed to the manuscript. The literature review and case report were prepared by Hani Henry and Amina Nasreldin.

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Correspondence to Hani M. Henry.

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No university approval was required for this case study as the consent was requested as part of therapy.

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Informed consent was obtained from the individual whose case was described in this report as this was a part of therapy consent.

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Informed consent was obtained from the individual whose case was described in this report as this was a part of therapy consent.

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Henry, H.M., Nasreldin, A. Integrating Schema Therapy with Kleinman's Cultural Explanatory Model: A Case Study. Psychol Stud 69, 105–111 (2024). https://doi.org/10.1007/s12646-023-00771-1

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