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Substantial numbers of dysthymic patients tend to suffer from higher co-occurrence in personality abnormalities Peper et al, ; Riso et al, , and early maladaptive schemas among patients with dysthymia are more common as compared to major depressive disorder. Maladaptive schemas, according to Young, Klosko and Weishaar , are defined as and relate mainly to the lack of basic emotional needs met in childhood and a lack of appropriate relationships, bonds, and behaviors of important others involved in the life of a growing child, making them emotionally and psychologically vulnerable to common co-occurring conditions of dysthymia including failed and troubled major depression, anxiety disorders, personality disorders, somatoform disorders, substance abuse and drug addiction Young, Avoidant, compensatory and surrendering to the schema modes or coping styles that block access to the vulnerable modes are our behavioral responses to the schemas in hopes of making things better, but in fact they very often wind up reinforcing the schema Young, Thimm asserted that people may permanently live within maladaptive schemas which are a pattern of established from childhood unstable reactions to any given situation in life.

Young et al , Wishman and Dobson stated that the basic assumptions of current cognitive-behavioral therapies are not in agreement with typical characteristics of dysthymia. Cognitive-behavioral therapy adopts a top-down approach in healing schemas and vulnerable modes, starting with, for example hopelessness, then fundamental components and finally schemas Leahy, Whereas, schema therapy employs a bottom-up approach, following the process inversely and logically, and starting with the deepest level of schema Young, On the one hand, Young model of schema therapy as a tailored therapeutic strategy can exert more beneficial and positive effect as compared to other forms of therapies.

On the other hand, through integrating the metaphorical-allegorical narrative training with cognitive-behavioral therapies, the patients can achieve a more distinct perceptional appearance of therapeutic applications and benefits, better called as therapeutic conceptualization. In terms of theoretical verbalization, some patients try to grasp the subjective and technical concepts of the therapist, however, they have no clear perception and recollection of these vaguely-stated matters and therefore, no appreciable and therapeutic effect can be observed.

The use of symbolic and figurative language allegory and metaphor creates a more effective process of receiving, retaining, processing, management and retrieval of the information and enables the therapist to transfer the imbalance information of two different linguistic variations from a more subjective system of psychological perception to a more objective one. Therefore, a lexicon of objective terms can provide us with a more vivid and clear description of propositional concepts.

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Dobson, Cognitive linguists emphasize that metaphors and allegories serve to facilitate the understanding of one conceptual domain, typically an abstract one, through expressions that relate to another and linking to a more familiar conceptual domain, typically a more concrete one.

Emphasizing the heavy usage of propositional language in a psychotherapeutic session may be largely responsible for reaching a dead end in grasping and framing the conceptual understanding during the therapeutic process. Hence, the psychotherapists are obliged to avoid such conceptual dead ends through the usage of symbolic language, e. Metaphors are effective, subtle, and potent tools for communicating the data from our research laboratories, acquiring deeper meaning and moving from nontangible conceptualization toward more understandable concepts Gibbs, ; ; Burns, ; Blenkiron Method According to Kazdin , the present research adopts a comparison, process and conclusion-based method.

Empirically-supported therapies are becoming increasingly commonplace. Moreover, clinical psychologists and psychotherapists are expected to design and conduct their research in way that points to defensible conclusions. Derubeis, Crits and Christophe, Sample of the Flashcard of Schema Therapy Techniques based on Metaphorical-Allegorical Training Two seeds that were laying side by side in the fertile soil having a conversation, the first seed said, "I want to grow! I want to send my roots deep into the soil beneath me, and thrust my sprouts through the earth's crust above me I want to unfurl my tender buds like banners to announce the arrival of spring I want to feel the warmth of the sun on my face and the blessing of the morning dew on my petals!

The second seed said, "Hmmmm. If I send my roots into the ground below, I don't know what I will encounter in the dark. If I push my way through the hard soil above me I may damage my delicate sprouts And if I were to open my blossoms, a small child may pull me from the ground. No, it is much better for me to wait until it is safe. A yard hen scratching around in the early spring ground for food found the waiting seed and promptly ate it. No chains, no cages.

CBT for Occupational Stress in Health Professionals: Introducing a Schema-Focused Approach

It is obvious that the elephants could, at any time, break away from their bonds but for some reason, they did not. As they grow up, they are conditioned to believe they cannot break away.

They believe the rope can still hold them, so they never try to break free. Therapeutic applications: The patient accepts that schema is accurate, goes through its emotional pain, repeats the schema-driven patterns and behaves in a way to assure himself of the accuracy of the maladaptive schema and relive the childhood experience while encountering the triggers of the schema; they can consciously experience their emotional responses.

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Method The population included the individuals suffering from dysthymic disorder who attended the counseling and mental health centers located in the east of Tehran, out of which a sample of 40 patients was selected using convenience sampling, these participants aged with at least qualification of secondary school diploma, and not having received psychological therapy or psychiatric treatment for the last four months. The patients who scored higher on BR and were diagnosed with severe personality disorder borderline personality disorder, schizophrenia and paranoia , or psychotic disorders were not sampled, to fulfill this criterion, MCMI-III was administered.

Dysthymia has a high degree of simultaneity with other disorders. To eliminate this problem we recruited patients who received definite and original diagnosis of dysthymia. The sample of 40 patients was subsequently assigned to experimental and control group. This interview incorporates the benefits of structured interviewing and makes more accurate and reliable diagnoses. SCID-CV helps not to resort to the lengthier and more complex process used principally in research studies and dispose of other diagnostic categories which are not related to the study Bakhtiyari et al, The SCID-CV is divided into six self-contained modules covering: module A: mood episode, module B: psychotic symptoms, module C: psychotic disorders, module D: mood disorders, module E: substance use disorders, module F: anxiety and other disorder, also included in module F are disorders without diagnostic criteria such as agoraphobia, social phobia, specific phobia, etc.

It is most appropriate for adults 18 years and over , but with slight modification, may be used with adolescents. Tran and Hagga , quoted form Tran and Smith, have reported the results indicate moderate to good reliability among formulations constructed by teams of independent clinician in the. A Persian version of this interview was administered on individuals by Sharifi et al and the result of kappa coefficient was over.

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The BDI-II, The development of the BDI was an important event in psychiatry and psychology; it represented a shift in health care professionals' view of depression from a Freudian, psychodynamic perspective, to one guided by the patient's own thoughts or cognitions. All but three of the items were reworded; only the items dealing with feelings of being punished, thoughts about suicide, and interest in sex remained the same.

Finally, participants were asked to rate how they have been feeling for the past two weeks, as opposed to the past week as in the original BDI. Beck's Depression Inventory sometimes referred as Beck Depression Scale can be used for both adults and adolescents 13 years of age and older. Beck Depression Test is a standard measure of depression used mainly in research and for the evaluation of effectiveness of depression therapies and treatments.

It is not meant to serve as an instrument of diagnosis, but rather to identify the presence and severity of symptoms consistent with the criteria of the DSM-IV. The statements are rank ordered and weighted. Like the BDI, the BDI-II also contains 21 questions, each answer being scored on a scale value of 0 to and has a set of at least four possible answer choices, ranging in intensity and then the total score is compared to a key to determine the depression's severity.

The cutoffs used, differ from the original: 0— minimal depression; 14— mild depression; 20— moderate depression; and 29— severe depression. Higher total scores indicate more severe depressive symptoms. Aggregate validity coefficient for each item equaled 0. The construct validity based on convergent validity was equal to 0. Overall, the Persian translation of the BDI-II version demonstrates good psychometric properties among Iranian population and its results can be trusted for statistical and psychometric analysis.

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Mohammadkhani, Young Schema Questionnaire-Long Form YSQ-LF , Young and Brown, which was developed as a method of identifying EMS in clinical practice is a item self-report inventory designed to measure these 16 EMS, the number of items used to measure each schema varies with each sub-scale and ranges from 9 to A series of studies represent the first attempts to develop and explore the psychometric properties of the Young Schema Questionnaire. This questionnaire was standardized among a population of students with a Cronbach's alpha coefficient of 0.

The test was also shown to have high two-week test—retest reliability of 0. Face validity and interjudge agreement have been checked and turned out to be satisfactory. Overall, many studies lend support for the efficiency of young schema questionnaire in measuring the early maladaptive schemas. Data Retrieval Scale, was designed and developed by Ghasem Zadeh and it measures the retrieval rate of the therapeutic content and the exchanged data throughout the previous therapeutic sessions.

Quantity of listened and learned concepts during the educational or medical process can be a function of the quality of coding the data and their features. Obviously, if these features are dominant, coding and decoding can be better applied. For example, semantic and visual features of metaphors can be a great aid to remembering the concepts.

The quantity of the recalled metaphorical and propositional theme content is the index of recalling or retrieving information. Each week 2 individuals simultaneously entered the base line with regard to the research design. The subjects who were absent for two consecutive sessions were excluded from the research. A two-month follow-up study was also conducted to assess the possible lessening of effectiveness with recovery rates after the completion of treatment Table 1- Female and Male Gender in the Present Study Gender Number Percent Female 23 Results In order to analyze the data, both descriptive and inferential statics, including two-factor variance analysis with repeated measurement on the second factor were employed using statistical analysis software.

In repeated measurement, two types of groups classical schema therapy and schema therapy based on metaphorical-allegorical narrative training were regarded as inter-subject factor while depression and maladaptive schemas entered the analysis as within-subject factor. The results of repeated measure for depression, maladaptive schemas, cognitive distortion and difficulty in emotion regulation are reported separately in pretest, post-test and follow-up. In this report, Mauchly's Test of Sphericity was also used to measure the covariance consistency.

Moreover, there was a drop- out of 3 subjects whose scores were calculated based on last observation carried forward LOCF. The results are discussed as following: Table 2. Hence, t-test assumptions based on the normality of the sample regarding the measured variable and homogeneity of the variances were examined in both groups. T-test demonstrated that there exists a significant between-group difference between classical schema therapy and schema therapy based on metaphorical-allegorical narrative training in terms of long-term retrieval rate of therapeutic techniques during therapy sessions among dysthymic patients.

Overall, the mean of metaphorical-allegorical narrative training is significantly higher in terms of the exchanged information in therapy as compared to classical schema therapy. That is to say that the examined qualities have normal distribution in population. QQ Plot- Schema Therapy based on Metaphorical-Allegorical Narrative Training in the Assessment of the Therapeutic Information Retrieval Rate in Therapy Sessions Clinical Implications Dysthymic patients show episodic memory deficit; moreover, other aspects of short-term memory confront the problem of poor retrieval rate which makes the unable in committing the therapeutic dialogues to memory.

Metaphors and allegories serve to facilitate the understanding of one conceptual domain through expressions that relate to another and linking to a more familiar conceptual domain which can be more easily memorized, processed, retained and retrieved. Hence, the psychotherapists are obliged to avoid such conceptual dead ends through the usage of symbolic language which create a form of indirect, imaginative, and implied communication with clients and serve as non-threatening means to help clients discuss problems and consider possible solutions.