Treating complex PTSD with Schema Therapy, ImRs and EMDR: a review and case study

Oct 29, 2025European journal of psychotraumatology

Treating complex PTSD with Schema Therapy, imagery rescripting, and EMDR: a review and case study

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Abstract

The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score decreased from severe to below the clinical cut-off for PTSD.

A combined therapy approach integrating , Imagery Rescripting, and was employed.
Notable reductions were observed in maladaptive schemas, including Unrelenting Standards/Hypercriticism and Detached Self-Soother.
The treatment was conducted over 50 sessions, divided into phases focusing on trust-building, trauma processing, and relapse prevention.
While promising outcomes were reported, further research is needed to confirm the efficacy of this combined therapy for .

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(CPTSD) often results from prolonged trauma, such as childhood abuse or domestic violence. Cognitive Behavioral Therapy (CBT) and (EMDR) are recommended for treating PTSD. However, their limited effectiveness for CPTSD highlights the need for alternatives such as (ST) and Imagery Rescripting. This case study evaluates the effectiveness of a combined therapy approach integrating ST, ImRs, and EMDR for treating CPTSD.A combination of Schema Therapy and EMDR was used. Treatment progressed in phases: Sessions 1-20 focused on building trust, case conceptualization (1-10) and reducing dysfunctional coping and Implementing Experiential Treatment (11-20). Sessions 21-40 were focused on trauma-focused therapy using a combination of ImRs and EMDR. The final phase (41-50) emphasized relapse prevention and was used as follow-up.Results showed notable reductions in maladaptive schemas, such as Unrelenting Standards/Hypercriticism and Detached Self-Soother and a decrease in the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) score from severe to below the clinical cut-off for PTSD.While the patient's case demonstrates promising outcomes, further research is needed to establish the efficacy of integrating ST, EMDR and ImRs for CPTSD. A randomized controlled trial is essential to compare this combined approach with each treatment separately and to explore the impact of treatment sequencing. Ultimately, optimizing therapy for CPTSD will require a personalized approach based on individual needs and responses. Introduction: Method: Results: Conclusion:

Key numbers

76 to 12

Decrease in CAPS-5 Score

CAPS-5 score at intake was 76, indicating severe PTSD.

2.94 points

Reduction in Unrelenting Standards/Hypercriticism Schema

Significant decrease in schema score by session 40.

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Treating complex PTSD with Schema Therapy, ImRs and EMDR: a review and case study

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