Draft:Evolutionary Systems Therapy for Schizotypy

Evolutionary Systems Therapy for Schizotypy (ESTS) is an experimental therapeutic process that integrates evolutionary psychiatry. , metacognitively oriented therapy, and compassion focused therapy. ESTS attempts to help those with clinical manifestations of schizotypy - and specifically schizotypal personality disorder (StPD) - to increase their feeling of safety in interpersonal relationships and interpreting their own thoughts and the thoughts of others. ESTS posits that those with high levels of openness to experience and introversion would have been exposed to a heightened risk of clinical manifestiations of schizotypy when dealing with traumatic experiences (such as child maltreatment).

Empirical support
ESTS is an experimental therapy that has been pilot-tested in a randomized controlled trial (RCT) and in a few cases series. An RCT showed how ESTS was as effective as a combination of cognitive behavioral therapy and psychopharmacotherapy in treating those with StPD. Despite these results are promising, confirmatory trial on large sample size is needed to provide evidence about effectiveness of ESTS

In practice
ESTS is an integrative form of therapy that consists of four modules. The first module aims to share with the patient an evolutionary conceptualization of StPD and promote a working alliance. The patient’s life history is explored to determine if early temperament was characterized by openness and introversion, and how these traits may have incurred in a perceived judgmental environment. Consequently, the patient may have experienced critical beliefs about self and others leading to a defensive stance in the form of schizotypal traits. In the second and third module, change is promoted by exploring and widening the self-to-self and self-to-other relationships, respectively. Different narrative, relational and experiential techniques are used. The last module aims at consolidating changes achieved and preventing relapses.