Schema therapy is a form of integrative psychotherapy developed by Jeffrey E. Young for use in the treatment of personality disorders and other chronic conditions such as long-term depression, anxiety, and eating disorders. Its basic assumption is that invalid assumptions and mental representations (schemas) hinder one's psychological functioning. Schema therapy aims to challenge and adjust those assumptions.
Theoretical background Schema therapy is an integrative psychotherapy combining original theoretical concepts and techniques with those from pre-existing models, including cognitive behavioral therapy, attachment theory, Gestalt therapy, constructivism, post-rationalist cognitive therapy, and psychodynamic psychotherapy.;
Four main theoretical concepts Four main theoretical concepts in schema therapy are early maladaptive schemas (or simply schemas), coping styles, modes, and core emotional needs:
Schema In cognitive psychology, a schema is an organized pattern of thought and behavior. It can also be described as a mental structure of preconceived ideas, a framework representing some aspect of the world, or a system of organizing and perceiving new information. In schema therapy, a schema specifically refers to an early maladaptive schema, defined as a pervasive self-defeating or dysfunctional theme or pattern of memories, emotions, and physical sensations, developed during childhood or adolescence and elaborated throughout one's lifetime. Often they have the form of beliefs about the self or the world. For instance, a person with an Abandonment schemaFollowing the convention in , the names of schemas and modes are capitalized. They are also italicized in this article for clarity. could be hypersensitive (have an "emotional button" or "trigger") about their perceived value to others, which in turn could make them feel sad and panicky in their interpersonal relationships.
Coping style "Coping styles" are a person's behavioral responses to schemas. There are three potential coping styles: In "avoidance" the person tries to avoid situations that activate the schema. In "surrender" the person gives into the schema, doesn't try to fight against it, and behaves passively in a manner consistent with an expectation that the feared outcome is inevitable. In "counterattack", also called "overcompensation", the person puts extra work into fighting back, hoping to prevent the schema's feared outcome from happening.
These maladaptive coping styles (overcompensation, avoidance, or surrender) very often wind up reinforcing the schemas. Continuing the Abandonment example: having imagined a threat of abandonment in a relationship and feeling sad and panicky, a person using an avoidant coping style might then behave in ways to limit the closeness in the relationship to try to protect him/herself from being abandoned. The resulting loneliness or even actual loss of the relationship could easily reinforce the person's Abandonment schema. Another example can be given for the Defectiveness schema: A person using an avoidant coping style might avoid situations that make them feel defective, or might try to numb the feeling with addictions or distractions. People using a surrender coping style might tolerate unfair criticism without defending themselves. A person using the counterattack/overcompensation coping style might put extra effort into appearing superhuman.
Modes "Modes" are states of mind that cluster schemas and coping styles into a temporary "way of being" that a person can shift into occasionally or more frequently. For example, a Vulnerable Child mode might be a state of mind encompassing schemas of Abandonment, Defectiveness, Mistrust/Abuse and a coping style of surrendering (to the schemas).
Core emotional needs Some basic emotional needs that have been identified are connection, safety, validation, reciprocity, and autonomy. If a patient's core emotional needs are not met in childhood, then schemas, coping styles, and modes can develop. For example, a child with unmet needs around connection—perhaps due to parental loss to death, divorce, or addiction—might develop an Abandonment schema.
Early maladaptive schemas
"Early maladaptive schemas" are self-defeating emotional and cognitive patterns established from childhood and repeated throughout life. They may be made up of emotional memories of past hurt, tragedy, fear, abuse, neglect, unmet safety needs, abandonment, or lack of normal human affection in general. Early maladaptive schemas can also include bodily sensations associated with such emotional memories. Early maladaptive schemas can have different levels of severity and pervasiveness: the more severe the schema, the more intense the negative emotion when the schema is triggered and the longer it lasts; the more pervasive the schema, the greater the number of situations that trigger it.
Schema domains: groups of early maladaptive schemas "Schema domains" are broad categories of unmet needs into which are grouped 18 early maladaptive schemas identified by : Disconnection/Rejection includes 5 schemas: Abandonment/Instability Mistrust/Abuse Emotional Deprivation Defectiveness/Shame Social Isolation/Alienation Impaired Autonomy and/or Performance includes 4 schemas: Dependence/Incompetence Vulnerability to Harm or Illness Enmeshment/Undeveloped Self Failure Impaired Limits includes 2 schemas: Entitlement/Grandiosity Insufficient Self-Control and/or Self-Discipline Other-Directedness includes 3 schemas: Subjugation Self-Sacrifice Approval-Seeking/Recognition-Seeking Overvigilance/Inhibition includes 4 schemas: Negativity/Pessimism Emotional Inhibition Unrelenting Standards/Hypercriticalness Punitiveness
did a primary and a higher-order factor analysis of data from a large clinical sample and smaller non-clinical population. The higher-order factor analysis indicated four schema domains—Emotional Dysregulation, Disconnection, Impaired Autonomy/Underdeveloped Self, and Excessive Responsibility/Overcontrol—that overlap with the five domains (listed above) proposed earlier by . The primary factor analysis indicated that the Emotional Inhibition schema could be split into Emotional Constriction and Fear of Losing Control, and the Punitiveness schema could be split into Punitiveness (Self) and Punitiveness (Other).
Schema modes
"Schema modes" are momentary mind states which every human being experiences at one time or another. A schema mode consists of a cluster of schemas and coping styles. Life situations that a person finds disturbing or offensive, or arouse bad memories, are referred to as "triggers" that tend to activate schema modes. In psychologically healthy persons, schema modes are mild, flexible mind states that are easily pacified by the rest of their personality. In patients with personality disorders, schema modes are more severe, rigid mind states that may seem split off from the rest of their personality.
Identified schema modes identified 10 schema modes, further described by , and grouped into four categories. The four categories are: Child modes, Dysfunctional Coping modes, Dysfunctional Parent modes, and the Healthy Adult mode. The four Child modes are: Vulnerable Child, Angry Child, Impulsive/Undisciplined Child, and Happy Child. The three Dysfunctional Coping modes are: Compliant Surrenderer, Detached Protector, and Overcompensator. The two Dysfunctional Parent modes are: Punitive Parent and Demanding Parent.
Vulnerable Child is the mode in which a patient may feel defective in some way, thrown aside, unloved, obviously alone, or may be in a "me against the world" mindset. The patient may feel as though peers, friends, family, and even the entire world have abandoned them. Behaviors of patients in Vulnerable Child mode may include (but are not limited to) falling into major depression, pessimism, feeling unwanted, feeling unworthy of love, and perceiving personality traits as irredeemable flaws. Rarely, a patient's self-perceived flaws may be intentionally withheld on the inside; when this occurs, instead of showing one's true self, the patient may appear to others as "egotistical", "attention-seeking", selfish, distant, and may exhibit behaviors unlike their true nature. The patient might create a narcissistic alter-ego/persona in order to escape or hide the insecurity from others. Due to fear of rejection, of feeling disconnected from their true self and poor self-image, these patients, who truly desire companionship/affection, may instead end up pushing others away. Angry Child is fueled mainly by feelings of victimization or bitterness, leading towards negativity, pessimism, jealousy, and rage. While experiencing this schema mode, a patient may have urges to yell, scream, throw/break things, or possibly even injure themself or harm others. The Angry Child schema mode is enraged, anxious, frustrated, self-doubting, feels unsupported in ideas and vulnerable. Impulsive Child is the mode where anything goes. Behaviors of the Impulsive Child schema mode may include reckless driving, substance abuse, cutting oneself, suicidal thoughts, gambling, or fits of rage, such as punching a wall when "triggered" or laying blame of circumstantial difficulties upon innocent people. Unsafe sex, rash decisions to run away from a situation without resolution, tantrums perceived by peers as infantile, and so forth are a mere few of the behaviors which a patient in this schema mode might display. Impulsive Child is the rebellious and careless schema mode. Happy Child occurs when one feels like their needs are being met. When people experience the Happy Child mode, they feel safe, loved, and content. They experience a joyful sense of wonder and playfulness about the world. This mode is healthy as it represents the absence of activation of maladaptive schemas. While healthy adults spend most of their time in the Healthy Adult mode, they also cultivate their Happy Child to balance the demands of life with a sense of lightheartedness. Compliant Surrenderer is a coping mode where one experiences the schema that triggered it as true. This in turn leads to feelings such as helplessness, sadness, guilt, or anger about the situation. People in this mode often believe it is pointless to challenge their schema, and that it must simply be accepted. They also often adopt an interpersonally passive and dependent style, seeking to please people in their lives, to minimize conflict, and therefore avoid further harm or abuse. Detached Protector is based in escape. Patients in Detached Protector schema mode withdraw, dissociate, alienate, or hide in some way. This may be triggered by numerous stress factors or feelings of being overwhelmed. When a patient with insufficient skills is in a situation involving excessive demands, it can trigger a Detached Protector response mode. Stated simply, patients become numb in order to protect themselves from the harm or stress of what they fear is to come, or to protect themselves from fear of the unknown in general. Overcompensator is marked by attempts to fight off schemas in a way that is rigid and extreme. It often involves aggressiveness, rebelliousness, violating the rights of other people, and an attempt to dominate them. In this mode, a person who feels emotionally deprived demands affection from others, while a person who believes others cannot be trusted will try to preemptively hurt them before they do. It may also involve obsessiveness in an excessive attempt to control the environment, or forced behaviors, such as extreme forgiveness for someone with a Punitiveness schema.