Tag: Schema Therapy

An Overview of Schema (in Psychology)

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Introduction

In psychology and cognitive science, a schema (pl.: schemata or schemas) describes a pattern of thought or behaviour that organises categories of information and the relationships among them. It can also be described as a mental structure of preconceived ideas, a framework representing some aspect of the world, or a system of organising and perceiving new information, such as a mental schema or conceptual model. Schemata influence attention and the absorption of new knowledge: people are more likely to notice things that fit into their schema, while re-interpreting contradictions to the schema as exceptions or distorting them to fit. Schemata have a tendency to remain unchanged, even in the face of contradictory information. Schemata can help in understanding the world and the rapidly changing environment. People can organise new perceptions into schemata quickly as most situations do not require complex thought when using schema, since automatic thought is all that is required.

People use schemata to organise current knowledge and provide a framework for future understanding. Examples of schemata include mental models, social schemas, stereotypes, social roles, scripts, worldviews, heuristics, and archetypes. In Piaget’s theory of development, children construct a series of schemata, based on the interactions they experience, to help them understand the world.

Refer to Schema Therapy.

Brief History

“Schema” comes from the Greek word schēmat or schēma, meaning “figure”.

Prior to its use in psychology, the term “schema” had primarily seen use in philosophy. For instance, “schemata” (especially “transcendental schemata”) are crucial to the architectonic system devised by Immanuel Kant in his Critique of Pure Reason.

Early developments of the idea in psychology emerged with the gestalt psychologists (founded originally by Max Wertheimer) and Jean Piaget. The term schéma was introduced by Piaget in 1923. In Piaget’s later publications, action (operative or procedural) schémes were distinguished from figurative (representational) schémas, although together they may be considered a schematic duality. In subsequent discussions of Piaget in English, schema was often a mistranslation of Piaget’s original French schéme. The distinction has been of particular importance in theories of embodied cognition and ecological psychology.

This concept was first described in the works of British psychologist Frederic Bartlett, who drew on the term body schema used by neurologist Henry Head in 1932. In 1952, Jean Piaget, who was credited with the first cognitive development theory of schemas, popularised this ideology. By 1977, it was expanded into schema theory by educational psychologist Richard C. Anderson. Since then, other terms have been used to describe schema such as “frame”, “scene”, and “script”.

Schematic Processing

Through the use of schemata, a heuristic technique to encode and retrieve memories, the majority of typical situations do not require much strenuous processing. People can quickly organise new perceptions into schemata and act without effort. The process, however, is not always accurate, and people may develop illusory correlations, which is the tendency to form inaccurate or unfounded associations between categories, especially when the information is distinctive.

Nevertheless, schemata can influence and hamper the uptake of new information, such as when existing stereotypes, giving rise to limited or biased discourses and expectations, lead an individual to “see” or “remember” something that has not happened because it is more believable in terms of his/her schema. For example, if a well-dressed businessman draws a knife on a vagrant, the schemata of onlookers may (and often do) lead them to “remember” the vagrant pulling the knife. Such distortion of memory has been demonstrated. (refer to Background research next) Furthermore, it has also been seen to affect the formation of episodic memory in humans. For instance, one is more likely to remember a pencil case in an office than a skull, even if both were present in the office, when tested on certain recall conditions.

Schemata are interrelated and multiple conflicting schemata can be applied to the same information. Schemata are generally thought to have a level of activation, which can spread among related schemata. Through different factors such as current activation, accessibility, priming, and emotion, a specific schema can be selected.

Accessibility is how easily a schema can come to mind, and is determined by personal experience and expertise. This can be used as a cognitive shortcut, meaning it allows the most common explanation to be chosen for new information.

With priming (an increased sensitivity to a particular schema due to a recent experience), a brief imperceptible stimulus temporarily provides enough activation to a schema so that it is used for subsequent ambiguous information. Although this may suggest the possibility of subliminal messages, the effect of priming is so fleeting that it is difficult to detect outside laboratory conditions.

Background Research

Frederic Bartlett

The original concept of schemata is linked with that of reconstructive memory as proposed and demonstrated in a series of experiments by Frederic Bartlett. Bartlett began presenting participants with information that was unfamiliar to their cultural backgrounds and expectations while subsequently monitoring how they recalled these different items of information (stories, etc). Bartlett was able to establish that individuals’ existing schemata and stereotypes influence not only how they interpret “schema-foreign” new information but also how they recall the information over time. One of his most famous investigations involved asking participants to read a Native American folk tale, “The War of the Ghosts”, and recall it several times up to a year later. All the participants transformed the details of the story in such a way that it reflected their cultural norms and expectations, i.e. in line with their schemata. The factors that influenced their recall were:

  • Omission of information that was considered irrelevant to a participant;
  • Transformation of some of the details, or of the order in which events, etc., were recalled; a shift of focus and emphasis in terms of what was considered the most important aspects of the tale;
  • Rationalisation: details and aspects of the tale that would not make sense would be “padded out” and explained in an attempt to render them comprehensible to the individual in question; and
  • Cultural shifts: the content and the style of the story were altered in order to appear more coherent and appropriate in terms of the cultural background of the participant.

Bartlett’s work was crucially important in demonstrating that long-term memories are neither fixed nor unchanging but are constantly being adjusted as schemata evolve with experience. His work contributed to a framework of memory retrieval in which people construct the past and present in a constant process of narrative/discursive adjustment. Much of what people “remember” is confabulated narrative (adjusted and rationalised) which allows them to think of the past as a continuous and coherent string of events, even though it is probable that large sections of memory (both episodic and semantic) are irretrievable or inaccurate at any given time.

An important step in the development of schema theory was taken by the work of D.E. Rumelhart describing the understanding of narrative and stories. Further work on the concept of schemata was conducted by W.F. Brewer and J.C. Treyens, who demonstrated that the schema-driven expectation of the presence of an object was sometimes sufficient to trigger its incorrect recollection. An experiment was conducted where participants were requested to wait in a room identified as an academic’s study and were later asked about the room’s contents. A number of the participants recalled having seen books in the study whereas none were present. Brewer and Treyens concluded that the participants’ expectations that books are present in academics’ studies were enough to prevent their accurate recollection of the scenes.

In the 1970s, computer scientist Marvin Minsky was trying to develop machines that would have human-like abilities. When he was trying to create solutions for some of the difficulties he encountered he came across Bartlett’s work and concluded that if he was ever going to get machines to act like humans he needed them to use their stored knowledge to carry out processes. A frame construct was a way to represent knowledge in machines, while his frame construct can be seen as an extension and elaboration of the schema construct. He created the frame knowledge concept as a way to interact with new information. He proposed that fixed and broad information would be represented as the frame, but it would also be composed of slots that would accept a range of values; but if the world did not have a value for a slot, then it would be filled by a default value. Because of Minsky’s work, computers now have a stronger impact on psychology. In the 1980s, David Rumelhart extended Minsky’s ideas, creating an explicitly psychological theory of the mental representation of complex knowledge.

Roger Schank and Robert Abelson developed the idea of a script, which was known as a generic knowledge of sequences of actions. This led to many new empirical studies, which found that providing relevant schema can help improve comprehension and recall on passages.

Schemata have also been viewed from a sociocultural perspective with contributions from Lev Vygotsky, in which there is a transactional relationship between the development of a schema and the environment that influences it, such that the schema does not develop independently as a construct in the mind, but carries all the aspects of the history, social, and cultural meaning which influences its development. Schemata are not just scripts or frameworks to be called upon, but are active processes for solving problems and interacting with the world. However, schemas can also contribute to influential outside sociocultural perspectives, like the development of racism tendencies, disregard for marginalised communities and cultural misconceptions.

Modification

New information that falls within an individual’s schema is easily remembered and incorporated into their worldview. However, when new information is perceived that does not fit a schema, many things can happen. One of the most common reactions is for a person to simply ignore or quickly forget the new information they acquired. This can happen on an unconscious level—meaning, unintentionally an individual may not even perceive the new information. People may also interpret the new information in a way that minimises how much they must change their schemata. For example, Bob thinks that chickens do not lay eggs. He then sees a chicken laying an egg. Instead of changing the part of his schema that says “chickens don’t lay eggs”, he is likely to adopt the belief that the animal in question that he has just seen laying an egg is not a real chicken. This is an example of disconfirmation bias, the tendency to set higher standards for evidence that contradicts one’s expectations. This is also known as cognitive dissonance. However, when the new information cannot be ignored, existing schemata must be changed or new schemata must be created (accommodation).

Jean Piaget (1896–1980) was known best for his work with development of human knowledge. He believed knowledge was constructed on cognitive structures, and he believed people develop cognitive structures by accommodating and assimilating information. Accommodation is creating new schema that will fit better with the new environment or adjusting old schema. Accommodation could also be interpreted as putting restrictions on a current schema, and usually comes about when assimilation has failed. Assimilation is when people use a current schema to understand the world around them. Piaget thought that schemata are applied to everyday life and therefore people accommodate and assimilate information naturally. For example, if this chicken has red feathers, Bob can form a new schemata that says “chickens with red feathers can lay eggs”. This schemata, in the future, will either be changed or removed entirely.

Assimilation is the reuse of schemata to fit the new information. For example, when a person sees an unfamiliar dog, they will probably just integrate it into their dog schema. However, if the dog behaves strangely, and in ways that does not seem dog-like, there will be an accommodation as a new schema is formed for that particular dog. With accommodation and assimilation comes the idea of equilibrium. Piaget describes equilibrium as a state of cognition that is balanced when schema are capable of explaining what it sees and perceives. When information is new and cannot fit into a previous existing schema, disequilibrium can happen. When disequilibrium happens, it means the person is frustrated and will try to restore the coherence of his or her cognitive structures through accommodation. If the new information is taken then assimilation of the new information will proceed until they find that they must make a new adjustment to it later down the road, but for now the person remains at equilibrium again. The process of equilibration is when people move from the equilibrium phase to the disequilibrium phase and back into equilibrium.

In view of this, a person’s new schemata may be an expansion of the schemata into a subtype. This allows for the information to be incorporated into existing beliefs without contradicting them. An example in social psychology would be the combination of a person’s beliefs about women and their beliefs about business. If women are not generally perceived to be in business, but the person meets a woman who is, a new subtype of businesswoman may be created, and the information perceived will be incorporated into this subtype. Activation of either woman or business schema may then make further available the schema of “businesswoman”. This also allows for previous beliefs about women or those in business to persist. Rather than modifying the schemata related to women or to business persons, the subtype is its own category.

Self-schema

Schemata about oneself are considered to be grounded in the present and based on past experiences. Memories are framed in the light of one’s self-conception. For example, people who have positive self-schemata (i.e. most people) selectively attend to flattering information and ignore unflattering information, with the consequence that flattering information is subject to deeper encoding, and therefore superior recall. Even when encoding is equally strong for positive and negative feedback, positive feedback is more likely to be recalled. Moreover, memories may even be distorted to become more favourable: for example, people typically remember exam grades as having been better than they actually were. However, when people have negative self views, memories are generally biased in ways that validate the negative self-schema; people with low self-esteem, for instance, are prone to remember more negative information about themselves than positive information. Thus, memory tends to be biased in a way that validates the agent’s pre-existing self-schema.

There are three major implications of self-schemata. First, information about oneself is processed faster and more efficiently, especially consistent information. Second, one retrieves and remembers information that is relevant to one’s self-schema. Third, one will tend to resist information in the environment that is contradictory to one’s self-schema. For instance, students with a particular self-schema prefer roommates whose view of them is consistent with that schema. Students who end up with roommates whose view of them is inconsistent with their self-schema are more likely to try to find a new roommate, even if this view is positive. This is an example of self-verification.

As researched by Aaron Beck, automatically activated negative self-schemata are a large contributor to depression. According to Cox, Abramson, Devine, and Hollon (2012), these self-schemata are essentially the same type of cognitive structure as stereotypes studied by prejudice researchers (e.g. they are both well-rehearsed, automatically activated, difficult to change, influential toward behavior, emotions, and judgments, and bias information processing).

The self-schema can also be self-perpetuating. It can represent a particular role in society that is based on stereotype, for example: “If a mother tells her daughter she looks like a tom boy, her daughter may react by choosing activities that she imagines a tom boy would do. Conversely, if the mother tells her she looks like a princess, her daughter might choose activities thought to be more feminine.” This is an example of the self-schema becoming self-perpetuating when the person at hand chooses an activity that was based on an expectation rather than their desires.

Schema Therapy

Schema therapy was founded by Jeffrey Young and represents a development of cognitive behavioural therapy (CBT) specifically for treating personality disorders. Early maladaptive schemata are described by Young as broad and pervasive themes or patterns made up of memories, feelings, sensations, and thoughts regarding oneself and one’s relationships with others; they can be a contributing factor to treatment outcomes of mental disorders and the maintenance of ideas, beliefs, and behaviours towards oneself and others. They are considered to develop during childhood or adolescence, and to be dysfunctional in that they lead to self-defeating behaviour. Examples include schemata of abandonment/instability, mistrust/abuse, emotional deprivation, and defectiveness/shame.

Schema therapy blends CBT with elements of Gestalt therapy, object relations, constructivist and psychoanalytic therapies in order to treat the characterological difficulties which both constitute personality disorders and which underlie many of the chronic depressive or anxiety-involving symptoms which present in the clinic. Young said that CBT may be an effective treatment for presenting symptoms, but without the conceptual or clinical resources for tackling the underlying structures (maladaptive schemata) which consistently organize the patient’s experience, the patient is likely to lapse back into unhelpful modes of relating to others and attempting to meet their needs. Young focused on pulling from different therapies equally when developing schema therapy. Cognitive behavioural methods work to increase the availability and strength of adaptive schemata while reducing the maladaptive ones. This may involve identifying the existing schema and then identifying an alternative to replace it. Difficulties arise as these types of schema often exist in absolutes; modification then requires replacement to be in absolutes, otherwise the initial belief may persist. The difference between cognitive behavioural therapy and schema therapy according to Young is the latter “emphasizes lifelong patterns, affective change techniques, and the therapeutic relationship, with special emphasis on limited reparenting”. He recommended this therapy would be ideal for clients with difficult and chronic psychological disorders. Some examples would be eating disorders and personality disorders. He has also had success with this therapy in relation to depression and substance abuse.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Schema_(psychology) >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Schema Therapy?

Published on by Andrew Marshall2 Comments

Introduction

Schema therapy was developed by Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies (for example, traditional cognitive behavioural therapy (CBT)). Schema therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including CBT, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.

Background

Four main theoretical concepts in schema therapy are early maladaptive schemas (or simply schemas), coping styles, modes, and basic emotional needs:

  1. In cognitive psychology, a schema is an organised pattern of thought and behaviour. 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 a belief about the self or the world. For instance, a person with an Abandonment schema 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.
  2. Coping styles are a person’s behavioural 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 changes their behavior in expectation that the feared outcome is inevitable. In “counterattack”, also called “overcompensation”, the person puts extra work into not allowing the schema’s feared outcome to happen. 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 avoidance coping style might then behave in ways to limit the closeness in the relationship to try to protect themself 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 avoidance coping style might avoid situations that make them feel defective, or might try to numb the feeling with addictions or distractions. A person using a surrender coping style might tolerate unfair criticism without defending themself. A person using the counterattack/overcompensation coping style might put extra effort into being superhuman.
  3. Modes are mind states 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).
  4. If a patient’s basic emotional needs are not met in childhood, then schemas, coping styles, and modes can develop. Some basic needs that have been identified are: connection, mutuality, reciprocity, flow, and autonomy. For example, a child with unmet needs around connection—perhaps due to parental loss to death, divorce, or addiction—might develop an Abandonment schema.

The goal of schema therapy is to help patients meet their basic emotional needs by helping the patient learn how to:

  • Heal schemas by diminishing the intensity of emotional memories comprising the schema and the intensity of bodily sensations, and by changing the cognitive patterns connected to the schema; and
  • Replace maladaptive coping styles and responses with adaptive patterns of behaviour.

Techniques used in schema therapy including limited reparenting and Gestalt therapy psychodrama techniques such as imagery re-scripting and empty chair dialogues. See § Techniques in schema therapy, below.

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

Schema domains are five broad categories of unmet needs into which are grouped 18 early maladaptive schemas identified by Young, Klosko & Weishaar (2003):

  1. Disconnection/Rejection includes 5 schemas:
    • Abandonment/Instability
    • Mistrust/Abuse
    • Emotional Deprivation
    • Defectiveness/Shame
    • Social Isolation/Alienation
  2. Impaired Autonomy and/or Performance includes 4 schemas:
    • Dependence/Incompetence
    • Vulnerability to Harm or Illness
    • Enmeshment/Undeveloped Self
    • Failure
  3. Impaired Limits includes 2 schemas:
    • Entitlement/Grandiosity
    • Insufficient Self-Control and/or Self-Discipline
  4. Other-Directedness includes 3 schemas:
    • Subjugation
    • Self-Sacrifice
    • Approval-Seeking/Recognition-Seeking
  5. Overvigilance/Inhibition includes 4 schemas:
    • Negativity/Pessimism
    • Emotional Inhibition
    • Unrelenting Standards/Hypercriticalness
    • Punitiveness

Yalcin, Lee & Correia (2020) 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 Young, Klosko & Weishaar (2003). 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

Young, Klosko & Weishaar (2003) identified 10 schema modes, further described by Jacob, Genderen & Seebauer (2015), 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. Behaviours 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 behaviours 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 fuelled 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. Behaviours 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 behaviours 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.
  • Punitive Parent is identified by beliefs of a patient that they should be harshly punished, perhaps due to feeling “defective”, or making a simple mistake. The patient may feel that they should be punished for even existing. Sadness, anger, impatience, and judgment are directed to the patient and from the patient. The Punitive Parent has great difficulty in forgiving themself even under average circumstances in which anyone could fall short of their standards. The Punitive Parent does not wish to allow for human error or imperfection, thus punishment is what this mode seeks.
  • Demanding Parent is associated with a strong sense of pressure to achieve. When experiencing this mode, people often feel like their performance is inadequate, no matter how well they do or how much effort they make. Common beliefs also involve the idea that rest, fun, and relaxation are not acceptable and that one’s attention should remain focused on achieving more. It is important to note that while this mode is often accompanied by Punitive Parent, this is not always the case. Clients with the Demanding Parent mode feel pressure and dissatisfaction with their achievements, but not necessarily guilt, shame or feelings of worthlessness.
  • Healthy Adult is the mode that schema therapy aims to help a patient achieve as the long-lasting state of well-being. The Healthy Adult is comfortable making decisions, is a problem-solver, thinks before acting, is appropriately ambitious, sets limits and boundaries, nurtures self and others, forms healthy relationships, takes on all responsibility, sees things through, and enjoys/partakes in enjoyable adult activities and interests with boundaries enforced, takes care of their physical health, and values themself. In this schema mode the patient focuses on the present day with hope and strives toward the best tomorrow possible. The Healthy Adult forgives the past, no longer sees themself as a victim (but as a survivor), and expresses all emotions in ways which are healthy and cause no harm.

Techniques in Schema Therapy

Treatment plans in schema therapy generally encompass three basic classes of techniques: cognitive, experiential, and behavioural (in addition to the basic healing components of the therapeutic relationship). Cognitive strategies expand on standard cognitive behavioural therapy techniques such as listing pros and cons of a schema, testing the validity of a schema, or conducting a dialogue between the “schema side” and the “healthy side”. Experiential and emotion focused strategies expand on standard Gestalt therapy psychodrama and imagery techniques. Behavioural pattern-breaking strategies expand on standard behaviour therapy techniques, such as role playing an interaction and then assigning the interaction as homework. One of the most central techniques in schema therapy is the use of the therapeutic relationship, specifically through a process called “limited reparenting”.

Specific techniques often used in schema therapy include flash cards with important therapeutic messages, created in session and used by the patient between sessions, and the schema diary – a template or workbook that is filled out by the patient between sessions and that records the patient’s progress in relation to all the theoretical concepts in schema therapy.

Schema Therapy and Psychoanalysis

From an integrative psychotherapy perspective, limited reparenting and the experiential techniques, particularly around changing modes, could be seen as actively changing what psychoanalysis has described as object relations. Historically, mainstream psychoanalysis tended to reject active techniques—such as Fritz Perls’ Gestalt therapy work or Franz Alexander’s “corrective emotional experience” – but contemporary relational psychoanalysis (led by analysts such as Lewis Aron, and building on the ideas of earlier unorthodox analysts such as Sándor Ferenczi) is more open to active techniques. It is notable that in a head-to-head comparison of a psychoanalytic object relations treatment (Otto F. Kernberg’s transference focused psychotherapy) and schema therapy, the latter has been demonstrated to be more effective in treating Borderline Personality Disorder.

Outcome Studies on Schema Therapy

Schema Therapy vs Transference Focused Psychotherapy Outcomes

Dutch investigators, including Josephine Giesen-Bloo and Arnoud Arntz (the project leader), compared schema therapy (also known as schema focused therapy or SFT) with transference focused psychotherapy (TFP) in the treatment of borderline personality disorder. 86 patients were recruited from four mental health institutes in the Netherlands. Patients in the study received two sessions per week of SFT or TFP for three years. After three years, full recovery was achieved in 45% of the patients in the SFT condition, and in 24% of those receiving TFP. One year later, the percentage fully recovered increased to 52% in the SFT condition and 29% in the TFP condition, with 70% of the patients in the SFT group achieving “clinically significant and relevant improvement”. Moreover, the dropout rate was only 27% for SFT, compared with 50% for TFP.

Patients began to feel and function significantly better after the first year, with improvement occurring more rapidly in the SFT group. There was continuing improvement in subsequent years. Thus investigators concluded that both treatments had positive effects, with schema therapy clearly more successful.

Less Intensive Outpatient, Individual Schema Therapy

Dutch investigators, including Marjon Nadort and Arnoud Arntz, assessed the effectiveness of schema therapy in the treatment of borderline personality disorder when utilised in regular mental health care settings. A total of 62 patients were treated in eight mental health centres located in the Netherlands. The treatment was less intensive along a number of dimensions including a shift from twice weekly to once weekly sessions during the second year. Despite this, there was no lessening of effectiveness with recovery rates that were at least as high and similarly low dropout rates.

Pilot Study of Group Schema Therapy for Borderline Personality Disorder

Investigators Joan Farrell, Ida Shaw and Michael Webber at the Indiana University School of Medicine Centre for BPD Treatment & Research tested the effectiveness of adding an eight-month, 30-session schema therapy group to treatment-as-usual (TAU) for borderline personality disorder (BPD) with 32 patients. The dropout rate was 0% for those patients who received group schema therapy in addition to TAU and 25% for those who received TAU alone. At the end of treatment, 94% of the patients who received group schema therapy in addition to TAU compared to 16% of the patients receiving TAU alone no longer met BPD diagnostic criteria. The schema therapy group treatment led to significant reductions in symptoms and global improvement in functioning. The large positive treatment effects found in the group schema therapy study suggest that the group modality may augment or catalyse the active ingredients of the treatment for BPD patients. As of 2014, a collaborative randomised controlled trial is under way at 14 sites in six countries to further explore this interaction between groups and schema therapy.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Schema_therapy >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Schema Therapy?

Published on by Andrew Marshall2 Comments

Introduction

Schema therapy was developed by Jeffrey E. Young for use in treatment of personality disorders and chronic DSM Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies (for example, traditional cognitive behavioural therapy, CBT). Schema therapy is an integrative psychotherapy combining theory and techniques from previously existing therapies, including CBT, psychoanalytic object relations theory, attachment theory, and Gestalt therapy.

Concepts

Four main theoretical concepts in schema therapy are early maladaptive schemas (or simply schemas), coping styles, modes, and basic emotional needs:

  1. In cognitive psychology, a schema is an organised pattern of thought and behaviour. 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 a belief about the self or the world. For instance, a person with an Abandonment schema 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.
  2. Coping styles are a person’s behavioural 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 changes their behaviour in expectation that the feared outcome is inevitable. In “counterattack”, also called “overcompensation”, the person puts extra work into not allowing the schema’s feared outcome to happen. 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 avoidance coping style might then behave in ways to limit the closeness in the relationship to try to protect themselves 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 avoidance coping style might avoid situations that make them feel defective, or might try to numb the feeling with addictions or distractions. A person 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 being superhuman.
  3. Modes are mind states 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).
  4. If a patient’s basic emotional needs are not met in childhood, then schemas, coping styles, and modes can develop. Some basic needs that have been identified are: connection, mutuality, reciprocity, flow, and autonomy. For example, a child with unmet needs around connection – perhaps due to parental loss to death, divorce, or addiction – might develop an Abandonment schema.

The goal of schema therapy is to help patients meet their basic emotional needs by helping the patient learn how to:

  • Heal schemas by diminishing the intensity of emotional memories comprising the schema and the intensity of bodily sensations, and by changing the cognitive patterns connected to the schema; and
  • Replace maladaptive coping styles and responses with adaptive patterns of behaviour.

Techniques used in schema therapy including limited reparenting and Gestalt therapy psychodrama techniques such as imagery re-scripting and empty chair dialogues (Refer to techniques in schema therapy, below).

There is a growing literature of outcome studies on schema therapy, where schema therapy has shown impressive results (Refer to outcome studies on schema therapy, below).

Early Maladaptive Schemas

Refer to List of 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

Schema domains are five broad categories of unmet needs into which are grouped 18 early maladaptive schemas identified by Young, Klosko & Weishaar (2003):

  • 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.
  • Over-vigilance/Inhibition includes 4 schemas:
    • Negativity/Pessimism.
    • Emotional Inhibition.
    • Unrelenting Standards/Hypercriticalness.
    • Punitiveness.

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

Young, Klosko & Weishaar (2003) identified 10 schema modes 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.

Angry ChildThis is fuelled mainly by feelings of victimisation 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 themselves or harm others. The Angry Child schema mode is enraged, anxious, frustrated, self-doubting, feels unsupported in ideas and vulnerable.
Impulsive ChildThis is the mode where anything goes. Behaviours 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 behaviours which a patient in this schema mode might display. Impulsive Child is the rebellious and careless schema mode.
Detached ProtectorThis 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.
Abandoned ChildThis 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. Behaviours of patients in Abandoned 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 behaviours 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.
Punitive ParentThis is identified by beliefs of a patient that they should be harshly punished, perhaps due to feeling “defective”, or making a simple mistake. The patient may feel that they should be punished for even existing. Sadness, anger, impatience, and judgement are directed to the patient and from the patient. The Punitive Parent has great difficulty in forgiving themselves even under average circumstances in which anyone could fall short of their standards. The Punitive Parent does not wish to allow for human error or imperfection, thus punishment is what this mode seeks.
Healthy AdultThis is the mode that schema therapy aims to help a patient achieve as the long-lasting state of well-being. The Healthy Adult is comfortable making decisions, is a problem-solver, thinks before acting, is appropriately ambitious, sets limits and boundaries, nurtures self and others, forms healthy relationships, takes on all responsibility, sees things through, and enjoys/partakes in enjoyable adult activities and interests with boundaries enforced, takes care of their physical health, and values themselves. In this schema mode the patient focuses on the present day with hope and strives toward the best tomorrow possible. The Healthy Adult forgives the past, no longer sees themselves as a victim (but as a survivor), and expresses all emotions in ways which are healthy and cause no harm.

Techniques in Schema Therapy

Treatment plans in schema therapy generally encompass three basic classes of techniques: cognitive, experiential, and behavioural (in addition to the basic healing components of the therapeutic relationship). Cognitive strategies expand on standard CBT techniques such as listing pros and cons of a schema, testing the validity of a schema, or conducting a dialogue between the “schema side” and the “healthy side”. Experiential and emotion focused strategies expand on standard Gestalt therapy psychodrama and imagery techniques. Behavioural pattern-breaking strategies expand on standard behaviour therapy techniques, such as role playing an interaction and then assigning the interaction as homework. One of the most central techniques in schema therapy is the use of the therapeutic relationship, specifically through a process called “limited reparenting”.

Specific techniques often used in schema therapy include flash cards with important therapeutic messages, created in session and used by the patient between sessions, and the schema diary – a template or workbook that is filled out by the patient between sessions and that records the patient’s progress in relation to all the theoretical concepts in schema therapy.

Schema Therapy and Psychoanalysis

From an integrative psychotherapy perspective, limited reparenting and the experiential techniques, particularly around changing modes, could be seen as actively changing what psychoanalysis has described as object relations. Historically, mainstream psychoanalysis tended to reject active techniques – such as Fritz Perls’ Gestalt therapy work or Franz Alexander’s “corrective emotional experience” – but contemporary relational psychoanalysis (led by analysts such as Lewis Aron, and building on the ideas of earlier unorthodox analysts such as Sándor Ferenczi) is more open to active techniques. It is notable that in a head to head comparison of a psychoanalytic object relations treatment (Otto F. Kernberg’s transference focused psychotherapy) and schema therapy, the latter has been demonstrated to be more effective in treating Borderline Personality Disorder.

Outcome Studies on Schema Therapy

Schema Therapy vs Transference Focused Psychotherapy Outcomes

Dutch investigators, including Josephine Giesen-Bloo and Arnoud Arntz (the project leader), compared schema therapy (also known as schema focused therapy or SFT) with transference focused psychotherapy (TFP) in the treatment of borderline personality disorder. 86 patients were recruited from four mental health institutes in the Netherlands. Patients in the study received two sessions per week of SFT or TFP for three years. After three years, full recovery was achieved in 45% of the patients in the SFT condition, and in 24% of those receiving TFP. One year later, the percentage fully recovered increased to 52% in the SFT condition and 29% in the TFP condition, with 70% of the patients in the SFT group achieving “clinically significant and relevant improvement”. Moreover, the dropout rate was only 27% for SFT, compared with 50% for TFP.

Patients began to feel and function significantly better after the first year, with improvement occurring more rapidly in the SFT group. There was continuing improvement in subsequent years. Thus investigators concluded that both treatments had positive effects, with schema therapy clearly more successful.

Less Intensive Outpatient, Individual Schema Therapy

Dutch investigators, including Marjon Nadort and Arnoud Arntz, assessed the effectiveness of schema therapy in the treatment of borderline personality disorder when utilised in regular mental health care settings. A total of 62 patients were treated in eight mental health centres located in the Netherlands. The treatment was less intensive along a number of dimensions including a shift from twice weekly to once weekly sessions during the second year. Despite this, there was no lessening of effectiveness with recovery rates that were at least as high and similarly low dropout rates.

Pilot Study of Group Schema Therapy for Borderline Personality Disorder

Investigators Joan Farrell, Ida Shaw and Michael Webber at the Indiana University School of Medicine Centre for BPD Treatment & Research tested the effectiveness of adding an eight-month, 30-session schema therapy group to treatment-as-usual (TAU) for borderline personality disorder (BPD) with 32 patients. The dropout rate was 0% for those patients who received group schema therapy in addition to TAU and 25% for those who received TAU alone. At the end of treatment, 94% of the patients who received group schema therapy in addition to TAU compared to 16% of the patients receiving TAU alone no longer met BPD diagnostic criteria. The schema therapy group treatment led to significant reductions in symptoms and global improvement in functioning. The large positive treatment effects found in the group schema therapy study suggest that the group modality may augment or catalyse the active ingredients of the treatment for BPD patients. As of 2014, a collaborative randomised controlled trial is under way at 14 sites in six countries to further explore this interaction between groups and schema therapy.