Introduction

Schema Therapy is a form of cognitive-behavioral therapy that was developed to help people with longstanding and deeply ingrained patterns of thinking, feeling, and behaving that are causing them distress and problems in their lives. These patterns, which are referred to as “schemas,” can be thought of as negative “life scripts” that can lead people to repeatedly make choices and engage in behaviors that are not in their best interests.

Schema therapy aims to help people identify and change these negative patterns in order to improve their quality of life and relationships. It is often used to treat a range of mental health issues, including personality disorders, depression, and anxiety.

The origin of Schema Therapy

Schema therapy was developed by Dr. Jeffrey Young in the 1990s. Jeffrey Young was using cognitive-behavioral therapy (CBT) but had poor results applying CBT to more difficult cases, especially in the case of personality disorders (borderline personality disorder, etc). He developed Schema therapy in order to treat these more difficult cases. This modality combines elements from several different theoretical approaches, including cognitive therapy, behavioral therapy.

What is a Schema?

The main goal of schema therapy is to help individuals identify and change negative patterns of thinking and behavior that are known as schemas. Schemas are deeply ingrained beliefs and thoughts about ourselves, others, and the world that can be negative and maladaptive. These negative schemas can lead to negative emotions, behaviors, and relationships, and can be triggered by certain life events or situations.

The Methodology of Schema Therapy

In schema therapy, the therapist works with the patient to identify their negative schemas and the triggers that activate them. The therapist then helps the patient develop coping strategies and new ways of thinking and behaving that are more adaptive and healthy.

Schema therapy often involves the use of techniques such as role-playing, chair work, and visualization (image rescripting similar to Ideal Parent Figure Protocol) to help the patient understand and change their schemas. The therapist may also use homework assignments and other techniques to help the patient practice and apply their new skills in real-life situations.

Overall, schema therapy is designed to help individuals overcome long standing patterns of negative and behavior, and develop a more positive and fulfilling sense of self and relationships with others.
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The Eighteen Early Maladaptive Schemas

Schema therapy has identified 18 schemas which are core, negative themes or patterns which shape an individual’s personality and behavior. These patterns are often formed in childhood or adolescence as a result of negative or unhealthy experiences and can continue to influence a person’s thoughts, feelings, and behaviors in adulthood. These 18 Early Maladaptive Schemas (EMSs) are negative patterns of thinking and behaving that are thought to be at the root of many emotional and relationship problems. They are called “early” because they are thought to develop in childhood or adolescence, and “maladaptive” because they interfere with a person’s ability to function effectively in their life.

The Five Schema Domains

The 5 schema domains refer to the broad categories that the 18 schemas fall into in schema therapy. In schema therapy, the therapist works with the client to identify the schema domains that are most relevant to their current problems and to develop strategies to challenge and overcome these schemas. This may involve a variety of techniques such as cognitive restructuring, emotional regulation, and experiential techniques. Schema therapy is typically a longer-term form of treatment, as it involves addressing deep-seated patterns of thinking and behavior that have been developed over time.

How the 18 Schemas are grouped into the 5 Schema Domains

Each of the 18 early maladaptive schemas can be segmented into one of the five schema domains:

Group 1. The Disconnection and Rejection Schema Domain:

This domain is the primary set of attachment schemas. In this program: Healing the Core Attachment Schemas, we work through each of the five attachment schemas.

1. Emotional Deprivation: The belief that one’s emotional needs will not be met by others.
2. Abandonment: The fear of being abandoned or rejected by others.
3. Mistrust/Abuse: The belief that others are unreliable or untrustworthy and may harm or exploit one.
4. Defectiveness/Shame: The belief that one is flawed or inadequate and not worthy of love or acceptance.
5. Social Isolation/Alienation: The belief that one is different or separate from others and does not fit in.

Group 2. The Impaired Autonomy and Performance Schema Domain:

This domain relates to the inability to go after what is important in life. In this program: Overcoming Obstacle to Exploration, we work through each of these schemas of impaired autonomy.

6. Dependence/Incompetence: The belief that one is unable to function independently and must rely on others for support.
7. Vulnerability to Harm or Illness: The fear of being physically or emotionally harmed or becoming sick.
8. Enmeshment/Undeveloped Self: The belief that one’s identity and goals are overly influenced by the needs and desires of others.
9. Failure: The belief that one is unable to succeed or achieve one’s goals.

Group 3. The Impaired Limits Schema Domain:

The schemas of this domain relate to entitlement and impulsiveness.

10. Insufficient Self-Control/Self-Discipline: The inability to control one’s thoughts, emotions, or behaviors.
11. Grandiosity/Entitlement: the belief that rules don’t apply to you, might involve a disregard for others, disregard for the long term consequences of actions, etc.

Group 4. The Other-Directedness Schema Domain:

This domain largely overlaps with ‘codependency’, an excessive and unbalanced concern for the well being of others over oneself. In this program: Codependency and other-directedness, we work through each of these schemas of excessive concern for others and work towards valuing ourselves.

12. Subjugation: The belief that one’s needs and desires must be suppressed in order to please or gain the approval of others.
13. Self-Sacrifice: The belief that one’s own needs and desires are unimportant and must be sacrificed for the benefit of others.
14. Approval-Seeking/Recognition-Seeking: The need for constant approval and validation from others.

Group 5. The Overvigilance and Inhibition Schema Domain:

This domain includes schemas related to feelings of vulnerability and a need for constant vigilance and protection. It also includes the inability to express or recognize one’s own emotions. In this program: Overcoming Negativity Bias and Perfectionism  we work through each of these schemas of the overvigilance and inhibition schema domain.

15. Negativity/Pessimism: The tendency to focus on the negative aspects of situations and expect negative outcomes.
16. Emotional Inhibition: The inability to express or recognize one’s own emotions.
17. Unrelenting Standards/Hyper-Criticalness: The belief that one must constantly strive for perfection and that any failure is unacceptable. This often has a moral aspect to it of holding to exceedingly high ethical standards.
18. Punitiveness: The belief that self or others must be punished for their mistakes or misbehaviors.

These schemas are often interconnected and can influence and reinforce one another. Schema therapy aims to help individuals identify and change these negative patterns of thinking and behavior in order to improve their emotional and mental health. Experiential techniques like chair work, mode interviews, and image descriptions are the primary means for bringing about this transformation.

Modes in Schema Therapy

In schema therapy, Modes are defined as “different psychological states that an individual experiences in response to certain triggers or life events.” There are four types of modes in schema therapy:

1. Healthy Adult Mode: This mode represents the healthy, adaptive part of the self that is able to think and act in a rational, realistic, and balanced way. It is able to manage emotions and behaviors effectively and make decisions based on one’s own needs and values. In this program Embodying Secure Attachment: developing the healthy adult mode we use meditation to systematically develop the qualities of the healthy adult which include: ego-strength, self-definition, self-agency, stress-tolerance, exploration, and becoming the secure-attachment-figure for others.
2. Child Modes: These modes represent the different aspects of the self that were developed during childhood and continue to influence thoughts, feelings, and behaviors in the present. There are three main types of child modes: the Vulnerable Child mode, the Angry Child mode, and the Happy Child mode.
3. Dysfunctional Parent Mode: This mode represents the internalized voice of critical or unhealthy caregivers or authority figures. It is characterized by negative, judgmental, and controlling thoughts and behaviors. In this course we use meditation to systematically confront and work through the inner critic (parent voices).
4. Maladaptive Coping Modes: These modes represent the unhealthy or maladaptive ways in which an individual may try to cope with or avoid their negative schemas or life stressors. Examples of maladaptive coping modes include the Detached Protector mode, the Compliant Surrenderer mode, and the Overcompensator mode. In this course we use meditation to work through the three major types of coping modes

In Schema Therapy, the therapist works with the patient to identify and understand their different modes and how they are activated by different triggers or life events. This is often done through chair-work  or “mode interviews”. The therapist then helps the patient develop healthier coping strategies and ways of interacting with their different modes in order to improve their emotional and mental health.

What conditions is schema therapy effective for?

Schema Therapy is designed to help people who have struggled with traditional forms of therapy, such as cognitive-behavioral therapy (CBT), or who have not responded well to other treatments.

Research has shown that schema therapy can be effective for a range of mental health conditions, including:

• Personality disorders: Schema therapy has been found to be effective in the treatment of personality disorders, particularly borderline personality disorder (BPD).
• Mood disorders: Schema therapy has been found to be effective in the treatment of depression and has also been used to treat bipolar disorder.
• Anxiety disorders: Schema therapy has been found to be effective in the treatment of anxiety disorders, including generalized anxiety disorder (GAD) and social anxiety disorder (SAD).
• Eating disorders: Schema therapy has been found to be effective in the treatment of eating disorders, including anorexia nervosa and bulimia nervosa.
• Substance abuse and addiction: Schema therapy has been found to be effective in the treatment of substance abuse and addiction.
• Relationship difficulties: Schema therapy has been found to be effective in the treatment of relationship difficulties, including conflicts with partners, family members, or coworkers.

It’s important to note that schema therapy is typically a longer-term form of treatment and may not be suitable for everyone. It’s important to work with a mental health professional to determine the best treatment approach for your specific needs and concerns.

How effective is Schema Therapy?

Research has shown that schema therapy can be effective in the treatment of a range of mental health conditions, including personality disorders, mood disorders, anxiety disorders, eating disorders, substance abuse and addiction, and relationship difficulties.

Several studies have found schema therapy to be effective in the treatment of borderline personality disorder (BPD), with one study finding that 74% of individuals with BPD who received schema therapy had significant improvements in symptoms and functioning, compared to only 33% of those who received treatment as usual. Other studies have also found schema therapy to be effective in the treatment of depression, anxiety disorders, and eating disorders.

Overall, schema therapy has been found to be a promising treatment approach, with studies showing that it can lead to significant improvements in symptoms and functioning for many individuals. However, it is important to note that schema therapy is typically a longer-term form of treatment and may not be suitable for everyone. It’s important to work with a mental health professional to determine the best treatment approach for your specific needs and concerns.

How do Attachment Theory and Schema Therapy interrelate?

Attachment theory and schema therapy are related in that both theories focus on the role that early experiences play in shaping an individual’s thoughts, feelings, and behaviors. In schema therapy, the therapist works with the client to identify and challenge their maladaptive schemas, which may have been formed as a result of negative experiences in childhood or adolescence. The therapist may also help the client develop more adaptive coping strategies and improve their relationships with others.

Overall, attachment theory and schema therapy can be seen as complementary approaches that both focus on the role of early experiences in shaping an individual’s thoughts, feelings, and behaviors, and how these patterns can be addressed in therapy to improve mental health and relationships.