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Early maladaptive schemas

Dr. Simon Moss

Overview

Schema therapy was proposed by Young and colleagues (e.g., Young, Klosko, & Weishaar, 2003). According to Young, early in life, individuals develop schemas--patterns of expectations that bias the interpretation of events and guide responses. These schemas, if developed during traumatic or maladaptive environments, can be dysfunctional. That is, these early maladaptive schemas can later generate interpretations or behaviors that provoke further difficulties. Environments that preclude safety and stability, autonomy and competence, freedom of expression, spontaneity and play, or realistic limits are especially likely to incite the evolution of these maladaptive schemas.

The events or features of environments that preclude these needs can be divided into four clusters (Young, Klosko, & Weishaar, 2003). First, environments can be deficient in some vital resource, such as love. Second, children can be victims of trauma or victimization. Third, children can receive excessive levels of one need, such as approval, undermining realistic limits. Finally, children may internalize the schemas of someone else, such as a parent, consistent with the notion that abusers sometimes become abusers themselves.

These schemas tend to be resistant to change for several reasons, according to Young, Klosko, and Weishaar (2003). First, schemas bias interpretations of events. Therefore, individuals often perceived events as consistent with their schemas. Their schemas, therefore, are often reinforced. Second, people may be attracted to environments that resonate with their schemas& such environments evoke a sense of fit or resonance with expectations. Indeed, a longitudinal study, conducted by Riso et al. (2006) over 5 years, confirmed these schemas tend to be stable over time.

In general, these schemas are activated in stressful circumstances only (Young, Klosko, & Weishaar, 2003). When activated, these schemas can generate negative interpretation or unhelpful behaviors, ultimately culminating in depression, anxiety, substance abuse, or similar problems.

Taxonomy of schemas

Schema therapists tend to differentiate around 15 to 18 schemas (Young, Klosko, & Weishaar, 2003). Several schemas relate to disconnection and rejection--the belief that a need to seek security and nurturance may not be fulfilled. These schemas often evolved in detached, cold families. In the following lists, comments in quotation marks are questions that are sometimes utilized to uncover these schemas.

Other schemas relate to impaired autonomy and performance. That is, when people adopt these schemas, they feel they cannot function independently and thrive in their environment, often because they were reared in an enmeshed family. Some of the schemas include:

A third set of schemas relates to impaired limits. In particular, some individuals do not experience the need to constrain or limit their behavior as a means to fulfill their responsibilities to other people or achieve their future aspirations, often because of unduly permissive parenting.

A fourth set of schemas revolves around an excessive focus on the desires and feelings of other people. The motivation of these individuals is to seek approval and avoid retaliation, common in families who offer conditional acceptance.

The fifth and final set of schemas relate to undue vigilance or inhibition, corresponding to rigid expectations or the excessive suppression of impulses. These schemas are common in families that are punitive, grim, and perfectionistic. These schemas include:

Consequences of schemas

These early maladaptive schemas underpin many psychological problems and psychopathologies. Indeed, according to Bosmans, Braet, and Van Vlierberghe (2010), the association between attachment anxiety and psychopathology is fully mediated by early maladaptive schemas--especially schemas that relate to disconnection and rejection or the excessive desire to fulfill the needs of other people. The association between avoidant attachment and psychopathologies is partly mediated by early maladaptive schemas (for more evidence on the relationship between attachment style and early maladaptive schemas, see Mason, Platts, & Tyson, 2005).

Mood disorders

Early maladaptive schemas have been shown to be associated with depression and other problems. Halvorsen et al. (2009), for example, revealed that depression severity is associated with most domains of these schemas, including disconnection, impaired autonomy, and impaired limits. Delattre et al. (2004) showed that most early maladaptive schemas, and particularly emotional deprivation, social isolation, and dependence, are activated in people who experience anxiety disorders than other individuals. Likewise, CBT with schema therapy, intended to redress early maladaptive schemas, has been shown to be more effective than CBT without schema therapy in diminishing PTSD in war veterans (Cockram, Drummond, & Lee, 2010).

Hawke and Provencher (2011) reviewed the literature that relates mood disorders to early maladaptive schemas. Although related to most schemas, depression tends to be especially associated with defectiveness or shame as well as insufficient control. Anxiety is also associated with most schemas but tends to be particularly associated with vulnerability to harm or illness. Schema therapy, in which the various early maladaptive schemas are redressed, has been shown to curb these mood disorders.

Gambling

Gambling tendencies may also be associated with early maladaptive schemas. Shorey, Anderson, and Stuart (2012), for example, conducted a study in which the participants were male alcohol users, seeking treatment. Participants received a set of questions, intended to characterize their gambling behavior. For example, they were asked whether they gamble more than intended, have felt guilty about their gambling, have been criticized because of their gambling, and have experienced financial problems as a consequence of gambling. In addition, they completed Young's measure of schemas.

Many of the early maladaptive schemas were positively associated with problem gambling. For example, people who reported problem gambling exhibited elevated levels of abandonment, approval seeking, emotional deprivation, emotional inhibition, entitlement, insufficient self-control, and punitiveness. Arguably, some of these schemas could foster avoidance of negative emotions or impulsive behavior, both of which underpin gambling.

Substance abuse

In addition to mood disorders, early maladaptive schemas are also associated with substance abuse. For example, as Brotchie, Meyer, Copello, Kidney, and Waller (2004) showed, alcohol consumption is associated with emotional inhibition, subjugation, and vulnerability to harm, demonstrating that alcohol use may reflect an attempt in people to cope with negative emotions.

Shorey et al. showed that early maladaptive schemas are associated with alcohol and opioid dependence in women. Alcohol dependence was especially associated with self-sacrifice, unrelenting standards, insufficient self-control and negativity or pessimism. Opioid dependence corresponded to a similar profile schemas but higher levels of punitiveness and dependence than alcohol dependence.

Sexual functioning

Early maladaptive schemas are also associated with sexual functioning. For example, after controlling anxiety, depression, and demographic variables, sexual functioning is negatively related to the schemas associated with impaired autonomy. Specifically, the schema associated with dependence and incompetence was especially associated with sexual dysfunction.

In one study, reported by Gomes and Nobre (2013), the sexual functioning of male participants was derived from a semi-structured interviews& the questions revolved around unwanted sexual experiences, sexual behavior, and related topics. Problems such as erectile dysfunction were identified. In addition, participants completed Young's schema questionnaire to gauge early maladaptive schemas as well as self-report measures of sexual dysfunction and psychopathology. Finally, participants imagined four scenarios, each epitomizing a sexual problem, and then answered questions that gauge the cognitive schemas these scenarios evoke.

Sexual functioning was negatively associated with the early maladaptive schema called dependence and incompetence. Furthermore, sexual functioning was also negatively associated with a variety of schemas that are evoked by sexual dysfunction, such as feelings of loneliness, rejection, undesirability, and incompetence--each of which are associated with the early maladaptive schema called dependence and incompetence.

Personality disorders

Early maladaptive schemas may also be associated with various personality disorders, as some evidence indicates. Jovev and Jackson (2004), for example, conducted a study in which participants completed the Millon Clinical Multiaxial Inventory II to gauge personality disorders as well as the Cognitive Schema Questionnaire to assess early maladaptive schemas. Cluster analyses uncovered five distinct clusters. For example, one cluster exhibited high scores on the histrionic and narcissistic scales with moderate aggression as well. These participants also tended to show, at least moderate, levels of self-sacrificing, emotional deprivation, and unrelenting standards. Narcissism, unsurprisingly, is associated with the entitlement schema (Zeigler-Hill et al. 2011).

Determinants of schemas

Activities that underpin schema therapy

Schema therapy entails a range of activities, each intended to diminish the impact of early maladaptive schemas. In addition to classical techniques such as cognitive and experiential interventions, schema therapy also comprises some more unique features, including limited reparenting.

The rationale of limited reparenting is that fulfilling the needs of individuals that were not satisfied during childhood should override early maladaptive schemas. The therapist attempts to fulfill these needs, within the bounds of professional practice. Limited reparenting may entail warmth, playfulness, setting limits, and other practices, often entailing a blend of tenderness and firmness, that parents should have offered--to provide support but prevent avoidance.

The therapist will utilize a range of exercises to fulfill these goals. Therapists will attempt to activate the relevant child modes--the schemas that individuals utilize in stressful circumstances--and then utilize guided imagery. Guided imagery is assumed to activate the right hemisphere, arguably the hemisphere in which many of these schemas evolve. Imagery is utilized to evoke upsetting memories during childhood with significant others. In addition, clients are granted an opportunity to express anger towards significant others who have not met their needs. Furthermore, the therapist enters into this image to foster a secure attachment and to imagine these needs were fulfilled.

Possible causes of early maladaptive schemas

Parental alcoholism and mistreatment

As Shainheit and Wright (2013) confirmed, the emotional maltreatment of children, unsurprisingly, is positively associated with a variety of early maladaptive schemas later in life. Furthermore, this association between mistreatment and early maladaptive schemas may be especially pronounced when parents are alcoholic.

In this study, a sample of university students first completed the lifetime experiences questionnaire, in which some of the questions assess childhood emotional abuse or neglect, epitomized by items like "Did your caretakers ever say they wished they were not parents or that you had never been born?" or "Did you ever ask any of your caretakers for attention, affection, or help with a problem, only to have them ignore you, push you aside, or avoid you". Next, they completed a questionnaire that assesses the degree to which the parents of participants had exhibited the manifestations of alcoholism. Finally, Young's schema questionnaire and a measure of trauma were administered.

Childhood emotional mistreatment was associated with all the domains of early maladaptive schemas, such as disconnection, impaired autonomy, impaired limits, and exaggerated standards. Furthermore, the association between childhood emotional mistreatment and some of the domains, such as impaired autonomy, were especially pronounced in males or in people with alcoholic parents. These findings are consistent with the notion that emotional stress, if moderate and coupled with support, can actually promote growth rather than trauma. For example, the stress of parental alcoholism might not culminate in early maladaptive schemas if coupled with support.

References

Bosmans, G., Braet, C., & Van Vlierberghe, L. (2010). Attachment and symptoms of psychopathology: Early maladaptive schemas as a cognitive link? Clinical Psychology and Psychotherapy, 17, 374-385.

Brotchie, T. A., Meyer, C., Copello, A., Kidney, R., & Waller, G. (2004). Cognitive representations in alcohol and opiate use: The role of core beliefs. The British Journal of Clinical Psychology, 43, 337-342.

Cockram, D. M., Drummond, P. D., & Lee, C. W. (2010). Role and treatment of early maladaptive schemas in Vietnam veterans with PTSD. Clinical Psychology & Psychotherapy, 17, 165-182.204861582010-10697-001

Delattre, V., Servant, D., Rusinek, S., Lorette, C., Parquetm, P. J., Goudemand, M., et al. (2004). The early maladaptive schemas: A study in adult patients with anxiety disorders. L'Encephale, 30, 255-258.

Gomes, A. L. Q., & Nobre, P. (2013). Early maladaptive schemas and sexual dysfunction in men. Archives of Sexual Behavior, 41, 311-320. doi: 10.1007/s10508-011-9853-y

Halvorsen, M., Wang, C. E., Richter, J., Myrland, I., Pedersen, S. K., Eisemann, M., & Waterloo, K. (2009). Early maladaptive schemas, temperament and character traits in clinically depressed and previously depressed subjects. Clinical Psychology and Psychotherapy, 16, 384-407.

Hawke, L. D., & Provencher, M. D. (2011). Schema theory and schema therapy in mood and anxiety disorders: A review. Journal of Cognitive Psychotherapy: An International Quarterly, 25, 257-276.

Jovev, M., & Jackson, H.J. (2004). Early maladaptive schemas in personality disordered individuals. Journal of Personality Disorders, 18, 467-478.

Mason, O., Platts, H., & Tyson, M. (2005). Early maladaptive schemas and adult attachment in a UK clinical population. Psychology and Psychotherapy: Theory, Research and Practice, 78, 549-564. doi:10.1348/147608304X21374.2006-03549-009

Riso, L. P., Froman, S. E., Raouf, M., Gable, P., Maddux, R. E., Turini-Santorelli, N., et al. (2006). The long-term stability of early maladaptive schemas. Cognitive Therapy and Research, 30, 515-529.

Shainheit, C. R., & Wright, M. O. (2013). Parental alcoholism and gender as moderators of maladaptive schema endorsement following childhood emotional maltreatment. Journal of Aggression, Maltreatment & Trauma, 21, 403-421. doi: 10.1080/10926771.2012.669822

Shorey, R., Anderson, S.,& Stuart, G. (2012). An examination of early maladaptive schemas among substance use treatment seekers and their parents. Contemporary Family Therapy, 34, 429-441.

Shorey, R. C., Anderson, S., & Stuart, G. L. (2012). Gambling and early maladaptive schemas in a treatment-seeking sample of male alcohol users: A preliminary investigation. Addictive Disorders & Their Treatment, 11, 173-183. doi: 10.1097/ADT.0b013e31823eda8f

Shorey, R., Stuart, G., & Anderson, S. (2013). Differences in early maladaptive schemas in a sample of alcohol and opioid dependent women: Do schemas vary across disorders? Addiction Research and Theory, 32, 132-140.

Young, J. E., & Brown, G. (2003). Young Schema Questionnaire: Short form. New York.

Young, J. E., Klosko, J., & Weishaar, M. E. (2003). Schema therapy: A practitioner's guide. New York: Guilford Press.

Zeigler-Hill, V., Green, B. A., Arnau, R. C., Sisemore, T. B., & Myers, E. M. (2011). Trouble ahead, trouble behind: narcissism and early maladaptive schemas. Journal of Behavior Therapy and Experimental Psychiatry, 42, 96-103. doi:10.1016/j.jbtep.2010.07.004






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Last Update: 7/21/2016