Towards a Reformulated Theory Underlying Schema Therapy: Position Paper of an International Workgroup

Background Improved understanding of the specific cognitive risk factors associated with depression is needed to inform prevention and treatment approaches. Recent research has examined the relationship between early maladaptive schemas (EMSs) and depression, but the findings were yet to be integrated using meta‐analytic methods. The aim of this review was to synthesize the evidence on the relationship between depression and EMS. Method A systematic review and meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement, by searching the PsycINFO, PubMed and CINAHL databases. Included studies were peer‐reviewed journal articles that examined the relationship between one or more EMS and depression in adulthood in participants aged 18 years or older. Results A total of 51 studies were included (k = 743; pooled N = 17,830). All 18 EMSs were positively correlated with depression, with effect sizes ranging from small (r = .23 [.17, .29]; Entitlement) to large (r = .53 [.46, .60]; Social Isolation; r = .50, 95% CI [.45, .54]; Defectiveness/Shame). Conclusion The evidence suggests that individuals who feel like they do not belong, or that they are flawed, bad or unlovable, report higher levels of depression. However, most studies used cross‐sectional designs, and further longitudinal research is needed to establish the direction of the relationship between EMS and depression. These findings can guide preventative and treatment approaches. Focusing treatment on the Social Isolation and Defectiveness/Shame EMS may aid in relieving depressive symptoms.

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“…behavioural avoidance or dissociation) and resignation (e.g. submitting or surrendering to the schemas; Arntz et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Early maladaptive schemas and depression in adulthood: A systematic review and meta‐analysis

Bishop

Younan²,

Low

et al. 2021

Clin Psychology and Psychoth

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“…Central to ST are the concepts early maladaptive schemas (EMS) and schema modes. EMS are self‐defeating emotional and cognitive thinking patterns that develop early in life if children’s basic emotional needs (e.g., safety and autonomy) are not met (Arntz et al., 2021; Young, Klosko, & Weishaar, 2003). Schema modes represent the active emotional and behavioural state of a person in response to EMS activation.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda

Peeters

Passel

Krans

2021

British J Clinic Psychol

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Objectives. We reviewed the evidence regarding the effectiveness of schema therapy for anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD).Methods. This systematic review followed the recommendation of the PRISMA guidelines. A database search (PsycINFO, MEDLINE, EMBASE, WEB OF SCIENCE, and Academic Search Ultimate) was conducted to identify eligible studies up until 2 April 2021. The search included the keywords ('schema therap*' or 'schema group therap*' or 'schema mode therap*' or 'schema focused' or 'young's model') and ('anxiety disorder*' or 'anxiety-related disorder*' or 'agoraphobia' or 'health anxiety' or 'phobi*' or 'panic disorder' or 'obsessive compulsive disorder' or 'OCD' or 'posttraumatic stress' or 'post traumatic stress' or 'PTSD' or 'hypochondria' or 'axis 1'). Included studies were appraised on methodological quality according to the Psychotherapy Outcome study Methodology Rating Form.Results. We identified 41 studies that were eligible based on the topic. However, only six (comprising 316 anxiety, OCD, and PTSD patients) could be included despite lenient methodological inclusion/exclusion criteria. Results showed that schema therapy can lead to beneficial effects in disorder-specific symptoms and early maladaptive schemas. Yet, we also uncovered substantial methodological limitations in most studies.Conclusions. Schema therapy is a promising treatment for anxiety, OCD, and PTSD. Yet, there is a systematic problem in the quality of research despite growing clinical interest and application. We therefore concluded with a research agenda presenting recommendations for future research that will be crucial for building a solid evidence-base for schema therapy in chronic anxiety, OCD, and PTSD.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…However, there is not a perfect fit, and, as will be seen, there are some coping modes that do not fit clearly within any category system. Arntz et al (2021) have recently suggested replacing the term Surrender with Resignation and Overcompensator with Inversion, however, the traditional terms will be used here.…”

Section: Modes and Their Relationshipsmentioning

confidence: 99%

Using Schema Modes for Case Conceptualization in Schema Therapy: An Applied Clinical Approach

Edwards

2022

Front. Psychol.

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This article is situated within the framework of schema therapy and offers a comprehensive and clinically useful list of schema modes that have been identified as being relevant to conceptualizing complex psychological problems, such as those posed by personality disorders, and, in particular, the way that those problems are perpetuated. Drawing on the schema therapy literature, as well as other literature including that of cognitive behavior therapy and metacognitive therapy, over eighty modes are identified altogether, categorized under the widely accepted broad headings of Healthy Adult, Child modes, Parent modes and coping modes which are, in turn, divided into Surrender, Detached/Avoidant, and Overcompensator. An additional category is included: Repetitive Unproductive Thinking. This draws attention to the recognition by metacognitive therapists that such covert behaviors play a significant role in amplifying distress and perpetuating a range of psychological problems and symptoms. In addition to the modes themselves, several concepts are defined that are directly relevant to working with modes in practice. These include: default modes, blended modes, mode suites and mode sequences. Attention is also drawn to the way in which Child modes may be hidden “backstage” behind coping modes, and to the dyadic relationship between Child modes and Parent modes. Also relevant to practice are: (1) the recognition that Critic voices may have different sources and this has implications for treatment, (2) the concept of complex modes in which several submodes work together, and (3) the fact that in imagery work and image of a child may not represent a Vulnerable Child, but a Coping Child. The modes and mode processes described are directly relevant to clinical practice and, in addition to being grounded in the literature, have grown out of and proved to be of practical use in conceptualizing my own cases, and in supervising the cases of other clinicians working within the schema therapy framework.

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Towards a Reformulated Theory Underlying Schema Therapy: Position Paper of an International Workgroup

Cited by 51 publications

References 26 publications

Early maladaptive schemas and depression in adulthood: A systematic review and meta‐analysis

Early maladaptive schemas and depression in adulthood: A systematic review and meta‐analysis

The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda

Using Schema Modes for Case Conceptualization in Schema Therapy: An Applied Clinical Approach

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