Schema Therapy: What It Is & How It Can Help
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Individuals who haven’t experienced a lasting change from therapy may benefit from a relatively new form of treatment called schema therapy. Developed specifically for those with long-term psychological suffering, schema therapy addresses the root beliefs that negatively impact a person’s life.
What Is Schema Therapy?
Schema therapy is an integrative treatment model created to help individuals who haven’t responded well to other types of therapies. Dr. Jeffery Young used cognitive-behavioral therapy as the foundation for schema therapy, then included aspects of other psychotherapy theories to make the treatment more robust.
Schema therapy focuses on challenging early maladaptive schemas (EMS) that negatively impact thoughts and behaviors. Think of a schema as a way in which you see the world. It’s a broad theme you use to understand yourself, relationships, and your environment. People with EMS likely have unhealthy thought and behavior patterns. Dr. Young believed that EMS are an underlying factor for mental health disorders, such as personality disorders, anxiety, depression, and eating disorders.
About Early Maladaptive Schemas
Early maladaptive schemas are self-defeating thoughts and emotional patterns that develop in childhood and then get repeated and expanded in adulthood. These schemas are dysfunctional and impact how someone views themselves and their relationships. In most cases, an individual develops EMS in response to childhood trauma or an unmet core emotional need.
- Healthy attachment
- Independence, sense of self
- Rational, age-appropriate limits and boundaries
- Opportunity to share needs and emotions
- Freedom and ability to be spontaneous and play
The child uses the schema to survive. Over time, the schema becomes ingrained. When the child reaches adulthood, the schema continues even though it’s no longer helpful.
An individual’s schema and associated feelings and thoughts are triggered when they’re reminded (consciously or unconsciously) of their childhood trauma or unmet need.
The 5 Schema Domains
There are 18 EMS clustered into five domains based on the core emotional needs. Each domain identifies common beliefs, family of origin concerns, childhood experiences, and interpersonal issues.
Disconnection and Rejection
Unmet Need: Healthy attachment
People with schemas within the disconnection and rejection domain often have difficulty forming and maintaining healthy relationships. They don’t believe they’ll get their needs met because they grew up in unpredictable, abusive or emotionally unavailable families.
Individuals who struggle with disconnection and rejection may believe:
- They’ll be abandoned
- People can’t be trusted because they’re always hurtful or abusive
- They won’t get the emotional support, guidance, or attention they need in their relationships
- They are unwanted, broken, or unloveable
- They’re different from everyone else and alone
Impaired Autonomy and Performance
Unmet Need: Independence, identity
People with schemas in the impaired autonomy and performance domain likely grew up in enmeshed families who didn’t support their autonomy. As adults, they often have difficulty being self-sufficient, functioning independently and performing because their caregivers did everything for them or undermined their self-confidence.
Individuals who experience impaired autonomy and performance might believe:
- They can’t function or handle daily life on their own
- Something terrible is always going to happen
- They or their loved one can’t survive or be happy outside of their relationship
- They’re nothing without other people
- They’re a failure
Unmet Need: Rational, age-appropriate limits and boundaries
Individuals with schemas in the impaired limits domain typically have difficulty setting and accomplishing goals, respecting people’s boundaries, practicing self-control, and upholding their commitments. They may also have very low-stress tolerance and lack self-awareness. Their family was most likely overindulgent, lacked rules and guidance or practiced superiority.
People struggling with impaired limits may:
- Believe they’re better than others or entitled to certain privileges
- Refuse or be unable to control themselves
Unmet Need: Opportunity to share needs and emotions
Within the other-directedness domain, individuals are overly focused on other people’s feelings, needs, and wants instead of their own to obtain approval, maintain connection, or avoid rejection. These individuals usually only received conditional love and acceptance from their family of origin and had primary caregivers who likely prioritized their own wants, needs, and emotions.
Individuals who struggle with other-directedness schemas might believe:
- They must submit to others to avoid conflict or being abandoned
- Other people’s needs are more important than their own
- Their self-worth comes from other’s approval
Overvigilance and Inhibition
Unmet Need: Freedom and ability to be spontaneous and play
Individuals within the overvigilance and inhibition domain typically subdue and restrict their feelings and impulses to meet their own rigid expectations. Their families were likely focused on perfectionism, self-discipline, avoiding failure and repressing emotions.
People who deal with overvigilance and inhibition may believe:
- Life is awful and things always go bad
- Feelings and impulses should be stuffed down and avoided
- They have to be perfect
- People should be punished when they make a mistake
How Does Schema Therapy Work?
Schema therapy treatment is broken into two phases, including the assessment and education phase and the change phase.
In the assessment and education phase, the clinician helps the client develop self-awareness and gain knowledge about EMS, coping and the link between their triggers and responses. They work with the client to identify:
- Early maladaptive schemas
- Means of coping
- Childhood experience(s) that developed the schema(s)
- Emotional, cognitive, and physical responses to schemas
- Schema triggers
- How they continue reinforcing their schemas
Once the client can recognize their schemas, they can begin to challenge them in the change phase. Clients work to replace negative behaviors and coping skills with helpful ones. The therapist also helps the client notice self-sabotaging behaviors. The therapist and client work together to battle the schemas.
Throughout schema therapy, a therapist uses:
- Cognitive techniques (e.g. create a list of evidence showing the schema is untrue.)
- Experience techniques (e.g. role-play a conversation with the client’s childhood abuser.)
- Behavioral pattern-breaking (e.g. practice alternative behaviors that challenge a schema.)
- Therapist-client Relationship (e.g. empathetic confrontation)
What Is Schema Therapy Used For?
The primary goal of schema therapy is to help clients identify and meet their own emotional needs in healthy ways. This is done by helping them learn how to:
- Stop using dysfunctional coping strategies
- Heal schemas by meeting their needs
- Build self-control by setting healthy limits on angry, impulsive and overindulgent patterns and behaviors
- Challenge critical or punishing schemas
- Cultivate healthy schemas
Research over the past decade has found schema therapy to be an effective form of treatment for personality disorders, chronic depression, anxiety, OCD and PTSD.
Schema Therapy and Borderline Personality Disorder
Borderline personality disorder (BPD) impacts the way a person views themselves and the world around them. People with BPD typically have an intense fear of abandonment, difficulty managing their emotions and unstable relationships. Research has found schema therapy to be an effective treatment for borderline personality disorder.
Schema Therapy and Narcissism
People with narcissism can lack empathy, not care about their impact on others, and have a deep sense of inferiority and fear of failure. Schema therapy has shown potential as an effective treatment for narcissism. The therapist helps the client understand how their schemas impact their behaviors, life and relationships.
Schema Therapy For PTSD
People develop post-traumatic stress disorder (PTSD) after experiencing or witnessing a traumatic event. Trauma can lead people to develop EMS that they carry into adulthood. Recent research has found schema therapy effective for individuals with PTSD and reported positive changes lasted during a three-month follow-up.
Schema Therapy For Depression
People with chronic depression can experience ongoing sadness, hopelessness and numbness, and are often unresponsive to treatment. Schema therapy may be an option; it’s designed for people who haven’t responded to other forms of treatment and have long-standing symptoms. One study found that participants improved after receiving schema therapy and maintained the changes through their six-month follow-ups.
Want to find out if schema therapy is the right fit for you? The Nobu app can help you learn more about mental health disorders and see what treatment is available.
The Nobu app is a free and easy-to-use tool that provides a wide range of services including mindfulness activities, writing exercises, guided lessons and more. For an additional fee, you can also connect with a licensed mental health professional for support. Find the support you need by downloading the Nobu app today.
Take Control Of Your Mental Health
- Bamelis, Lotte, et al. “Results of a Multicenter Randomized Controlled Trial of the Clinical Effectiveness of Schema Therapy for Personality Disorders.” American Journal of Psychiatry, March 1, 2014. Accessed June 22, 2022.
- Malogiannis, I.A., et al. “Schema Therapy for Patients With Chronic Depression: A Single Case Series Study.” Journal of Behavior Therapy and Experimental Psychiatry, September 2014. Accessed June 22, 2022.
- Peeters, Nancy, van Passel, Borris, Krans, Julie. “The Effectiveness of Schema Therapy for Patients With Anxiety Disorders, OCD, or PTSD: A Systematic Review and Research Agenda.” British Journal of Clinical Psychology, July 23, 2021. Accessed June 22, 2022.
- Young, Jeffrey E., Klosko, Janet S., and Weishaar, Marjorie E. “Schema Therapy: A Practitioner’s Guide.” Guilford Publications, 2003. Accessed June 22, 2022.