Emotional Inhibition

A brief introduction to schema therapy

Schema therapy is an integrative therapy initially developed for treating complex, longstanding, and diffuse psychological difficulties. It combines cognitive behavioral, attachment, gestalt, object relationships, constructivist, psychoanalytic, and neurobiological approaches within a unifying conceptual model (Young, 1990, 1999; Young et al., 2003). Additional interventions have since been outlined, such as EMDR (Young et al., 2002), mindfulness (van Vreeswijk et al., 2014), and body-focused methods (Briedis & Startup, 2020). Schema therapy expands on CBT by emphasizing the developmental origins of psychological problems, incorporating relational and experiential interventions, and targeting the maladaptive coping styles that perpetuate these difficulties (Young et al., 2003)

Early maladaptive schemas

Schemas are enduring and foundational mental structures that play an essential role in cognitive processing, enabling humans to represent the complexities of the world (Rafaeli et al., 2016). By simplifying reality, they make the vast array of information we encounter manageable, so that we can take quick and automatic action. Schemas also act as shortcuts that help us reach conclusions without unnecessary processing. However, while these shortcuts are efficient, they can produce distorted interpretations of reality. Research confirms that schemas can be adaptive or maladaptive, and positive or negative, depending on their output (Young et al., 2003). Adaptive schemas are associated with positive functions and adaptive behavioral dispositions (Louis et al., 2018).

In schema therapy, EMS are defined as negative, pervasive themes or patterns regarding oneself and one’s relationship with others that are dysfunctional and self-defeating. Structurally, EMS are believed to consist of thoughts, memories, emotions, bodily sensations, and the meanings ascribed to them (Van Genderen et al., 2012). Importantly, behavior is not a component of schemas, but a response to their activation. In other words, EMS activation results in schema-driven actions (Young et al., 2003).

Interactions between a child’s temperament, parenting, sociocultural context, and significant life experiences (e.g., traumatic events) can give rise to unmet emotional needs, which form the basis of EMS. EMS are usually accurate representations of these early environments and lead to responses that help the child survive and adapt to these contexts (Farrell et al., 2014; Young et al., 2003). EMS become dysfunctional when they are indiscriminately and repeatedly applied to later life experiences.

EMS are elaborated and strengthened throughout their lifespan, becoming the ‘filters’ through which individuals understand and make predictions about themselves, others, and the world (Young & Klosko, 1994). Accordingly, EMS developed in early life are superimposed on current events (even when not applicable), leading to dysfunctional patterns of thought, feeling, and behavior (Young et al., 2003).

[EMS] become dysfunctional because … they render all new situations, even ones that are profoundly different from the toxic early experiences, similarly toxic (even when in reality they are not), and … lead the person to maintain particular types of [toxic] environments or relationships, even when they can exert influence or choice and create other kinds of experiences.

Rafaeli et al., 2011.

Schema development

Core emotional needs

Satisfying core emotional needs during childhood leads to the development of healthy schemas, while unmet needs give rise to EMS. Young and colleagues (2003) originally outlined 5 core emotional needs based on Bowlby’s (1977) attachment theory and clinical observation (Bach et al., 2018). While they are believed to be universal, the strength of these needs can vary across individuals and potentially across cultures (e.g., Hahn & Oishi, 2006). They are:

1. Secure attachments (e.g., safety, protection, acceptance, stability, and belonging).
2. Autonomy, competence, and sense of identity.
3. Freedom to express needs and emotions.
4. Spontaneity and play.
5. Realistic limits and self-control.

Given that core needs initially relate to the child’s primary attachments, difficulties within the nuclear family are often the principal source of EMS (Rafaeli et al., 2011). Young acknowledged that attachment needs were of primary importance for the developing child, laying the foundation for the satisfaction of other needs (Brockman et al., 2023). However, as children mature, needs arising other arenas such as school and the wider community become important (e.g., stable friendships, peer group acceptance, etc.). While unmet needs in these later contexts can lead to EMS, schemas emerging in adolescence are usually less pervasive than those developed during childhood (Young et al., 2003). EMS can also develop in later life (such as in response to deeply disturbing events), although this is much less common (Louis et al., 2018)

Other core needs have also been proposed, such as fairness, self-coherence (Arntz et al., 2021), novelty, self-comprehension (Flanagan, 2010), self-esteem (Loose et al., 2020), meaning (Meier, 2019), and connectedness to nature (O’Sheedy, 2021). However, these core needs have not yet been fully incorporated into the schema therapy model. Core needs are described in more detail in the Psychology Tools Unmet Emotional Needs information handout.

Early experiences

Interactions between a child’s early environment and innate temperament can frustrate their core emotional needs, leading to EMS development. Young and colleagues (2003) identify 4 childhood experiences that contribute to EMS:

1. Toxic withholding. The child is given too little of what they need (e.g., insufficient attention, affection, protection, etc.).
2. Toxic excess. The child is given too much of what they need (e.g., they are over-indulged, overprotected, granted excessive freedoms, etc.).
3. Traumatization. The child is harmed, victimized, or humiliated (e.g., parental abuse, bullying, discrimination, etc.).
4. Selective internalization. The child internalizes maladaptive attitudes that are modeled by a caregiver or family member  (e.g., perfectionism, pessimism, etc.).

Emotional temperament

Temperament refers to enduring differences in children’s behavioral style and reactivity (Zentner & Bates, 2008). It can contribute to EMS formation by influencing parenting styles (Eisenberg et al., 1999; Kiff et al., 2011; Pekdoğan & Mehmet, 2022). For example:

• Irritable children tend to elicit punitive parenting, leading to increased anger.
• Fearful children tend to elicit protective parenting, leading to increased anxiety.
• Impulsive children tend to elicit controlling parenting, increasing impulsivity.

Moreover, children have a ‘differential susceptibility’ to their childhood environments and experiences (Belsky, 2013). For example, reactive children are more likely to flounder in response to poor parenting. This partly explains why some individuals develop EMS in the absence of severe trauma (Lockwood & Perris, 2012).

Schema perpetuation

EMS are remarkably obstinate: they “fight for survival”. Young and colleagues (2003) suggest the durability of EMS partly stems the need for ‘cognitive consistency’: people strive to maintain a stable view of themselves and the world, even if it is inaccurate and distressing. Moreover, EMS are often central to an individual’s sense of self, making the idea of a schematic “paradigm shift” extremely threatening (Beck et al., 2004; Young & Klokso, 1994):

Although [the client’s] schematic structure may be unrewarding and lonely, change means that [they] are in new territory... They are being asked not just to change a single chain of behaviors, or reframe a simple perception, but rather to give up who they are and how they have defined themselves for many years, and across many contexts.

Beck et al., 2004.

Several other factors account for why EMS persist and are strengthened over time.

• Cognitive factors. EMS act as cognitive filters, distorting information and generating unhelpful thinking styles (Young et al., 2003). For example, schema-consistent information is exaggerated, while schema-inconsistent information is filtered out (i.e., magnification and minimization). Other cognitive distortions linked to EMS perpetuation include selective abstraction, overgeneralization, and labeling (Da Luz et al., 2017; Young, 1999). Research indicates schema activation not only generates negative automatic thoughts, but that these appraisals in turn reinforce EMS (Calvete et al., 2013).
• Affective factors. Individuals often block painful emotions linked to their EMS. Consequently, EMS do not reach conscious awareness which prevents their disconfirmation (Young et al., 2003). Affect can also make schema-congruent perceptions feel true. Finally, schema maintenance processes and their centrality to the individual’s sense of self can engender hopelessness about change (Young, 1999).
• Behavioral factors. EMS lead to self-defeating behaviors, referred to as ‘coping responses’. For example, individuals might remain in toxic situations, provoke negative responses from others, or select partners that reinforce their EMS (Rafaeli et al., 2011).

Maladaptive coping styles

Coping styles refer to the characteristic ways individuals manage their EMS. Coping styles develop in childhood and operate outside of awareness, helping individuals adapt to their EMS, the intense affect accompanying them, and the environments in which they were formed (Rafaeli et al., 2011; Young et al., 2003). Much like EMS, factors that may influence the emergence of coping styles include temperament, modeling, conditioning, and culture (Loose et al., 2020; Nia & Sovani, 2014). While they are apparent in all individuals, coping styles tend to be more rigid, extreme, and ‘overlearned’ in clinical groups (Beck et al., 2004). Most importantly, coping styles play a central role in EMS perpetuation.

Coping styles, in turn, give rise to idiographic ‘coping responses’ – the situation-specific manifestations of the client’s coping style. While coping styles are repetitious, coping responses are more variable and can take the form of behavioral, cognitive, or emotional reactions to EMS activation (Simeone-DiFrancesco et al., 2015).

Young and colleagues (Young & Klosko, 1994; Young et al., 2003) identify three coping styles, recently reformulated by an international working group (Arntz et al., 2021). While most individuals use a mix of coping styles, some disorders are characterized by the predominance of one coping style (e.g., overcompensatory control in narcissistic personality disorder; Rafaeli et al., 2011):

• ‘Surrender’ (Young et al., 2003) or ‘Resignation’ (Arntz et al., 2021). Corresponding to the evolutionary ‘freeze’ or ‘fawn’ response, the individual responds to their EMS by accepting its core message and behaving as if it were true. Consequently, they experience the pain of the EMS directly.
• ‘Avoidance’ (Young et al., 2003) or ‘Escape’ (Young & Klosko, 1994). Corresponding to the evolutionary ‘flight’ response, the individual arranges their life such that their EMS is not triggered. The pain of their EMS is avoided or suppressed. Avoidant coping may be overt (e.g., escaping from schema activating situations or individuals) or covert (e.g., using substances or dissociation to dull schema-related distress).
• ‘Overcompensation’ (Young et al., 2003) or ‘Inversion’ (Arntz et al., 2021). Corresponding to the ‘fight’ response, the individual responds to schema activation by attacking, overcorrecting, or externalizing their EMS (Greenwald & Young, 1998). The pain of the EMS is masked with other thoughts, emotions, and actions (e.g., the individual replaces feelings of inferiority with superiority).

Three additional coping styles (indolence, mockery, and gaucherie) have also been proposed (Askari, 2021).

Young (1990) originally described 15 EMS, which were later increased to 18 schemas (Young et al., 2003). Additional schemas have since been proposed (e.g., Arntz et al., 2021; Brockman et al., 2023; Yalcin et al., 2023). The 18 EMS described by Young and colleagues (2003) were subsequently clustered into ‘schema domains’ which correspond to specific unmet emotional needs. Emotional inhibition was initially grouped with EMS in the ‘overvigilance and inhibition’ domain (Young et al., 2003), which is characterized by the suppression of spontaneous feelings and impulses, and the pursuit of demanding, internalized standards. However, it was subsequently recategorized into the ‘disconnection and rejection’ domain, which relates to difficulties forming secure attachments and the expectation that one’s basic emotional needs (e.g., connection, acceptance, and understanding) will not be met (Bach et al., 2018; Young, 2014).

Emotional Inhibition

Individuals with emotional inhibition constrain their spontaneous emotional expressions, actions, and communications. As a result, they often appear detached, self-controlled, impersonal, or emotionally flat (Young et al., 2003). Young (2014) identifies 6 areas in which emotional inhibition tends to manifest:

1. Inhibition of anger and aggression.
2. Inhibition of love, warmth, and affection.
3. Inhibition of positive impulses (e.g., joy, excitement, sexual desire, playfulness).
4. Difficulties communicating personal feelings or emotional experiences.
5. Difficulties expressing vulnerability and associated needs.
6. Prioritization of rationality and self-control over emotionality and intimacy.

For many individuals, emotional inhibition is primarily motivated by anxiety: they fear that emotional expressiveness will result in disapproval, punishment, abandonment, or impulsive (and potentially harmful) actions (Young et al., 2003). For others, emotional inhibition may stem from difficulties identifying, describing, and communicating emotional states, such as alexithymia (Lawson et al., 2008).

Subsequent research suggests that the emotional inhibition might be better sub-divided into two separate and overlapping schemas (Yalcin et al., 2020; Yalcin et al., 2022). They are:

• Emotional constriction: The individual inhibits their spontaneous emotional expressions, including both positive impulses (e.g., joy, affection, playfulness) and negative impulsives (e.g., anger, sadness, anxiety), for fear of shame or embarrassment. As a result, they struggle to freely communicate their thoughts, feelings, needs, and vulnerabilities (Bricker, Young, & Yalcin, 2023).
• Fear of losing control: The individual inhibits their emotional expressiveness for fear of losing control over these impulses, which may have serious consequences. This might include a fear of negative evaluation (e.g., being criticized, rejected, or abandoned by others), fear of causing harm (e.g., aggressive acts towards oneself or others), and fear of being overwhelmed by emotions (e.g., experiencing panic or despair; Bricker, Young, & Yalcin, 2023).

Unable to either recognize or express their emotional experiences, there is a risk that some individuals with emotional inhibition will turn to destructive behaviors to regulate their feelings. Research confirms this, highlighting associations between emotional inhibition and binge eating (Waller et al., 2000), alcohol use (Can et al., 2019), and self-harm (Lewis et al., 2015).

Young and colleagues (2003) highlight the significant impact that emotional inhibition can have on relationships. Individuals with this EMS struggle to express their emotional experiences (particularly anger) or be intimate, which can result in mutual misunderstanding, resentment, and feelings of neglect. Some individuals seek to extend their emotional overcontrol to others, such as trying to censor or curtail other peoples’ expressiveness (e.g., scolding a child for being emotional). Finally, ‘schema chemistry’ can attract emotionally inhibited individuals to partners who are emotional and impulsive, which may become a source of tension (e.g., criticizing the other person’s emotional intensity or ‘neediness’; Farrell & Shaw, 2018).

Therapists should note that emotional inhibition can have a deleterious impact on treatment outcomes. Research indicates that higher pre-treatment levels of emotional inhibition are associated with poorer therapy responses among people with obsessive compulsive disorder (OCD) and some personality disorders (Lunding & Hoffart, 2016; Thiel et al., 2014). Reasons for this might include experiential avoidance, reduced emotional involvement in therapy, or impaired emotional processing during treatment.

As with all EMS, emotional inhibition has multiple structural components. Individuals with this schema are prone to several cognitive distortions or ‘unhelpful thinking styles’ (Lorzangeneh & Issazadegan, 2022; Young & Klosko, 1994; Young et al., 2003), including:

• All or nothing thinking (e.g., “Either I control myself, or I’ll lose control”).
• Catastrophizing (e.g., “I’ll do something dangerous if I let my anger out”).
• Discounting the positives (e.g., “My wife says she likes it when express myself, but she’s just being nice”).
• Emotional reasoning (e.g., “Expressing myself feels wrong, so it must be wrong”).
• Fortune-telling (e.g., “People won’t accept me if I’m vulnerable”).
• Labeling (e.g., “Crying makes me weak”).
• Mental filter (e.g., “Feelings aren’t helpful - it’s better to be rational about things”).
• Overgeneralization (e.g., “My parents didn’t like my playful side, so no one will”).
• Personalization (e.g., “My husband seems distant – I must have shared too much”).
• “Should” statements (e.g., “I shouldn’t show affection”).

Emotions associated with emotional inhibition seeking include:

• Fear associated with losing control over one’s emotions (e.g., causing harm to oneself or others; being punished, humiliated, or rejected).
• Shame associated with being expressive, spontaneous, or vulnerable.
• Resentment associated with suppressed anger and unexpressed emotional needs.

As a result, people with emotional inhibition may experience difficulties when it comes to:

• Recognizing, expressing, and valuing their emotions (e.g., joy, anger, sadness, fear).
• Tolerating others’ emotional expressiveness.
• Being affectionate, vulnerable, or sexual/flirtatious with others.
• Navigating conflicts with others.
• Fun and playfulness.
• Spontaneity and acting on impulse.

Clinical observation suggests that, as with other conditional EMS, emotional inhibition is often associated unconditional EMS. Young and colleagues (2003) suggest that conditional (or ‘secondary’) EMS emerge in later development and are an attempt to forestall the activation of unconditional (or ‘primary’) schemas. In other words, conditional schemas compensate for unconditional EMS. Unfortunately, conditional EMS tend to chronify and reinforce their unconditional counterparts in the long term: not only are they impossible to consistently fulfil, but the needs underlying unconditional EMS continue to be frustrated (Roediger et al., 2018). Unconditional EMS that are sometimes associated with emotional inhibition include:

• Abandonment. The client fears that expressing their true feelings will lead to abandonment.
• Defectiveness. The client believes that emotional expression risks exposing their faults and deficiencies.
• Emotional deprivation. The client struggles to recognize, validate, and express their emotions and associated needs. Both schemas are likely to stem from misattuned, invalidating, and/or emotionally unavailable caregivers.
• Insufficient Self-Control. Difficulties expressing emotions culminate in uncontrolled outbursts or behaviors (e.g., binge eating).
• Self-Sacrifice. The client has learnt to suppress or inhibit the ‘negative’ emotions that accompany self-sacrifice (e.g., anger).
• Social isolation. The client believes that if they suppress their emotional reactions, they are more likely to be accepted and fit in.
• Unrelenting standards. The client’s demanding expectations extend to being fully in control of their emotions at all times.

Emotional inhibition is associated with a range of difficulties, including addictions (Kahouei et al., 2020), avoidant personality disorder (Kunst et al., 2020), body image problems (Abedi et al., 2018), bipolar disorder (Ak et al., 2011), borderline personality disorder (Lawrence et al., 2011), burnout (Bamber & McMahon, 2008; Simpson et al., 2019), childhood trauma (Pilkington et al., 2021a), depression (Bishop et al., 2022), eating disorders (Maher et al., 2022), narcissistic personality disorder (Nordahl et al., 2005), personality disorders (Nordahl et al., 2005), PTSD (Cockram et al., 2010), relationship problems (Janovsky et al., 2020), self-harm (Pilkington et al., 2021b), social anxiety (Drummond & Gatt, 2018), and suicidal ideation (Pilkington et al., 2021b).

Development origins

Emotional inhibition may have a genetic component (e.g., McRae et al., 2017). However, developmental experiences are likely to play a more important role.

Emotional inhibition is associated with unmet emotional needs relating to self-expression, mutual sharing, emotional validation and support, spontaneity, and playfulness (Bach et al., 2018; Farrell & Shaw, 2018; Lockwood & Perris, 2012). Formative experiences that play a role in the development of this EMS may include:

• Criticism, humiliation, or disapproval for spontaneous or visible displays of emotion.
• Cold, inexpressive, or excessively self-controlled parenting.
• Familial messages that certain emotions should not be expressed (e.g., the importance of maintaining a ‘positive household’).
• Cultural or community influences such as ‘display rules’ prohibiting the expression of certain emotions or emotions more generally (e.g., avoidance of angry communication in some Asian cultures; Porter & Samovar, 1996).

Research confirms that specific developmental experiences are associated with emotional inhibition, including emotional and physical neglect (Pilkington et al., 2021a), and emotional, physical, and sexual abuse (Lumey, 2007; May et al., 2022). Parenting styles that are emotionally depriving, emotionally inhibited, belittling, and controlling are also associated with this EMS (Bach et al., 2018; Sheffield et al., 2005).

"Many people struggle with emotional inhibition, and it sounds like it might be relevant to you too. Would you be willing to explore this schema more with me?"

Clinicians might begin by providing psychoeducation about emotional inhibition and EMS more generally:

• Schemas are negative themes and patterns that start in your childhood and continue throughout your life. Some are very common.
• Schemas get stronger as time passes, becoming the negative filters people use to understand and predict the world. You could think of them as dark sunglasses – they colour and distort our experiences in unhelpful ways. 
• Schemas operate ‘behind the scenes’: we’re not usually aware of them or when they are active. However, with practice, you can become more aware of them. It is a bit like a theatre – you can learn to bring your backstage schemas to the main stage. 
• One common schema is ‘emotional inhibition’. If you have this schema, you tend to hide your feelings because you worry that expressing yourself will lead to disapproval, shame, or losing control. Some people with this schema also find it difficult to name and describe their feelings. People are usually more at ease with those who express themselves, so being too inhibited often has a negative effect on your relationships. 
• Signs that you have an emotional inhibition schema include feeling uncomfortable expressing your feelings, showing affection, or talking about certain topics (e.g., sex). You might hold negative beliefs about your emotions (e.g., that anger is unacceptable or difficult to control) or struggle to know what you feel at times. Some people with this schema turn to other things to manage or suppress their emotions (e.g., binge eating or drinking alcohol).  
• People develop schemas because some of their emotional needs were not met growing up. As children, schemas help us make sense of early experiences and to get by. If you have an emotional inhibition schema, your parents might have avoided expressing their feelings or criticised you for being emotional. Some cultures emphasise the importance of not showing feelings or vulnerabilities. Whatever the origin, the key message was that expressing yourself is risky, unacceptable, or unattractive.  
• People manage their schemas in different ways. In response to this schema, you might try to control your emotions, avoid expressive activities or people, or be so expressive that it comes across as excessive, unnatural, or awkward.

Standard treatment techniques for working with emotional inhibition are listed below. They include:

• Self-monitoring (e.g., schema diaries). 
• Cognitive interventions (e.g., historical review, decentring, flashcards).
• Emotion-focused interventions (e.g., imagery rescripting, chairwork, letter-writing). 
• Relational interventions (e.g., limited reparenting, empathic confrontation).
• Behavioral interventions (e.g., experimentation, behavioral pattern-breaking).  

In light of the unmet needs associated with emotional inhibition, individuals with this EMS also require a specific ‘need-meeting’ style of interaction from the outset of therapy (Cutland Green & Balfour, 2020). This includes emotional openness, expressiveness, and encouragement to be playful and spontaneous (Lockwood & Samson, 2020). 

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