How Your Past Affects Your Present (Schema Therapy)

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 incorporated, 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, enabling 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. For this reason, schemas can be adaptive or maladaptive, and positive or negative, depending on their output (Young et al., 2003). Research confirms the existence of both adaptive and maladaptive schemas, the former being associated with positive functions and adaptive behavioral dispositions (Louis et al., 2018).

In schema therapy, EMS are defined as negative and 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). Crucially, 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). For example, viewing oneself as defective (rather than viewing one’s parent as abusive) fosters hope for the child and protects critical attachments. This strategy becomes dysfunctional when it is indiscriminately and repeatedly applied to later life experiences.

EMS are elaborated and strengthened throughout individuals’ lifespan, becoming the ‘filters’ through which they 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 they are 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)

Studies have confirmed links between EMS and psychopathology, indicating that schemas are not only more pronounced in clinical groups (Thimm & Chang, 2022) but predict the presence or absence of psychopathology (Rijkeboer et al., 2005). Further research suggests that EMS influence responses to psychotherapy. For example, higher pre-treatment levels of abandonment schema are related to poorer outcomes in OCD, while decreases in failure schemas are related to better outcomes (Haaland et al., 2011).

Schema characteristics

EMS are remarkably obstinate: they “fight for survival” (Young & Lindemann, 2002). 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)

Other characteristics of EMS include:

• EMS are dynamic. EMS ‘sleep’ in the background until they are triggered by relevant cues (Roediger et al., 2018). In other words, schemas can be active or inactive (Beck, 2015). Situations resembling early experiences associated with the formation of the EMS are likely to be most activating.
• EMS are prepotent. Despite their inactivity, latent EMS are ready to supersede other schemas and bias information processing in unhelpful ways (Beck et al., 2004).
• EMS are inhibitory. Once activated, EMS tend to displace other schemas that might be more adaptive or appropriate for the situation (e.g., positive schemas) (Beck, 2015).
• EMS vary in strength. Severe EMS are triggered by a broader range of cues, accompanied by greater affect, and remain activated for longer (Young et al., 2003). Pronounced EMS also have lower thresholds for activation (Beck, 2015).
• EMS are dense. Their prominence in the cognitive organization can vary (Beck, 2015). Compared to other schemas (e.g. positive ones), EMS have thicker and more tightly interconnected memory structures or ‘nodes’, meaning that activation of one node rapidly activates the entire EMS (Louis et al., 2018).

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:

• Secure attachments (e.g., safety, protection, acceptance, stability, and belonging).
• Autonomy, competence, and sense of identity.
• Freedom to express needs and emotions.
• Spontaneity and play.
• 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). As children mature, needs arising in 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 (Young et al., 2003). EMS can also develop in later life (such as in response to deeply disturbing events), but 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), connectedness to nature and creativity (O’Sheedy, 2021; Kudryavtsev, 2011). 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:

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

Research confirms that toxic childhood experiences contribute to EMS development, highlighting the roles of childhood abuse (Pilkington et al., 2021), dysfunctional parenting (e.g., Bach et al., 2018), bullying (Alba et al., 2018), and other traumatic events (Noor & Dildar, 2021; Wells & Hackmann, 1993). Evidence has also been found for the intergenerational transmission of EMS (e.g., Sundag et al., 2018).

Emotional temperament

Temperament refers to enduring differences in children’s behavioral style and reactivity (Zentner & Bates, 2008). Temperament 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

Several 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’ (see below). 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. They 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). Like EMS, factors that 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 is 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).

"A key idea in schema therapy is that personal difficulties sometimes stem from painful early maladaptive schemas and how people try to cope with them. However, people aren’t born with schemas: they develop them in response to emotional needs that weren’t met during their early lives. Can we use this handout to explore how these ideas fit together?"

Clients may find it easiest to begin at the top level and work downwards. The iceberg can be used as a metaphor for the ‘visibility’ of each schema component.

1. Unhelpful patterns in your life. These are the problems people struggle with in their adult lives, and often mirror attempts to cope with early maladaptive schemas. Clients may already be aware of negative themes, patterns, or ‘traps’ in their lives: likening this to seeing the tip of an iceberg above water encourages them to examine the ‘deeper’ schema components that lie under the surface. Consider asking:
   • "When you think about your life, do any negative themes seem to run through it?"
   • "Are you aware of any unhelpful patterns in the way you think and feel?"
   • "Have you noticed unhelpful relationship patterns that you keep falling into?"
   • "Do you keep having the same setbacks in certain areas of your life?"
2. Early maladaptive schemas. Clients are often unaware of the schemas they hold, so will benefit from prompts and questions that help them elaborate any schemas they developed as a child:
   • "Are you aware of any negative beliefs you hold about yourself, other people, or the world?"
   • "Can you put your schema(s) into words? For example, “I am…”, “I need to…”, or “People are…”."
   • "Would you say there is a negative ‘same old story’ that seems to define your life?"
   • "Do you see a connection between your schema(s) and the negative patterns in your life?"
3. Unmet needs. Early maladaptive schemas stem from unmet core emotional needs. Every child is born with the same emotional needs, like the need to feel safe and accepted, but people fall on a spectrum regarding how well these needs were fulfilled when they were young. Prompts might include:
   • "How well were your emotional needs responded to as a child?"
   • "How well were your needs responded to as a teenager?"
   • "Which of your needs weren’t met, or were met inconsistently? What was missing?"
   • "Were any of your needs met too much or too intensely?"
4. Experiences. Many things can contribute to unmet emotional needs, like how the client was parented, the environment they grew up in, painful things that happened to them, or how other people responded to them:
   • "When you were growing up, what experiences might have contributed to your unmet needs?"
   • "Can you think of any life events that might have contributed to your unmet needs?"
   • "Can you think of relationships or interactions that contributed to your unmet needs?"
   • "Were you told or taught things that might have impacted your emotional needs?"
   • "Did you see others doing things that might have affected your emotional needs?"
   • "Are there other factors that might be relevant to your unmet needs, like the culture, community, or society you were born into?"

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