Vulnerability To Harm

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

"Many people struggle with a vulnerabilty to harm schema, 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 vulnerability to harm 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 color 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 ‘vulnerability to harm’. If

• Abedi, A., Sepahvandi, M. A., & Mirderikvand, F. (2018). Investigating the role of early maladaptive schemas in body image disturbance. Journal of Advanced Pharmacy Education and Research, 8, 51-57.
• Alba, J., Calvete, E., Wante, L., Van Beveren, M. L., & Braet, C. (2018). Early maladaptive schemas as moderators of the association between bullying victimization and depressive symptoms in adolescents. Cognitive Therapy and Research, 42, 24-35. DOI: 10.1007/s10608-017-9874-5.
• Arnaudova, I., Kindt, M., Fanselow, M., & Beckers, T. (2017). Pathways towards the proliferation of avoidance in anxiety and implications for treatment. Behaviour Research and Therapy, 96, 3-13. DOI: 10.1016/j.brat.2017.04.004.
• Arntz, A., & Jacob, G. (2013). Schema therapy in practice: An introductory guide to the schema mode approach. John Wiley and Sons.
• Arntz, A., Rijkeboer, M., Chan, E., Fassbinder, E., Karaosmanoglu, A., Lee, C. W., & Panzeri, M. (2021). Towards a reformulated theory underlying schema therapy: Position paper of an international workgroup. Cognitive Therapy and Research, 45,