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Mental Disorders

Cognitive-Behavioral Theory Expanded: Schema Theory

Simone Hoermann, Ph.D., Corinne E. Zupanick, Psy.D. & Mark Dombeck, Ph.D.

Schema theory was developed by the psychologist Jeffrey Young, Ph.D. It is considered an integrative approach; meaning, it links together several psychological theories. It derives mainly out of cognitive-behavioral theory, but also includes elements of attachment theory, and object relations theory. Unlike conventional cognitive-behavioral theory, schema theory takes into account the childhood origins of distorted thinking.  The therapy associated with this theory employs not only traditional cognitive techniques, but places a heavy emphasis on experiential-emotional techniques to correct damaged personality structures. Schema therapy has recently emerged as an effective treatment for Borderline Personality Disorder (Young & Klosko, 2005) and is discussed in the treatment section.

woman thinkingSchemas are considered an organizing framework of the mind. Schemas represent patterns of internal experience.  This includes memories, beliefs, emotions, and thoughts.  Maladaptive schemas form when a child's core needs are not met. These core needs may include such things as: safety, security, nurturance, acceptance, respect, autonomy, guidance, direction, love, attention, approval, self-expression, joy, pleasure, and relaxation.  Young contends that the problem for people with personality disorders is that these core needs were not met during childhood.  These unmet needs lead to the development of "early maladaptive schemas."  He defines these early maladaptive schemas as broad, pervasive relationship themes.  They are developed during childhood and further elaborated throughout one's lifetime. They are dysfunctional to a significant degree (Young, 2005).  This basically means that people with personality disorders have schemas that cause them to have a lot of problems with other people, and with their own feelings about themselves.   

Young believes that people with personality disorders have developed maladaptive schemas stemming from "toxic childhood experiences." These toxic experiences cause self-defeating patterns of interaction to form.  These self-defeating patterns of interaction get played out throughout the person's lifetime causing them a great deal of trouble, heartache, and grief.   People with personality disorders tend to use maladaptive coping strategies in response to the maladaptive schemas. Ironically, the coping strategies themselves end up causing them problems. What was once a child's adaptive attempt to cope with a painful problem now becomes the problem itself.   

According to Young, these maladaptive coping strategies develop during childhood in response to damaging childhood experiences. These maladaptive coping responses take one of three basic forms: surrender, avoidance, or over-compensation.

Three maladaptive coping strategies:

1. Surrender: avoid conflict, people pleasing
2. Avoidance: excessive autonomy, addictions, stimulus-seeking
3. Over compensation: behaving in the extreme opposite manner

Surrender refers to compliance and dependence. People with this coping strategy avoid conflict at all cost and engage in people-pleasing behaviors. Avoidance strategies include excessive autonomy or isolation, addictive forms of self-soothing, and compulsive stimulus-seeking. For example, someone who was abandoned as a child might avoid intimate relationships, or abruptly leave a relationship at the slightest sign of discord, in order to avoid the possibility of future abandonment. Over-compensation means to behave in a manner that is the extreme opposite of how we really feel. So, if I feel insignificant and unimportant, I might behave in a haughty and arrogant manner in an effort to conceal or deny my insecurities. It becomes clear that these maladaptive coping strategies can lead to devastating consequences.

Schema theory maintains that based on our early childhood experiences, certain patterns or themes emerge. These later get played out in all our future relationships.  Thus, the way in which we behave in the world is driven by our schemas.  Let's consider the example of a young woman who was abandoned during her childhood.  This could include abandonment through divorce or death of a parent, but could also include emotional abandonment through neglect or parental indifference.  Now as an adult, whenever she experiences an event that reminds her of this early abandonment, her abandonment schema will become triggered. She will immediately experience strong negative emotions such as rage, shame, or fear.  The intensity of her emotions is disproportionate to the actual, present-day event.  In response to the schema activation, a maladaptive coping strategy will be elicited.  So, whenever her husband goes away on a short business trip, this abandonment schema might be triggered.  She might experience intense emotions, and get so overwhelmed with these emotions that she responds by overcompensation. For example, she might refuse to take his phone calls, in an effort to prove, "I don't need you" when in fact, she desperately does need him.  Her husband, on the other hand, will be baffled by the intensity of these emotions ("It's just a short trip.").  The result is there will likely be a conflict whenever he must take such a trip.  Such chronic discord naturally leads to significant relationship problems.

Because problems in interpersonal relationships are found in all personality disorders as the dominant and most important feature, schema theory is an appealing theory. This is because its main thesis surrounds how problematic relationship patterns are developed and then repeated throughout one's lifetime. In addition, the concept of schemas readily accounts for the thematic, chronic, and inflexible nature of interpersonal problems that are so characteristic of the personality disorders. Schema Therapy is based upon these concepts and is discussed in the treatment section.