Skip to main content Accessibility help
×
Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-15T13:21:37.951Z Has data issue: false hasContentIssue false

Chapter 2 - Research Support for Schema Therapy

from Part I - Overview of the Schema Therapy Model

Published online by Cambridge University Press:  27 July 2023

Robert N. Brockman
Affiliation:
Australian Catholic University
Susan Simpson
Affiliation:
NHS Forth Valley and University of South Australia
Christopher Hayes
Affiliation:
Schema Therapy Institute Australia
Remco van der Wijngaart
Affiliation:
International Society of Schema Therapy
Matthew Smout
Affiliation:
University of South Australia
Get access

Summary

Schema therapy research has increased significantly over the last twenty years. This chapter reviews empirical support for the schema therapy model, including evidence for the existence of core emotional needs, that early maladaptive schemas result from unmet needs, and that early maladaptive schemas and schema modes are associated with various forms of psychopathology. Next, it reviews the randomized controlled trials of schema therapy for personality disorders and the uncontrolled trials of schema therapy for a range of other problems including anxiety and related disorders and eating disorders. Finally, empirical support for two key interventions within schema therapy – imagery rescripting and chair dialogues – is discussed. There is strong support for the efficacy of long-term individual schema therapy for females with borderline personality disorder. Support for other applications of schema therapy is promising but requires replication with more rigorous study designs. There is evidence that belongingness/secure attachment, competence, and autonomy are basic psychological needs. Both maladaptive and adaptive schemas cluster according to themes of whether or not early experiences provided connection, autonomy, and reasonable limits.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Young, J, Klosko, J, Weishaar, M. Schema therapy: A practitioners guide. New York: Guilford; 2003.Google Scholar
Bach, B, Lockwood, G, Young, J. A new look at the schema therapy model: Organization and role of early maladaptive schemas. Cognitive Behaviour Therapy. 2017;47(4):328–49.Google Scholar
Arntz, A, Rijkeboer, M, Chan, E et al. Towards a Reformulated Theory Underlying Schema Therapy: Position Paper of an International Workgroup. Cognitive Therapy and Research. 2021.Google Scholar
Yalcin, O, Lee, C, Correia, H. Factor structure of the Young Schema Questionnaire (Long Form‐3). Australian Psychologist. 2020;55(5):546–58.Google Scholar
Marais, I, Moir, VK, Lee, CW. The effects of item placement in the Young Schema Questionnaire. Journal of Applied Measurement, 2017;18(4):370–82.Google ScholarPubMed
Lockwood, G, Perris, P. A new look at core emotional needs. In van Vreekswijk, M, Broersen, J, Nadort, M, eds. The Wiley-Blackwell handbook of schema therapy. Wiley-Blackwell, pp. 4166.CrossRefGoogle Scholar
Louis, J, Davidson, A, Lockwood, G, Wood, A. Positive perceptions of parenting and their links to theorized core emotional needs. Journal of Child and Family Studies. 2020;29(12):3342–56.CrossRefGoogle Scholar
Dweck, C. From needs to goals and representations: Foundations for a unified theory of motivation, personality, and development. Psychological Review. 2017;124(6):689719.CrossRefGoogle ScholarPubMed
Deci, E, Ryan, R. The ‘what’ and ‘why’ of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry. 2000;11(4):227–68.CrossRefGoogle Scholar
Baumeister, R, Leary, M. The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin. 1995;117(3):497529.CrossRefGoogle ScholarPubMed
Ainsworth, M. Attachment as related to mother-infant interaction. In Rosenblatt, J, ed. Advances in the Study of Behaviour. Academic Press; 1979. pp. 151.Google Scholar
Bowlby, J. Attachment and Loss: Attachment (Vol 1). Basic Books; 1969.Google Scholar
Harlow, H. The nature of love. American Psychologist. 1958;13(12):673–85.CrossRefGoogle Scholar
Murray, H. A. Explorations in personality: A clinical and experimental study of fifty men of college age. Oxford University Press; 1938Google Scholar
McClelland, DC. Human motivation. Cambridge; 1987Google Scholar
Maslow, A. A theory of human motivation. Psychological Review. 1943;50(4):370–96.Google Scholar
O’Neill, M, Pillai Riddell, R, Bureau, J et al. Longitudinal and concurrent relationships between caregiver–child behaviours in the vaccination context and preschool attachment. Pain. 2020;162(3):823–34.Google Scholar
Calders, F, Bijttebier, P, Bosmans, G et al. Investigating the interplay between parenting dimensions and styles, and the association with adolescent outcomes. European Child & Adolescent Psychiatry. 2019;29(3):327–42.Google Scholar
Ryan, R. M., & Deci, E. L. Self-determination theory: Basic psychological needs in motivation, development, and wellness. The Guilford Press; 2017.CrossRefGoogle Scholar
Baumrind, D. Rearing competent children. In Damon, W, ed. Child development today and tomorrow. Jossey-Bass/Wiley; 1988. pp. 349–78.Google Scholar
Lamborn, S, Mounts, N, Steinberg, L, Dornbusch, S. Patterns of competence and adjustment among adolescents from authoritative, authoritarian, indulgent, and neglectful families. Child Development. 1991;62(5):1049.CrossRefGoogle ScholarPubMed
Hinnant, J, Erath, S, Tu, K, El-Sheikh, M. Permissive parenting, deviant peer affiliations, and delinquent behavior in adolescence: The moderating role of sympathetic nervous system reactivity. Journal of Abnormal Child Psychology. 2015;44(6):1071–81.Google Scholar
Barton, A, Hirsch, J. Permissive parenting and mental health in college students: Mediating effects of academic entitlement. Journal of American College Health. 2015;64(1):18.CrossRefGoogle Scholar
Shumow, L, Vandell, D, Posner, J. Harsh, firm, and permissive parenting in low-income families. Journal of Family Issues. 1998;19(5):483507.CrossRefGoogle Scholar
Gray, M, Steinberg, L. Unpacking authoritative parenting: Reassessing a multidimensional construct. Journal of Marriage and the Family. 1999;61(3):574.Google Scholar
Farkas, M, Grolnick, W. Examining the components and concomitants of parental structure in the academic domain. Motivation and Emotion. 2010;34(3):266–79.Google Scholar
Grolnick, W, Raftery-Helmer, J, Marbell, K et al. Parental provision of structure: Implementation and correlates in three domains. Merrill-Palmer Quarterly. 2014;60(3):355.Google Scholar
Soenens, B, Vansteenkiste, M, Niemic, C. Should parental prohibition of adolescents’ peer relationships be prohibited? Personal Relationships. 2009;16(4):507–30.CrossRefGoogle Scholar
Feeney, B, Collins, N. The importance of relational support for attachment and exploration needs. Current Opinion in Psychology. 2019;25:182–6.CrossRefGoogle ScholarPubMed
Silvia, P, Kwapil, T. Aberrant asociality: How individual differences in social anhedonia illuminate the need to belong. Journal of Personality. 2011;79(6):1315–32.CrossRefGoogle ScholarPubMed
Stanley, P, Schutte, N, Phillips, W. A meta-analytic investigation of the relationship between basic psychological need satisfaction and affect. Journal of Positive School Psychology. 2021;5(1):116.CrossRefGoogle Scholar
Pilkington, P, Bishop, A, Younan, R. Adverse childhood experiences and early maladaptive schemas in adulthood: A systematic review and meta‐analysis. Clinical Psychology & Psychotherapy. 2020;28(3):569–84.Google Scholar
Young, JE, Klosko, JS. Reinventing your life: The breakthrough program to end negative behavior and feel great again. Plume; 1994.Google Scholar
Mertens, Y, Yılmaz, M, Lobbestael, J. Schema modes mediate the effect of emotional abuse in childhood on the differential expression of personality disorders. Child Abuse & Neglect. 2020;104:104445.CrossRefGoogle ScholarPubMed
Specht, M, Chapman, A, Cellucci, T. Schemas and borderline personality disorder symptoms in incarcerated women. Journal of Behavior Therapy and Experimental Psychiatry. 2009;40(2):256–64.CrossRefGoogle ScholarPubMed
Saldias, A, Power, K, Gillanders, D, Campbell, C, Blake, R. The mediatory role of maladaptive schema modes between parental care and non-suicidal self-injury. Cognitive Behaviour Therapy. 2013;42(3):244–57.CrossRefGoogle ScholarPubMed
Lumley, M, Harkness, K. Specificity in the relations among childhood adversity, early maladaptive schemas, and symptom profiles in adolescent depression. Cognitive Therapy and Research. 2007;31(5):639–57.CrossRefGoogle Scholar
Bach, B, Farrell, J. Schemas and modes in borderline personality disorder: The mistrustful, shameful, angry, impulsive, and unhappy child. Psychiatry Research. 2018;259:323–9.CrossRefGoogle ScholarPubMed
Bach, B, Lobbestael, J. Elucidating DSM-5 and ICD-11 diagnostic features of borderline personality disorder using schemas and modes. Psychopathology. 2018;51(6):400–7.Google Scholar
Dadashzadeh, H, Hekmati, I, Gholizade, H, Abdi, R. Schema modes in cluster B personality disorders. Archives of Psychiatry and Psychotherapy. 2016;18(2):22–8.CrossRefGoogle Scholar
Bamelis, L, Renner, F, Heidkamp, D, Arntz, A. Extended schema mode conceptualizations for specific personality disorders: An empirical study. Journal of Personality Disorders. 2011;25(1):4158.CrossRefGoogle ScholarPubMed
Jacobs, I, Lenz, L, Wollny, A, Horsch, A. The higher-order structure of schema modes. Journal of Personality Disorders. 2020;34(3):348–76.Google Scholar
Kotov, R, Krueger, R, Watson, D et al. The hierarchical taxonomy of psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology. 2017;126(4):454–77.Google Scholar
Keulen-de Vos, M, Bernstein, D, Clark, L, et al. Validation of the schema mode concept in personality disordered offenders. Legal and Criminological Psychology. 2017;22(2):420–41.CrossRefGoogle Scholar
Sempértegui, G, Karreman, A, Arntz, A, Bekker, M. Schema therapy for borderline personality disorder: A comprehensive review of its empirical foundations, effectiveness and implementation possibilities. Clinical Psychology Review. 2013;33(3):426–47.Google Scholar
Giesen-Bloo, J, van Dyck, R, Spinhoven, P et al. Outpatient psychotherapy for borderline personality disorder: Randomizedtrial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry. 2006;63(6):649.CrossRefGoogle Scholar
Arntz, A, van Genderen, H. Schema therapy for borderline personality disorder. Wiley. 2009.Google Scholar
Sieswerda, S, Arntz, A, Kindt, M. Successful psychotherapy reduces hypervigilance in borderline personality disorder. Behavioural and Cognitive Psychotherapy. 2007;35(4):387402.Google Scholar
van Asselt, A, Dirksen, C, Arntz, A, Severens, J. The cost of borderline personality disorder: Societal cost of illness in BPD-clients. European Psychiatry. 2007;22(6):354–61.CrossRefGoogle Scholar
Nadort, M, Arntz, A, Smit, J et al. Implementation of outpatient schema therapy for borderline personality disorder with versus without crisis support by the therapist outside office hours: A randomized trial. Behaviour Research and Therapy. 2009;47(11):961–73.CrossRefGoogle ScholarPubMed
Farrell, JM, Shaw, JM. Group schema therapy for borderline personality disorder a step-by-step treatment manual with patient workbook. Wiley-Blackwell. 2012CrossRefGoogle Scholar
Dickhaut, V, Arntz, A. Combined group and individual schema therapy for borderline personality disorder: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry. 2014;45(2):242–51.CrossRefGoogle ScholarPubMed
Arntz, A, Jacob, GA, Lee, CW et al. Effectiveness of predominantly group schema therapy and combined individual and group schema therapy for borderline personality disorder: A randomized clinical trial. JAMA Psychiatry. 2022;79(4):287–99.CrossRefGoogle ScholarPubMed
Hilden, H, Rosenström, T, Karila, I et al. Effectiveness of brief schema group therapy for borderline personality disorder symptoms: a randomized pilot study. Nordic Journal of Psychiatry. 2020;75(3):176–85.Google Scholar
Bohus, M, Kleindienst, N, Limberger, M et al. The short version of the borderline symptom list (BSL-23): Development and initial data on psychometric properties. Psychopathology. 2008;42(1):32–9.Google ScholarPubMed
Hamid, N, Molajegh, R, Bashlideh, K, Shehniyailagh, M. The comparison of effectiveness of dialectical behavioral therapy (DBT) and schema therapy (ST) in reducing the severity of clinical symptoms (disruptive communication, emotional deregulation and behavioral deregulation) of borderline personality disorder in Iran. Pakistan Journal of Medical and Health Sciences. 2020;14:1354–62.Google Scholar
Fassbinder, E, Assmann, N, Schaich, A et al. PRO*BPD: Effectiveness of outpatient treatment programs for borderline personality disorder: A comparison of Schema therapy and dialectical behavior therapy: Study protocol for a randomized trial. BMC Psychiatry. 2018;18(1).CrossRefGoogle ScholarPubMed
van Vreeswijk, M, Spinhoven, P, Eurelings-Bontekoe, E, Broersen, J. Changes in symptom severity, schemas and modes in heterogeneous psychiatric patient groups following short-term schema cognitive-behavioural group therapy: A naturalistic pre-treatment and post-treatment design in an outpatient clinic. Clinical Psychology & Psychotherapy. 2012;21(1):2938.CrossRefGoogle Scholar
Skewes, S, Samson, R, Simpson, S, van Vreeswijk, M. Short-term group schema therapy for mixed personality disorders: A pilot study. Frontiers in Psychology. 2015;5(1592):19.Google Scholar
Schaap, G, Chakhssi, F, Westerhof, G. Inpatient schema therapy for nonresponsive clients with personality pathology: Changes in symptomatic distress, schemas, schema modes, coping styles, experienced parenting styles, and mental well-being. Psychotherapy. 2016;53(4):402–12.Google Scholar
van Vreeswijk, M, Spinhoven, P, Zedlitz, A, Eurelings-Bontekoe, E. Mixed results of a pilot RCT of time-limited schema mindfulness-based cognitive therapy and competitive memory therapy plus treatment as usual for personality disorders. Personality Disorders: Theory, Research, and Treatment. 2020;11(3):170–80.CrossRefGoogle ScholarPubMed
Bamelis, L, Evers, S, Spinhoven, P, Arntz, A. Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry. 2014;171(3):305–22.CrossRefGoogle ScholarPubMed
Arntz, A, Jacob, G. Schema therapy in practice: An introductory guide to the schema mode approach. Wiley-Blackwell; 2013Google Scholar
Hopwood, C, Thomas, K. Schema therapy is an effective treatment for avoidant, dependent and obsessive-compulsive personality disorders. Evidence Based Mental Health. 2014;17(3):90–1.CrossRefGoogle ScholarPubMed
Bernstein, D, Keulen-de Vos, M, Clercx, M et al. Schema therapy for violent PD offenders: A randomized clinical trial. Psychological Medicine. 2021:115.CrossRefGoogle Scholar
Videler, A, van Alphen, S, van Royen, R et al. Schema therapy for personality disorders in older adults: A multiple-baseline study. Aging & Mental Health. 2017;22(6):738–47.Google Scholar
Videler, A, Rossi, G, Schoevaars, M, van der Feltz-Cornelis, C, van Alphen, S. Effects of schema group therapy in older outpatients: a proof of concept study. International Psychogeriatrics. 2014;26(10):1709–17.Google ScholarPubMed
van Dijk, S, Veenstra, M, Bouman, R et al. Group schema-focused therapy enriched with psychomotor therapy versus treatment as usual for older adults with cluster B and/or C personality disorders: a randomized trial. BMC Psychiatry. 2019;19(1):26.CrossRefGoogle ScholarPubMed
Gude, T, Hoffart, A. Change in interpersonal problems after cognitive agoraphobia and schema-focused therapy versus psychodynamic treatment as usual of inpatients with agoraphobia and Cluster C personality disorders. Scandinavian Journal of Psychology. 2008;49(2):195–9.CrossRefGoogle ScholarPubMed
Cockram, D, Drummond, P, Lee, C. Role and treatment of early maladaptive schemas in vietnam veterans with PTSD. Clinical Psychology & Psychotherapy. 2010;17(3):165–82.CrossRefGoogle ScholarPubMed
Thiel, N, Jacob, G, Tuschen-Caffier, B et al. Schema therapy augmented exposure and response prevention in clients with obsessive-compulsive disorder: Feasibility and efficacy of a pilot study. Journal of Behavior Therapy and Experimental Psychiatry. 2016;52:5967.CrossRefGoogle ScholarPubMed
Simpson, S, Morrow, E, van Vreeswijk, M, Reid, C. Group schema therapy for eating disorders: A pilot study. Frontiers in Psychology. 2010;1(182):110.Google Scholar
Calvert, F, Smith, E, Brockman, R, Simpson, S. Group schema therapy for eating disorders: study protocol. Journal of Eating Disorders. 2018;6(1):17.Google Scholar
Simpson, S, Slowey, L. Video therapy for atypical eating disorder and obesity: A case study. Clinical Practice & Epidemiology in Mental Health. 2011;7(1):3843.Google Scholar
McIntosh, V, Jordan, J, Carter, J et al. Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy. Psychiatry Research. 2016;240:412–20.CrossRefGoogle ScholarPubMed
Mohtadijafari, S, Ashayeri, H, Banisi, P. The effectiveness of schema therapy techniques in mental health and quality of life of women with premenstrual dysphoric isorder. Iranian Journal of Psychiatry and Clinical Psychology. 2019;25(3):278–91.Google Scholar
Nameni, E, Saadat, S H, Keshavarz-Afshar, H, Askarabady, F. Effectiveness of group counseling based on schema therapy on quality of marital relationships, differentiation and hardiness in women seeking divorce in families of war veterans. Journal of Military Medicine. 2019; 21 (1):91–9.Google Scholar
Farrell, J, Shaw, I, Webber, M. A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry. 2009;40(2):317–28.Google Scholar
Yakın, D, Grasman, R, Arntz, A. Schema modes as a common mechanism of change in personality pathology and functioning: Results from a randomized controlled trial. Behaviour Research and Therapy. 2020;126:103553.Google Scholar
Hyett, M, Bank, S, Lipp, O et al. Attenuated psychophysiological reactivity following single-session group imagery rescripting versus verbal restructuring in social anxiety disorder: Results from a randomized controlled trial. Psychotherapy and Psychosomatics. 2018;87(6):340–9.CrossRefGoogle ScholarPubMed
Kunze, A, Lancee, J, Morina, N, Kindt, M, Arntz, A. Mediators of change in imagery rescripting and imaginal exposure for nightmares: Evidence from a randomized wait-list controlled trial. Behavior Therapy. 2019;50(5):978–93.CrossRefGoogle ScholarPubMed
Romano, M, Moscovitch, D, Huppert, J, Reimer, S, Moscovitch, M. The effects of imagery rescripting on memory outcomes in social anxiety disorder. Journal of Anxiety Disorders. 2020;69:102169.CrossRefGoogle ScholarPubMed
Boterhoven de Haan, K, Lee, C et al. Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial. The British Journal of Psychiatry. 2020;217(5):609–15.Google Scholar
Paulik, G, Steel, C, Arntz, A. Imagery rescripting for the treatment of trauma in voice hearers: A case series. Behavioural and Cognitive Psychotherapy. 2019;47(6):709–25.CrossRefGoogle ScholarPubMed
Siegesleitner, M, Strohm, M, Wittekind, C, Ehring, T, Kunze, A. Improving imagery rescripting treatments: Comparing an active versus passive approach. Journal of Behavior Therapy and Experimental Psychiatry. 2020;69:101578.CrossRefGoogle ScholarPubMed
Rafaeli, E, Young, J, Bernstein, D. Schema therapy: Distinctive features. Routledge. 2011Google Scholar
Greenberg, L, Clarke, K. Differential effects of the two-chair experiment and empathic reflections at a conflict marker. Journal of Counselling Psychology. 1979;26(1):18.Google Scholar
Greenberg, L, Dompierre, L. Specific effects of Gestalt two-chair dialogue on intrapsychic conflict in counselling. Journal of Counselling Psychology. 1981;28(4):288–94.CrossRefGoogle Scholar
Greenberg, L, Higgins, H. Effects of two-chair dialogue and focusing on conflict resolution. Journal of Counseling Psychology. 1980;27(3):221–24.CrossRefGoogle Scholar
Bell, T, Montague, J, Elander, J, Gilbert, P.A definite feel‐it moment’: Embodiment, externalisation and emotion during chair‐work in compassion‐focused therapy. Counselling and Psychotherapy Research. 2019;20(1):143–53.Google Scholar
Conoley, C, Conoley, J, McConnell, J, Kimzey, C. The effect of the ABCs of rational emotive therapy and the empty-chair technique of gestalt therapy on anger reduction. Psychotherapy: Theory, Research & Practice. 1983;20(1):112–17.Google Scholar
Trachsel, M, Ferrari, L, Holtforth, MG. Resolving partnership ambivalence: A randomized controlled trial of very brief cognitive and experiential interventions with follow-up. Canadian Journal of Counselling and Psychotherapy. 2012; 46(3):239–58.Google Scholar
Greenberg, L. The intensive analysis of recurring events from the practice of Gestalt therapy. Psychotherapy: Theory, Research & Practice. 1980;17(2):143–52.CrossRefGoogle Scholar
Greenberg, L, Webster, M. Resolving decisional conflict by Gestalt two-chair dialogue: Relating process to outcome. Journal of Counseling Psychology. 1982;29(5):468–77.CrossRefGoogle Scholar
Stiegler, J, Molde, H, Schanche, E. Does an emotion-focused two-chair dialogue add to the therapeutic effect of the empathic attunement to affect? Clinical Psychology & Psychotherapy. 2017;25(1):e86e95.Google Scholar
Watson, J, Gordon, L, Stermac, L, Kalogerakos, F, Steckley, P. Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology. 2003;71(4):773–81.CrossRefGoogle ScholarPubMed
Greenberg, L, Malcolm, W. Resolving unfinished business: Relating process to outcome. Journal of Consulting and Clinical Psychology. 2002;70(2):406–16.Google Scholar
Paivio, S, Jarry, J, Chagigiorgis, H, Hall, I, Ralston, M. Efficacy of two versions of emotion-focused therapy for resolving child abuse trauma. Psychotherapy Research. 2010;20(3):353–66.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×