Youngs early maladaptive schemas

Schemas develop in childhood in response to biological predispositions and

environmental influences. Je Youngs view is that schemas that are maladaptive
and lie at the core of personality disturbance and disorder result from unmet
emotional needs in childhood (Young et al., 2003). He intro-duced the concept of
early maladaptive schemas (EMSs) to account for these unhelpful schemas that
develop as a response to coping with early relationships with family members
(Young, 1990). The content of these schemas is concerned with self-identity and
relationships with others, and although developed during childhood, these are
elaborated throughout ones life. EMSs are the cumulative result of early
dysfunctional experiences with people in the childs immediate environment
(Young and Lindemann, 1992). Each schema is thought to comprise cognitive,
aective and inter-personal components. These schemas are concerned with
themes relating to hypothesized developmental stages of personality. The most
common themes noted relate to the need for security, autonomy, desirability, self-
expression, gratification and self-control. Cognitive therapy for personality
disorder aims to modify these early maladaptive schemas.
Young has developed an instrument for assessing early maladaptive schemas
called the Schema Questionnaire (Young, 1990). This can be pro-ductive in
generating an initial list of potential dysfunctional beliefs and in monitoring
change in patients. In Youngs original model of personality disorder (1990) he
proposed that schemas are reinforced through three dierent processes: schema
maintenance, schema avoidance and schema compensation.
 Cognitive models of personality disorder 23

Schema maintenance
This is the process by which information or evidence that would disconfirm the
schema is resisted through cognitive distortions and by self-defeating behavioural
patterns. This type of information processing appears to be common in patients
with personality disorders. It is as if the patient cannot accommodate new
information that would not fit with what they believe to be true of themselves or
others. Information that would appear to be evidence that would directly
disconfirm a belief is readily dismissed or discounted and may even appear to be
totally ignored. This type of processing is illustrated by a patient with a borderline
personality disorder who believed that she was worthless. This young woman
could not make sense of several women at work repeatedly inviting her to go out
with them, even though she kept refusing. Her explanation for the invitations was
that her colleagues somehow knew that she had no friends and felt sorry for her
or that they might need another person to make up numbers. Alternative
explanations such as that they might want to get to know her better were given no
consideration and dismissed as being impossible as she thought that everyone,
including her colleagues, could see by looking at her that she was boring,
worthless and had nothing to say. She could not conceive that her colleagues
might have been acting in a genuinely friendly manner towards her.

Schema avoidance
When maladaptive schemas are activated, intense negative emotions are
experienced which are so unpleasant that individuals will automatically attempt
to suppress or avoid triggering the schema or the unpleasant aect associated with
the schema. Avoidance can operate at a cognitive level where patients will not
want to speak or think about an event that would bring a schema into sharp focus.
Other avoidance tactics include suppressing or dulling down feelings (aective
avoidance) and overt behavioural avoid-ance. A patient with a diagnosis of
antisocial personality disorder, who held the dysfunctional belief that he was
superior to others, avoided any challenges to this belief by never putting himself
in the position of finding work that would have provided evidence of his talents
and abilities. These processes of avoidance prevent opportunities for schemas to
be modified and thus the subjective belief in negative schemas is reinforced.

Schema compensation
An individual may overcompensate for a negative schema by acting in the
direction opposite to the schemas content; this process can sometimes appear to
be functional. For example, a female patient with a schema con-cerning
defectiveness and unattractiveness might behave in a manner that
24 Cognitive models of personality disorder

demands attention and admiration from men. However, her attempts are likely to
backfire as she is unlikely to be able to modify her behaviour appropriately and
may get involved with men who may ultimately reject her, thus confirming her
belief that she is unattractive.

Youngs schema therapy

Traditional cognitive therapy used in the treatment of mental disorders has been
adapted for the treatment of personality disorders. Youngs schema therapy
(Young et al., 2003) is also a problem-focused therapy but diers from the
cognitive therapy described here in that it has developed the idea of a set of highly
specific schemas and makes more explicit use of imagery and experiential
techniques to trigger the patients schemas and to modify these in therapy.
However, Young is cautious about using these techniques too early in therapy
with patients who, like many individuals with personality disorders, have more
severe schemas and who have diculties in forming a trusting bond with the
therapist (Young et al., 2003).
In schema therapy, imagery can be used to identify the patients schemas in the
assessment phase of therapy. This helps both the therapist and the patient to
understand the childhood origins of the schemas and link the schemas with the
patients current areas of diculty. It also helps the patient experi-ence the
emotional states that are associated with the schemas that developed in early
childhood. It is recognized that some patients may have diculty in the process
of visualization or bringing up specific memories in childhood as they have learnt
to avoid painful recollections of previous experiences. This is described as the
detached protector state whereby the painful memories that trigger a negative
schema are avoided and feelings are cut o. In schema therapy, a therapist can
patiently get round this protector state to gain access to areas of the patients
childhood that have made them vulnerable, but usually only if the therapist has
first formed a secure and trusting bond with the patient.

Youngs schema therapy also utilizes experiential, cognitive and behavioural

techniques, as well as imagery. Experiential work is used to help change or heal
schemas. The patient is carefully guided to an early image that is triggered by the
schema and uses imagery dialogues with key figures in child-hood to change the
maladaptive schema. For example, if a patient had an overbearing critical father,
the patient would first bring to mind a clear image from childhood of an encounter
with the father but in this image, the unmet needs experienced in childhood would
be able to be met. In this new image, the patient can say to the father that she
needs to be loved and respected and not criticized unfairly. In therapy, this new
mode of thinking is often reinforced with a letter that the patient writes to a parent.
Cognitive strategies help patients to voice more adaptive reasoning skills to
evaluate and dispute the early maladaptive schemas and to develop a more
 Cognitive models of personality disorder 25

constructive adult type of reasoning. Young et al. (2003) provide an excellent description of the various techniques,
such as flashcards and schema diaries used to answer schemas in a more adaptive manner. Schema therapy also
places importance on helping patients make changes in maladaptive behavioural patterns. Using standard
behavioural techniques learnt in ther-apy, patients attempt to change their usual coping styles that have been
utilized to avoid or overcompensate for self-defeating maladaptive schemas.