Schema Therapy
What is Schema Therapy?
Schema therapy is an integrative psychological therapy developed by Dr Jeffrey Young, drawing upon concepts and techniques from psychodynamic psychotherapy, cognitive-behavioural therapy, and attachment theory. Schema therapy seeks to help people understand repetitive, unsatisfying patterns of thinking, feeling and behaviours and to improve the way in which they relate to themselves and other people, to ensure that their emotional and physical needs are well met.
The theory underpinning schema therapy posits a crucial role for early maladaptive schemas (EMS) in the development and onset of mental health difficulties. An EMS is considered a “broad and pervasive theme regarding oneself and one’s relationships with others which [may originate] from adverse childhood experiences” [1] (Thimm & Chang, 2022). Specifically, where key emotional needs (such as the need to be accepted, or feel secure and safe) are not consistently met in early life, an EMS (of which there are 18) may develop.
An EMS can activate or be triggered in day to day life - experienced as intense emotion, negative thoughts, beliefs and/or memories - and be highly disruptive. When an EMS is activated, there may also be particular unhelpful coping strategies that are used to manage the difficult experience.
While the idea of an EMS was originally developed to explain and understand features of personality disorder (e.g. emotionally unstable personality disorder, or EUPD), there is now substantial evidence that EMS can be used to understand and explain a variety of different mental health difficulties including:
- Chronic, long-term depression, repetitive negative thinking [2-3]
- Anxiety disorders including OCD [4] and social anxiety [5]
- Attachment (i.e. relational) difficulties [6]
Indeed, evidence suggests schema therapy can lead to long-term improvement in a range of mental health problems including those that have not responded to other forms of therapy such as CBT. Schema therapy has been demonstrated to be an effective treatment for conditions such as:
- Depression [7]
- Anxiety disorders including post-traumatic stress disorder and OCD [8-9]
- Eating disorders including those of a severe and enduring form [10]
- Personality disorders [11]
What does schema therapy involve?
Schema therapy is typically a longer-term therapy, often involving engagement with a therapist for weekly 50-minute sessions for months or even years (rather than a fewer number of individual sessions which may be more typical in a short-term approach such as CBT). However, it can also be delivered in a short-term fashion (i.e. 6-months)
In schema therapy, a central aim is - with the help of your therapist- to identify schemas that are relevant to you and to develop helpful and adaptive ways of responding to them when they are active. Once schemas and coping styles have been identified, work can begin on changing schemas and developing new ways of coping through harnessing different cognitive, emotional and behavioural techniques.
Schema therapy involves use of a number of experiential techniques (i.e. those that involve more than just talking), which distinguish it from other types of therapy. These include ‘chair-work’ and imagery re-scripting. Chair-work is an emotionally engaging experiential exercise that has been reported to have long-term positive effects, as well as greater self awareness and acceptance and enhanced coping and interpersonal relationships (reported in a study of experiences of those with a diagnosis of personality disorder [12].
Schema therapy positions the therapeutic relationship (i.e. the connection between the therapist and client) as a core vehicle for change and so substantial attention is made in the therapy (by therapist and client) to ensure that this connection is prioritised and made safe. As such, it’s essential to seek a therapist with whom you feel comfortable and who is both empathetic and understanding to your needs and behaviours.
Schema therapy in London
Schema therapy is one of several types of therapy I offer from my practice in Central London. It is a model I was originally introduced to (and began using in my practice) during my doctoral training and it has had a substantial influence on my practice over the past decade. This has led me to complete additional specialist training in the model to further develop my practice. Elements of the approach can be readily integrated with other types of therapy (e.g. CBT, EMDR and DBT), depending on a person’s needs and preferences, and it can be helpful for longer-term chronic difficulties for which other therapies perhaps have not had the desired effect. It is also a helpful model of therapy for those who wish to understand and explore the link between their present day emotional experiences and past experiences, but who value doing this in a structured, intentional way and in a manner that does not omit a role for concrete, practical strategies that can be used day to day.
As with any therapeutic approach, the choice of therapy should be based on a careful assessment of an individual's specific needs, preferences and the available evidence. If any of the concepts relating to schema therapy resonate or are of interest, please do not hesitate to reach out to arrange an initial consultation where treatment options can be discussed.
[1] Thimm, J. C., & Chang, M. (2022). Early maladaptive schemas and mental disorders in adulthood: A systematic review and meta-analysis. International Journal of Cognitive Therapy, 15(4), 371-413.
[2] Renner, F., Arntz, A., Leeuw, I., & Huibers, M. (2013). Treatment for chronic depression using schema therapy. Clinical Psychology: Science and Practice, 20(2), 166.
[3] Stavropoulos, A., Haire, M., Brockman, R., & Meade, T. (2020). A schema mode model of repetitive negative thinking. Clinical Psychologist, 24(2), 99-113.
[4] Dostal, A. L., & Pilkington, P. D. (2023). Early maladaptive schemas and obsessive-compulsive disorder: A systematic review and meta-analysis. Journal of Affective Disorders.
[5] Norton, A. R., Penney, E., & Abbott, M. J. (2023). An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization. Journal of Clinical Psychology, 79(4), 1021-1038.
[6] Karantzas, G. C., Younan, R., & Pilkington, P. D. (2023). The associations between early maladaptive schemas and adult attachment styles: A meta-analysis. Clinical Psychology: Science and Practice, 30(1), 1.
[7] Körük, S., & Özabacı, N. (2018). Effectiveness of Schema Therapy on the Treatment of Depressive Disorders: A Meta-Analysis. Current Approaches in Psychiatry/Psikiyatride Guncel Yaklasimlar, 10(4).
[8] Peeters, N., van Passel, B., & Krans, J. (2022). The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda. British Journal of Clinical Psychology, 61(3), 579-597.
[9] Remmerswaal, K. C., Cnossen, T. E., van Balkom, A. J., & Batelaan, N. M. (2023). Schema therapy with cognitive behaviour day-treatment in patients with treatment-resistant anxiety disorders and obsessive-compulsive disorder: an uncontrolled pilot study. Behavioural and Cognitive Psychotherapy, 51(2), 174-179.
[10] Joshua, P. R., Lewis, V., Kelty, S. F., & Boer, D. P. (2023). Is schema therapy effective for adults with eating disorders? A systematic review into the evidence. Cognitive Behaviour Therapy, 52(3), 213-231.
[11] Zhang, K., Hu, X., Ma, L., Xie, Q., Wang, Z., Fan, C., & Li, X. (2023). The efficacy of schema therapy for personality disorders: a systematic review and meta-analysis. Nordic Journal of Psychiatry, 1-10.
[12] Josek, A. K., Schaich, A., Braakmann, D., Assmann, N., Jauch-Chara, K., Arntz, A., ... & Fassbinder, E. (2023). Chairwork in schema therapy for patients with borderline personality disorder—A qualitative study of patients' perceptions. Frontiers in Psychiatry, 14, 1180839.
