Cognitive, Behavior, & Schema Therapy Clinic


Cognitive-Behavioral Therapy (CBT) is one of the most effective therapies today. Most effective for Depression & Anxiety Disorders.

Schemas
Based on the work of Jeff Young, Ph.D.


What are schemas?

Schema is a cognitive term which plainly means a structured framework or plan, a blue print, or a mental codification (to reduce to a code) of experience that includes a particularly organized way of perceiving cognitively and responding to a complex situation or set of stimuli. It’s the deepest level of our cognitive (thinking) structure. According to the cognitive psychology theorists, our mental process is divided into four different hierarchal levels:
1. At the top of the list is what is known as Voluntary or Trivial Thoughts…most surface, most accessible, and most changeable thoughts.
2. Automatic Thoughts…responses to situations or events that may have been learned through past experiences (Everyone will see I am nervous). Automatic thoughts are the rules or traffic signals that guide us through the streets of life, heuristics.
3. Basic Assumptions…Beliefs, Values, Morals, Ethics, etc. They are deep and most resistant. (I am a good person…, People are nice in nature…, Hurting others is OK if they hurt me first. Etc.)
4. Schemas…patterns in thinking that mostly develop early in life…get repeated and elaborated upon. They are perpetuated behaviorally through coping styles of maintenance, avoidance, and compensations.


Since schemas are at the bottom of our thinking process, it operates at an unconscious level by which our beliefs, values, morals, ethics, rules, etc. get filtered. Since they operate on unconscious level, we are not aware of them, but they dictate our current behaviors and feelings. Although we can’t explain many of our surface behaviors and they don’t seem to make sense, we still do them nevertheless because they are operating from our schemas. To make this clearer, here is an example of how it works:


Assume that Malcolm’s schema is Abandonment, but of course he doesn’t know this. Malcolm is 48 years old and is still single, working, but has very few friends. He had few relationships but never turned into anything long-term. When asked as to why he was still single, he would reply that he had not found the right person yet. As to the very few friends, his answer was, it’s not the quantity but the quality. On the surface, he seems to have an answer for everything you ask him. Sadly, he has no idea that he may be operating on an abandonment schema among others. He can’t get too close to people for fear of abandonment. He keeps himself closed off and keeps a distance between himself and others. He even sabotages relationships, if he ever gets close to one. He will probably continue to do this as long as his schema is operating in the background and he is not aware of it.


See a list of schemas at the back of this packet.
How do schemas develop?


Schemas develop at an early age, and as soon as our cognitive brain goes on line which is usually around the age of two. Our genes play a huge role in how we operate in the world around us. However, our environment plays a role in shaping these genes and molding them in such ways that help us to operate in that particular environment. As children perceive their world, they begin to make conclusions about that world and develop coping styles to deal with that world. It does not matter if the child’s perceptions are accurate, however, the child will continue to make these conclusions unless corrected by the caregivers around. For children’s survival, it’s imperative to continue to learn and make conclusions about their world in order to develop coping strategies that help them survive. Sometimes, these conclusions are erroneous and it’s simply made because of what the self-centered child assumes. To illustrate what this means, here is an example:


A two-parent family has one child who is left home with a babysitter five days/week. The parents are both working and trying their best to provide a good life for the child. However, due to the lack of bonding that the child is experiencing because of the frequent absence of the parents, the child may conclude some erroneous conclusions. For instance, the child may assume he/she is being abandoned, or unlovable.


You can see from the above example that the parents’ intention is not what the child concluded. Of course, the child will not conclude this overnight. This takes years of patterns of repeated behaviors. As the child makes these conclusions about his/her world, they will also begin to develop their own coping mechanisms to deal with such abandonment. The child may begin to be exhibit colder reactions to the parents, or separation anxiety, or destructive behaviors, or chronic pains and crying fits. You may wonder that these don’t exactly sound like coping mechanisms, and you are right. They don’t on the surface, however, at a deeper level, the child may learn that these behaviors may get them attention. Additionally, some of the symptoms such as chronic stomachaches or sleepless nights, maybe symptoms of anxiety or depression. Regardless, the child will develop whatever coping skills they can muster to deal with what they perceive as abandonment.


Sometimes, children are born with chronic nervous conditions where they will have continuous chronic crying spells, irritability, agitation, and discomfort that even a mother’s touch can’t heal. As you can see, this would be a very difficult child to handle, and some parents can get extremely frustrated especially when they try many remedies and find no definitive cure. As a result, the parent may develop detachment from the child and cannot bond with it well. As this negative cycle develops, the child-parent bonding or attachment grows weaker and further apart. The child, nevertheless, may develop the idea that they are not loveable and feel that the parent does not love them and could conclude that they are unlovable. The reason I am mentioning this is because the whole idea behind talking about schemas is not to bash the parents for what they did or didn’t do, but to understand where our current behaviors, feelings and beliefs about the world come from. So please, although reading this may result in some horrific memories, and bring up issues of resentment and anger toward our caregivers, the purpose is for us to work through it and focus on what to do now, and not the whys or the why nots!


How To Identify Schemas?


Once the child begins to develop the schemas about themselves and the world around them, they have to develop coping styles and mechanisms to deal with them. For instance, a child that develops an abandonment schema might resort to being withdrawn and isolative for fear of bonding with someone and being abandonment. Therefore, their coping styles become their survival mechanisms in dealing with the conclusions they make about themselves and their world. From there on, the child begins to refine and modify their coping skills until they perfect it as the best coping (survival) mechanism. Since a long time has passed since we have developed those schemas and their matching coping skills, they become ingrained and established as common behaviors. It’s almost difficult if not impossible at times, to try and trace how each of these behaviors develop.


You ever notice that you keep doing the same bad mistakes over and over again. You know it’s wrong, and you understand the consequences, but you keep doing them over and over again. These behaviors are most likely indicative of the inner workings of schemas. But as mentioned in the last paragraph, the original behaviors started so long ago that we can’t even recall why the behaviors started in the first place. Therefore, your current maladaptive behaviors are the key to your inner beliefs and schemas. If your current behaviors are leading you to feeling bad and you keep repeating them over and over again, that’s your biggest hint. You must remember that behaviors are not defined by being good or bad but rather by the purpose they serve. All behaviors serve a purpose. The key is to find out what purpose they serve. And if you trace a maladaptive behavior back, it will eventually lead you to some distorted thoughts, negative beliefs, or dysfunctional schemas. If you can find out the WHYs, you will get the HOWs.


If you recall from the previous example about Malcolm who suffered from an abandonment schema, that he currently had no romantic relationships, or any deep or profound relationships with others. In order to avoid the pain of facing his deeper issues, he makes up excuses such as the right one hasn’t come along yet, or he has no time for friends etc. However, the truth of the matter is that he is still fearful of being abandoned. Therefore, all his behaviors are keened toward that. That’s his survival mechanism. To avoid being abandoned and hurt he avoids getting close. On other hand, Malcolm has an instinctual and deep need to be loved and be in a loving relationship. Those two conflicting issues will continuously result in an emotional turmoil. The only way to get rid of the emotional conflict is to identify with the real deeper issues such as his schemas.


In summation, do not look at behaviors as good or bad, but as to what purpose they serve. Connect these behaviors to the deeper issues such as schemas rather than surface self-defeating reasons such as denial or resistance.


Additionally, these behaviors are there for survival purposes and you need to understand and begin to rationalize how to survive with other healthier behaviors than the maladaptive ones you have now. There will be more on this below.


What Coping Styles (mechanisms) Did You Develop for Your Schemas?


In reaction to the schemas we developed about our environment and ourselves, we have also developed coping styles to deal with them. Some of the coping styles were maladaptive and helped us get here today, unfortunately, not happily. These maladaptive styles or mechanisms consist of behaviors that we do to cope or deal with our perceived environment. According to Dr. Young, these maladaptive coping styles can be grouped into three major responses: Surrendering Styles, Avoidance Styles, and Overcompensation categories.


• Surrendering Styles
• Those who belong to this coping style are usually:
1. Compliant and Dependent.
Behaviors: Relying on others, giving in, seeking affiliation, passive, dependent, submissive, clinging, avoids conflicts, people pleasing. Remember, this person is only doing this to cope (survive), however, at the cost of sacrificing self and self-needs. This price comes heavy since we pay for it through depression, anxiety, suppressed anger, and suppression of all kinds of feelings. Additionally, we can have physical and medical issues such as stomachaches, headaches, backaches, poor immune system among other things.


• Avoiding Styles
• Those who belong to this group are usually:
1. Socially Withdrawn, and Excessively Autonomous.
Behaviors: Social isolation, disconnection and withdrawal. May demonstrate an exaggerated focus on independence and self-reliance, rather than getting involved with others. Some retreat through private activities such as excessive TV watching, reading, recreational computing, or solitary work.
2. Compulsive Stimulation-seeking.
Behaviors: Seeking excitement or distraction through compulsive shopping, sex, gambling, risk-taking, physical activity, novelty, etc.
3. Addictive Self-Soothing.
Behaviors: Avoids through addictions involving the body, such as alcohol, drugs, overeating, excessive masturbation, etc.


• Overcompensation Styles

• Those who belong to this group are usually:

1. Aggression, Hostility.
Behaviors: Counterattacks through defying, abusing, blaming, attacking, or criticizing others.
2. Dominance, Excessive Self-assertion.
Behaviors: Controls others through direct means to accomplish goals.
3. Recognition-Seeking, Status-Seeking.
Behaviors: Overcompensation through impressing, high achievement, status, attention seeking, etc.
4. Manipulation, Exploitation.
Behaviors: Meets own needs through covert manipulation, seduction, dishonesty, or conning.
5. Passive-Aggressiveness, Rebellion.
Behaviors: Appears overtly compliant while punishing others or rebelling covertly through procrastination, pouting, “backstabbing,” lateness, complaining, rebellion, non-performance, etc.
6. Excessive Orderliness, Obessionality.
Behaviors: Maintains strict order, tight self-control, or high level of predictability through order and planning, excessive adherence to routine or ritual, or undue caution. Devotes inordinate time to finding the best way to accomplish tasks or avoid negative outcomes.

Schema Modes
The concept of a Schema Mode is probably the most difficult part of schema theory to explain, because it encompasses many elements.

As we mentioned on an earlier page , schema modes are the moment-to-moment emotional states and coping responses that we all experience. Often our schema modes are triggered by life situations that we are oversensitive to (our "emotional buttons").

At any given point in time, some of our schemas, coping responses, and emotional states are inactive, or dormant, while others have become activated by life events and predominate our current mood and behavior. The predominant state that we are in at a given point in time is called our schema mode. All of us flip from mode to mode over time.

Here is our formal definition: a schema mode represents "those schemas, coping responses, or healthy behaviors that are currently active for an individual". A schema mode is activated when particular schemas or coping responses have erupted into strong emotions or rigid coping styles that take over and control an individual's functioning.

An individual may shift from one schema mode into another; as that shift occurs, different schemas or coping responses, previously dormant, become active.

Modes As Dissociated States

Viewed in a slightly different way, a schema mode is: a facet of the self, involving specific schemas or coping responses, that has not been fully integrated with other facets. According to this perspective, schema modes can be characterized by the degree to which a particular schema mode state has become dissociated, or cut off, from an individual's other modes. A schema mode, therefore, is a part of the self that is cut off, to some degree, from other aspects of the self.

The term Dissociative Identity Disorder (or Multiple Personality Disorder) is used to describe individuals who flip into schema modes that are at the extreme end of the dissociative spectrum. Patients with Dissociative Identity Disorder usually have different names (like John, Susan, or Danny) for each schema mode.

At the other extreme of dissociation -- the mildest form of a schema mode -- is a normal mood shift, such as a lonely mood or an angry mood.

We have currently identified 10 schema modes. The modes are grouped into four general categories: the Child modes, the Maladaptive Coping modes, the Maladaptive Parent modes, and the Healthy Adult mode. Some modes are healthy for an individual, while others are maladaptive.

One important goal of Schema Therapy is to teach patients how to strengthen their Healthy Adult mode, so that they can learn to navigate, negotiate with, nurture, or neutralize their other modes.

Schema Mode Listing


CHILD MODES


1. Vulnerable Child: feels lonely, isolated, sad, misunderstood, unsupported, defective, deprived, overwhelmed, incompetent, doubts self, needy, helpless, hopeless, frightened, anxious, worried, victimized, worthless, unloved, unlovable, lost, directionless, fragile, weak, defeated, oppressed, powerless, left out, excluded, pessimistic


2. Angry Child : feels intensely angry, enraged, infuriated, frustrated, impatient because the core emotional (or physical) needs of the vulnerable child are not being met


3. Impulsive/Undisciplined Child : acts on non-core desires or impulses in a selfish or uncontrolled manner to get his or her own way and often has difficulty delaying short-term gratification; often feels intensely angry, enraged, infuriated, frustrated, impatient when these non-core desires or impulses cannot be met.; may appear “spoiled”


4. Happy Child : feels loved, contented, connected, satisfied, fulfilled, protected, accepted, praised, worthwhile, nurtured, guided, understood, validated, self-confident, competent, appropriately autonomous or self-reliant, safe, resilient, strong, in control, adaptable, included, optimistic, spontaneous


MALADAPTIVE COPING MODES


5. Compliant Surrenderer : acts in a passive, subservient, submissive, approval-seeking, or self-deprecating way around others out of fear of conflict or rejection; tolerates abuse and/or bad treatment; does not express healthy needs or desires to others; selects people or engages in other behavior that directly maintains the self-defeating schema-driven pattern


6. Detached Protector : cuts off needs and feelings; detaches emotionally from people and rejects their help; feels withdrawn, spacey, distracted, disconnected, depersonalized, empty or bored; pursues distracting, self-soothing, or self-stimulating activities in a compulsive way or to excess; may adopt a cynical, aloof or pessimistic stance to avoid investing in people or activities


7. Overcompensator : feels and behaves in an inordinately grandiose, aggressive, dominant, competitive, arrogant, haughty, condescending, devaluing, overcontrolled, controlling, rebellious, manipulative, exploitative, attention-seeking, or status-seeking way. These feelings or behaviors must originally have developed to compensate for or gratify unmet core needs.


MALADAPTIVE PARENT MODES


8. Punitive Parent : feels that oneself or others deserves punishment or blame and often acts on these feelings by being blaming, punishing, or abusive towards self (e.g., self-mutilation) or others. This mode refers to the style with which rules are enforced rather than the nature of the rules.


9. Demanding Parent : feels that the “right” way to be is to be perfect or achieve at a very high level, to keep everything in order, to strive for high status, to be humble, to puts others needs before one's own or to be efficient or avoid wasting time; or the person feels that it is wrong to express feelings or to act spontaneously. This mode refer to the nature of the internalized high standards and strict rules, rather than the style with which these rules are enforced; these rules are not compensatory in their function.


HEALTHY ADULT MODE


10. Healthy Adult : nurtures, validates and affirms the vulnerable child mode; sets limits for the angry and impulsive child modes; promotes and supports the healthy child mode; combats and eventually replaces the maladaptive coping modes; neutralizes or moderates the maladaptive parent modes. This mode also performs appropriate adult functions such as working, parenting, taking responsibility, and committing; pursues pleasurable adult activities such as sex; intellectual, esthetic, and cultural interests; health maintenance; and athletic activities.


How to Change our Schemas?
Although schemas are the deepest and hardest to change, nevertheless, they are changeable. Since they are deep rooted, know that it will take some time to modify them or get rid of them once and for all. This will take a lot of work and effort on your part. Here are few steps to help you begin the recovery process:


• Awareness – The first step is awareness. The fact that you are now reading this and thinking about all your life from a schema perspective is a great start. But don’t stop here. You must be aware of your inner process at all times. Don’t let your behaviors guide your life, rather understand why you behave the way you behave and try to connect it with some sort of belief or schema.
• Insight - Now that you have become aware, begin connecting the dots together. Remember what I said before on how these mechanisms happened so long ago that you may not recall how they developed or why they are there. Insight will help you through that by being honest and persistent to find your inner truth.
• Rationalization – Remember that when you made your conclusions about yourself and the world around you was somewhere between the ages of two and twelve. Would you trust a little child to make such big decisions for you that will impact your life forever? The two to twelve-year-old brain is just that, young and immature. Begin to think like an adult now, and make decisions just like an adult.
• Proof – You based your current behaviors on child-like conclusions. You went on the rest of your life proving this theory to be true. As an adult today, confirm this theory with current data. Does it still stand true? You must prove it or disprove it by trying something different from what you tried before. In other words, you must take chances. The quality of your life is in direct proportion of the comfort level you have with taking chances. The more chances you take the more likely your quality of your life will improve. If abandonment is what you fear, go out and make friends and see for yourself what results you get today. Just remember, think like an adult with an open mind, not like the abandoned child.
• Stop Being Self-Centered – Just because people reject you today that does not mean it’s because of you. There could be a million other reason why others may reject you, but most of all it’s about them and not about you. In other words, stop being self-centered. Not everything that others do is about you. In fact, the majority of things that others do are about them. From the moment you wake up and to the minute you go to sleep, who do you think more about, others or you? Get my point?
• Get Rid of Blame – Blame has no more purpose any more. It disabled you long enough. It took responsibility and control out of your hands. It’s no one’s fault. It’s not your parents’ fault; it’s not your teachers’ fault, or the other kid’s fault. It was just circumstantial. People do what they have to do or think they can do just to survive. Just like the beach shark that attacked the surfer, his intent was not to harm the surfer, but simply to survive. If this is hard for you to grasp now, then you may not be able to recover from your pain yet and you could be at an earlier stage of denial, resistance, avoidance or simply a hurtful stage.
• Behavior Modification – Now that you have done all the thinking you can do, it’s time for action. The key here is not to do the same old behaviors, but new ones that are designed to get your needs met but in a healthy and appropriate way. For the behavior to become anchored or second nature, it requires you to repeat it over and over again. Remember that the new behavior will be competing with your old ones. You may have a few relapses at first, and that’s ok and expected. However, the less of the old behaviors you do and the more of the new ones the more likely the new behaviors will eventually win.
• Taking Responsibility for Your Behaviors – To be an adult and act like an adult we must take responsibility for what we do. Excuses are just excuses. It’s not what you say to others, it’s what you say to yourself. As children, we learned to be afraid of punishment for what we did. When we erred we blamed someone else; “She did it!!!!” We learned these modes of behaviors for survival. However, once we learn where this originated from and once we can connect our current behaviors with our maladaptive schemas, we no longer need to fear consequences. Instead, we are now in charge of our behaviors and aware of why we are doing them. By now, hopefully, you are doing healthy adaptive behaviors and you know the intention of each behavior. Therefore, it’s easy to own and be responsible for your behaviors. If you slip, it’s not the end of the world. Just own it, fix it if it’s fixable and move on.
• Acceptance and Forgiving Self – After beliefs are changed and behaviors are modified and before we begin to feel good about ourselves, we must accept and forgive ourselves. Acceptance comes from knowing that we cannot change the past but we can make a new future. It’s not our fault and we weren’t bad, we just had to do what we had to do to survive. This does not mean we were not responsible, but there is not much we can do about now except accept it and learn from it. “Do not let your past dictate who you are now, but let it be part of you who you will become in the future.” Next comes forgiving ourselves. Although it’s sometimes said that we can’t forgive ourselves, but others must do it for us. I disagree. To forgive ourselves is the best gift we can give ourselves so long as we are honest and intend never to do it again. It’s simply realizing that we are human and we are made to err in order to learn from it.
• Peace of Mind and Forgiveness of Others – Now that you have done it all, there is one thing left to do. If you are feeling angry right now or even resentful for seeing this part, then you are not ready for this stage. This is why this is the final stage. We can only do this once we have gone through all the steps and we have recovered from our pains and now we want to make peace with the world. Acid will first hurt and destroy its container. To have a peace of mind is to rid ourselves of the hate and resentment. These feelings do nothing but harm their owner. To live healthfully and happily, we MUST (willingly) let go of the hate and resentment so that the anger subsides and we can be at peace again. As it was said before, those who hurt us did not do it intentionally, but it was a byproduct of their own schemas, beliefs, past experiences and so on. Learn to forgive, it’s a much more pleasant way to live.


Summary


The hardest part about schemas is that we are so deeply entrenched in them we can hardly see them or observe ourselves behaving under their spell. Therefore, one of the most important steps is being aware of them and making the connections between them and today’s behaviors and maladaptive coping skills. The recovery process is long and hard, however, you are worth it. Although it’s not your fault that all these things happened to you, however, it’s your responsibility now to take care of you. No one else will do it. You have been surviving all this time; why not keep on doing it but better and with a rewarding emotional state. Use the pain and anger you have accumulated throughout the years to give you the will power to change. Don’t let pain disable you, that’s not why we have pain. Just be patient and keep on trying, taking chances and be OK with relapses and failures. After all, how do recognize what success is without failure. In fact, don’t look at it as failure, but as a learning experience. When Watson was questioned by his students as to why he was taking notes underneath his desk after his lab had exploded during one of his 1000 attempts of inventing the light bulb, he simply said: “So I can remember how to make an explosion next time.” Your past coping skills got here, so the effort is already there, just divert it to healthier coping skills that can give you better results.
It will take time to change and it will take repetition and persistence. According to one study, after a minimum of six months of doing exercise on a regular basis, the majority of the participants continued on for life. Less than six months, and many had discontinued it. The point is, for certain behaviors to get established or get distinguished, it will take a period of time. Each person is different and each behavior requires a different effort and time. However, continue on doing the new behaviors and it will eventually become a second nature.


Finally, everything that you have read and learned thus far has been studied and researched. However, the biggest difficulty about psychology is that no one can ever fit neatly and precisely to one theory or one diagnosis or one schema or coping skill. It took you years and years to develop and get here today. Millions upon billions of experiences and behaviors compounded with genes made us who we are today. So use this information as guideline to assist you in the recovery process. Do not pigeonhole yourself in one category or another. Just use this to help get more insight to understand yourself and becoming an expert on who you are and why you do what you do. Once you know the why, you can know the how.


You have learned a lot so far and you have begun the road of recovery by just thinking and discovering about yourself. It’s hard and at times painful, but as the old cliché says: “No Pain! No Gain!” And remember, this time you are doing it on your own and under your control. No one is responsible but you. Think of how rewarding it is to be the new and improved you. What a great gift it is to give yourself that. Someone you love and admire, someone whom you can trust and count on, someone who can be your best friend and your best fan. Someone who you always wanted to be, but now you can. YOU!
Live with Love and Peace of Mind.


For more information, please call:
Gabi L. Deak, LCSW
(310) 666-3097


or email us at:
gabi.deak@cbstclinic.com