Introduction

Schema Therapy (ST) is an integrative therapy that assimilates concepts and strategies from cognitive-behavioral therapy, psychodynamic and gestalt therapy to address chronic, stable, recurring, and longstanding psychological structures developed in early childhood associated with symptomatology and personality disorders (Lobbestael & Arntz, 2012; Young et al., 2003). Early Maladaptive Schemas (EMSs), a core concept in ST, are dysfunctional beliefs, memories, emotions and bodily sensations regarding oneself as well as others. EMSs are theorized to be associated with toxic childhood experiences that deprive a child of having his/her core emotional needs from being met satisfactorily by early caregivers (Young et al., 2003; Louis, 2022; Louis et al., 2022). Young et al. (2003), grouped these 18 EMSs into five domains although empirical investigations in recent years of the second-order structure of EMSs have resulted in support for four domains. These four domains, which represent the four essential core emotional needs, were labeled as: (a) connection and acceptance; (b) healthy autonomy and performance, (c) realistic standards and reciprocity; and (d) reasonable limits (Louis et al., 2020).

The clinical relevance of EMSs has been systematically reported in scientific literature, not only at the symptomatic level (surface level) but also at the personality level (structural level). For instance, at a structural level, previous research suggests that EMSs are associated with difficulties in the regulation of psychological needs, interpersonal cycles, cognitive fusion, and emotional processing (Faustino & Vasco, 2020a, b, c). Also, EMSs are associated with adverse childhood experiences (Pilkington et al., 2021) and adult attachment styles (Karantzas et al., 2022). At a symptomatic level, EMSs are associated with a wide range of psychological variables and disorders (Taylor et al., 2017) such as depression (Bishop et al., 2022; Halvorsen et al., 2010), satisfaction with life (Louis et al., 2018a, b), humor (Louis et al., 2018a, b), bipolar disorder (Hawke et al., 2011), and posttraumatic stress disorder (Cockram et al., 2010). Finally, EMSs were associated with COVID-19 anxiety (Faustino et al., 2022). However, studies showing the contribution of positive schemas or Early Adaptive Schemas (EASs), the counterpart to EMSs, to disorders and mental health is lacking.

The concept of positive schemas or EASs was introduced by Lockwood & Perris (2012) to complement the negative schemas or EMSs and provide a more balanced approach to the theory of ST. Similar to EMSs, EASs are stable psychological structures composed of beliefs, memories, emotions and bodily sensations regarding the self and others which are adaptive. These EASs are theorized to develop when emotional core needs are adequately met by early primary caregivers (Young et al., 2003; Louis, 2022). Recent research has shown support for the value of positive constructs such as optimism (Hoffart, 2018) and reward sensitivity (Craske et al., 2019) that have had a significant impact on several therapeutic outcomes (e.g., depression, anxiety, stress).

Two measures in literature, namely the Positive Schema Questionnaire, (Keyfitz et al., 2013) and the core self- and other adaptive subscales of the Brief Core Schemas Scales, (BCSS, Fowler et al., 2006) are focused on the assessment of adaptive schemas. However, they are not relevant to the concepts used in ST as the Young Positive Schema Questionnaire (YPSQ by Louis et al., 2018a, b). The YPSQ showed adequate psychometric properties in the original studies (Louis et al., 2018a, b) and recently, was translated and adapted to German population (Paetsch et al., 2022) where only 10 factors were found to be robust.

While the psychometric validation of the YSQ-S3 has been more widespread - United Kingdom (Waller et al., 2001), Turkey (Soygüt et al., 2009), China (Cui et al., 2011) and Norway (Hoffart et al., 2005), including a European Portuguese version by Rijo (2017), to date no version of the YPSQ has been developed for the Portuguese (European) population. Further, when the original YPSQ was developed both Asian and US samples were used but it did not include any European samples. While a German sample showed support for only 10 out of the 14 EASs, this study hypothesized that the factors of the YPSQ would fit a European-Portugal sample.

The present research

The first aim of this study is to psychometrically validate the 14 factors in a Portuguese European-speaking population. The second aim is to support the four-higher-factor structure of EASs (Louis et al., 2020) in the present sample. The third aim is to provide evidence of concurrent validity by comparing it with other established measures. The fourth aim is to perform a comparison between mean values in two subsamples delineated by symptomatic intensity levels and replicate the work of Paetsch et al. (2022). Also, gender differences will be explored.

Methods

Sample

The sample consists of 430 participants of which 98 were males (22.8%) and 323 were females (77.2%). The ages of the men varied between 18 and 66 years (mean = 29.74, SD = 15.23) and those of the women between 18 and 64 years (mean = 25.46, SD = 12.39). Educational level frequencies were as follows: Five (1.2%) with basic nine years of study, 295 (68.1%) completed 12th grade, 97 (22.6%) had a bachelor’s degree, 25 (5.8%) had a master’s and eight (1.9%) had a doctoral degree. Relationship status was as follows: 335 (77.9%) were single, 64 (14.9%) were married, 9 (2.1%) cohabit, 19 (4.4%) were divorced, and three (0.7%) were widows.

Instruments

Young positive Schema Questionnaire (YPSQ)

Cross-cultural adaptation of the YPSQ to European Portuguese

Translation and cultural adaptation of the YPSQ was according to Brislin’s (1980), guidelines. The YPSQ was translated to European Portuguese with informed consent from the original author and owner Dr. John Philip Louis, Ph.D.

  • Stage 1: First, the YPSQ was translated from English into Portuguese by a bilingual speaker (English Portuguese).

  • Stage 2: Second, a back-translation was carried out by another independent bilingual speaker. Two versions were then compared, and semantic changes were conducted to match the conceptual clarity of the original items.

  • Stage 3: Final draft was revised by the original author.

  • Stage 4: Final version was completed by 10 individuals without previous knowledge about the YPSQ, to verify conceptual clarity.

  • Stage 5: Finally, the YPSQ was administered to Portuguese-European participants.

The YPSQ (Louis et al., 2018a, b, translated and adapted to European Portuguese by Faustino & Louis - this issue), is a self-report measure developed to measure 14 EASs. It has 56 items, using a 6-point Likert Scale (1 – “Completely untrue of me” to 6 – “Describes me perfectly”), that represents 14 EASs. The YPSQ in the original study showed good values of internal reliability, factorial structure, convergent validity, and incremental validity (Louis et al., 2018a, b). See Table 1 for the internal reliability of the Portuguese version of the YPSQ.

Brief symptoms inventory (BSI-53)

The BSI-53 (Degorois, 1983 translated and adapted to European Portuguese by Canavarro, 1999) is a self-report measure used to assess nine psychopathological domains (e.g., depression, anxiety, hostility). It has a 5-point scale (0 – “Not at all” to 4–“Very strongly”), concerning the last 7 days (including today) before the response of the participant. See Table 1 for the internal reliability of the BSI-53 used in the present study.

Procedures

Participants were recruited from an undergraduate course in psychology from Faculty of Psychology of the University of Lisbon and had 3 days to complete the online questionnaires, which were hosted using the Qualtrics platform. Individuals received one credit for bonification. At the beginning of the study, informed consent was requested, and participants were told that all responses were mandatory. Participants were also informed that he/she could withdraw at any given moment. Participants also answered a short sociodemographic questionnaire which consisted of a few closed questions (yes or no) regarding any reported medical or mental diagnosis (e.g., “do you have a diagnosed neurocognitive disorder?”). In the present study, the inclusion criteria were as follows: Had to be over 18 years old, be able to speak Portuguese as a native language (or have spoken Portuguese for more than five years), and not have any neurodevelopmental and/or neurodegenerative disorder. This study received scientific approval from the Faculty of Psychology of the University of Lisbon ethics committee and deontology.

Statistical procedures

This study followed a cross-sectional/transversal design. G-power 3.1 was used to sample calculation process, suggesting a 400-sample size, to a 0.25 of effect size for p. < 0.05. Chi-square test was used to examine interactions between gender and the YPSQ. Pearson moment-to-moment correlations were used to explore associations between variables under study and the Welsh t-test was used to explore mean differences between sub-groups. Mplus 8 (Muthen & Muthen, 1998-2017), SPSS 25 version, and AMOS 27 software version were used in all statistical analyses. Descriptive statistics was used to describe some of the characteristics of the sample used in this study. The factorial structure of the YPSQ was explored using Confirmatory Factor Analysis (CFA), as well as MGCFA. The latter was done to show invariance in all seven levels (Milfont & Fischer, 2010) of the 14-factor structure across several cultures using the original samples when the YPSQ (Eastern and Western) was developed with the inclusion of the Portugal sample used in this study. Mplus software using a weighted least-squares means and variance-adjusted estimation (WLSMV) algorithm was used to take into account the ordered-categorical nature of the response scales (Wirth & Edwards, 2007).

Skewness and Kurtosis tests were used to assess the normality of the sample. Meyers et al. (2016) criteria were used to test the CFA model with the following indexes: Chi-2 (χ2) with a ratio < 5 was considered as adequate; Comparative Fit Index (CFI) and a Tucker–Lewis’s index (TLI), with a cut-off ≥ 0.90 was also considered as adequate; Root Mean Square Error of Approximation (RMSEA) with a value < 0.08 was considered adequate (Awang, 2012). A sample size higher than 150 is considered adequate for CFA (Muthén & Muthén, 2002). Internal reliability was explored with Cronbach’s alpha, with values higher than α ≥ 60 considered adequate (Kline, 2000).

Results

Table 1 shows Cronbach alphas, amplitude, minimum, maximum, means, standard deviations, asymmetry, and kurtosis of the YPSQ scales, BSI global index and subscales. Chi-square test did not suggest an interaction between gender and the global index of YSPQ (x2 = 157,891, df = 149, p.> . 29).

Table 1 Descriptive statistics for YPSQ and BSI-53 scales
Full size table

Confirmatory factor analysis

The first aim was to confirm the original 14-factor structure of the YPSQ using CFA. The model showed excellent goodness-of-fit indices χ2(426) = 3252.165, TLI = 0.92, CFI = 0.93, RMSEA = 0.056[0.053 − 0.058]. Measurement invariance was tested with CFA results from Kuala-Lumpur (n = 229), Singapore (n = 628), the USA (n = 214) samples - see Table 2.

Table 2 MG CFA results for Kuala-Lumpur (n = 229), Singapore (n = 628), the USA (n = 214), and Portugal (n = 430) samples
Full size table

The second aim was to test the 4-factor structure of EAS domains, namely: Realistic Standards and Reciprocity, Connection and Acceptance, Healthy Autonomy and Performance and Reasonable Limits (Louis et al., 2020). Therefore, a second-order 4-factor model was explored showing adequate model-fit-indexes: χ2(66) = 308,340, TLI = 0.90, CFI = 0.93, RMSEA = 0.093, (0.082–0.103) – see Fig. 1. Errors 1 to 4, 3 to 5, 6 to 8, 7 to 9 and 10 to 11 were correlated to achieve model fit through the observation of the modification indices.

Fig. 1
figure 1

Confirmatory Factor Analysis for 4-factor structure of EAS domains of the YPSQ (N = 430)

Full size image

Correlational analysis

The third aim was to explore the of construct validity. In this sense, correlations between higher-order EAS domains and EAS were explored. All correlations were statistically significant. As example, Realistic Standards and Reciprocity correlated strongly with Self-Compassion (r = .87, p < .01), Realistic Expectations (r = .82, p < .01) Self-Directedness (r = .80, p < .01) and Basic Health and Safety /Optimism (r = .77, p < .01). Connection and Acceptance correlated strongly with Emotional Fulfillment (r = .84, p < .01), Emotional Openness and Spontaneity (r = .80, p < .05) and Social Belonging (r = -.84, p < .01)– see Table 3.

Table 3 Correlational analysis for YPSQ in EASs domains and subscales and with BSI-53 general index and subscales
Full size table

Similar to previous patterns, almost all correlations followed the predicted path: YPSQ scales and subscales correlated negatively with GSI, and all BSI-53 subscales (p < .01). As examples, Realistic Standards and Reciprocity correlated negatively with GSI (r = -.54, p < .01), Psychoticism (r = -.56, p < .01), Depression (r = -.53, p < .01), Interpersonal Sensitivity (r = -.50, p < .01). Connection and Acceptance correlated negatively with Psychoticism (r = -.60, p < .01), Interpersonal Sensitivity (r = -.56, p < .01) and GSI (r = -.54, p < .01). Healthy Autonomy and Performance correlated negatively with GSI (r = -.46, p < .01), Obsessive-Compulsive (r = -.44, p < .01), Interpersonal Sensitivity (r = -.44, p < .01) and Depression (r = -.42, p < .01). Reasonable Limits correlated negatively with Depression (r = -.53, p < .01), Obsessive-Compulsive (r = -.52, p < .01), Interpersonal Sensitivity (r = -.50, p < .01) and GSI (r = -.49, p < .01) – see Table 3.

Welsh T-test for mean comparisons by gender and clinical sub-groups

The fourth aim was to perform comparisons between gender and subgroups defined by symptomatology intensity. A cutoff value (1.7<) is available on the Portuguese version of BSI-53. Individuals with a GSI value higher than 1.7 indicate that they may manifest clinically significant symptoms (Canavarro, 1999). Using this as a cut-off score it was possible to identify which individuals in the present sample had intense symptomatology scores. Based on this criterion the sample was split into two: individuals with higher symptoms (HSS, High Symptoms Sub-sample), and individuals with lower symptoms (LSS, Low Symptoms Sub-sample). Comparison of scores from the YPSQ measure was now possible between both groups. It was hypothesized that mean values of EASs were higher in the LSS than in the HSS, which was consistently found in almost all EASs (p. < 0.01). Only differences in the Empathic Consideration were not significant.

Table 4 Group comparisons for gender and symptomatic sub-samples
Full size table

Gender differences in mean values were observed in almost all EAS, with exceptions of Emotional Openness and Spontaneity and Healthy Self Control / Self Discipline (p. > 0.05). Consistently, males scored higher than females in YPSQ total index and subscales (p. < 0.05).

Discussion

Schema therapy has become a popular integrative approach in the treatment of chronic and lifelong psychological disorders. Several theoretical improvements (Arntz et al., 2021), empirical evidence (Faustino & Vasco, 2020a, b, c; Faustino et al., 2022) and new schema assessment measures (Louis et al., 2018a, b; Paetsch et al., 2021) consolidate the relevance of this form of therapy. The present study provided initial psychometric properties of the YPSQ using European Portuguese, and the results and support those from previous validation studies of the YSPQ.

The first aim was to confirm the 14-factor structure of the YPSQ. The 14-factor structure and 56 items were replicated in the European Portuguese sample with excellent values of fit indices. Moreover, a MGCFA analysis, which is considered the most powerful approach for invariance testing (Milfont & Fischer, 2010), showed invariance of the factor structure of the PPSI across Eastern and Western samples, which included the Portugal sample. This gave evidence of validity of the internal structure. This testing is significant because it showed that participants of different samples, both Eastern and Western, and now also the European Portuguese participants ascribe the same meanings to the items of the YPSQ scale, and that the same psychological constructs were measured in both samples. Internal consistency was considered satisfactory in all scales and subscales. Only the subscale of Healthy Self-Interest / Self-Care had a low internal consistency, and, further studies are needed to test the reliability of this subscale.

The second aim was to confirm the higher-order four-factor structure of EAS domains (Louis et al., 2020). A significant model of four factors with satisfactory indexes was obtained. All EASs saturated on each specific EASs domain as expected. This result supports previous assumptions regarding different conceptualizations of higher-order schema domains. According to Young et al. (2003), theoretically, EMSs are grouped in 5 schema domains: Disconnection and Rejection, Impaired Autonomy and performance, Impaired Limits, Others Domain, and Overvigilance and Inhibition. Nevertheless, a four-factor structure of EASs was obtained empirically (Louis et al., 2020), which suggests a discrepancy between EMSs and EASs domains. Further studies should be focused on the exploration of differences and similarities between schema domains, although the present study supports a four-factor model for EASs domains.

The third aim was to explore the concurrent validity of this instrument. Construct validity was achieved through correlations between EASs and their specific domains. Divergent validity was observed by the negative correlations between EASs and EASs domains with all symptomatic domains of BSI-53. Only Empathic Consideration did not correlate with Somatization, Anxiety and Phobic Anxiety. However, it correlated negatively with Hostility which is theoretically congruent. One likely explanation may be that Empathic Consideration EAS may be more focused on interpersonal relationships, while these symptomatic domains (e.g., Somatization) may be focused on intrapersonal domains. Somatization and Anxiety tend to be related to self-directed attention, while empathy is typically related to the relationship between the self and others. Also, in the German psychometric study of the YPSQ (Paetsch et al., 2021), the Empathic Consideration EAS was found to not be significantly different in two samples (community vs. psychiatric). Further studies should address the robustness of this EAS.

Another interesting finding that emerged from this study was that the mean EASs scores for men were higher than those for women. This cannot be accounted for with certainty but a possible explanation for this could be the following - a recent credible study has shown that men, in general, are more optimistic than women, and women are more risk averse than men (Dawson, 2023). Being optimistic taps into a part of the healthy adult side of a person and has overlaps with several adaptive schemas, and this may be an explanation as to why the scores of men were higher than women in this study. However, the generalizability of the results from this study should not be applied to other populations. More in-depth studies have to be carried out in order to flush out meaningful gender differences with regards to scores in EASs.

Fourth, differences in mean values of all YPSQ domains and subscales were found between two subsamples (HSS and LSS) and between gender, where male have higher scores in EASs when comparing to females. Regarding clinical subsample comparisons, this result replicates previous findings where differences in all EASs were found between a community and a psychiatric sample (Paetsch et al., 2021). One major difference is that in the present study, all EASs and EASs domains were significantly higher in the LSS when compared with HSS. These findings strengthen theoretical assumptions which state that individuals with greater presence of EASs tend to manifest less symptomatology (Lockwood & Perris, 2012). In this sense, the intrapsychic oscillation between two dialectical extremes (views of the self as adaptive and views of the self as maladaptive) is associated with different degrees of symptomatology. Thus, recent research suggests that individuals swing back and forth on a continuum of two axes with four representational poles articulated dialectically that mediate psychological well-being and symptomatology (Faustino et al., 2023a). Nevertheless, more research is required to see if this can be replicated on clinical samples.

Clinical implications, limitations future directions

In schema therapy treatment one of the main goals is to weaken the strength of EMSs as well as strengthen the EASs simultaneously. These EASs are labelled as the “healthy adult” of a client. The strengthening of the healthy adult of a client involves a therapist meeting his or her core emotional needs which were not met adequately during childhood. This process is called “Limited Reparenting” (Young et al., 2003; Giesen-Bloo et al., 2006) and it involves the therapist to assume the role of a nurturing parent but within the professional boundaries of therapist-client relationship. As the core emotional needs of the client are gradually met, the EMSs gradually become weaker, but the EASs will become stronger. Therefore, well-being of a client, from the vantage point of schema therapy, is viewed from two separate but related angles– the weakening of the EMSs, and the strengthening of the EASs. Psychological recovery will not be just in terms of weakening the EMSs but about strengthening the EASs, which is in line with studies that have shown that adaptive domains contribute in unique ways over and above the reduction of the negative constructs (Wood & Tarrier, 2010). With a validated YPSQ in Portuguese clients from this population will be able to identify that type of EASs that are needed to counter with specific active EMSs that are currently driving their unhealthy thinking and behavioral disposition. A focus on both constructs will enhance schema therapy treatment and lead to better therapeutical outcomes.

The exploration of adaptive self domains in psychotherapeutic patients is gaining widespread attention. Clinical assessment and case conceptualization should be focused not only on the maladaptive domains and symptoms but also on the adaptive strengths of a person. Balancing strategies and tasks focused on healing emotional vulnerabilities with tasks and strategies for self-development and improvement may be an asset in the psychotherapeutic processes.

This study has several limitations. This study was conducted with participants in one setting and with a high education level, which suggests that our sample may be homogeneous, and do not represent Portuguese population correctly. Therefore, extrapolations for should be performed with caution. Similarly, the sample had more females than males which may reflect some bias in the results. According to Becker (2022), females are more likely to participance in survey studies than males, fostering skewed response bias. In this sense, further studies should focus on gender balance to overcome this issue. All measures were based on self-report ratings. Further studies of the YPSQ should be focused on exploring additional construct validity with the YSQ-S3 (Portuguese version by Rijo, 2017) or with schema-related instruments, such as the BCSS (Portuguese version by Faustino, 2023), States of Mind Questionnaire (Faustino et al., 2021) and the Personality Beliefs Questionnaire-Short Version (Portuguese version by Faustino et al., 2023b). Finally, YPSQ psychometric properties should be explored in clinical samples.