J. E. Young’s (1995) Early Maladaptive Schemas (EMS) are assumed to be highly stable and enduring beliefs that are responsible for the persistence and poor treatment response of a variety of clinical problems. EMS are now the basis for a growing number of specialized “schema-focused” treatments. However, the critical assumption that they are stable constructs remains largely unexamined and open to question. This study examined the long-term stability of Young’s EMS in 55 depressed outpatients over a 2.5 to 5-year interval. EMS exhibited moderate to good levels of stability, even after controlling for severity of depression and neuroticism at both time points, and moderate levels of discriminant validity. A comparison of these results with existing literature revealed that the stability and discriminant validity of EMS are quite similar to the stability and discriminant validity of personality disorder features. Additional work is needed to examine the stability of EMS across greater fluctuations in mood and in different clinical populations. Our findings for the stability of EMS may be generalizable to the more general notion of core beliefs. Future work needs to focus on further theoretical development and improved measurement of EMS.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Given the range of follow-up intervals for our participants, it is important to consider whether the time to follow-up affected the size of the stability correlations. To address this question, we examined whether the length of the follow-up interval moderated the stability correlations for total scores on the Young Schema Questionnaire (YSQ; Young, 1995; described more fully in the Method section). In multiple regression equations, total YSQ scores at follow-up were used as the dependent variable with baseline total YSQ, follow-up interval, and their interaction entered as predictors. The interaction term was not significant (β=.075, ns) suggesting that the follow-up interval was not a moderator. Therefore, all participants were analyzed together despite some differences in their follow-up intervals.
A multiple regression was performed to examine whether months of psychotherapy served as a moderator of stability. Paralleling the analysis of the follow-up interval as a moderator, total YSQ served as the dependent variable with baseline total YSQ, months of psychotherapy, and their interaction entered as predictors. As with the analysis of time to follow-up, the interaction term was not significant (β=.003, ns) and so months of psychotherapy was not a moderator of stability.
Several patients had achieved remission during the follow-up period but then met full threshold for a depressive disorder again when they were assessed at follow-up. These patients were not counted as remitted.
Using the five higher order schema clusters of the YSQ (i.e., Disconnection and Rejection, Impaired Autonomy, Other Directedness, Impaired Limits, and Overvigilance) did not improve the discriminant validity of EMS over that using individual schemas (data available upon request).
REFERENCES
Ball, S. A. (1998). Manualized treatment for substance abusers with personality disorders: Dual Focus Schema Therapy. Addictive Behaviors, 23, 883–891.
Ball, S. A., & Cecero, J. J. (2001). Addicted patients with personality disorders: Symptoms, schemas, and traits. Journal of Personality Disorders, 15, 72–83.
Ball, S. A., & Young, J. E. (2000). Dual focus schema therapy for personality disorders and substance dependence: Case study results. Cognitive and Behavioral Practice, 7, 270–281.
Barrett, P. T., Petrides, K. V., Eysenck, S. B. G., & Eysenck, H. J. (1998). The Eysenck Personality Questionnaire: An examination of the factorial similarity of P, E, N, and L across 34 countries. Personality and Individual Differences, 25, 805–819.
Beck, A. T. (1967). Depression: Causes and Treatment. Philadelphia: University of Pennsylvania Press.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. E., & Erbaugh, J. K. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York: Guilford Press.
Beevers, C. G., & Miller, I. W. (2004). Depression-related negative cognition: Mood-state and trait dependent properties. Cognitive Therapy and Research, 28, 293–307.
Clark, D. A., & Beck, A. T. (1999). Scientific Foundations of Cognitive Theory and Therapy of Depression. New York: Wiley.
Cooper, M. (1997). Cognitive theory in anorexia nervosa and bulimia nervosa: A review. Behavioural and Cognitive Psychotherapy, 25, 113–145.
Cooper, M., & Hunt, J. (1998). Core beliefs and underlying assumptions in bulimia nervosa and depression. Behaviour Research and Therapy, 36, 895–898.
Dohr, K. B., Rush, J. J., & Berstein, I. H. (1989). Cognitive biases in depression. Journal of Abnormal Psychology, 98, 263–267.
Dykema, J., Bergbower, K., Doctora, J. D., & Peterson, C. (1996). An attributional style questionnaire for general use. Journal of Psychoeducational Assessment, 14, 100–108.
Elliott, C. H., & Lassen, M. K. (1997). A schema polarity model for case conceptualization, intervention, and research. Clinical Psychology: Science and Practice, 4, 12–28.
Eysenck, S. B. G., Eysenck, H. J., & Barrett, P. (1985). A revised version of the Psychoticism scale. Personality and Individual Differences, 6, 21–29.
Ferro, T., Klein, D. N., Schwartz, J. E., Kasch, K., & Leader, J. B. (1998). 30-Month stability of personality disorder diagnoses in depressed outpatients. American Journal of Psychiatry, 155, 653–659.
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatric Press.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P), version 2.0. New York: Psychiatric Institute.
Fraley, R. C., & Shaver, P. R. (2000). Adult romantic attachment: Theoretical developments, emerging controversies, and unanswered questions. Review of General Psychology, 4, 132–154.
Hamilton, E. W., & Abramson, L. Y. (1983). Cognitive patterns and major depressive disorder: A longitudinal study in a hospital setting. Journal of Abnormal Psychology, 92, 173–184.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62.
Hollingshead, A. B. (1975). Four Factor Index of Social Position. Unpublished manuscript, Yale University, New Haven, CT.
Ingram, R. E., Miranda, J., & Segal, Z. V. (1998). Cognitive Vulnerability to Depression. New York: Guilford Press.
James, I. A., Southam, L., & Blackburn, M. (2004). Schemas revisited. Clinical Psychology and Psychotherapy, 11, 369–377.
Keller, M. B., Lavorie, P. W., Friedman, B., Nielsen, E., Endicott, J., McDonald-Scott, P., et al. (1987). The longitudinal interval follow-up evaluation: A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540–548.
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., & Gelenberg, A. J., et al. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462–1470.
Lee, C. W., Taylor, G., & Dunn, J. (1999). Factor structure of the schema questionnaire in a large clinical sample. Cognitive Therapy and Research, 23, 441–451.
Lenzenweger, M. F. (1999). Stability and change in personality disorder features. Archives of General Psychiatry, 56, 1009–1015.
McCrae, R. R., & Costa, P. T. (1999). A five-factor theory of personality. In L. A. Pervin & O. P. John (Eds.), Handbook of Personality 2nd edn. (pp. 139–153). New York: Guilford Press.
Oliver, J. M., & Baumgart, E. P. (1985). The Dysfunctional Attitudes Scale: Psychometric properties and relation to depression in an unselected adult population. Cognitive Therapy and Research, 9, 161–167.
Peterson, C. (1991). Meaning and measurement of explanatory style. Psychological Inquiry, 2, 1–10.
Riso, L. P., du Toit, P.L., Blandino, J. A., Penna, S., Dacey, S., Duin, J. S., et al. (2003). Cognitive aspects of chronic depression. Journal of Abnormal Psychology, 112, 72–80.
Riso, L. P., & Newman, C. (2003). The application of cognitive therapy to chronic depression. In Session: Journal of Clinical Psychology, 59, 817–831.
Roberts, B. W., & DelVecchio, W. F. (2000). The rank-order consistency of personality traits from childhood to old age: A quantitative review of longitudinal studies. Psychological Bulletin, 126, 3–25.
Rogers, R. (2001). Handbook of Diagnostic and Structured Interviewing. New York: Guilford Press.
Rush, A. J., Giles, D. E., Schlesser, M. A., Fulton, C. L., Weissenburger, J. E., & Burns, C. T. (1986). The Inventory for Depressive Symptomatology (IDS): Preliminary findings. Psychiatry Research, 18, 65–87.
Rush, A. J., Gullion, C. M., Basco, M. R., Jarrett, R. B., & Trivedi, M. H. (1996). The inventory of depressive symptomatology (IDS): Psychometric properties. Psychological Medicine, 26, 477–486.
Scher, C. D., Ingram, R. E., & Segal, Z. V. (2005). Cognitive reactivity and vulnerability: Empirical evaluation of construct activation and cognitive diatheses in unipolar depression. Clinical Psychology Review, 25, 487–510.
Schmidt, N. B., Joiner, T. E., Young, J. E., & Telch, M. J. (1995). The schema questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemas. Cognitive Therapy and Research, 3, 295–321.
Segal, Z. V. (1988). Appraisal of the self-schema construct in cognitive models of depression. Psychological Bulletin, 103, 147–162.
Segal, Z. V., & Ingram, R. E. (1994). Mood priming and construct activation in tests of cognitive vulnerability to unipolar depression. Clinical Psychology Review, 14, 663–695.
Stein, D. J., & Young, J. E. (1992). A schema approach to personality disorders. In D. J. Stein & J. E. Young (Eds.), Cognitive Science and Clinical Disorders. San Diego, CA: Academic Press.
Stewart, M. E., Ebmeier, K. P., & Deary, I. J. (2005). Personality correlates of happiness and sadness: EPQ-R and TPQ compared. Personality and Individual Differences, 38, 1085–1096.
Stopa, L., & Waters, A. (2005). The effect of mood on responses to the Young Schema Questionnaire: Short form. Psychology and Psychotherapy: Theory, Research and Practice, 78, 45–57.
Surtees, P. G., & Barkely, C. (1994). Future imperfect: The long-term outcome of depression. British Journal of Psychiatry, 164, 327–341.
Waller, G., Ohanian, V., Meyer, C., & Osman, S. (2000). Cognitive content among bulimic women: The role of core beliefs. International Journal of Eating Disorders, 28, 235–241.
Waller, G., Kennerly, H., & Ohanian, V. (in press). Schema-focused cognitive behaviour therapy with eating disorders. In L. P. Riso, P. T. du Toit, D. J. Stein, & J. E. Young (Eds.), Cognitive Schemas and Core Beliefs in Psychiatric Disorders: A Scientist-Practitioner Guide. New York: American Psychological Association.
Waller, G., Meyer, C., Ohanian, V., Elliott, P., Dickson, C., & Sellings, J. (2001). The psychopathology of bulimic women who report childhood sexual abuse: The mediating role of core beliefs. Journal of Nervous and Mental Disease, 189, 700–708.
Warshaw, M. G., Keller, M. B., & Stout, R. L. (1994). Reliability and validity of the longitudinal interval follow-up evaluation for assessing outcome of anxiety disorders. Journal of Psychiatric Research, 28, 531–548.
Weissman, A. (1979). The Dysfunctional Attitude Scale: A Validation Study. Unpublished doctoral dissertation, University of Pennsylvania, Philadelphia.
Young, J. E. (1995). Cognitive Therapy for Personality Disorders: A Schema-Focused Approach. Sarasota, FL: Professional Resource Exchange.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner’s Guide. New York: Guilford Press.
Zuroff, D. C., Blatt, S. J., Sanislow, III, C. A., Bondi, C. M., & Pilkonis, P. A. (1999). Vulnerability to depression: Reexamining state dependence and relative stability. Journal of Abnormal Psychology, 108, 76–89.
ACKNOWLEDGMENTS
This research was supported by National Institute of Mental Health Grant MH 57880-01 (Dr. Riso). We are indebted to Michael Thase for important conceptual input into this project. Christopher Beevers and Daniel Klein provided helpful comments on an earlier draft of this paper. We greatly appreciate the efforts of Amy Fasiczka, Tim Harden, Jan Jozefov, Michael Lightfoot, and Janice McGeary for help in data collection and processing. Finally, we are also grateful to our anonymous reviewers whose comments led to substantial improvements in this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Riso, L.P., Froman, S.E., Raouf, M. et al. The Long-Term Stability of Early Maladaptive Schemas. Cogn Ther Res 30, 515–529 (2006). https://doi.org/10.1007/s10608-006-9015-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-006-9015-z