Theoretically, Early Maladaptive Schemas (EMSs) develop due to marked frustrations of the child’s core needs. In this blog post, Asle Hoffart and Synve Hoffart Lunding describe an empirical examination of this statement. In their study, they explored the relationships between parental bonding, EMSs, and outcome in schema therapy of personality problems. Forty-five patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits participated in an 11-week inpatient schema-based program. Notable results included relations between: maternal protection and schema domains of impaired autonomy and exaggerated standards; lower paternal care and more reduction in Cluster C personality traits from pre-treatment to one-year follow-up. Additionally, perceived maternal care was reduced from pre-treatment to one-year follow-up, and more reduction in maternal care was related to less reduction in Cluster C traits. 

                Synve Hoffart Lunding

           Child and Adolescent Mental Health Services  in Stockholm County, Sweden

Asle Hoffart

Research Institute, Modum Bad, Vikersund, Norway

         Schema therapy (Young et al., 2003) is a modification of standard cognitive therapy purported to adapt to the specific needs of patients with personality disorders and/or more chronic anxiety and depressive disorders. Central in the schema therapy model is the concept of Early Maladaptive Schemas (EMSs), which represent oneself and one’s relationship with others. EMSs typically develop in the wake of adverse experiences involving marked frustrations of the child’s core needs for connectedness, autonomy, worthiness, reasonable expectations, and realistic limits. For instance, a child may be overly criticized when he/she does not meet parental standards and develop a defectiveness/shame EMS. Based on clinical experience, Young (1990) formulated a list of EMSs which are assumed to cluster in five schema domains each reflecting frustrations of one of the core needs referred to above.

          We conducted a study to examine the relationship between parental bonding, schema domains/EMSs, and outcome in schema therapy of personality problems. Patients with panic disorder and/or agoraphobia and DSM-IV Cluster C personality traits (n = 45) who participated in an 11-week inpatient program were studied. The program consisted of two phases: the first phase was five-week panic/agoraphobia-focused, while the second six-week phase was personality-focused and based on Young’s (1990) schema-focused approach. We expected that non-optimal parenting (low care, high protection) would influence EMSs/schema domains and that the EMSs/schema domains in turn would influence how the patients engaged in therapy - and thus, respond to it.  

          Opposite to our hypothesis, lower paternal care at pre-treatment was related to more reduction in Cluster C personality traits from pre-treatment to one-year follow-up. Maternal protection was related to the schema domains of impaired autonomy and exaggerated standards (see Table). Overall schema severity and the specific severity of the emotional inhibition schema at pre-treatment were associated with less change in Cluster C traits. Perceived maternal care was reduced from pre-treatment to one-year follow-up, and more reduction in maternal care was related to less reduction in Cluster C traits.

          Our conclusions were:

·  Most schemas within the impaired autonomy domain and the self-sacrifice schema seem to be related to high perceived maternal protection.

·  Overall schema severity and the emotional inhibition schema predict poorer outcome of schema therapy of Cluster C personality problems, and therapy should give priority to emotional inhibition when this schema is endorsed.

·  Therapists should be aware that schema therapy carries the risk to lead to a more negative view of mother’s care during upbringing and this risk is accentuated with less benefit of therapy.  

Table. Correlations between dimensions of parental bonding and schema domains

                                                                      Schema domain

PBI subscale	Disconnection	Impaired Autonomy	Exaggerated Standards	Impaired Limits
Maternal care	-.21	-.02	-.24	.00
Paternal care	-.07	.09	-.03	.04
Maternal protection	.13	.39*	.51**	.26
Paternal protection	.08	.01	.17	-.02

*p < .05; **p < .001. PBI = Parental Bonding Instrument. Note that we used an empirically derived ordering of schema domains into 4 instead of the five domain structure proposed by Young (1990).  

REFERENCES

Lunding, S. H., Hoffart, A. (2014). Perceived parental bonding, early maladaptive schemas and outcome in schema therapy of Cluster C personality problems. Clinical Psychology and Psychotherapy. doi: 10.1002/cpp.1938.

Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. Sarasota: Professional Resource Exchange.

Young, J. E., Klosko, J., & Weishaar, M. E. (2003). Schema Therapy: A practitioner’s guide. New York: Guilford.