Schema theory and schema therapy in mood and anxiety disorders: A review.

Schema theory was developed for patients with chronic psychological problems who fail to make significant gains in cognitive therapy. Although the theory has been applied most frequently to personality disorders, mood and anxiety disorders may also be a relevant application. This article reviews the literature applying schema theory to mood and anxiety disorders. The literature suggests that people with mood and anxiety disorders present high levels of early maladaptive schemas, some of which would appear to reflect the characteristics of the individual disorders. Preliminary research suggests that schema therapy may be successfully extended to mood and anxiety disorders. Further research is necessary to examine the utility of schema therapy for these clienteles and to identify the individuals who stand to benefit most. Keywords: cognitive schemas; schema therapy; mood disorders; anxiety disorders; literature review Mood and anxiety disorders encompass a wide range of highly prevalent mental health problems. An estimated 20.8% of the population will experience a mood disorder at some point in their lives, whereas 28.8% will experience an anxiety disorder (Kessler et al., 2005). Among the risk factors for developing mood or anxiety disorders are a positive family history of a psychiatric disorder and childhood trauma (de Graaf, Bijl, Smit, Vollebergh, & Spijker, 2002). The cognitive vulnerability-stress theory has been advanced to explain mood and anxiety disorders (Alloy & Riskind, 2006). Based on Beck's (1987) cognitive theory, individuals who have negative cognitive schemas or core beliefs are at an increased risk for depression. When a stressful life event occurs, negative cognitive schemas are activated and affect the way the individual interprets the event, leading to depressive symptoms. A similar process has been proposed to explain the vulnerability to anxiety (e.g., Hankin & Abela, 2005). Considerable evidence supports the cognitive vulnerability-stress theory as applied to the mood and anxiety disorders (e.g., Hankin, Abramson, Miller, & Haeffel, 2004; Reardon & Williams, 2007). Based on Beck's cognitive model, cognitive behavioral therapy (CBT) has evolved as a treatment of choice (Clark & Beck, 2010; Clark, Beck, & Alford, 1999; Newman, Leahy, Beck, Reilly-Harrington, & Gyulai, 2002). CBT employs techniques such as cognitive restructuring, behavioral activation, exposure, and relaxation training. For example, patients undergoing CBT are asked to track their automatic thoughts and the associated beliefs, emotions, and behaviors. They are then taught to challenge their maladaptive beliefs and test alternative behaviors. This form of psychotherapy has been demonstrated effective for a wide range of disorders (Nathan & Gorman, 2007). Although as a whole CBT is quite effective for the mood and anxiety disorders, some patients continue to show symptoms or experience relapses subsequent to treatment, particularly in chronic cases (Durham, Chambers, MacDonald, Power, & Major, 2003; Fournier et al., 2009). For these patients, a different approach would seem to be required. To this end, Jeffrey Young developed schema theory for patients with severe, chronic psychological problems who fail to make significant gains in traditional cognitive therapy (Young, 1990; Young, Klosko, & Weishaar, 2003). Young suggests that certain patients are a poor fit for cognitive therapy and require a more extensive treatment approach, in part because of their difficulty identifying, accessing, and changing their cognitions and emotions. Young's schema theory does not attempt to compete with traditional Beckian theory, but rather expands on it for a treatment-resistant clientele whose psychological problems are thought to be maintained by complex characterological underpinnings. It does so by placing greater emphasis on the developmental origins of severe psychopathology. …