Parental death,depression and beck's theory of cognitive vulnerability: A critical appraisal and suggestions for research

An adequate model of depression should be able to (i) specify the origins of the disorder; (ii) explain the maintenance of depressive behaviour and (iii) result in effective therapy. The adequacy of Beck's cognitive theory of depression has been increasingly questioned (e.g. Alagaratnam, 1984; Alladin, 1985; Bebbington, 1985; Power & Champion (1986); Beidel & Turner (1986); Power (1987) and fundamental questions remain unexplored. In this paper, we focus on the assumption that early parental death results in the development of depressive schemas which constitute a cognitive vulnerability to depression. Bereavement is the most severe psychological trauma most people will encounter in the course of their lives (cf. Parkes & Weiss, 1983). Thus a most stringent test of Beck's hypothesis that depressive schemas are formed in early childhood by loss experiences such as parental death may be conducted by assessing the relationship between adult depression and parental death in childhood. In this paper the evidence will be considered briefly, within the context of Beck's theory of cognitive vulnerability. The specificity of parental loss to depression is questioned. Then, the role of schemas in cognitive theory is explored critically. Problems with Beck's idiosyncratic conceptualisation of depressive schemas are highlighted. A more adequate conceptualisation of the concept of loss is suggested. Finally, suggestions for future research into the origins of depression are offered.     

Thérapie cognitive et schémas cognitifs : un aspect du paradoxe

On one hand, schemas responsible for psychopathologies are said to be slowly formed during the childhood which means they become stable, rigid and practically non-modifiable structures. On the other hand, cognitive therapy aims at modifying these schemas, sometimes a few appointments are enough for the shortest techniques. To explain this paradox, we have measured the activity of 13 early maladaptive schemas among 36 patients (20 men and 16 women), suffering from panic disorders with agoraphobia, before and after a 10 weekly session group therapy—the symptoms being totally reduced. We compare these measures with those made on subjects free from any psychiatric disorders. Our results indicate that if therapy modifies symptoms, it has no immediate effect on early maladaptive schemas.     

儿童期创伤对特质抑郁和特质焦虑的影响：图式中介特异性研究

根据Beck的认知内容特异性假说(Cognitive Content Specificity Hypothesis, CCSH), 本研究假设早期适应不良图式(EMSs)在儿童期创伤与特质抑郁和特质焦虑间存在中介效应的特异性。然后对668名大学生施以儿童期创伤问卷(CTQ-SF), Young图式问卷短版(YSQ-SF), 特质抑郁问卷(T-DEP)以及特质焦虑问卷(T-AI), 经中介效应检验程序分析, 结果表明：(1)三类儿童期创伤：情感虐待、情感忽视和躯体忽视与特质抑郁和特质焦虑相关均显著, 且三类创伤与特质抑郁和特质焦虑的相关系数差异不显著; (2)针对三类创伤的中介分析均表明情感剥夺、羞耻、社交孤立/疏离和自我牺牲等与没价值、无能力有关的图式在儿童期创伤和特质抑郁间起中介作用, 而不信任/虐待和对疾病/伤害易感性等与危险有关的图式在儿童期创伤和特质焦虑间起中介作用。结论：早期适应不良图式在儿童期创伤与特质抑郁和特质焦虑间存在中介效应的特异性。     

Sources of Emotional Maltreatment and the Differential Development of Unconditional and Conditional Schemas

Schema theory posits that experiences of maltreatment result in the early development of maladaptive schemas (EMS; Young, Klosko, & Weishaar, 2003, Schema therapy: A practitioner's guide, The Guilford Press: New York, NY). EMS are organized by conditionality; unconditional schemas are theorized to develop early in childhood predominantly in response to experiences of parenting and conditional schemas are theorized to develop later in life in response to other relationships. Despite this distinction, minimal previous research has investigated their differential development. The current study examined the relative contributions of parental and other (peer and intimate partner) emotional maltreatment (EMT) in the differential development of unconditional and conditional schemas. Ninety-seven undergraduate students retrospectively reported their maltreatment experiences using the Lifetime Experiences Questionnaire and completed the Young Schema Questionnaire to measure EMS. Consistent with hypotheses, parental EMT was the strongest predictor of unconditional schemas. Unexpectedly, parental EMT also emerged as the strongest predictor of conditional schemas. Theoretical and clinical implications of these findings are discussed.     

Effectiveness of treatment of childhood memories in cognitive therapy for personality disorders: a controlled study contrasting methods focusing on the present and methods focusing on childhood memories

This study tested the hypothesis that treatment of childhood memories is an effective way to change personality disorder related schemas and psychopathology in cognitive therapy for personality disorders. To test this hypothesis, a crossover design was used to compare the effectiveness of methods focusing on the present and methods focusing on childhood memories. After the exploration period, the therapist focused either first on the present during 24 sessions and than for 24 sessions on childhood memories, or followed the reverse order. Twenty-one patients with one or more Axis II disorders were included. Participants were randomly assigned to order of focus. Results indicate that CT methods focusing on childhood memories produce good outcomes, comparable to those of methods focusing on the present. There was no significant effect of order, but both patients and therapists preferred the past-present order. Total effects of the package were large and were maintained till one-year follow-up (d's 0.97-1.90). Experience of the therapist with CT for personality disorders was related to better outcome (d=0.73).     

An Examination of Early Maladaptive Schemas among Substance Use Treatment Seekers and their Parents

Early maladaptive schemas, which are cognitive and behavioral patterns of viewing oneself and the world that result in substantial distress, are gradually being documented as important vulnerabilities for substance abuse. Unfortunately, there is limited research on early maladaptive schemas among substance abusers and their family members. Research on this topic may carry important implications for family-focused substance use interventions. The current study examined similarities and differences in early maladaptive schemas among a sample of substance abuse treatment seeking adults (n?=?47) and at least one parent (n?=?58). Results demonstrated that the substance abusers scored higher than their parents on 17 of 18 early maladaptive schemas, with most differences falling into the large effect size range. There were some similarities in the specific early maladaptive schemas endorsed by both groups despite substance abusers scoring higher on all schemas. Implications of these findings for future research and family-focused substance use treatment programs are discussed.     

Early Maladaptive Schemas as Moderators of the Impact of Stressful Events on Anxiety and Depression in University Students

The aim of this study was to test the effects of early maladaptive schemas (EMS) derived from the Schema Therapy model (Young 1999) according to the diathesis-stress paradigm. We expected that EMS would make students more vulnerable to symptoms of depression and anxiety in the presence of stressful events and that the effects of these schemas would be different for each symptom. In particular, it was hypothesised that abandonment, emotional deprivation, defectiveness, and failure schemas would interact with stressful events to predict depressive symptoms, whereas abandonment, vulnerability to harm, and dependence schemas were expected to moderate anxiety symptoms. Due to gender differences in EMS and depressive and anxiety symptoms, we also expected that sex would act as a moderator of the relationships between EMS and symptoms. A two-wave prospective study showed that the presence of EMS constitutes a vulnerability factor for both, depressive and anxiety symptoms, and this effect was also moderated by sex. Moreover, the EMS’s content specificity revealed which schemas were more relevant to each symptom, providing valuable information for prevention and intervention programmes.     

A new look at the schema therapy model: organization and role of early maladaptive schemas

This study reexamined the organization of Young’s 18 early maladaptive schemas and their hypothesized associations with experiences of need-thwarting parental experiences in childhood and the “vulnerable child” mode of emotional distress in adulthood. A large Danish sample (N = 1054) of 658 clinical- and 391 nonclinical adults completed measures of early maladaptive schemas, parenting styles, and the vulnerable child mode. We identified four higher-order schema domains as most appropriate in terms of interpretability and empirical indices (“Disconnection & Rejection”, “Impaired Autonomy & Performance”, “Excessive Responsibility & Standards”, and “Impaired Limits”). All four schema domains were differentially associated with conceptually relevant need-thwarting parental experiences. Apart from “Impaired Limits”, the schema domains meaningfully accounted for the association between need-thwarting parental experiences in childhood and emotional states of feeling like a “vulnerable child” in adulthood. We conclude that four domains of early maladaptive schemas are empirically and conceptually consistent with Young’s schema therapy model of personality pathology and longstanding emotional disorders. Findings warrant replication using different populations and if possible a prospective multi-method design. A scoring key for computing the four schema domains is provided.     

Changes in schemas of patients with severe borderline personality disorder: The Oulu BPD study

Borderline personality disorder (BPD) is a relatively common and severe psychiatric disorder that can impair quality of life in many ways. The aim of this study was to determine whether a combined treatment model for BPD patients, utilising major principles from schema‐focused therapy (SFT) and dialectical behavioral therapy (DBT), could be more effective in relieving early maladaptive schemas of BPD patients, compared to treatment as usual (TAU). This study is a part of the Oulu BPD study conducted at mental health care services run by Oulu city social and health care services. The study is a multisite, randomized controlled trial conducted over a one year period, involving two groups of patients with severe BPD: (1) Community Treatment By Experts (CTBE) patients (n = 18) receiving the combined treatment model, and 2) TAU patients (n = 27). The patients' schemas were assessed using the Young Schema Questionnaire (YSQ‐L3a) before and after one year of treatment. The results reveal that CTBE patients who attended the combined treatment model showed a statistically significant reduction in eight out of 18 early maladaptive schemas, while patients receiving treatment as usual did not demonstrate any significant changes in schemas. The cognitive therapeutic treatment model can be applied for clinical use in public mental health settings using existing professionals, and appears to produce positive changes in patients with BPD.     

Metaphor and Meaning in Early China

Western scholarship on early Chinese thought has tended to either dismiss the foundational role of metaphor or to see it as a uniquely Chinese mode of apprehending the world. This article argues that, while human cognition is in fact profoundly dependent on imagistic conceptual structures, such dependence is by no means a unique feature of Chinese thought. The article reviews empirical evidence supporting the claims that human thought is fundamentally imagistic; that sensorimotor schemas are often used to structure our understanding of abstract concepts; that these schemas can be selectively combined to result in novel structures; and that there are inextricable connections between body, emotion, and thought in both everyday and philosophical cognition. It also provides a review of a recent trend where, explicitly or not, scholars from a variety of backgrounds have begun to take metaphor more seriously as a foundational bearer of philosophical meaning in early China.     

Self-awareness: behavior analysis and neuroscience

Self-awareness is a specific type of autoclitic discriminative behavior and inferential generalization to similar performances exhibited by other people. Brain imaging findings take on special importance within behavior analysis when they indicate that dysfunctions in these areas are related to differential effects of our interventions, with some acquiring substantially typical self-awareness skills and others failing to do so. It appears that those individuals whose brain dysfunctions are limited to these areas, and are not part of more generalized brain abnormalities, are amenable to substantial acquisition of those most basic of human skills called self-awareness, whereas individuals with more generalized brain dysfunction are not so disposed. Through a combination of less or more effective teaching contingencies during childhood, and degrees of dysfunction of those brain structures, some children grow up lacking self-reflective abilities and self-insight, whereas others are extraordinarily astute at those capacities. Among children with autism spectrum disorders who lack those skills due to abnormal brain development, approximately half of them can acquire those skills, at least to some degree through the use of effective, intensive, early behavior therapy methods.     

Childhood maltreatment and adulthood proneness to shame and guilt: The mediating role of maladaptive schemas

Motivation and Emotion - The current study aimed to examine the mediating role of early maladaptive schemas (EMSs) in the associations between types of childhood maltreatment and adulthood...     

The etiology of variation in language skills changes with development: a longitudinal twin study of language from 2 to 12 years

The present study is the first long-term longitudinal examination of the etiology of individual differences in language from early childhood through to adolescence. We applied a multivariate latent factor genetic model to longitudinal data from the Twins Early Development Study in order to (a) compare the magnitude of genetic and environmental influences on language skills in early childhood (2, 3 and 4 years), middle childhood (7, 9 and 10 years), and early adolescence (12 years); and (b) determine to what extent the same genetic and environmental factors underlie variation in language skills at these three stages of language development. We found that while shared environmental influences appear to be dominant (latent factor c2 = .74) in early language, with a smaller though significant role for genetic factors (latent factor a2 = .24), the pattern is reversed by middle childhood such that genetic influences are substantially more important (latent factor a2 = .57-.63 at 7, 9 and 10 years and .47-.57 at 12 years) and shared environmental influences less so (latent factor c2 = .31-.37 at 7, 9 and 10 years and .31-.32 at 12 years). The increase in the heritability of language skills between early and middle childhood appears to be due to new genetic factors that come into play at that transition. In contrast, genetic factors remain stable from middle childhood through to early adolescence, and account for the phenotypic continuity in language skills across these two stages.     

Early maladaptive schemas in Finnish adult chronic pain patients and a control sample

Engel (1959) suggested that negative physical or emotional experiences in childhood predispose to the development of chronic pain. Studies have shown that physical and sexual abuse in early life is connected with chronic pain. Emotional adversities are much less studied causes contributing to the development of chronic pain and disability. Early emotional abuse, neglect, maltreatment and other adversities are deleterious childhood experiences which, according to Young's schema theory (1990), produce early maladaptive schemas (EMSs). The primary goal of this study was to examine whether early adversities were more common in chronic pain patients than in a control group. A total of 271 (53% women) first-visit chronic pain patients and 331 (86% women) control participants took part in the study. Their socio-demographic data, pain variables and pain disability were measured. To estimate EMSs the Young Schema Questionnaire was used. Chronic pain patients scored higher EMSs reflecting incapacity to perform independently, catastrophic beliefs and pessimism. The most severely disabled chronic pain patients showed an increase in all the EMSs in the Disconnection and Rejection schema domain, namely Abandonment/Instability, Mistrust/Abuse, Emotional Deprivation, Defectiveness/Shame and Social Isolation/Alienation EMSs. The results of the study suggested that chronic pain patients had suffered early emotional maltreatment.     

Cognitive schemas as longitudinal predictors of self-reported adolescent depressive symptoms and resilience

Given that depression risk intensifies in adolescence, examining associates of depressive symptoms during the shift from childhood to adolescence is important for expanding knowledge about the etiology of depression symptoms and disorder. A longitudinal youth report was employed to examine the trajectory of both the content and structure of positive and negative schemas in adolescence and also whether these schemas could prospectively predict depressive symptoms and youth-reported resilience. One hundred and ninety-eight participants (aged 9 to 14) were recruited from four schools to complete measures of youth depressive symptoms, resilience, and schema content and structure. Those who consented to a follow-up study completed the same measures online (50 participants completed). Negative and positive schema content and structure were related over time. After controlling depressive symptoms/resilience at Time 1, negative schema content was the only significant predictor (trend level) of depressive symptoms and resilience at Time 2. Implications for cognitive theories and clinical practice are discussed.     

Imaginary Companions in Childhood: What Can Prospective Longitudinal Research Tell Us About Their Fate by Adolescence?

Do adolescents remember imaginary companions (ICs) from early childhood? Researchers interviewed 46 adolescent participants in a prospective longitudinal study about their ICs from early childhood (age 5½). The existence of one or more ICs was documented in early childhood for 48% of children (G. Trionfi & E. Reese, 2009). At age 16, most adolescents had forgotten their early childhood ICs: Only 5 of the 23 participants who had early childhood ICs recalled those ICs later. Eight participants who had forgotten their early childhood ICs recalled a later IC, and four participants who did not have an IC at age 5 ½ reported one by age 16. Ten of the 23 participants who had early childhood ICs claimed never to have had an IC. Girls were more likely to recall their early childhood ICs. Retrospective reports of ICs in adolescence or later life may be unreliable for investigating differences between those with and without imaginary companions. Those with ICs may not be a homogenous group, with some creating ICs throughout childhood and some desisting from this behavior in early childhood. Findings indicate that both the remembering and forgetting of ICs has potential to illuminate cognitive and creative processes surrounding both memory and imagination.     

Addicted patients with personality disorders: traits, schemas, and presenting problems

We evaluated the association of Structure Clinical Interview for the DSM-IV Axis II (SCID-II) severity and personality traits, early maladaptive schemas, and presenting symptoms in 41 methadone-maintained patients meeting criteria for either antisocial, borderline, avoidant, or depressive personality disorder. Correlational analyses indicated that the severity of each personality disorder was associated with a unique profile of presenting problems and underlying traits and schemas. The evaluation of multiple psychological indicators appears to be a useful method for case conceptualization and planning interventions within a promising individual therapy model that focuses both on substance abuse and psychiatric symptoms and maladaptive schemas and coping styles.     

The item-based nature of children's early syntactic development

Recent research using both naturalistic and experimental methods has found that the vast majority of young children's early language is organized around concrete, item-based linguistic schemas. From this beginning, children then construct more abstract and adult-like linguistic constructions, but only gradually and in piecemeal fashion. These new data present significant problems for nativist accounts of children's language development that use adult-like linguistic categories, structures and formal grammars as analytical tools. Instead, the best account of these data is provided by a usage-based model in which children imitatively learn concrete linguistic expressions from the language they hear around them, and then - using their general cognitive and social-cognitive skills - categorize, schematize and creatively combine these individually learned expressions and structures.     

大学生亲密恐惧的图式干预研究

为研究图式治疗对大学生亲密恐惧的临床疗效,以54名有亲密恐惧问题的大学生为被试,采用支持咨询和图式治疗对比的实验研究,对疗效评估的各项指标进行了重复测量(前测、后测和追踪测量)的方差分析。结果表明干预后图式组亲密恐惧以及情感剥夺、缺陷/羞耻、伤害/疾病的易感性、情感抑制等四个适应不良图式都显著低于支持组,而且干预后图式组人际功能和适应功能等两项心理治疗效果评估指标都显著高于支持组。结论:图式治疗比支持支持咨询能更有效地减轻大学生亲密恐惧。     

A Model of Therapist Competencies for the Empirically Supported Cognitive Behavioral Treatment of Child and Adolescent Anxiety and Depressive Disorders

While a plethora of cognitive behavioral empirically supported treatments (ESTs) are available for treating child and adolescent anxiety and depressive disorders, research has shown that these are not as effective when implemented in routine practice settings. Research is now indicating that is partly due to ineffective EST training methods, resulting in a lack of therapist competence. However, at present, the specific competencies that are required for the effective implementation of ESTs for this population are unknown, making the development of more effective EST training difficult. This study therefore aimed to develop a model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders using a version of the well-established Delphi technique. In doing so, the authors: (1) identified and reviewed cognitive behavioral ESTs for child and adolescent anxiety and depressive disorders, (2) extracted therapist competencies required to implement each treatment effectively, (3) validated these competency lists with EST authors, (4) consulted with a panel of relevant local experts to generate an overall model of therapist competence for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders, and (5) validated the overall model with EST manual authors and relevant international experts. The resultant model offers an empirically derived set of competencies necessary for effectively treating children and adolescents with anxiety and depressive disorders and has wide implications for the development of therapist training, competence assessment measures, and evidence-based practice guidelines for working with this population. This model thus brings us one step closer to bridging the gap between science and practice when treating child and adolescent anxiety and depression.