Research

Early Maladaptive Schemas (EMSs) are central to schema therapy and are most commonly measured by the Young Schema Questionnaire (YSQ). The short form (YSQ-S3) is widely used in both research and clinical contexts, but concerns remain about its structural validity, including inconsistent factor structures and poor model fit across studies. Recently, a revised version (YSQ-R) was introduced using Rasch analysis to improve psychometric properties, but its structural validity has not yet been thoroughly tested

Study 1: Systematic review of nine CFA studies (11 samples, N = 10,363) assessing the YSQ-S3 at the item level.

Study 2: Large-scale CFA (N = 995) testing the most common YSQ-S3 models identified in Study 1.

Study 3: CFA of the YSQ-R (N = 873), applying the same models used in Study 2

Study 1 found inconsistent results: some models achieved acceptable fit, but many demonstrated misfit across key indices.

Study 2 showed that none of the YSQ-S3 models tested achieved strong structural validity, with persistent issues of model misfit.

Study 3 demonstrated that, despite being designed to overcome limitations, the YSQ-R also failed to achieve satisfactory model fit

Both the YSQ-S3 and YSQ-R exhibit structural validity issues. The findings suggest that either (1) the items within these measures require revision, or (2) the conceptualization of EMSs within schema therapy needs to be reconsidered. This paper highlights an urgent need for re-evaluation of schema assessment tools to ensure reliable and valid measurement for both research and clinical practice.

Schema Therapy is widely used, but key gaps remain across its theory, measurement, and evidence base—making it hard to decide which questions should be tackled first. This project set out to define a clear, field-wide research agenda.

A three-round Delphi study gathered ratings from 56 international schema therapy experts (43 clinicians, 13 researchers). Potential research areas (n = 81) were generated from an interview with Jeffrey Young, a focus group with the ISST executive, and recommendations from recent reviews. Items were rated across three rounds; consensus was set at ≥75% endorsing “High/Very high priority.”

Nineteen priorities reached consensus, clustering into four themes:

1. Constructs & measures — e.g., clarifying overlaps/differences between EMSs, coping, modes, and attachment; developing work on core emotional needs. (Top items: 79%–77% priority.) ACU Research Bank

2. Testing theoretical assumptions — e.g., longitudinal research on how adversity, temperament, parenting, and gender relate to EMSs and modes. (75%–80%.) ACU Research Bank

3. Contexts & outcomes — priorities to examine effects on interpersonal and parenting outcomes. (86%, 77%.) ACU Research Bank

4. Effectiveness & mechanisms of change — strongest endorsements included:

   • Effectiveness for complex trauma (89%).

   • Identifying mechanisms of change (e.g., imagery, limited reparenting, mode work) (88%).

   • Trials with patients non-responsive to CBT (86%).

   • Multi-site RCTs and TAU comparisons (80% and 77%).

   • Trials in chronic depression/dysthymia; tests of whether ST changes EMSs/modes/coping; moderators and imagery research (all 75%–77%).

This Delphi consensus study established a clear roadmap for future schema therapy research. Experts from around the world highlighted the need to refine core constructs and measures, rigorously test theoretical assumptions about the development of schemas and modes, and explore schema therapy’s impact across interpersonal and parenting contexts. Importantly, there was strong consensus on advancing mechanism-of-change research and conducting large-scale, multi-site trials, particularly for complex trauma and treatment-resistant populations.

Together, these findings provide a shared set of priorities to guide researchers, clinicians, and funders in building a stronger, more cohesive evidence base for schema therapy.

Many people with chronic anxiety disorders do not achieve lasting benefit from standard cognitive behaviour therapy (CBT). Childhood trauma and entrenched maladaptive schemas can underlie ongoing symptoms. Group Schema Therapy (GST), originally developed for personality disorders, is increasingly used for complex anxiety presentations.

This multi-study report outlines an adaptation of GST for severe anxiety disorders including panic disorder, agoraphobia, social phobia, generalised anxiety disorder, and OCD. The program condensed the Farrell et al. protocol to 18 group sessions plus 2–4 individual sessions, combining experiential, cognitive, and behavioural pattern-breaking techniques within a supportive group environment.

Case material demonstrated significant clinical improvements. Participants showed reductions in panic attacks and anxiety severity, improved well-being, and stronger “Healthy Adult” functioning. The group format fostered universality, belonging, and vicarious learning, enhancing schema change and relapse prevention.

This brief GST program shows promise for adults with severe anxiety who have not responded to CBT, highlighting the value of targeting schemas and modes alongside symptom management. Further controlled research is recommended to confirm these findings.

This article reports on the first meta-analysis into the relationships between attachment styles and early maladaptive schemas (EMS).

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, by searching the PsycINFO, PubMed, and CINAHL databases. Included studies were peer-reviewed journal articles that examined the relationship between one or more EMS and attachment styles.

Fifteen studies were included. All associations were estimated using a random-effects model. Overall, insecure attachment styles were significantly positively associated with EMS (anxious attachment r = .36, avoidant attachment r = .22, fearful attachment r = .28) and significantly negatively associated with secure attachment (r =
.13). Subgroup analyses revealed differences in the magnitude of the associations between attachment styles and specific EMS. Anxious attachment demonstrated larger associations with EMS (compared to avoidant attachment) within the schema domains of disconnection/rejection (r = .49 vs. r = .31) and other-directedness (r = .32 vs. r = .12).

This study is the first quantitative review into the state of the field regarding the associations between adult attachment styles and early maladaptive schemas. The integration of adult attachment styles with early maladaptive schemas as part of this meta-analysis provides an important organizational framework regarding the maladaptive mental representations that insecure individuals harbor regarding their views of themselves and others. The findings provide therapists with an understanding of the maladaptive schemas that can feature in the presentation of clients who differ in attachment styles and how to tailor therapy to address the maladaptive schemas and coping patterns for different forms of attachment insecurity.

This study aimed to review evidence on the associations between childhood emotional, physical and sexual abuse; neglect and bullying and early maladaptive schemas, as measured in adolescence

PubMed, PsycInfo and CINAHL were searched to identify peer-reviewed studies reporting original quantitative data on the association

between early maladaptive schemas or schema domains (e.g., Disconnection and

Rejection) and childhood emotional, physical and sexual abuse; neglect and bullying,

measured in individuals aged up to 18 years. Meta-analyses were conducted to estimate the magnitude of the associations between schemas and childhood experiences. Twelve studies were included: Seven explored schemas, and five examined schema domains. Most studies had somewhat representative samples that were adequate in size, and all used validated measures of schemas or schema domains. Three studies explored emotional neglect, two each for emotional abuse, physical abuse and peer problems, one explored family violence and one adolescent stressors.

Metaanalyses indicated small to medium pooled associations between emotional abuse and Emotional Deprivation, r = .33 (95% CI [.19, .46]) and Subjugation, r = .32 (95% CI [.14,.47]) and emotional neglect and Mistrust Abuse, r = .41 (95% CI [.32, .49]), Abandonment, r = .25 (95% CI [.22, .28]), Social Isolation r = .23 (95% CI [.10, .35]) and Failure, r = .35 (95% CI [.26, .44]). Associations between childhood abuse and neglect experiences and schemas were evident in adolescents. There were limited data on some adverse experiences including sexual abuse and neglect.

The evidence thus far suggests that maladaptive schemas are related to experiences of childhoodemotional abuse and neglect and are evident before adulthood.

Autism spectrum disorder (ASD) and borderline personality disorder (BPD) share clinical features such as interpersonal difficulties and emotional dysregulation. This review examined how often these conditions co-occur and whether overlapping symptoms may contribute to diagnostic challenges.

A comprehensive search of Ovid Medline, PsycInfo, and PubMed identified studies reporting on co-occurring ASD and BPD diagnoses or traits. Nineteen studies met inclusion criteria, with twelve included in meta-analysis.

Across largely small, clinically recruited samples, the pooled prevalence of BPD in individuals with ASD was 4% and of ASD in individuals with BPD was 3%. Evidence for overlapping clinical characteristics was mixed and many studies carried a high risk of bias.

Findings suggest that while ASD and BPD can share behavioural features, dual diagnosis appears to occur at rates similar to the general population prevalence of each disorder. Larger, well-validated studies are needed to clarify diagnostic boundaries and guide treatment approaches.

Young's early maladaptive schemas represent a possible pathway between childhood adversity and Intimate Partner Violence (IPV). The evidence suggests that being a victim of IPV is associated with an expectation that one's needs for love and safety will not be met and doubt regarding one's capacity to handle responsibilities or succeed in life.

The aim of this review was to synthesize the evidence on early maladaptive schemas and IPV. PubMed, PsycInfo, and CINAHL databases were searched, in compliance with PRISMA, to identify peer reviewed studies that reported on the relationship between schema or schema domain scores and IPV victimization or perpetration.

Based on nine included studies, meta-analyses indicated that IPV victimization showed a moderate association with the Disconnection and Rejection and Impaired Autonomy domains, and a small association with Other-Directedness. The Mistrust Abuse and Vulnerability to Harm schemas were moderately correlated with victimization. Mistrust Abuse was also implicated in perpetration but insufficient data were available for meta-analysis.

The evidence suggests that being a victim of IPV is associated with an expectation that one's needs for love and safety will not be met and doubt regarding one's capacity to handle responsibilities or succeed in life.

Improved understanding of the specific cognitive risk factors associated with depression is needed to inform prevention and treatment approaches. Recent research has examined the relationship between Early Maladaptive Schemas (EMS) and depression, but the findings were yet to be integrated using meta-analytic methods. The aim of this review was to synthesize the evidence on the relationship between depression and EMS.

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, by searching the PsycINFO, PubMed, and CINAHL databases. Included studies were peer-reviewed journal articles that examined the relationship between one or more EMS and depression in adulthood in participants aged 18 years or older.

A total of 51 studies were included (k = 743; Pooled N = 17,830). All 18 EMS were positively correlated with depression, with effect sizes ranging from small (r = .23 [.17, .29]; Entitlement) to large (r =.53 [.46, .60]; Social Isolation; r = .50, 95% CI [.45, .54]; Defectiveness/Shame).

The evidence suggests that individuals who feel like they do not belong, or that they are flawed, bad, or unlovable, report higher levels of depression. However, most studies used cross-sectional designs, and further longitudinal research is needed to establish the direction of the relationship between EMS and depression. These findings can guide preventative and treatment approaches. Focusing treatment on the Social Isolation and Defectiveness/Shame EMS may aid in relieving depressive symptoms.

Understanding the risk factors for suicidality is essential to the prevention of death by suicide and the effective treatment of suicidal ideation and self-harm. The objective of this review was to summarise the evidence on the associations between suicidal ideation, suicidal or non-suicidal self-harm, and early maladaptive schemas.

A systematic review and meta-analysis was completed based on the PRISMA statement. Searches were conducted via PubMed, PsycInfo, and CINAHL. Included studies were peer-reviewed and reported on the bivariate association between one or more of the 18 schemas and either suicidal ideation or self-harm behavior.

We included 17 studies reporting more than 200 associations. Suicidal ideation demonstrated a large mean correlation with Defectiveness Shame (r = .50 [.43, .57]), moderate correlations with Social Isolation (r = .43 [.34, .50]), Failure (r =. 35 [.27, .42]), and Dependence Incompetence (r = .33 [.13, .51]), and small correlations with Subjugation (r = .26, [.13, 38]) and Emotional Inhibition (r = .29 [.13, .44]). Self-harm demonstrated small correlations with Emotional Deprivation (r = .21, [.13, .29]), Social Isolation (r = .29, [.18, .38]), and Emotional Inhibition (r = .19, [.13, .24]).

Confidence in the findings is limited by high heterogeneity across several analyses and the inability to investigate possible moderators due to the low number of included studies.

Believing that one is isolated, unlovable, or incapable is associated with an increased risk of suicidal thoughts. The findings correspond with the risk factors identified by the Interpersonal Theory of Suicide: thwarted belonging and burdensomeness.

Pathological narcissism has a long history dating back 2000 years, that has evolved into contemporary clinical psychology as a trait that may require clinical attention (Grenyer, 2013). Traditionally, Narcissistic personality disorder(NPD)is one of the 10 identified personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

An alternative trait-based model of personality disorders in DSM-5 described in Section III includes a more contemporary version of NPD. The former NPD description only describes the grandiose form characterized by a grandiose sense of self-importance, fantasies of success, power etc, a belief in one’s specialness, desire for admiration, sense of entitlement, interpersonal exploitativeness, and lack of empathy. The alternative NPD alsodescribes impairments in functioning across identity, self-direction, empathy, and intimacy and while identifying pathological personality traits of grandiosity and attention seeking (both facets of antagonism) as well as more vulnerable narcissism presentations with aspects of negative affectivity such as depressivity and anxiousness (American Psychiatric Association, 2013). (see Pincus, Dowgwillo, & Greenberg (2016) for descriptions of 3 cases of NPD using the alternative DSM-5 model).

Thus, contemporary views of pathological narcissism recognise both grandiose and vulnerable components.

Group schema therapy is an emerging treatment for personality and other psychiatric disorders. It may be particularly suited to individuals with complex trauma given that early abuse is likely to create maladaptive schemas.

This pilot study explored the feasibility and effectiveness of a 4-week in-patient group schema therapy programme for adults with complex trauma in a psychiatric hospital setting.

Thirty-six participants with complex trauma syndrome participated in this open trial. Treatment consisted of 60 hours of group schema therapy and 4 hours of individual schema therapy administered over 4 weeks. Feasibility measures included drop-out rates, qualitative interviews with participants to determine programme acceptability and measures of psychiatric symptoms, self-esteem, quality of life and schema modes pre-, post- and 3 months following the intervention.

Drop-out rate for the 4-week program was 11%. Thematic analysis of interview transcripts revealed four major themes: connection, mode language explained emotional states, identifying the origin of the problem and the emotional activation of the programme. Measures of psychiatric symptoms, self-esteem and quality of life showed improvement post-treatment and at 3 months post-treatment. There was a reduction in most maladaptive schema modes pre-/post-treatment. Conclusions: A group schema therapy approach for complex trauma is feasible and demonstrates positive effects on psychiatric symptoms and maladaptive schemas.

A group schema therapy approach for complex trauma is feasible and demonstrates positive effects on psychiatric symptoms and maladaptive schemas.