Early maladaptive schemas, depression and anxiety among young people

Abstract

Depression and anxiety are two of the most frequently occurring mental health conditions among young people. Symptoms of depression and anxiety are often ascribed to various aetiological factors, including early childhood experiences, maltreatment/violence, insecure parental attachment, and cognitive factors. One line of research has focused explicitly on a particular form of cognitive vulnerability, Early Maladaptive Schemas (EMS), as an underlying contributing factor toward developing depression and anxiety symptoms (Young et al., 2003).

The current PhD thesis consists of three phases. In Phase One, two meta-analyses were carried out to explore the strength of associations between EMS, depression and anxiety. Findings from 24 studies revealed that EMS was positively correlated with depression with large effect sizes, indicating that predominately active EMS were highly associated with depressive symptoms among adolescents and young adults. Similarly, results from 15 studies found a strong association between EMS and anxiety symptoms, suggesting a substantial relationship of EMS with anxiety symptoms among adolescents and young adults. Details of the two meta-analyses are reported in Chapter two and Chapter three, respectively.

In Phase Two, an empirical study was conducted to explore further the associations between EMS, anxiety and depression using standardised measures of Young’s Schema Questionnaire (YSQ-short form) and Depression, Anxiety, Stress Scale (DASS-21) among young people. Based on a large sample of 946 young people (aged 16-25 years; M = 20.82, SD = 2.75), this cross-sectional study replicated the meta-analyses described above, suggesting significant inter-relationships between EMS, anxiety and depressive symptoms. This study further explored the role of self-compassion and mindfulness in these associations using standardised measures of the Self-compassion scale (SCS-short form) and the Five Facet Mindfulness Questionnaire (FFMQ). The findings from structural equation modelling (SEM) suggest significant predictive associations between EMS with depression and anxiety symptoms. The results demonstrate a significant negative relationship and a strong mediating effect of self-compassion among the associations between various EMS domains and depressive symptoms. On the contrary, mindfulness significantly mediates the associations between different EMS domains and anxiety symptoms. Due to the volume of data and analyses involved, for clarity, the empirical findings for depressive and anxiety symptoms were reported separately in Chapter four and Chapter five, respectively.

These findings have potentially important clinical implications, raising the hypothesis that increased levels of self-compassion and mindfulness can potentially mediate the association between EMS and subsequent anxiety and depression among young people. This hypothesis is consistent with the current development of clinical research in this field. While different intervention techniques have been developed to overcome the effects of maladaptive schemas, such as Schema Therapy and Cognitive Behavioural Therapy, current research trends have instead shifted from using traditional therapeutic approaches to third-wave therapeutic techniques to buffer the impact of schemas on the development of subsequent psychological distress. Instead of ‘fixing’ early maladaptive schemas, third-wave therapies seek to diminish the effect of maladaptive schemas through enhancing empathetic, non-judgemental, and mindful awareness of these negative thoughts, beliefs, and feelings.

Building on the above, in Phase Three of the PhD, a self-help intervention study was designed to examine whether and to what extent strategies to enhance mindfulness and self-compassion would be an effective way to minimise the effects of maladaptive schemes on depression and anxiety symptoms in young people. The intervention was tested using a non-concurrent multiple baseline study, with a series of A-B replications) using the methodological design outlined by What Works Clearinghouse Guidelines (Kratochwill et al., 2021; Kratochwill et al., 2013). A sample of 7 participants (aged 16-25 years; M = 23.57; SD = 1.38) with higher scores on EMS took part in the self-help intervention. Given the utility and potential effects of self-help intervention and the increasing evidence of the benefits of using self-compassion/mindfulness, it was hypothesised that self-help interventions designed to help people develop the skills of self-compassion/mindfulness would be a valuable, easily accessible, and helpful resource for young people with predominant early maladaptive schemas. Consistent with this, findings suggest that the self-help compassion-based interventions elicited a significant decrease in EMS scores from pre-intervention to post-intervention and 2-week follow-up time, indicating the effectiveness of self-help intervention across 7 participants. The findings further highlight the need for early preventive and intervention strategies to buffer the impact of maladaptive schemas in causing mental health crises among young people. This study was reported in Chapter six, with a detailed discussion on the implication of current findings, limitations and future directions reported in Chapter seven.