Early maladaptive schemas and their relationship to psychopathology in adolescence

Abstract

Schema therapy was developed by Jeffery Young to treat adults with personality disorders, and has been evidenced to be effective in treating both Axis I and Axis II disorders. While Young stipulates that schemas are likely to be in place by adolescence, there is currently little agreement over the appropriateness of schema theory and therapy in understanding and treating psychopathology in adolescence. This thesis aims to explore the evidence–base and potential utility of applying schema theory to adolescent psychopathology, and consists of a systematic review and research article. The review included published studies measuring Early Maladaptive Schemas (EMS) in 12 to 18 year olds, including those exploring relationships between EMS and psychopathology. The search of relevant literature from 1990 to 2012 yielded 19 articles for review, which were then subject to assessment of methodological quality. Most studies were assessed as ‘moderate’ in quality. Good quality evidence was found for the detection of higher rates of EMS in clinical or referred adolescent populations compared to non–clinical populations, as well as some evidence for effects of age and gender on EMS. Less consistent evidence was found for specific associations between individual EMS or domains and particular types of psychopathology or problem behaviour. Common limitations of the articles reviewed included poor control of confounding variables and little testing of EMS alongside contextual constructs to provide validation of findings. The main research article used a quantitative, questionnaire–based cross– sectional design to test the dimensionality of the schema concept in a population of 12 to 18 year–olds, comparing levels of EMS between a referred and non–referred group. EMS were measured alongside attachment and interpersonal behaviours to test their unique predictive effect on psychopathology. Specific relationships between individual groups of EMS and type of psychopathology were also explored. Results showed that the referred group scored significantly higher than the non–referred group on overall schema score. Schemas were found to significantly predict level of psychopathology, over and above prediction by attachment or interpersonal behaviour scores. There was also evidence for the specific prediction of internalising and externalising problem behaviour, affective, anxiety, oppositional–defiant and conduct problems by clusters of EMS. In conclusion, EMS appear to be a valid concept in predicting and understanding psychopathology in adolescence. A conceptual model is suggested for future research to explore the adaptation of schema theory more fully within developmental psychopathology. It is hoped that future research will test other aspects of schema theory in adolescents such as coping styles and modes. It is proposed that, following further validating evidence, this may result in the development of improved interventions for a range of presenting problems in adolescence.