Understanding the reparative effects of schema modes: an in-depth analysis of the healthy adult mode.

Objectives: Evidence in favor of schema therapy's effectiveness in treating personality disorders is growing. One of the central and recently popular concepts of schema therapy is schema modes [i.e., temporary emotional-cognitive-behavioral states resulting from the activation of early maladaptive schemas (EMSs)]. A key aspect herein is self-reparenting, i.e., a healing relationship between the healthy adult (HA, i.e., compassionate and healthy emotional states, and functional dealing with reality) and the child modes (i.e., representation of fragile and hurt feelings and dysfunctional coping). Through an in-depth qualitative analysis, we aimed to better understand the components of the HA that enable self-reparenting. Method: Purposive sampling procedures were used to recruit eligible participants (n = 10) with relatively strong HA modes, as determined by high scores on positive affect and satisfaction with life measures and low scores on EMSs and psychopathological symptom measures. Semi-structured 45- to 60-min face-to-face interviews were conducted individually, in which individuals were asked to help the child modes reflected in the pictures. Interviews were then analyzed using deductive thematic analysis in MaxQDA. Results and discussion: The analysis revealed three superordinate themes comprising of a total of 10 group themes: (1) bonding between HA and the vulnerable child modes ("Bond"); (2) balancing expression and inhibition of adult and child mode emotions ("Balancing"); and (3) opposing demanding and critical voices and maladaptive coping styles ("Battle"). Furthermore, a strong HA mode seems to have a reciprocal relationship with the child modes: the HA gives nurturance and protection to the child modes, and the child modes boost up the HA with spontaneity and happiness. In conclusion, emotional stability and resilience may be highest when HA-child mode interaction happens bidirectionally; when the child modes get reparented by the HA, and the HA is informed by the child modes.

Schema modes as a common mechanism of change in personality pathology and functioning: Results from a randomized controlled trial.

OBJECTIVE: We aimed to empirically test whether schema modes are central to the change process in schema therapy, clarification-oriented psychotherapy, and treatment as usual, i.e., predictive of personality pathology, and global and social-occupational functioning. METHOD: A multicenter randomized controlled trial was conducted (N = 139 men, N = 181 women) over the course of three years. Repeated assessments of schema modes, personality disorder (PD) severity and functioning (controlled for concurrent PD-pathology) were analyzed using a multilevel autoregressive model. Variables were person-centered to ensure that within-person changes were analyzed. Through a process of backward elimination, the schema modes predictive of the dependent variable (i.e., PD-severity and functioning) at a later point in time were identified while controlling for concurrent dependent variable levels. Bidirectionality was tested by assessing whether dependent variables predicted later schema modes. RESULTS: The Healthy Adult, Vulnerable Child, Impulsive Child, and Avoidant Protector predicted later personality pathology, with no bidirectionality observed for the first two. The Healthy Adult and Self-Aggrandizer predicted functioning at a later point in time, with no bidirectionality for Self-Aggrandizer. There was no moderation by treatment type for PD symptomatology, except for Self-Aggrandizer, which predicted functioning only in schema therapy. CONCLUSIONS: The Healthy Adult and Vulnerable Child are central to the change process and appear to reflect common mechanisms of change. The Self-Aggrandizer might reflect a change mechanism specific for schema therapy. Our findings support the recent emphasis on these modes in schema therapy.

An integrative perspective on the interplay between early maladaptive schemas and mental health: The role of self-compassion and emotion regulation.

OBJECTIVES: We aimed to test whether negative emotion regulation difficulties and self-compassion mediate the relationship between early maladaptive schemas (EMSs) and symptoms of psychopathology and life satisfaction. METHODS: Data were collected from 296 adults (179 females, 117 males), whose age ranged from 17 to 52 years. The mediating roles of self-compassion and negative emotion regulation were examined via Hayes' procedure (PROCESS) for multiple mediation. RESULTS: Negative emotion regulation was the only mediator to psychopathological symptoms, with no additional role for self-compassion, whereas self-compassion mediated only to life satisfaction, with no additional role for negative emotion regulation. CONCLUSIONS: The results provide evidence for unique mediating roles of negative emotion regulation and self-compassion, depending on the outcome variable. That helps to understand how problems that may be identified in terms of positive and negative domains are related to EMSs, and allows to put forward potential strategies within the frame of schema therapy.