Stronger coupling of emotional instability with reward processing in borderline personality disorder is predicted by schema modes.

BACKGROUND: Mood instability and risk-taking are hallmarks of borderline personality disorder (BPD). Schema modes are combinations of self-reflective evaluations, negative emotional states, and destructive coping strategies common in BPD. When activated, they can push patients with BPD into emotional turmoil and a dissociative state of mind. Our knowledge of the underlying neurocognitive mechanisms driving these changes is incomplete. We hypothesized that in patients with BPD, affective instability is more influenced by reward expectation, outcomes, and reward prediction errors (RPEs) during risky decision-making than in healthy controls. Additionally, we expected that these alterations would be related to schema modes. METHODS: Thirty-two patients with BPD and thirty-one healthy controls were recruited. We used an established behavioral paradigm to measure mood fluctuations during risky decision-making. The impact of expectations and RPEs on momentary mood was quantified by a computational model, and its parameters were estimated with hierarchical Bayesian analysis. Model parameters were compared using High-Density Intervals. RESULTS: We found that model parameters capturing the influence of RPE and Certain Rewards on mood were significantly higher in patients with BPD than in controls. These model parameters correlated significantly with schema modes, but not with depression severity. CONCLUSIONS: BPD is coupled with altered associations between mood fluctuation and reward processing under uncertainty. Our findings seem to be BPD-specific, as they stand in contrast with the correlates of depressive symptoms. Future studies should establish the clinical utility of these alterations, such as predicting or assessing therapeutic response in BPD.

An exploratory investigation of schema modes in social anxiety disorder: Empirical findings and case conceptualization.

BACKGROUND: Current "gold standard" treatments for social anxiety disorder (SAD) are limited by the limited emphasis of key etiological factors in conceptualization, and many individuals with SAD experience residual symptoms posttreatment. Hence, the novel application of the Schema Therapy Mode Model may provide a helpful framework for extending clinical understanding and treatment options for SAD. This exploratory study aimed to investigate the presence and pattern of schema modes among SAD individuals. METHOD: Forty individuals with SAD completed questionnaire measures of symptomatology, social anxiety-relevant cognitions, schema modes, childhood trauma, and parental style. RESULTS: Key maladaptive schema modes identified in SAD were Vulnerable Child, Punitive Critic, Demanding Critic, Compliant Surrender, and Detached Self-Soother. CONCLUSION: Outcomes provide the basis for a proposed schema mode case conceptualization for SAD and are hoped to provide a rationale for testing the applicability of Schema Therapy as a novel treatment for SAD. Key limitations are discussed.

Implementation of a case formulation to reduce restrictive interventions on a psychiatric intensive care unit: quasi-experimental single case evaluation.

BACKGROUND: Despite the use of case formulation being encouraged for in-patient psychiatric care, there have been no previous examples and evaluations of this type of work on a psychiatric intensive care unit (PICU). AIMS: To evaluate whether a schema-informed formulation with a patient diagnosed with emotionally unstable personality disorder (EUPD), autism spectrum disorder (ASD) and mild learning difficulties was effective in reducing the use of restrictive interventions. METHOD: A biphasic n = 1 quasi-experimental design with an 8-week baseline versus an 8-week intervention phase. The restrictive outcomes measured were use of physical restraint, seclusion, and intramuscular rapid tranquilisation. The formulation was developed through eight one-to-one sessions during the baseline period, and was implemented via six one-to-one sessions during the intervention phase and discussion at the ward reflective practice group. The intervention encouraged better communication of schema modes from the patient and for staff to then respond with bespoke mode support. RESULTS: Incidents involving need for seclusion, restraint and rapid tranquilisation extinguished. DISCUSSION: The need for making access to psychological input a routine aspect of the care in PICUs and the necessity for developing a methodologically more robust evidence base for psychological interventions on these wards.

Childhood trauma, posttraumatic stress disorder symptoms, early maladaptive schemas, and schema modes: a comparison of individuals with obesity and normal weight controls.

BACKGROUND: Previous research on the psychological mechanisms of obesity has primarily focused on acute psychopathology. However, there is limited literature on the role of more complex and entrenched psychological processes in weight management. The current study aimed to expand previous research by examining more enduring psychological constructs, including early maladaptive schemas (EMS), schemas modes, and trauma. METHODS: Participants (N = 125) comprised adults with normal weight (n = 40) and obesity (n = 85) from community and clinical settings in Australia. Eligible participants completed a series of self-report questionnaires via Research Electronic Data Capture (REDCap). Two, separate, one-way multivariate analysis of variance (MANOVA) were conducted to examine group differences on the outcome variables. RESULTS: Findings indicated a significant effect of group on EMS and schema modes, V = .51, F(32, 92) = 2.97, p < .001, partial η2 = .51. Follow-up univariate tests revealed that individuals with obesity endorsed significantly more maladaptive schemas and schema modes and significantly less healthy schema modes than individuals with normal weight. In addition, results demonstrated a significant effect of group on childhood trauma and posttraumatic stress disorder (PTSD) symptoms, V = .19, F(6, 118) = 4.70, p < .001, partial η2 = .19. Subsequent univariate tests and chi-square analyses indicated that individuals with obesity reported significantly more childhood trauma as well as significantly more PTSD symptoms within the last month than normal weight individuals. CONCLUSION: This was the first study to compare EMS and schema modes in treatment-seeking individuals with obesity and normal weight controls using the short form version 3 of the Young Schema Questionnaire and revised, 118-item, Schema Mode Inventory. Overall, findings revealed that individuals with obesity experience more complex and enduring psychological difficulties than normal weight individuals. Increased assessment and targeted treatment of these underlying mental health concerns may contribute to a more holistic conceptualisation of obesity and could improve the long-term success of weight management.

The influence of maladaptive coping modes, resilience, and job demands on emotional exhaustion in psychologists.

Although it is well established that emotion-focused coping is associated with burnout, the schema therapy model may improve the prediction of who is most vulnerable to using emotion-focused coping and what kinds of emotion-focused coping carry the greatest risk of burnout. It is also unknown the extent to which resilience might buffer against maladaptive coping in protecting against burnout. The present study investigated whether maladaptive coping modes would incrementally predict emotional exhaustion (EE) adjusting for resilience and whether resilience might moderate the effect of maladaptive coping on EE. The possible role of maladaptive coping as a mediator of job demands on EE was also explored. Four hundred and forty-three clinical and counselling psychologists completed online measures of job demands, EE, resilience, and maladaptive coping modes. The Detached Protector mode was associated with greater EE after adjusting for resilience. Bully and Attack mode was associated with greater EE when considered separately from other coping modes but associated with decreased EE when considered together. Resilience did not moderate the effect of job demands on EE, or the effect of coping modes on EE, except for Compliant Surrenderer. Coping modes only partially mediated the effect of job demands on EE accounting for 20% or less of its effect. Maladaptive coping modes appear to make independent contributions to the risk of EE and efforts to reduce burnout in psychologists should focus dually on increasing resilience-building practices and decreasing maladaptive coping.

Evaluating schema modes and cognitive distortions in borderline personality disorder: A mixed-method approach.

OBJECTIVES: Cognitive processes, such as schema modes and cognitive distortions, may play a role in the genesis and maintenance of affective, interpersonal, and behavioral difficulties in individuals with Borderline Personality Disorder (BPD). This study aimed at exploring the schema modes and cognitive distortions in individuals with BPD. METHODS: Using a mixed-method approach, 30 individuals with BPD and 30 healthy participants were assessed on the Borderline Personality Questionnaire, the Schema Mode Inventory, the Cognitive Distortions Scale, and a semi-structured interview schedule. RESULTS: The BPD group had higher scores than the control group on all the maladaptive schema modes and cognitive distortions subscales. The child modes were the commonest and were also the strongest correlate of BPD symptomatology. Qualitative analysis of the content of the semi-structured interview also corroborated these findings. CONCLUSIONS: There could be many schema modes and cognitive distortions operating behind the diverse psychopathology seen in BPD.

A trait emotional intelligence perspective on schema modes.

Schema modes (or modes) are a key concept in the theory underlying schema therapy. Modes have rarely been related to established models of personality traits. The present study thus investigates the associations between trait emotional intelligence (TEI) and 14 modes, and tests a global TEI-mode factors-general psychological distress mediation model. The study draws on self-report data from 173 inpatients from a German clinic for psychosomatic medicine. Global TEI correlated positively with both healthy modes (happy child and healthy adult) and negatively with 10 maladaptive modes. When modes were regressed on the four TEI factors, six (emotionality), five (well-being), four (sociability), and four (self-control) significant partial effects on 10 modes emerged. In the parallel mediation model, the mode factors internalization and compulsivity fully mediated the global TEI-general psychological distress link. Implications of the results for the integration of modes with traits in general and with TEI in particular as well as implications of low TEI as a transdiagnostic feature of personality malfunctioning are discussed.

The mediating role of externalising and healthy schema modes in the relationship between early maladaptive schemata and overt behaviours in adolescent boys with offending behaviours, and a comparison of their early schemata with those of typically developing boys.

BACKGROUND: Evidence-based treatments in routine clinical practice often fail to achieve or sustain amelioration of severe behaviour problems in adolescents. Better understanding of mechanisms underlying such severe behaviour problems could improve treatments. Underlying schemata and schema modes may play an important role. AIMS: To compare early maladaptive schemata, schema modes and behaviour problems in adolescent boys showing disruptive and offending behaviours with those in typically developing boys. We hypothesised a relationship between disconnection and rejection schemata on the one hand and behaviour problems (including offending) on the other in adolescent boys with disruptive behaviour disorders. We also hypothesised that this offending group would differ significantly from typically developing boys on these measures and that schema modes would mediate relationships between schemata and overt behaviours. METHOD: In this cross-sectional study, fifty-five 12-19-year-old boys with disruptive behaviour disorders referred to an in- or out-patient clinic were matched to fifty-five typically developing boys from a previously generated school sample. Group differences on self-reported schema related measures and externalising behaviour measures were compared using t-tests. Mediation analyses were performed to assess the mediating role of schema modes in the relation between schemata and behaviour. RESULTS: Boys diagnosed with disruptive behaviour disorders and engaging in offending behaviours had higher scores on externalising modes and lower scores on healthy modes than the typically developing boys. There were no differences between these groups, however, in disconnection and rejection schemata. In the offending behaviour group, externalising modes mediated the relationship between disconnection and rejection schemata and externalising behaviours while healthy modes mediated a relationship between these schemata and overt prosocial behaviours. IMPLICATIONS: The potential impact of healthy modes has not previously been shown in studies of schemata in young offenders. Our findings suggest that treatments for adolescents with severe behaviour problems should not only target maladaptive schemata and dysfunctional modes, but seek also to boost healthy modes.

The network structure of schema modes.

A fundamental question in psychotherapy is whether interventions should target client problems (i.e., problem-focused approaches) or client strengths (i.e., strength-focused approaches). In this study, we first propose to address this question from a network perspective on schema modes (i.e., healthy or dysfunctional patterns of co-occurring emotions, cognitions, and behaviours). From this perspective, schema modes mutually influence each other (e.g., healthy modes reduce dysfunctional modes). Recent evidence suggests that changes in modes that are strongly associated to other modes (i.e., central modes) could be associated with greater treatment effects. We therefore suggest research should investigate the relative centrality of healthy and dysfunctional modes. To make an exploratory start, we investigated the cross-sectional network structure of schema modes in a clinical (comprising individuals diagnosed with paranoid, narcissistic, histrionic, and Cluster C personality disorders) and non-clinical sample. Results showed that, in both samples, the Healthy Adult was significantly less central than several dysfunctional modes (e.g., Undisciplined Child and Abandoned and Abused Child). Although our study cannot draw causal conclusions, this finding could suggest that weakening dysfunctional modes (compared to strengthening the Healthy Adult) might be more effective in decreasing other dysfunctional modes. Our study further indicates that several schema modes are negatively associated, which could suggest that decreasing one might increase another. Finally, the Healthy Adult was among the modes that most strongly discriminated between clinical and non-clinical individuals. Longitudinal and experimental research into the network structure of schema modes is required to further clarify the relative influence of schema modes.

Recurrent bilateral frontal lobe lesion with maladaptive schema modes and post-traumatic stress disorder symptoms: a case study.

The frontal lobe is responsible for high-order functioning, such as memory, attention, decision-making, and personality. Lesions in the frontal lobe may lead to different physical and psychological problems. The current study was conducted to examine the emotional, cognitive, and behavioural states and coping strategies of a patient with recurrent bilateral frontal lobe lesion. It also attempted to determine post-traumatic stress disorder (PTSD) symptoms in a patient. This study described the case of an adult with recurrent bilateral frontal lobe tumour. It covered the clinical presentation, administration of Urdu translation of the Schema Mode Inventory (SMI) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and analysis of the case. The results of the study showed that the recurrent bilateral frontal lobe brain tumour patient engaged in child mode and had a dysfunctional coping style and a maladaptive punitive parent mode. Furthermore, the patient also had moderate PTSD symptoms.

Maladaptive schema modes as the predictor of post-traumatic stress disorder among trauma survivors.

OBJECTIVE: To study the relationship between dysfunctional schema modes and post-traumatic stress disorder among trauma survivors. METHODS: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from March to August 2019, and comprised patients of traumatic brain injury and orthopaedic trauma. Data was collected using Schema Mode Inventory and the Clinician Administered Post-Traumatic Stress Disorder Scale version 5. Data was analysed using SPSS 23. RESULTS: Of the 281 patients, 203(72.2%) were males, 78(27.8%) were females, and 157 (55.9%) were aged 18-40 years. Besides, 137(48.8%) had orthopaedic trauma, 96(34.2%) traumatic brain injuries, and 48(17%) had multiple injuries. Post-traumatic stress disorder symptoms and dysfunctional schema modes were higher in patients with moderate injuries with a mean of 42.14±7.36. Intentionally injured patients 42.70±6.92 and female trauma survivors 42.05±8.26 had more symptoms. CONCLUSIONS: Maladaptive schema mode could lead to post-traumatic stress disorder symptoms among trauma survivors with history of orthopaedic injury, traumatic brain injury and multiple injuries.

Schema in older adults: does the schema mode model apply?

BACKGROUND: The relevance of schema theory to psychopathology, in particular personality disorder, in younger adults is established. Investigations into the relevance of schema theory to older adults, however, is highly limited. AIMS: To consider the relationship of schema modes to psychopathology in older adults and establish whether maladaptive schema modes are associated with unmet needs and that this relationship is mediated by the healthy adult mode of responding in this population. METHOD: One hundred and four older adults were recruited from an established database. Participants completed questionnaires assessing psychopathology, schema modes (YAMI: Young-Atkinson Mode Inventory) and basic psychological needs (BPNS: Basic Psychological Needs Scale - autonomy, competence and relatedness). Ninety-four responses were included after applying exclusion criteria. RESULTS: The healthy adult schema mode was found to be associated with reduced psychopathology, and maladaptive child modes (angry and vulnerable child) to increased psychopathology. The healthy adult schema mode mediated the relationship between maladaptive child modes and needs satisfaction. CONCLUSIONS: As predicted by schema theory, the presence of one of the maladaptive child modes makes it difficult for an older individual to have their needs met, but the presence of healthy adult mode works to support this process.

Turkish adaptation of the Short Schema Mode Inventory.

The purpose of the current study is to present the psychometric properties of the Short Schema Mode Inventory in the Turkish culture. The study sample comprised 1,287 participants, including both clinical and nonclinical participants. The age of the participants ranged between 18 and 48 years. The construct validity of the scale was tested using confirmatory factor analysis. The internal (Cronbach's alpha) and test-retest reliability coefficients were used to examine the reliability of the scale. Discriminant validity was investigated by comparing the nonclinical and clinical participants. Concurrent validity was tested via the Splitting Scale. The results of the study showed that the tested model had good data-model fit statistics. Additionally, the reliability analyses revealed that the scales had good internal and test-retest reliability coefficients. A significant association was found between the subscales of the Schema Mode Inventory. Furthermore, the scores of the clinical participants were significantly higher compared with the scores of the nonclinical participants for the maladaptive schema modes. Nonetheless, the participants in the nonclinical group had significantly higher levels of the healthy schema modes than individuals in the clinical group. The results of this study demonstrated that the Schema Mode Inventory was a reliable and valid instrument to measure schema modes in the Turkish population.

Young Schema Questionnaire - Short Form Version 3 (YSQ-S3): Preliminary validation in older adults.

OBJECTIVES: The aim of the current study was to establish the reliability and validity of one of the most used schema questionnaires, Young Schema Questionnaire Short Form Version 3 (YSQ-S3) in older adults. METHOD: 104 participants aged 60-84 years were recruited. They were administered a battery of questionnaires, including the YSQ-S3, Young-Atkinson Mode Inventory (YAMI), Germans (Personality) Screener, the Geriatric Depression Scale (GDS), The Geriatric Anxiety Inventory (GAI) and the Basic Psychological Needs Scale (BPNS). The YSQ-S3 was completed a second time by 83 participants a median of 12 days later. RESULTS: Satisfactory internal consistency reliability was found for 13 of the 18 early maladaptive schemas (EMS) of the YSQ-S3. Test-retest reliability was satisfactory for 17 of 18 EMS. Convergent validity was evident from significant correlations between the EMS of the YSQ-S3 and the vulnerable child and angry child schema modes from the YAMI. Congruent validity was evident from correlations of the majority of the EMS with the GDS, the GAI, German's (Personality) Screener and the BPNS measure. CONCLUSIONS: By and large the YSQ-S3 demonstrates internal and test re-test reliability in as well as congruent and convergent validity, in older adults. This suggests the YSQ-S3 may be of use in work establishing the utility of schema therapy in this population, and that schema therapy with older people warrants further exploration. Notwithstanding this some re-development of some EMS items appears to be required for the YSQ-S3 to be more relevant to older people.

Schema Modes and Personality Disorder Symptoms in Alcohol-Dependent and Cocaine-Dependent Patients.

Substance use disorders (SUD) and personality disorders co-occur frequently. This relationship might be understood by studying schema modes (a key concept in Schema therapy), which explain the dysfunctions characterizing personality disorder patients. In the present study, we compared the schema modes and personality disorder symptoms between alcohol-dependent patients, cocaine-dependent patients and healthy controls. We found indications that specific schema modes are specific for SUD patients. However, no differences between specific subtypes of SUD patients (alcohol- vs. cocaine-dependent patients) could be found regarding schema modes. Further, it is suggested that borderline personality disorder symptoms are highly relevant for SUD patients. A first step is made in understanding the relationship between schema modes and SUD, which may contribute to the understanding of the problematic behaviour seen in patients with personality disorders and SUD (and may possibly contribute to the improvement of the treatment of this group of patients).

Elucidating DSM-5 and ICD-11 Diagnostic Features of Borderline Personality Disorder Using Schemas and Modes.

BACKGROUND: Borderline personality disorder (BPD) comprises a heterogeneous constellation of problems operationalized in the DSM-5 and the forthcoming ICD-11. In schema therapy, schemas and modes are employed to conceptualize and treat these problems. AIM: The current study investigated whether the 9 diagnostic BPD features are associated with schemas and modes. METHOD: Psychiatric outpatients with predominant BPD features (n = 142; 68% females) were administered the Structured Clinical Interview for DSM-IV Axis II (SCID-II) and self-report inventories for schemas and modes. Associations were investigated by means of bivariate point-biserial correlations and multiple logistic regression analysis. RESULTS: BPD features were largely associated with conceptually related schemas and modes. Consistent with the schema therapy literature and previous research, we found schemas of Abandonment/Instability and Mistrust/Abuse along with modes of Angry/Enraged Child, (internalized) Punitive Parent, and Impulsive Child to uniquely predict thematically related BPD features including fear of abandonment, self-destructiveness, feelings of emptiness, stress-related paranoid ideation, inappropriate anger, and impulsivity. CONCLUSION: Most of the 9 BPD features were related to conceptually meaningful schemas/modes, suggesting that BPD is composed of dormant themes along with salient affective-behavioral responses. Consequently, individual BPD features may be differentially conceptualized and targeted in therapy by means of schemas and modes.

The role of aggression-related early maladaptive schemas and schema modes in aggression in a prisoner sample.

Contemporary social-cognitive aggression theory and extant empirical research highlights the relationship between certain Early Maladaptive Schemas (EMSs) and aggression in offenders. To date, the related construct of schema modes, which presents a comprehensive and integrated schema unit, has received scant empirical attention. Furthermore, EMSs and schema modes have yet to be examined concurrently with respect to aggressive behavior. This study examined associations between EMSs, schema modes, and aggression in an offender sample. Two hundred and eight adult male prisoners completed self-report psychological tests measuring their histories of aggression, EMSs, and schema modes. Regression analyses revealed that EMSs were significantly associated with aggression but did not account for a unique portion of variance once the effects of schema modes were taken into account. Three schema modes, Enraged Child, Impulsive Child, and Bully and Attack, significantly predicted aggression. These findings support the proposition that schema modes characterized by escalating states of anger, rage, and impulsivity characterize aggressive offenders. In this regard, we call attention to the need to include schema modes in contemporary social-cognitive aggression theories, and suggest that systematic assessment and treatment of schema modes has the potential to enhance outcomes with violent offenders.

Short-term, manualized schema-focused group therapy for patients with CBT-resistant disorders within primary care: a pilot study with a naturalistic pre-treatment and post-treatment design.

The aim of this study was to explore the feasibility and preliminary effectiveness of a short-term, manualized schema therapy group for 77 patients with CBT-resistant mood and/or anxiety and/or personality disorders (PDs) in primary care. The primary focus was on the effects of this treatment on Early Maladaptive Schemas (EMS), schema modes, and psychological well-being. These aspects were assessed pre-and post-treatment treatment using the Young Schema Questionnaire (YSQ), the Schema Mode Inventory version 1.1 (SMI), and the Symptom Questionnaire-48 (SQ-48). The treatment consisted of 16 sessions, incorporating cognitive, behavioral, and experiential techniques. EMS significantly decreased from pre-treatment to post-treatment, as along with maladaptive schema modes. Adaptive modes increased, as did psychological wellbeing. There were no significant differences between the DSM-5 classifications regarding changes in the aforementioned measures, except for the maladaptive modes, where the value of the corrected within-subject effect indicated a significant interaction. Post hoc comparisons were therefore conducted which showed that patients with a mood disorder experienced more positive changes in maladaptive modes compared to patients with anxiety disorders and PDs (p < 0.001). There was no significant difference between those with PDs and those with Anxiety Disorders. Our findings provide preliminary evidence that short-term, manualized schema therapy might be an effective treatment for patients with CBT-resistant mood and/or anxiety and/or PDs in primary care.

A mixed methods study of schema modes amongst people living with eating disorders.

BACKGROUND: Schema therapy is promising for people with eating disorders, especially those unresponsive to cognitive behavioural therapy. Complex underlying psychological constructs include dysfunctional schemas and maladaptive modes. This study aimed to explore people living with eating disorders' schema modes and their identification with and understanding of their high scoring modes. METHODS: Sixteen women with enduring eating disorders without prior exposure to schema therapy completed the schema mode inventory for eating disorders short form (SMI-ED-SF), then participated in semi-structured interviews discussing their high scoring modes. Interviews were analysed by thematic analysis. RESULTS: All participants scored above clinical concern on at least one maladaptive mode and many scored high on multiple modes, most commonly Demanding Mode, Vulnerable Child and Detached Self-Soother. Qualitatively, four themes emerged: 1) Adverse family environments related to (a) trauma and the vulnerable and angry child and (b) unrealistically high standards; 2) Mode effects on (a) everyday life and (b) disordered eating; 3) Modes are psychologically protective in (a) avoiding emotion by detachment and soothing, (b) people pleasing by compliance and surrender; 4) Help seeking including (a) barriers to recovery from an eating disorder, (b) dissatisfaction with interventions experienced to date, (c) schema therapy as a promising alternative. DISCUSSION: Participants recognised and identified with their high scoring schema modes. After negative experiences with previous interventions, they considered schema therapy to be a promising alternative that could understand and work on their deeper psychological issues. This suggests that schema modes are a promising way of understanding and working with enduring eating disorders.

Maladaptive modes are important in Schema Therapy for eating disorders. They are momentary patterns of thought, feeling and behaviour, triggered by experiences to which people with eating disorders can be oversensitive. In a child mode the person may be inexplicably childish. A coping mode may involve detachment, surrender to others, or perfectionist overcompensation. A parent mode may involve unrealistic standards and demands. There are also two healthy modes of Healthy Adult and Happy Child, which are often lacking in people with eating disorders. In this study women with enduring eating disorders completed the schema mode inventory and then discussed their high scoring modes. Common maladaptive modes were vulnerable child, demanding parent mode and perfectionistic over-compensator. Participants identified with their high scoring modes and thought them useful for self-understanding, so schema therapy is a promising way of understanding the psychopathology underlying enduring eating disorders.