Cognitive Schemas and Core Beliefs in Psychological Problems A Scientist-Practitioner Guide Edited by Lawrence P. Riso, Pieter L. du Toit, Dan J. Stein, and Jeffrey E. Young AMERICAN PSYCHOLOGICAL ASSOCIATION • WASHINGTON, DC Copyright © 2007 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org To order In the U.K., Europe, Africa, and the Middle APA Order Department East, copies may be ordered from P.O. Box 92984 American Psychological Association Washington, DC 20090-2984 3 Henrietta Street Tel: (800) 374-2721 Covent Garden, London Direct: (202) 336-5510 WC2E 8LU England Fax: (202) 336-5502 TDD/TTY (202) 336-6123 Online: www.apa.org/books/ E-mail: order@apa.org Typeset in Goudy by World Composition Services, Inc., Sterling, VA Printer: Edwards Brothers, Inc., Ann Arbor, MI Cover Designer: Mercury Publishing Services, Rockville, MD Technical/Production Editor: Tiffany L. Klaff The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association. Library of Congress Cataloging-in-Publication Data Cognitive schemas and core beliefs in psychological problems : a scientist-practitioner guide / edited by Lawrence P. Riso . . . [et al.].— 1st ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-1-59147-782-2 ISBN-10: 1-59147-782-4 1. Cognitive therapy. 2. Schemas (Psychology) I. Riso, Lawrence P. II. American Psychological Association. [DNLM: 1. Cognitive Therapy. 2. Mental Disorders—therapy. 3. Psychological Theory. WM 425.5.C6 C6777 2007] RC489.C63C645 2007 616.89'142—dc22 2006035438 British Library Cataloguing-in-Publication Data A CIP record is available from the British Library. Printed in the United States of America First Edition To Lisa, Alana, Hannah, and Alec Lawrence P. Riso To Karen and Tashi Pieter L. Du Toil To Heather, Gabriella, Joshua, and Sarah Dan ]. Stein To my close circle of friends over so many years Jeffrey E. Young CONTENTS Contributors ix Acknowledgments xi Chapter 1. Introduction: A Return to a Focus on Cognitive Schemas 3 Lawrence P. Riso and Carolina McBride Chapter 2. Major Depressive Disorder and Cognitive Schemas 11 Carolina McBride, Peter Farvolden, and Stephen R. Swallow Chapter 3. Early Maladaptive Schemas in Chronic Depression 41 Lawrence P. Riso, Rachel E. Maddux., and Noelle Turini Santorelli Chapter 4. Schema Constructs and Cognitive Models of Posttraumatic Stress Disorder 59 Matt J. Gray, Shira Maguen, and Brett T. Litz Chapter 5. Specialized Cognitive Behavior Therapy for Resistant Obsessive—Compulsive Disorder: Elaboration of a Schema-Based Model 93 Debbie Sookman and Gilbert Pinard Chapter 6. Cognitive-Behavioral and Schema-Based Models for the Treatment of Substance Use Disorders Ill Samuel A. Ball Chapter 7. Schema-Focused Cognitive—Behavioral Therapy for Eating Disorders 139 Glenn Waller, Helen Kennerley, and Vartouhi Ohanian vn Chapter 8. Case Formulation and Cognitive Schemas in Cognitive Therapy for Psychosis 177 Anthony P. Morrison Chapter 9. Maladaptive Schemas and Core Beliefs in Treatment and Research With Couples 199 Mark A. Whisman and Lisa A. Uebelacker Afterword 221 Lawrence P. Riso Index 225 About the Editors 239 viii CONTENTS CONTRIBUTORS Samuel A. Ball, PhD, Associate Professor of Psychiatry, Yale University School of Medicine, Division of Substance Abuse, New Haven, CT Pieter L. du Toit, MA, Psychologist, National Health Service in the United Kingdom, Cambridge, England Peter Farvolden, PhD, Assistant Professor of Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada Matt J. Gray, PhD, Assistant Professor of Psychology, University of Wyoming, Laramie Helen Kennerley, PhD, Consultant and Clinical Psychologist, Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, England Brett T. Litz, PhD, Professor, Boston Veterans Affairs Health Care System and Boston University School of Medicine, Boston, MA Rachel E. Maddux, MA, Georgia State University, Atlanta Shira Maguen, PhD, Psychologist, San Francisco Veterans Administration Medical Center, San Francisco, CA Carolina McBride, PhD, Research Director, Interpersonal Psychotherapy Clinic, Department of Psychiatry, University of Toronto, Ontario, Canada Anthony P. Morrison, PhD, Senior Lecturer, University of Manchester, Manchester, England Vartouhi Ohanian, PhD, Lakeside Mental Health Unit, West London Mental Health NHS Trust, West Middlesex University Hospital, Middlesex, England Gilbert Pinard, MD, Professor of Psychiatry, McGill University Health Centre, Montreal, Quebec, Canada Lawrence P. Riso, PhD, Associate Professor, American School of Professional Psychology, Argosy University/Washington, DC Noelle Turini Santorelli, MA, Georgia State University, Atlanta IX Debbie Sookman, PhD, Associate Professor of Psychiatry and Director, Obsessive—Compulsive Disorder Clinic, McGill University Health Centre, Montreal, Quebec, Canada Dan J. Stein, MD, PhD, Professor and Chair, Department of Psychiatry and Mental Health, University of Cape Town; Director, Medical Research Council Unit on Anxiety Disorders, Cape Town, South Africa; Mt. Sinai School of Medicine, New York, NY Stephen R. Swallow, PhD, Psychologist, Oakville Centre for Cognitive Therapy, Oakville, Ontario, Canada Lisa A. Uebelacker, PhD, Brown University Medical School and Butler Hospital, Providence, RI Glenn Waller, PhD, Professor, Eating Disorders Section, Institute of Psychiatry, King's College London; Vincent Square Clinic, Central and North West London Mental Health Trust, London, England Mark A. Whisman, PhD, Associate Professor, Department of Psychology, University of Colorado, Boulder Jeffrey E. Young, PhD, Founder and Director, Cognitive Therapy Centers of New York and the Schema Therapy Institute, New York, NY; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY CONTRIBUTORS ACKNOWLEDGMENTS The editors would like to thank and acknowledge Ms. Tiffany L. Klaff for her help in preparation of the manuscript. XI Cognitive Schemas and Core Beliefs in Psychological Problems 1 INTRODUCTION: A RETURN TO A FOCUS ON COGNITIVE SCHEMAS LAWRENCE P. RISO AND CAROLINA McBRIDE More than 30 years ago, Aaron T. Beck (1967, 1976) emphasized the operation of cognitive schemas as the most fundamental factor in his theories of emotional disorders. Schemas, accordingly, played a principal role in the development and maintenance of psychological disorders as well as in the recurrence and relapse of episodes. Despite the central place of cognitive schemas in the earliest writings of cognitive therapy, the cognitive techniques and therapeutic approaches that later emerged tended to address cognition at the level of automatic negative thoughts, intermediate beliefs, and attributional style. In a similar way, the psychotherapy protocols that developed tended to be short term. Relatively less attention was paid to schema-level processes. In most accounts of clinical cognitive theory, cognition can be divided into different levels of generality (Clark & Beck, 1999). Automatic thoughts (ATs) are at the most specific or superficial level. Automatic thoughts are moment-to-moment cognitions that occur without effort, or spontaneously, in response to specific situations. They are readily accessible and represent conscious cognitions. Examples of ATs include "I'm going to fail this test," "She thinks I'm really boring," or "Now I'll never get a job." ATs are often negatively distorted, representing, for instance, catastrophizing, [...]... that the therapist can use when trying to assess interpersonal schemas 18 McBRIDE, FARVOLDEN, AND SWALLOW Assessing Implicit Schemas There has been an increasing realization that core cognitive structures and processes are largely outside the realm of overt awareness and are implicit in nature (Dowd & Courchaine, 2002) Implicit learning has been described as having several properties including being... down, and he is more irritable with his wife Andrew's sleep has been affected, and he finds that he wakes up at least four or five times a night He is tired and agitated during the day, and he finds that he is making mistakes at work Andrew describes himself as a perfectionist and notes that he has always been highly self-critical At intake, he reported a change in his mood dating to 1 year ago, which... hurt." At the highest level of generality are cognitive schemas Negative automatic thoughts and intermediate beliefs are heavily influenced by underlying cognitive schemas, particularly when these schemas are activated In cognitive psychology, the notion of cognitive schemas has played an important role in the understanding of learning and memory For clinical contexts, A T Beck (1967) described a cognitive. .. self, Safran (1990; Safran, Vallis, Segal, & Shaw, 1986) introduced the notion of the interpersonal schema Interpersonal schemas are generalized cognitive representations of interactions with others that initially develop from patterns of interactions with attachment figures, and allow an individual to predict interactions with significant others and maximize the probability of maintaining interpersonal... McBRIDE, FARVOLDEN, AND SWALLOW using the idea of prejudice as a metaphor to explain the idea that schemas, like prejudices, are maintained by discounting, distorting, and ignoring information that is not consistent with them For example, Andrew's schema "I'm a failure" was maintained by his overevaluation of mistakes, misinterpretation of people's comments, and discounting of successes The positive data log... Andrew also endorsed marital difficulties as a stressor, which suggests that schemas about relatedness might also be activated and maintaining his depressed state Examining Early Childhood Experiences Cognitive theorists (A T Beck, 2002; Young, Klosko, & Weishaar, 2003) have argued that maladaptive schemas that develop the earliest (i.e., within the nuclear family) are the strongest, whereas schemas. .. relationships and patterns in past and current relationships outside of therapy, the therapeutic relationship itself can provide important opportunities for understanding and modifying interpersonal schemas (Safran & Segal, 1990) Andrew described his father as a "tyrannical" figure who was easily provoked and, as a result, the family "walked on eggshells" when his father was around He was also a highly critical... schema formation and maintenance Researchers and clinicians are also beginning to understand similarities and differences in women's and men's accounts of depression and how these apply to the schema model More work, however, is needed to extend the schema model of depression and clinical interventions to include the importance of both relatedness and autonomy concerns for men and women, and take into account... that the active mechanisms of CT are the interventions aimed at the core schemas and that schema change can reduce risk of relapse (A T Beck et al., 1979) Some empirical evidence suggests that CT produces schema change, and that schema change reduces relapse (Segal et al., 1999) Segal and colleagues found that patients who were treated with pharmacotherapy and recovered showed a significant increase... hopeless after you and Michael broke up Stephanie: Yes, I just can't understand what happened or what I did wrong I really thought it was going to work out this time But instead I drove him away, and now I'm alone again Therapist: How would you finish this statement? "Being alone means " Stephanie: It means that there's something wrong with me That I'm a loser, and I'll always be alone Ascertaining the patient's . Maladaptive Schemas and Core Beliefs in Treatment and Research With Couples 199 Mark A. Whisman and Lisa A. Uebelacker Afterword 221 Lawrence . thoughts and intermediate beliefs are heavily influenced by under- lying cognitive schemas, particularly when these schemas are activated. In cognitive