Schema in clinical psychology and psychotherapy – Beck’s model

processing and cognition, the so-called cognitive revolution, became increasingly prominent in clinical psychology and psychotherapy due to Aaron T. Beck’s cogni-tive model for depression and psychopathology (Beck, 1964; Beck, 1967; Beck, 1976;

Beck, 1979). Beck’s information-processing model of psychopathology is based on a

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view that individual’s cognitive, emotional and behavioural responses to events are automatically affected by constant perception interpretation, recall and storage of data from the environment and that this process is prone to biases, distortions and defects (Pretzer & Beck, 2005). Influenced by Albert Ellis’ (1962) theory of emotions as self-evaluative beliefs, in Beck’s diathesis-stress model for the aetiology of depres-sion mood alternation is not placed at the centre of depressive disorders. Beck viewed self-castigation, exaggeration of external problems and hopelessness as the key symptoms of depression, which in turn would lead to dysphoria, passivity and re-duced desire (Beck, 1967; Kovacs & Beck, 1978). Schemas were noted in the model as a central cognitive structure together with the negative triad (negative views about self, others and the world) and cognitive errors.

In traditional accounts of cognitive theory, cognitive systems are commonly viewed from a hierarchical perspective with automatic thoughts at the most superfi-cial level, dysfunctional attitudes at an intermediate level, and cognitive schemas at the deepest, implicit or non-accessible level (Clark & Beck, 1999; Segal, 1988). In Beck’s (1964) formulation, the negative triad is incorporated in negative self-schemas, which constitute the vulnerability to depression. Schema was defined by Beck (1967, p. 283) as:

“a structure for screening, coding, and evaluating the stimuli that impinge on the organ-ism. It is the mode by which the environment is broken down and organized into its many psychologically relevant facets. On the basis of the matrix of schemas, the individual is able to orient himself in relation to time and space and to categorize and interpret his experiences in a meaningful way”

In this sense, the Beckian schema is both a deep structure of memory, which organ-izes the individual’s experience, and a concept that can be used to explain why dif-ferent individuals react difdif-ferently to the same situation, or why a single individual shows a similar response across a variety of apparently dissimilar events. Subsequent development of Beck’s model of depression placed greater emphasis on the origins and nature of schemas. Kovacs and Beck (1978) described schemas as latent and rel-atively enduring building blocks of personality and hypothesized that schemas are formed or acquired early in development. In Beck’s model, schemas relevant to de-pression are maladaptive cognitive structures involving immature “either-or” rules of conduct and inflexible or unattainable self-expectations (Kovacs & Beck, 1978). Ac-cording to Beck’s model, if these schemas are uncritically carried into adulthood, the schema activates in stressful situations, which leads to cognitive biases and subse-quently to symptoms of depression.

Despite schemas playing a significant conceptual role in Beck’s model, cognitive theory and cognitive therapy of depression initially placed greater emphasis on other aspects of the model, such as the role of negative automatic thoughts or cognitive

35 distortions (Clark & Beck, 1999; Edwards & Arntz, 2012; Pretzer & Beck, 2005). The role and nature of schemas in Beck’s model also received criticism for issues relating to ambiguous formulations of the effects of schemas in individuals’ thinking, prob-lems in assessing schemas and the overall testability of the model (Segal, 1988; Segal

& Swallow, 1994). Towards the 1990s several cognitively oriented approaches (some-times referred to as “post-rationalist” and “constructivist”) were developed as alter-native adaptations of the cognitive model for personality disorders (Safran, 1990;

Young, 1990) and many authors started to emphasise the role of developmental fac-tors and deeper schema levels of cognition in their modifications of cognitive therapy (Perris, 2000).

Based on criticism and a growing interest in adapting cognitive model to person-ality disorders (Clark & Beck, 1999; Pretzer & Beck, 2005), Beck and co-workers have over the years revised the concept of schema in cognitive theory. The influence of work by Kant, Bartlett, Piaget, Kelly and Adler together for instance with cognitive and cognitive-behavioural perspectives of Mahoney (1974) and Lazarus (1966) as well as social learning theory (Bandura, 1977) are present in Beck’s model (Edwards

& Arntz, 2012; Pretzer & Beck, 2005). In the contemporary cognitive model, schemas are considered as the basis of personality and personality pathology (Clark & Guyitt, 2016; Pretzer & Beck, 2005; Salkovskis, 1996). Personality is viewed in the model as interaction between 1) cognitive schemas, which process information and assign meaning; 2) affective schemas, which generate feelings; 3) motivational and behav-ioural schemas, which prepare or inhibit action, and 4) physiological schemas, refer-ring to the role of motor and sensory systems and the autonomic nervous system (Pretzer & Beck, 2005). Other notable modifications to the schema concept have in-cluded introductions of core beliefs as cognitive content and verbal representation of cognitive schemas (Clark & Guyitt, 2016) and the concept of mode, which moves be-yond the idea of a hierarchical structure of cognitive systems and assumes a parallel relationship between different cognitive structures (Beck et al., 2004).

As mentioned earlier, schemas are widely used concepts in modern psychother-apy. However, different theoretical roots and the ubiquitous use of the schema con-cept have led to much confusion (James et al., 2004). In addition to schemas and core beliefs, terms such as interpersonal schemas (Safran, 1990), person and self-schemas (Horowitz, 1991; Segal, 1988), EMSs (Young, 1990; Young et al., 2003), and uncondi-tional beliefs and dysfuncuncondi-tional attitudes (A. N. Weissman & Beck, 1978) have been used to refer to various cognitive systems, which are viewed as sometimes develop-mental and sometimes state-related in relation to psychopathology. As several au-thors use similar cognitively oriented terminology in relation to psychological dis-tress, James et al. (2004) propose that, in order to understand and compare these con-cepts, it is necessary to consider the following assumptions when referring to any deeper level of cognitions:

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o time of formation of the schema or belief

o the extent to which the schema or belief has dysfunctional impact o whether the schema or belief is conditional or unconditional o pervasiveness and level of activity the schema or belief has o possibility and degree of change that can happen or be achieved

To clarify the use of schema in clinical psychology and psychotherapy, James et al.

(2004) have developed a tripartite definition of schema and related cognitive struc-tures. In their view, schemas are best understood as a parent concept that comprise, as in Bartlett’s and Piaget’s view, the building blocks of a long-term memory system, i.e. specific networks of information about some aspect of the individual’s world and that can be activated consciously or unconsciously. For James et al. (2004), a second level of schemas comprises core beliefs. In this sense, core beliefs refer to a sub-com-ponent of schemas that are brought into conscious awareness through reflection, i.e.

are verbal presentations of a certain schema. At a third level of their definition, James et al. (2004) note self-referent beliefs, which refer to specific types of core-beliefs in which the individual evaluates self in relation to the world and to the future. To sum-marise, James et al. (2004) consider that the concept of schema should be used to refer to multi-component processing units, and that a clear definition and differentiation between schemas, core beliefs and self-referent beliefs would be beneficial for re-search, assessment and the treatment of psychological distress.