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  Article reprinted withpermission of John Wiley &Sons. To learn more abouttheir journals, Clinical Psychology and Psychotherapy  ,   Vol. 1 (5), 267-278 (1994)  Schema Change Processes inCognitive Therapy Christine A. Padesky* Center for Cognitive Therapy, Newport Beach, CA, USA Schemas are core beliefs which cognitive therapists hypothesize play a centralrole in the maintenance of long-term psychiatric problems. Clinical methods aredescribed which can be used with clients to weaken maladaptive schemas andconstruct new, more adaptive schemas. Guidelines are presented for identifyingmaladaptive and alternative, more adaptive schemas. Case examples illustratethe use of continuum methods, positive data logs, historical tests of schema,psychodrama, and core belief worksheets to change schemas. Specification of therapeutic methods for changing schemas can lead to the development of treatment standards and protocols to measure the impact of schema change onchronic problems. INTRODUCTIONIn recent years, cognitive therapists have devotedincreased attention to schemas, core beliefs which arehypothesized to play a key role in the maintenance of long-term psychiatric problems including personalitydisorders, chronic depression, chronic anxiety disorders,and chronic relationship difficulties. Case descriptionsof treatment outcome with these disorders often credit positive results to changing maladaptive core schemasand building alternative, more adaptive schemas (Beck  et al.,  1990) . However, there are few detaileddescriptions in the literature of the clinical processesused to accomplish schema change. This paper describesschema change processes in detail with caseillustrations.DEFINITIONS OF SCHEMAAaron T. Beck, MD introduced the concept of schemasto cognitive therapy. Beck's first book (1967) creditsPiaget (1948) with the srcin of the word schema todescribe cognitive structures. Summarizing Harvey et al.(1961), Beck added his own definition that 'a schema isa structure for screening, coding, and evaluating thestimuli that impinge on the organism. It is the mode by which the environment is broken down and organized into its many psychologicallyrelevant facets. On the basis of schemas, the individual isable to ... categorize and interpret his experiences in ameaningful way' (p. 283).This early definition was echoed in later works whichdefined schemas as 'stable cognitive patterns' which provide a 'basis for screening out differentiating, andcoding the stimuli that confront the individual' (Beck et al. 1979, pp.12-13) and as 'specific rules that governinformation processing and behavior' (Beck et a1. , 1990, p.8) . In this latter book, the authors differentiate betweencore beliefs such as 'I'm no good' and conditional beliefssuch as 'If people got close to me, they would discover the real me and would reject me' (p. 43). Both core andconditional beliefs are referred to as 'schemas' in their text.In this paper 'schemas' will be used only to describe core beliefs. For clinical purposes, this author finds it useful todifferentiate between schemas (core beliefs), underlyingassumptions (conditional beliefs), and automatic thoughts(cognitions that automatically and temporarily flowthrough one's mind). Theoretically, core beliefs andconditional beliefs are similar in that they are both deeper cognitive structures than automatic thoughts. However,different therapeutic processes are used to evaluate andchange these two types of beliefs. Conditional  _____________________________________________________________________________________________  *  Address for correspondence: Christine A. PadeskyWebsite CCC1063-3995/94/050267-12©1994 by John Wiley & Sons, Ltd.Reprinted by permission of John Wiley & Sons, Ltd.  268C. A. Padesky  beliefs are often best tested through the use of  behavioural experiments. Core beliefs are best suited tothe evaluation methods described here. DEVELOPMENT AND MAINTENANCE OFSCHEMAS Cognitive therapy is based on an information processingtheory which posits that schemas develop as part of normal cognitive development. According to information processing theory, we group experiences into categoriesto help us understand and organize our world. A childgroups dogs, cats, and lions as 'animals' and may have amore specific schema of 'pet' that includes the first twoanimals but not the third.The schemas that are of greatest interest in therapy arethose closely related to affective states or behavioural patterns. Each person has self schemas as well asschemas about others and the world that affect emotionaland behavioural reactions. Schemas do not necessarilycause chronic emotional or behavioural difficulties.However, schemas seem to play a central role in themaintenance of chronic problems regardless of theaetiological roots of these problems.For example, one person may have experienced lifelongdepression due to a variety of factors including a strong positive loading for depression and serious life stressesand strains (e.g. childhood abuse, familial deaths, andmultiple failure experiences). Along the way, this personis likely to have developed negative schemas such as 'I'mno good' (self), 'Others can't be trusted' (others) and'effort does not pay off' (world).To overcome depression, it may be necessary for this person to make behavioural and cognitive changes. Evenif environmental stressors and heredity are assumed to play a primary role in the development of this depression,key therapeutic steps are unlikely to be attempted andmaintained by this person unless the schemas areevaluated and modified. This person's world-schema willerode motivation to attempt change, the self-schema mayinterfere with recognition of therapy progress, and theschema regarding others may lead to difficulties in thetherapy relationship and in relationships with family andfriends who might otherwise support progress.Schemas serve a powerful maintenance function for  problems because schemas determine what we notice,attend to, and remember of our experiences(Hastie, 1981; Marcus and Zajonc, 1985; Miller andTurnbull, 1986). A person who believes 'effort does not pay off' will notice and remember failure experiencesmore readily than success experiences. Someone with aself-schema, 'I am bad', will focus on personal defects,flaws, and errors, noticing and remembering these morethan strengths, positive gains, and successes. Onceformed, schemas are maintained in the face of contradictory evidence through the processes of distorting, not noticing, and discounting contradictoryinformation or by seeing this information as anexception to the schematic, and therefore 'normative',rule (Hastie, 1981; Bodenhausen, 1988; Beck et al. ,1990).The ease with which schemas are maintained even in theface of contradictory evidence poses a dilemma for cognitive therapists. Much of cognitive therapy relies onmodifying beliefs through the review or production of evidence that contradicts negative or maladaptiveconclusions drawn by a client. With problems of relativeshort duration (several months for a child or severalyears for an adult), production of contradictory evidenceoften leads to a shift in belief. This shift in belief canoccur quickly (within a therapeutic hour or over thecourse of several weeks) if supporting alternativeschemas exist. That is, a depressed person who currentlyhas an 'I am bad' self-schema activated may be able toshift this belief within a few weeks if this person has an'I'm OK' schema which is normally activated in the non-depressed state.However, people with lifelong or chronic problemsoften do not have an alternative schema available, andtherefore, no amount of contradictory evidence will shifttheir beliefs. A person whose only self-schema over thecourse of a lifetime has been 'I am bad' will look at a listof data supporting an 'I'm OK' conclusion and say to thetherapist, 'Yes, I see this evidence, but I am still bad'.For this reason, treatment of chronic problems withincognitive therapy usually involves not only testingmaladaptive beliefs but also identifying andstrengthening alternative, more adaptive schemas. Analternative schema must be developed before the clientwill be capable of looking at the evidence and saying,'Yes, this suggests I might be OK'. The remainder of thisarticle will focus on clinical methods that seem helpfulin accomplishing the dual goals of weakeningmaladaptive schemas and developing more adaptiveschemas.   Schema Change Processes269 IDENTIFYING MALADAPTIVE SCHEMASBeck (1967) postulated that schemas and affect areclosely joined (pp.288-289). For this reason, a therapistwishing to identify maladaptive schemas should followthe affect. A client who is feeling intensely depressed,anxious, angry, guilty or ashamed can be asked, 'Whatdoes this [internal or external event] say about you?' toaccess self-schemas, 'What does this say about other  people?' to access other-schemas, and What does this sayabout your life or how the world operates?' to accessworld-schemas.It is important to identify all three types of schemas because they will interact with each other to help explaina person's affect, behaviour, and motivations. For example, two people may have self-schemas, 'I'minadequate'. The first may have an other-schema, 'Othersare critical', and, therefore, adopt avoidant behaviouralstrategies and withdraw from challenging situations. Thesecond person may have an other-schema, 'Others are protective', and adopt dependent interpersonal strategiesand be willing to enter any situation if accompanied by ahelpful other.While questioning the meaning of high affect events willusually quickly lead to the identification of schemas,other methods can also be employed. Clients can berequested to do a simple series of sentence completions, 'Iam _____________', 'People are ___________' and 'Theworld is ______________'. Since schemas are usuallystated as absolutes, these sentences can usually becompleted with a single word to identify a schema.Belief questionnaires can also be used as a starting pointto identify core beliefs. These include the DysfunctionalAttitude Scale (Weissman and Beck, 1978; Weissman,1979), the schema checklist in Appendix A of the text on personality disorders written by Beck and colleagues(Beck et al. , 1990  ), and the schema questionnairedeveloped by Young (Young, 1990). Thesequestionnaires include a variety of core and conditional beliefs and clients can be expected to endorse many of the beliefs listed. For these reasons, these questionnairesare helpful for broadly conceptualizing a client's belief system. Further discussion with the client will benecessary to determine which of the many beliefsendorsed are most strongly held and central to the problem of focus in therapy.Once a therapist and client have identified core schemas,it is important that these be expressed in the client's personal language and idiom. For one client, 'I amworthless' may be expressed in thosewords. For another client, the same concept might bestated as 'I am a zero'. A third might capture the schemawith a phrase yelled at them by a parent, '[You're a] small piece of dirt'. By labelling the maladaptive schema inwords or images that come directly from the client'sexperience and mind, the affect associated with theschema will be greater and the meaning of any changeachieved will impact the client more deeply. Therefore, if the therapist identifies a potential schema and the clientagrees the therapist has correctly captured the concept, itis important to ask the client, 'How would you say this inyour own words? Can you give me an example of howthis works in your life?' 'Do any images or memoriescome to mind associated with this belief ?'IDENTIFYING ALTERNATIVE SCHEMASAfter identifying key maladaptive schemas, therapist andclient need to identify alternative, more adaptiveschemas. It is important to identify the desired schema asearly as possible. As will be clear in subsequent sections,clinical methods for schema change will be moreeffective if the alternative, more desirable schema is thefocus of data collection and evaluation rather than themaladaptive schema.To identify the alternative, more adaptive schema, ask theclient, 'How would you like it to be?' For self-schemasask, 'If you weren't ____________________, how wouldyou like to be?' For other-schemas ask, 'If people weren't ________, how would you like them to be?' For world-schemas ask, 'If the world wasn't_________ , how wouldyou like it to be?' For clients who cannot name analternative, it may be necessary to ask further questionswith a shift in perspective. For example, 'You seeyourself as worthless, how do you see other people whomyou admire? Would you like to be more like that? If youwere like that, would you still be worthless?'The new, more adaptive schema also should be labeled inthe client's own words. Sometimes the alternative schemawill be the direct opposite of the maladaptive schema.For example, 'I'm lovable' might be a desired alternativeto 'I'm unlovable'. Often, however, the alternative schemawhich the client chooses is quite different from what thetherapist or linguistics would predict. For example, oneclient had a negative schema, 'Others are critical', and thedesired alternative was, 'Others are similar to me'.The process of identifying maladaptive and alternativeschemas can take several weeks in therapy. Often, either the old or new schema concept will be  270C. A. Padesky modified a number of times as interventions andtherapeutic discussions proceed. Changes in the wordsand images used to describe maladaptive and alternativeschemas will often clarify for both client and therapistsubtle nuances in meaning that can be quite helpful for identifying possible avenues for change.For example, one client identified a schema, 'The world isdangerous and violent' which was maladaptive because itmaintained an immobilizing depression and fear. Inobserving events which activated this schema over thefollowing weeks, she was able to clarify that her strongest affect actually came with a related schema,'Kindness is meaningless in the face of pain andviolence'. Working with this schema and the alternative,'Kindness is as strong as violence and pain', helped her cope better with the violent and painful realities she facedand sustained a spirit of hope and effort in her life. Her depression and anxiety were resolved over subsequentmonths. Moreover, this client considered her ability todevelop new approaches for coping and transforming asometimes harsh world her most significant therapeuticgain.Clinicians sometimes wonder whether the alternativeschemas should be absolute in form or represent a more balanced conclusion. Should the alternative to 'I'munlovable' be 'I'm lovable' or 'I'm lovable sometimes tosome people?' Since schemas are absolute, the alternativeused in therapy should be stated as an absolute statement.A negative absolute will be paired with a more positiveabsolute. This is important or the maladaptive schemamay not be shifted at all. 'I'm lovable sometimes to some people' could be incorporated by the maladaptive schemaas merely evidence of occasional exceptions to the rule or as evidence that some people are especially charitable (or foolish) without making any shift in the core belief 'I'munlovable'.Interestingly, a negative absolute will be more absolutethan a positive form of the same absolute. This is becausenegative schemas imply absence (e.g. unlovable meansnever lovable under any circumstances) whereas positiveschemas imply presence which may not be perfect (e.g.lovable means someone can love you but not necessarilythat everyone will love you). This semantic meaningdifference between positive and negative absolutes meansthat a more positive alternative schema will, by its verynature, be more balanced and more capable of summarizing a range of life experiences than a negativelystated schema. SCHEMA CHANGE: CLINICAL METHODS Schema change usually involves a simultaneous focus onweakening old schemas and strengthening new ones.Most clinical methods discussed here contribute to bothtasks if the maladaptive and adaptive alternative schemashave each been well-defined by therapist and client.These schema change methods are most usefullyemployed with a client who has already mastered basictherapy skills such as identification of thoughts andemotions and testing automatic thoughts. Further, theywill have greatest impact when applied to schemas whichare closely related to the client's primary problems. Continuum Methods Pretzer (1983) was among the first to recommend the useof a continuum to evaluate negative schemas. Since themaladaptive and alternative schemas are absolutes, andoften opposites, a continuum charts the territory betweenthese poles. In its simplest form, a client could be askedto place themselves on a continuum between 100%unlovable and 100% lovable. Through questioning theevidence, the therapist could try to shift the client's self evaluation to a midpoint on this continuum to reduceabsolutistic thinking.Extensive use of continuum by this author and her colleagues led to the development of strategies whichmaximize the effectiveness of continua used for schemachange. These strategies, summarized here, include:charting on the adaptive continuum, constructing criteriacontinua, two-dimensional charting of continua, andusing a two-dimensional continuum graph to illustrateinterdependent schematic beliefs. Charting on the Adaptive Continuum Development of the alternative more adaptive schemacan be enhanced if continuum work is done on acontinuum which charts the presence of the adaptiveschema only. Thus, rather than using a continuum whichranges from 100% unlovable to 100% lovable, it is oftenmore productive to use a continuum which ranges from 0- 100% lovable. A clinical example illustrates theadvantages in this approach.One of the purposes of a continuum is to shift absolutistic beliefs to more balanced mid-range beliefs. Lydia believed she was unlovable. Lydia rated herself as 100%unlovable on an initial continuum which ranged from100% unlovable to 100% lovable. Her therapist asked her to place other 

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