Schema-Focused Cognitive Therapy - Treatment for Lifelong Patterns

This cognitive-development model is based on the assumption that many negative

cognitions have their roots in past experiences.
Schema-Focused Cognitive Therapy proposes an integrative systematic model of
treatment for a wide spectrum of chronic, difficult and characterological problems.
Jeffrey Young developed the schema-focussed approach to deliberately address
lifelong, self-defeating patterns called early maladaptive schemas. Over a period of
15 years, Young and associates identified 18 early maladaptive schemas through
clinical observation, as opposed to the concept of unconscious phantasy, or
unproven theory.
A basic premise of Jeffrey Youngs approach is that individuals with more complex
problems have one or more early maladaptive schemas, which makes them
vulnerable to emotional disorders. He felt that the more pure form of cognitive
therapy he had learned during his training with Aaron Beck was insufficient for
treating these types of problems.
What is an Early Maladaptive Schema (EMS)?
An early maladaptive schema has been defined by Jeffrey Young as a broad
pervasive theme or pattern regarding oneself and one's relationship with others,
developed during childhood and elaborated throughout one's lifetime, and
dysfunctional to a significant degree. Schemas are extremely stable and enduring
patterns, comprising of memories, bodily sensations, emotions, cognitions and once
activated intense emotions are felt. When a person has an EMS like abandonment,
they have all the memories of early abandonment, the emotions of anxiety or
depression, which are attached to abandonment, bodily sensations and thoughts
that people are going to leave them. An Early Maladaptive Schema, therefore, is
the deepest level of cognition that contains memories and intense emotions when
activated.
What is the origin of early maladaptive schemas?
The three basic origins are:
1.
2.
3.

Early childhood experiences.

The innate temperament of the child.
Cultural influences.

It is believed that the combination of these three lead to early maladaptive

schemas.
What type of early childhood experiences lead to the acquisition of schemas?
The child who does not get his/her core needs met. The child needed affection,
empathy and guidance but didnt get it etc.
The child who is traumatised or victimised by a very domineering, abusive, or
highly critical parent.

The child who learns primarily by internalising the parents voice. Every child
internalises or identifies with both parents and absorbs certain characteristics of
both parents, so when the child internalises the punitive punishing voice of the
parent and absorbs the characteristics they become schemas.
The child who receives too much of a good thing. The child who is overprotected,
overindulged or given an excessive degree of freedom and autonomy without any
limits being set.
Therefore Early Maladaptive Schemas began with something that was done to us by
our families or by other children, which damaged us in some way. We might have
been abandoned, criticised, overprotected, emotionally or physically abused,
excluded or deprived and, consequently, the schema becomes part of us.
Schemata are essentially valid representations of early childhood experiences, and
serve as templates for processing and defining later behaviours, thoughts, feelings
and relationships with others. Early maladaptive schemas include entrenched
patterns of distorted thinking, disruptive emotions and dysfunctional behaviours.
These schemata become fixed when they are reinforced and/or modelled by
parents.
Long after we leave the home we grew up in, we continue to create situations in
which we are mistreated, ignored, put down or controlled and in which we fail to
reach our desired goals.
Schemata are perpetuated throughout ones lifetime and become activated under
conditions relevant to that particular schema.
Schema domains and developmental needs:
A schema domain is a grouping of schema resulting from the frustration of related
developmental needs. The schemas are grouped into five categories, the notion is
that children have certain developmental needs, and each of the five domains
relates to one grouping of childhood needs, and then the schemas are grouped into
these five broad areas of needs, so, for example disconnection and rejection domain
has to do with the childs need for love, attention, connection and acceptance and
schemas that are learned and frustrate those needs, e.g. when a child doesnt get
enough attention or love they develop an emotional deprivation schema which is
part of disconnection and rejection domain.
Changing early maladaptive schemas
One of the reasons that schemas are hard to change is because they are not stored
through logic, but in an emotional part of the brain called the amygdala, as opposed
to a part of the brain thats readily amenable to logical analysis or discourse. They
are self-perpetuating, very resistant to change and usually do not go away without
therapy.
Schema-Focused Cognitive Therapy utilises encompasses a variety of techniques to
address the varied psychological and behavioural problems presented by clients,
including experimental, cognitive, behavioural and interpersonal (object relations)
techniques. Another recent development in the treatment of trauma
is Eye Movement Desensitisation and Reprocessing (EMDR). When used as an
adjunct to Schema-Focused Cognitive Therapy, EMDR processing, can often be

helpful in changing the meaning of early painful memories, which have resulted in
negative core beliefs and schemas. (see EMDR)
It is important to realise that schemas can be functional or dysfunctional and are
core cognitive constructs in what is typically referred to as our personality style. For
example, someone may have a schema of personal incompetence, from which his
or her actions are consistently interpreted as not good enough". Someone else may
have a schema of mistrust, from which all interpersonal actions by others are seen
as suspicious. A third person may have a dependency schema and feel unable to
function alone without help. Even when presented with evidence that disproves the
schema, individuals distort data to maintain its validity.
Some schemas are developed in the preverbal period and therefore the most
central core early maladaptive schemas are the ones developed in the preverbal
stage. It is these preverbal schemas that tend to be entrenched and absolute, whilst
the later ones tend to be conditional.
Early maladaptive schemas are typically unconditional themes (entrenched beliefs
and feelings) held by individuals, which are often linked to the individuals selfconcept and that of the environment. Because of this concept, together with the
fact that schemata begin so early in life, people feel secure in knowing who they are
and what their world is like. This sense of secureness and predictability is
comfortable and familiar, making it difficult to change without therapy.
How are schemas maintained?
Once a childhood pattern is established we tend to repeat it over and over. Freud
called this 'repetition compulsion'. It refers to the universal tendency of individuals
to repeat in their lives distressing or even painful situations without realising they
are doing so, or even understanding they are bringing about the recurrence and
repeating in their current situations the worst times from the past. Somehow people
manage to create, in adult life, conditions remarkably similar to those that were so
destructive in childhood. An example is a woman who took emotional care (selfsacrifice or subjugation) of her father who was emotionally depriving. Later in life
the tendency could be to go after a man who in one way was unavailable or
emotionally unstable, unaware of the similarity with her father. A schema is all the
ways in which we recreate these patterns.
The above example explains why individuals are likely to be drawn to partners
where there is a high degree of chemistry, as this triggers their schemas, even
when they are not objectively healthy for them. People with (EMS) tend to be drawn
to partners who trigger their core schemas and that maladaptive partner selection
is another strong mechanism through which schemas are maintained.
There are three broad coping styles, which ultimately reinforce the schemata
through avoiding experiencing painful emotions associated with schema activation.
These coping styles are processes that overlap with the psychoanalytical concepts
of resistance and defence mechanisms:
Schema surrender everything the person does to keep the schema going, by
remaining in the situation and doing things to keep the schema going, e.g. if

someone has a defectiveness schema and they stay in a relationship with someone
who has criticised them, they are surrendering to the schema, they are staying in
the situation but allowing themselves to be criticised thus enhancing the schema.
Schema avoidance is avoiding the schema either by avoiding situations that trigger
the schema or by psychologically removing yourself from the situation so you dont
have to feel the schema. An example of avoidance might be the person with a
mistrust schema who avoids making friendships because of the fear of being hurt or
taken advantage of. This action only tends to reinforce the belief when others pick
up the coolness and distance themselves.
Schema overcompensation is an excessive attempt to fight the schema by trying to
do the opposite of what the schema would tell you to do. So if someone has a
subjugation schema, they might rebel against the people who are subjugating them.
If the overcompensation is too extreme it ultimately backfires and reinforces the
schema. A form of overcompensation is externalising the schema, by blaming
others and becoming aggressive. Another way can be achieving at a very high level,
whereby, a person who feels defective works 80 hours a week to overcompensate.
The Schema-Focused model of treatment is designed to help people break these
maladaptive coping styles which perpetuate negative patterns of thinking, feeling
and behaving, so that individuals can get their core needs met.
How does schema-focused cognitive therapy differ from traditional cognitive
therapy?
In comparison with standard cognitive therapy, schema therapy probes more deeply
into early life experiences. It utilises experimental, cognitive, behavioural and
interpersonal (object relations) techniques, which promotes higher levels of affect in
sessions and is somewhat longer-term.
A greater use is placed on the therapy relationship as a means for change with the
therapist working directly and collaboratively with the client, in identifying and
modifying any schema driven thoughts and feeling that are activated in or outside
of the session.
By switching between past events and current problems, using imagery and role
playing, higher levels of affect are activated. Using imagery and elaborate
discussion of early life experiences, clients are able to understand where the
dysfunctional schema originated from and how it is being maintained.
However, because insight rarely leads to change schema-focussed therapy utilises
cognitive, behavioural and interpersonal techniques including empathetic reality
testing, whereby, the therapist fully acknowledges and validates distressing feelings
and schema-driven beliefs, while pointing out another more accurate view. This
process serves to challenge and modify negative thoughts and behaviours, which
are rigidly intact.
Is schema-focused therapy right for you?
Schema-focused therapy deals with life long patterns rather than current
situations, which have arisen. Because schemas are dimensional it is not whether

you have it or you dont have it thats relevant but how much do you have it. In
other words how intense is the schema when its activated and how pervasive and
broadly does it affect your life.
Some of these problems and signs that could indicate you probably have an early
maladaptive schema influencing your life include being stuck in some area of your
life which you dont seem to be able to change, feelings of inadequacy, loneliness,
relapsing depression, dependency on others, problems choosing appropriate
partners, and being out of touch with one's feelings. Presenting problems, which
are chronic or long-term, eating disorders, drug abuse, relapsing depression, ridged
thinking and behaviour patterns.
Those with presenting problems, which are vague but pervasive and those with
existential problems such as feeling life has no meaning - I dont know what life is
about - Feeling slightly down on a regular basis.
Other signs include those with long-term relationship problems. Choosing the
wrong partners, getting into relationships where you always feel criticised, deprived,
controlled, always fighting and feeling angry - displaying repetitive patterns.
Cognitive therapy is often combined with schema therapy and focuses on exactly
what traditional therapies tend to leave out how to achieve beneficial change, as
opposed to mere explanation or insight. Because understanding the past is rarely
curative without change, both traditional cognitive therapy and schema focussed
cognitive therapy are structured and systematic, helping clients to identify,
challenge and change core cognitive schemas.
The main goals of schema-focussed therapy are:
identifying early maladaptive schemas which maintaining the clients presenting
problem and seeing how they are played out in everyday situations
changing dysfunctional beliefs and building alternative beliefs, which can be used
to fight the schemas
breaking down maladaptive life patterns into manageable steps and changing the
coping styles, which maintain the schemas, one step at a time
providing clients with the skills and experiences that create adaptive thinking and
healthy emotions
empowering clients and validating their emotional needs that were not met, so
that their needs will be met in everyday life.
The 18 identified early maladaptive schemas have been organised into five themes
known as domains. Each of the five domains contain categories of schemata which
represents an important component of a childs core needs. When these needs are
not met negative schemas may develop, resulting in unhealthy life patterns:

Domain i: DISCONNECTION & REJECTION

Schemas in this domain result from early experiences of a detached, explosive,
unpredictable, or abusive family environment. People with these schemas expect
that their needs for security, safety, stability, nurturance, and empathy in intimate
or family relationships will not be met in a consistent or predictable way.
Abandonment/Instability
This schema refers to the expectation that one will soon lose anyone with whom an
emotional attachment is formed. The person believes that one way or another close
relationships will end imminently. This schema usually occurs when the parent has
been inconsistent in meeting the child's needs.
Mistrust
This schema refers to the expectation that others will intentionally take advantage
in some way. People with this schema expect others to hurt, cheat, or put them
down. Often significant others were abusive emotionally or sexually and betrayed
the child's trust.
Emotional Deprivation
This schema refers to the belief that others will never meet ones primary emotional
needs. These needs include nurturance, empathy, affection, protection, guidance
and caring from others. Often significant others were emotionally depriving to the
child.
Social Isolation/ Alienation
This schema refers to the belief that one is isolated from the world, different from
others, and/or not part of any community. This belief is usually caused by
experiences in which children see that either they, or their families, are different
from other people.
Defectiveness/ Shame
This schema refers to the belief that one is internally flawed, and that, if others get
close, they will realize this and withdraw from the relationship. This feeling of being
flawed and inadequate often leads to a strong sense of shame. Generally, parents
were very critical of their children and made them feel not worthy of being loved.
Social Undesirability
This schema refers to the belief that one is outwardly unattractive to others. People
with this schema see themselves as physically unattractive, socially inept, or
lacking in status. Usually there is a direct link to childhood experiences in which
children are made to feel, by family or peers, that they are not attractive.
Failure to Achieve
This schema refers to the belief that one is incapable of performing as well as one's
peers in areas such as career, school, or sports. These clients may feel stupid, inept,
untalented, or ignorant. People with this schema often do not try to achieve,
because they believe that they will fail. This schema may develop if children are put
down and treated as if they are a failure in school or other spheres of

accomplishment. Usually the parents did not give enough support, discipline, and
encouragement for the child to persist and succeed in areas of achievement such as
schoolwork or sports.
Domain ii: IMPAIRED AUTONOMY & PERFORMANCE
Schemas in this domain have to do with expectations about oneself and the
environment that interfere with one's ability to separate and function independently
and one' s perceived ability to survive alone. The typical family of origin is
enmeshed, undermining of the child's judgement, or overprotective.
Dependence/Incompetence
This schema refers to the belief that one is not capable of handling day-to-day
responsibilities competently and independently. People with this schema often rely
on others excessively for help in areas such as decision making and initiating new
tasks. Usually parents who did not encourage these children to act independently
and develop confidence in their ability to take care of themselves.
Vulnerability to Harm and Illness
This schema refers to the belief that one is always on the verge of experiencing a
major catastrophe (financial, natural, medical, criminal, etc.). It may lead to taking
excessive precautions to protect oneself. Usually there was an extremely fearful
parent who passed on the idea that the world is a dangerous place.
Enmeshment/Undeveloped Self
This schema refers to the sense that one has too little individual identity or inner
direction. There is often a feeling of emptiness or of floundering. This theme is
usually developed from parents who are so controlling; abusive, or overprotective
that the child is discouraged from developing a separate sense of self.
Failure
This schema refers to the belief that one has failed, will fail, or is fundamentally
inadequate compared to others. Parents, who did not give enough support,
expected the child to fail, treated him/her as stupid and/or never taught the child
the discipline to succeed, usually cause this belief.
Domain iii: IMPAIRED LIMITS
Schemas in this domain relate to deficiencies in internal limits, respect and
responsibility to others, or meeting realistic personal goals. The typical family origin
is permissiveness and indulgence.
Entitlement/Self-Centeredness
This schema refers to the belief that you should be able to do, say, or have
whatever you want immediately, regardless of whether that hurts others or seems
unreasonable to them. You are not interested in what other people need, nor are
you aware of the long-term costs to you of alienating others. Parents who
overindulge their children and who do not set limits about what is socially
appropriate, may promote the development of this schema. Alternatively, some
children develop this schema to compensate for feelings of emotional deprivation,

defectiveness, or social undesirability.

Insufficient Self-Control/Self-Discipline (Low Frustration Tolerance)
This schema refers to the inability to tolerate any frustration in reaching one's goals,
as well as an inability to restrain expression of one's impulses or feelings. When lack
of self-control is extreme, criminal, or addictive behaviour rule your life. Parents who
did not model self-control, or who did not adequately discipline their children, may
predispose them to have this schema as adults.
Domain iv: OTHER-DIRECTNESS
Schemas in this domain relate to an excessive focus on meeting the needs of
others, at the expense of ones own needs. The typical family origin is based on
conditional acceptance, whereby children suppress normal needs and emotions in
order to gain attention, approval and love.
Subjugation
This schema refers to the belief that one must submit to the control of others in
order to avoid negative consequences. Often these clients fear that, unless they
submit, others will get angry or reject them. Clients who subjugate ignore their own
desires and feelings. In childhood there was generally a very controlling parent.
Self-Sacrifice
This schema refers to the excessive sacrifice of one's own needs in order to help
others. When these clients pay attention to their own needs, they often feel guilty.
To avoid this guilt, they put others' needs ahead of their own. Often people whom
self-sacrifice gain a feeling of increased self-esteem or a sense of meaning from
helping others. In childhood the person may have been made to feel overly
responsible for the well being of one or both parents.
Approval-Seeking
This schema refers to an excessive emphasis on gaining approval and recognition
from others at the expense of ones own ideas. May involve an overemphasis on
status, money, and achievement. Usually parents who were concerned with social
status, appearance by others, or offered conditional acceptance etc.
Domain v: OVERVIGILANCE & INHIBITION
Schemas in this domain involve an excessive focus of controlling, suppressing, or
ignoring of one's emotions and spontaneous feelings in order to avoid making
mistakes, or meeting rigged internalised rules. Typical family origins are domination
and suppression of feelings, or a bleak environment where performance standards
and self-control take priority over pleasure and playfulness
Negativity/Vulnerability to Error
This schema refers to an exaggerated expectation that things will go wrong at any
moment, an inordinate fear of making mistakes that could lead in that direction.
That which can go wrong, will! This may involve financial loss, humiliation, making
mistakes leading to excessive worrying. Parents who were pessimistic, worried, or
expected the worst outcome.

Overcontrol/Emotional Inhibition
This schema refers to the belief that you must inhibit emotions and impulses,
especially anger, because any expression of feelings would harm others, or lead to
loss of self-esteem, embarrassment, retaliation, or abandonment. You may lack
spontaneity, or be viewed as uptight. Usually parents who discourage the
expression of feelings often bring on this schema.
Unrelenting Standards/Hypocriticalness
This schema refers to two related beliefs. Either you believe that whatever you do is
not good enough, that you must always strive harder; and/or there is excessive
emphasis on values such as status, wealth, and power, at the expense of other
values such as social interaction, health, or happiness. Usually these clients' parents
were never satisfied and gave their children love that was conditional on
outstanding achievement.
Punitiveness
This schema refers to the belief that one must be angry and harshly punishing with
those people (including oneself) who do not meet ones (high) expectations or
standards. Usually these parents blamed, punished, or were verbally abusive when
mistakes were made.

What is Schema Therapy?

Schema Therapy (or more properly, Schema-Focused Cognitive Therapy)is an

integrative approach to treatment that combines the best aspects of cognitivebehavioral, experiential, interpersonal and psychoanalytic therapies into one unified
model. Schema-Focused Therapy has shown remarkable results in helping people to
change negative ("maladaptive") patterns which they have lived with for a long
time, even when other methods and efforts they have tried before have been
largely unsuccessful.
The Schema-Focused model was developed by Dr. Jeff Young, who originally worked
closely with Dr. Aaron Beck, the founder of Cognitive Therapy. While treating clients
at the Center for Cognitive Therapy at the University of Pennsylvania, Dr. Young and
his colleagues identified a segment of people who had difficulty in benefiting from
the standard approach. He discovered that these people typically had long-standing
patterns or themes in thinking, feeling and behaving/coping that required a different
means of intervention. Dr. Young's attention turned to ways of helping patients to
address and modify these deeper patterns or themes, also known as "schemas" or
"lifetraps."
The schemas that are targeted in treatment are enduring and self-defeating
patterns that typically begin early in life. These patterns consist of
negative/dysfunctional thoughts and feelings, have been repeated and elaborated
upon, and pose obstacles for accomplishing one's goals and getting one's needs
met. Some examples of schema beliefs are: "I'm unlovable," "I'm a failure," "People

don't care about me," "I'm not important," "Something bad is going to happen,"
"People will leave me," "I will never get my needs met," "I will never be good
enough," and so on.
Although schemas are usually developed early in life (during childhood or
adolescence), they can also form later, in adulthood. These schemas are
perpetuated behaviorally through the coping styles of schema maintenance,
schema avoidance, and schema compensation. The Schema-Focused model of
treatment is designed to help the person to break these negative patterns of
thinking, feeling and behaving, which are often very tenacious, and to develop
healthier alternatives to replace them.
Schema-Focused Therapy consists of three stages. First is the assessment phase, in
which schemas are identified during the initial sessions. Questionnaires may be
used as well to get a clear picture of the various patterns involved. Next comes the
emotional awareness and experiential phase, wherein patients get in touch with
these schemas and learn how to spot them when they are operating in their day-today life. Thirdly, the behavioral change stage becomes the focus, during which the
client is actively involved in replacing negative, habitual thoughts and behaviors
with new, healthy cognitive and behavioral options.
1. ABANDONMENT / INSTABILITY (AB)
The perceived instability or unreliability of those available for support and
connection. Involves the sense that significant others will not be able to
continue providing emotional support, connection, strength, or practical
protection because they are emotionally unstable and unpredictable (e.g.,
angry outbursts), unreliable, or erratically present; because they will die
imminently; or because they will abandon the patient in favor of someone
better.
2. MISTRUST / ABUSE (MA)
The expectation that others will hurt, abuse, humiliate, cheat, lie, manipulate,
or take advantage. Usually involves the perception that the harm is
intentional or the result of unjustified and extreme negligence. May include
the sense that one always ends up being cheated relative to others or
"getting the short end of the stick."
3. EMOTIONAL DEPRIVATION (ED)
Expectation that one's desire for a normal degree of emotional support will
not be adequately met by others. The three major forms of deprivation are: A.
Deprivation of Nurturance: Absence of attention, affection, warmth, or
companionship. B. Deprivation of Empathy: Absence of understanding,
listening, self-disclosure, or mutual sharing of feelings from others. C.
Deprivation of Protection: Absence of strength, direction, or guidance from
others.
4. DEFECTIVENESS / SHAME (DS)

The feeling that one is defective, bad, unwanted, inferior, or invalid in

important respects; or that one would be unlovable to significant others if
exposed. May involve hypersensitivity to criticism, rejection, and blame; selfconsciousness, comparisons, and insecurity around others; or a sense of
shame regarding one's perceived flaws. These flaws may be private (e.g.,
selfishness, angry impulses, unacceptable sexual desires) or public (e.g.,
undesirable physical appearance, social awkwardness).
5. SOCIAL ISOLATION / ALIENATION (SI)
The feeling that one is isolated from the rest of the world, different from other
people, and/or not part of any group or community.
6. DEPENDENCE / INCOMPETENCE (DI)
Belief that one is unable to handle one's everyday responsibilities in a
competent manner, without considerable help from others (e.g., take care of
oneself, solve daily problems, exercise good judgment, tackle new tasks,
make good decisions). Often presents as helplessness.
7. VULNERABILITY TO HARM OR ILLNESS (VH)
Exaggerated fear that imminent catastrophe will strike at any time and that
one will be unable to prevent it. Fears focus on one or more of the following:
(A) Medical Catastrophes: e.g., heart attacks, AIDS; (B) Emotional
Catastrophes: e.g., going crazy; (C): External Catastrophes: e.g., elevators
collapsing, victimized by criminals, airplane crashes, earthquakes.
8. ENMESHMENT / UNDEVELOPED SELF (EM)
Excessive emotional involvement and closeness with one or more significant
others (often parents), at the expense of full individuation or normal social
development. Often involves the belief that at least one of the enmeshed
individuals cannot survive or be happy without the constant support of the
other. May also include feelings of being smothered by, or fused with, others
OR insufficient individual identity. Often experienced as a feeling of emptiness
and floundering, having no direction, or in extreme cases questioning one's
existence.
9. FAILURE (FA)
The belief that one has failed, will inevitably fail, or is fundamentally
inadequate relative to one's peers, in areas of achievement (school, career,
sports, etc.). Often involves beliefs that one is stupid, inept, untalented,
ignorant, lower in status, less successful than others, etc.
10.
ENTITLEMENT / GRANDIOSITY (ET)
The belief that one is superior to other people; entitled to special rights and
privileges; or not bound by the rules of reciprocity that guide normal social
interaction. Often involves insistence that one should be able to do or have
whatever one wants, regardless of what is realistic, what others consider
reasonable, or the cost to others; OR an exaggerated focus on superiority
(e.g., being among the most successful, famous, wealthy) -- in order to
achieve power or control (not primarily for attention or approval). Sometimes
includes excessive competitiveness toward, or domination of, others:

asserting one's power, forcing one's point of view, or controlling the behavior
of others in line with one's own desires -without empathy or concern for
others' needs or feelings.
11.
INSUFFICIENT SELF-CONTROL / SELF-DISCIPLINE (IS)
Pervasive difficulty or refusal to exercise sufficient self-control and frustration
tolerance to achieve one's personal goals, or to restrain the excessive
expression of one's emotions and impulses. In its milder form, patient
presents with an exaggerated emphasis on discomfort-avoidance: avoiding
pain, conflict, confrontation, responsibility, or overexertion - at the expense of
personal fulfillment, commitment, or integrity.
12.
SUBJUGATION (SB)
Excessive surrendering of control to others because one feels coerced usually to avoid anger, retaliation, or abandonment. The two major forms of
subjugation are: A. Subjugation of Needs: Suppression of one's preferences,
decisions, and desires. B. Subjugation of Emotions: Suppression of emotional
expression, especially anger. Usually involves the perception that one's own
desires, opinions, and feelings are not valid or important to others. Frequently
presents as excessive compliance, combined with hypersensitivity to feeling
trapped. Generally leads to a build up of anger, manifested in maladaptive
symptoms (e.g., passive-aggressive behavior, uncontrolled outbursts of
temper, psychosomatic symptoms, withdrawal of affection, "acting out",
substance abuse).
13.
SELF-SACRIFICE (SS)
Excessive focus on voluntarily meeting the needs of others in daily situations,
at the expense of one's own gratification. The most common reasons are: to
prevent causing pain to others; to avoid guilt from feeling selfish; or to
maintain the connection with others perceived as needy. Often results from
an acute sensitivity to the pain of others. Sometimes leads to a sense that
one's own needs are not being adequately met and to resentment of those
who are taken care of. (Overlaps with concept of codependency.)
14.
APPROVAL-SEEKING / RECOGNITION-SEEKING (AS)
Excessive emphasis on gaining approval, recognition, or attention from other
people, or fitting in, at the expense of developing a secure and true sense of
self. One's sense of esteem is dependent primarily on the reactions of others
rather than on one's own natural inclinations. Sometimes includes an
overemphasis on status, appearance, social acceptance, money, or
achievement - as means of gaining approval, admiration, or attention (not
primarily for power or control). Frequently results in major life decisions that
are inauthentic or unsatisfying; or in hypersensitivity to rejection.
15.
NEGATIVITY / PESSIMISM (NP)
A pervasive, lifelong focus on the negative aspects of life (pain, death, loss,
disappointment, conflict, guilt, resentment, unsolved problems, potential
mistakes, betrayal, things that could go wrong, etc.) while minimizing or
neglecting the positive or optimistic aspects. Usually includes an exaggerated
expectation - in a wide range of work, financial, or interpersonal situations -

that things will eventually go seriously wrong, or that aspects of one's life
that seem to be going well will ultimately fall apart. Usually involves an
inordinate fear of making mistakes that might lead to: financial collapse, loss,
humiliation, or being trapped in a bad situation. Because potential negative
outcomes are exaggerated, these patients are frequently characterized by
chronic worry, vigilance, complaining, or indecision.
16.
EMOTIONAL INHIBITION (EI)
The excessive inhibition of spontaneous action, feeling, or communication usually to avoid disapproval by others, feelings of shame, or losing control of
one's impulses. The most common areas of inhibition involve: (a) inhibition of
anger & aggression; (b) inhibition of positive impulses (e.g., joy, affection,
sexual excitement, play); (c) difficulty expressing vulnerability or
communicating freely about one's feelings, needs, etc.; or (d) excessive
emphasis on rationality while disregarding emotions.
17.
UNRELENTING STANDARDS / HYPERCRITICALNESS (US)
The underlying belief that one must strive to meet very high internalized
standards of behavior and performance, usually to avoid criticism. Typically
results in feelings of pressure or difficulty slowing down; and in
hypercriticalness toward oneself and others. Must involve significant
impairment in: pleasure, relaxation, health, self-esteem, sense of
accomplishment, or satisfying relationships. Unrelenting standards typically
present as: (a) perfectionism, inordinate attention to detail, or an
underestimate of how good one's own performance is relative to the norm;
(b) rigid rules and "shoulds" in many areas of life, including unrealistically
high moral, ethical, cultural, or religious precepts; or (c) preoccupation with
time and efficiency, so that more can be accomplished.
18.
PUNITIVENESS (PU)
The belief that people should be harshly punished for making mistakes.
Involves the tendency to be angry, intolerant, punitive, and impatient with
those people (including oneself) who do not meet one's expectations or
standards. Usually includes difficulty forgiving mistakes in oneself or others,
because of a reluctance to consider extenuating circumstances, allow for
human imperfection, or empathize with feelings.