8
Conclusion
The Training Mindfulness and Schema Therapy is a detailed program intended to help bring awareness to the functioning of schemas and modes, learning to recognize the processes that shape our automatic responses. The automatic pilot switches on as soon as our schemas are triggered and we enter a certain mode.
Some people with personality problems will get all they need from just this training. They will internalize the principles of mindfulness and give it a permanent place in their lives, whether they hang on to the exercises learned in this training or find their own way.
Others may have only just begun their therapeutic process. They have started to become aware of their automatic pilot, and will continue their development through follow-up treatments or ongoing therapy. These individuals may benefit from regular refreshers of the material imparted in this training. A useful approach in therapy is to initiate and conclude every session with a brief mindfulness exercise. Therapists and patients alike will profit from continued emphasis on a therapeutic alliance where mindfulness and an open, inquisitive attitude are the norm. The mindfulness-based approach is highly compatible with the principle of limited parenting, so much so that it is described in Schema Therapy literature as a powerful therapeutic medium. Nonetheless, mindfulness remains one of the most challenging skills to be applied in daily life. This simple technique for focused awareness, free from automatic pilot, has been described by some as the equivalent to a professional sport. It requires constant practice from both the patient and therapist.
Appendix II-A
Test Result Example
Summary of Assessment Test Results
Mindfulness and Schema Therapy
Name: ____________________
Date of birth: ____________________
Date of assessment: ____________________
Assessed by: ____________________
Test material:
BSI
Schema questionnaire
Modes questionnaire
(Optional: additional personality questionnaire)
Test results:
Participant’s BSI score relative to normal clinical values: ___________
Participant’s primary complaint ___________
(Three highest-scoring BSI subscales)
- _________________________
- _________________________
- _________________________
The participant rates low/below average/average/high on the schema questionnaire.
Participant’s three highest-scoring schemas are:
(Descriptions of participant’s top three schemas + explanations based on schema information in the “Mindfulness and Schema Therapy” folder)
- _________________________
- _________________________
- _________________________
The participant rates low/below average/average/high on the modes questionnaire.
Participant’s three highest-scoring modes are:
(Descriptions of participant’s top three modes + explanations based on mode information in the “Mindfulness and Schema Therapy” folder)
- _________________________
- _________________________
- _________________________
In terms of personality, the participant is someone who:
(Results from the optional personality questionnaire, if included)
______________________________________________________________________
______________________________________________________________________
_______________________________________________________
Therapist signature: _____________________
Appendix II-B
Mindfulness and Schema Therapy Handout
Introduction
Schemas are deep-seated, long-established ways of thinking about yourself, others, and the world around you. These engrained and trusted perspectives influence what you perceive, how you behave, and what you feel. For example, people with the Unrelenting Standards/Hypocritical schema have a fixed perception that they need to do better, and that others should live up to their high standards and values too. These people are rarely satisfied with themselves or with other people, which leads to further irritation.
When one or more schemas are triggered a particular mood (or mode) sets in. Each mode is characterized by specific behaviors and intense emotions. For instance, when the Unrelenting Standards/Hypocritical schema and the Emotional Deprivation schema are activated, you might go into Vulnerable Child mode. This may happen when, in spite of your best efforts, someone leaves you high and dry—even when you would have been there for that person if they were in your situation. You feel lonely, misunderstood, and unsupported.
In Schema Therapy there are 19 schemas and 20 modes (described later in this section). It is assumed that everyone has schemas and modes, but that these are present to different degrees in different people. Furthermore, some people have a hard time dealing with their modes.
Mindfulness and Schema Therapy
One way in which we organize information is by dividing facts into right and wrong. It’s a strategy with undeniable advantages. But schemas and modes influence this process in subtle and automatic ways, without us being aware of it. It is that unawareness—our inability to perceive more than we are used to perceiving—that can get us into trouble. Many problems arise or persist because we react to situations on automatic pilot, as if we are suffering from tunnel vision. This training program is designed to help you become more aware of your automatic pilot and the influence of your schemas and modes. You will learn how to disengage the automatic pilot. You will learn to observe your attitude, the situation, and your thoughts, feelings, and behavior with an open and curious mind. You will learn that thoughts, feelings, and behaviors come and go with equal ease. Being aware of what is, and letting it be, is what mindfulness is all about.
The training program consists of eight weekly meetings of an hour and a half each, in which you will practice mindfulness exercises together with a group. As homework you will be asked to practice these exercises four times a week. You will also carry out shorter mindfulness exercises on a daily basis. You will discuss your practice experiences with other members of the group. Reflecting on these exercises will help you become more aware of the way your schemas and modes operate. Together you will learn to experience what is, doing so without judgment or the need to react. The first step in developing mindfulness is learning how to avoid launching into doing-mode on automatic pilot.
Pitfalls
Schemas and modes often push people to immediately launch into action. As if something needs to be done right away. Mindfulness training will allow you to let go of that urge to act and to simply be aware. Taking time to step out of automatic pilot mode will improve the odds of recognizing your schemas and modes; of becoming more aware. Once you have gained that perspective you can mindfully consider which actions are appropriate to your situation. How you choose to behave will then be a conscious decision, rather than an automatic reaction.
This training can be difficult for people who are used to pushing away unpleasant feelings on a daily basis. Mindfulness exercises involve paying close attention to your feelings, so you may experience some serious discomfort. Experience shows, however, that emotions are most effectively dealt with when they are faced, not avoided. Doing so will allow you to take better care of yourself. On the other hand, continuing to avoid or ignore your emotions tends to seriously worsen your symptoms.
Another common pitfall happens when participants expect immediate results from the training. People wish to suffer less from their worries, sadness, anxiety, and pain. They become frustrated when the Mindfulness Training for Personality Problems program does not (directly) yield the results they desire. Their frustration can be difficult to accept. Participants should recognize that this training is not meant to wipe away their problems. The goal of the training is to develop a more mindful lifestyle; to become more aware of your needs, feelings, thoughts, behaviors, bodily experience, and the influence of your schemas and modes. Our objective is not change per se, but improved awareness.
Definitions of the 19 Schemas and 20 Modes
Note: These schema and mode definitions have been taken from the Wiley-Blackwell Handbook of Schema Therapy – Theory, Practice, and Research (Van Vreeswijk, Broersen, & Nadort, 2012).
The 19 schemas
Emotional Deprivation
The individual expects that others will never or not adequately meet his primary emotional needs (e.g. for support, nurturance, empathy, and protection). He feels isolated and lonely.
Abandonment/Instability
The individual expects that significant others will eventually abandon him. Others are unreliable and unpredictable in their support and connection. When the individual feels abandoned he switches between feelings of anxiety, grief, and anger.
Mistrust and/or Abuse
The individual is convinced that others will intentionally abuse him in some way or that they will cheat or humiliate him. These feelings vary greatly and the individual is continuously on edge.
Social Isolation/Alienation
The individual feels isolated from the world and believes that he is not part of any community.
Defectiveness/Shame
The individual believes that he is internally flawed and bad. If others get close, they will realize this and withdraw from the relationship. The feeling of being worthless often leads to a strong sense of shame.
Social Undesirability
The individual believes that he is socially inept and physically unattractive. He sees himself as boring, dull, and ugly.
Failure
The individual believes that he is incapable of performing as well as his peer group. He feels stupid and untalented.
Dependence/Incompetence
The individual feels extremely helpless and incapable of functioning independently. He is incapable of making day-to-day decisions and is often tense and anxious.
Vulnerability to Harm and Illness
The individual believes that imminent catastrophe will strike him and significant others, and that he is unable to prevent this.
Enmeshment/Undeveloped Self
The individual has an excessive emotional involvement and closeness with one or more significant others (often his parents), as a result of which he cannot develop his own identity.
Subjugation
The individual submits to the control of others in order to avoid negative consequences. The individual ignores his own needs because he fears conflict and punishment.
Self-Sacrifice
The individual focuses on voluntarily meeting the needs of others, whom he considers weaker than himself. If he pays attention to his own needs, he feels guilty, and he gives priority to the needs of others. Finally, he becomes annoyed with the people he is looking after.
Approval Seeking*
The individual focuses excessively on gaining recognition, approval, and attention, at the expense of his own development and needs.
Emotional Inhibition
The individual inhibits emotions and impulses because he believes that any expression of feelings will harm others or lead to embarrassment, retaliation, or abandonment. He lacks spontaneity and stresses rationality.
Unrelenting Standards/Hypocritical
The individual believes that whatever he does is not good enough and that he must always strive harder. He is hypercritical of himself and others, and he is a perfectionist, rigid and extremely efficient. This is at the expense of pleasure, relaxation, and social contacts.
Negativity and Pessimism*
The individual is always focused on the negative aspects of life and ignores or plays down the positive aspects. He is frequently anxious and hyper-alert.
Punitiveness*
The individual believes that people should be harshly punished for making mistakes. He is aggressive, intolerant, impatient, and unforgiving.
Entitlement/Grandiosity
The individual believes that he is superior to others and entitled to special rights. He insists that he should be able to do or have what he wants, regardless of what others think. The core theme is power and being in control of situations or people.
Insufficient Self-Control/Self-Discipline
The individual has no tolerance of frustration and is unable to control his feelings and impulses. He cannot bear dissatisfaction or discomfort (pain, conflicts, or overexertion).
* These schemas are not yet identifiable using the Schema Questionnaire (YSQ).
The 20 modes
Vulnerable Child
The individual believes that nobody will fulfill his needs and that everyone will eventually abandon him. He mistrusts others and believes that they will abuse him. He feels worthless and expects rejection. He is ashamed of himself and he often feels excluded. He behaves like a small, vulnerable child who clings to the therapist for help, because he feels lonely and believes there is danger everywhere.
Angry Child
The individual feels intensely angry, enraged, and impatient because his core needs are not being met. He can also feel abandoned, humiliated, or betrayed. He expresses his anger in extreme manifestations, both verbal and nonverbal, just like a small child who has an outburst of anger.
Enraged Child
The individual feels enraged for the same reason as the Angry Child, but loses control. This is expressed in offensive and injurious actions toward people and objects, in the same way a small child hurts his parents.
Impulsive Child
The individual wants to satisfy his (non-core) desires in a selfish and uncontrolled manner. He cannot control his feelings and impulses and he becomes enraged and infuriated when his (non-core) desires or impulses are not met. He often behaves like a spoiled child.
Undisciplined Child
The individual has no tolerance of frustration and cannot force himself to finish routine or boring tasks. He cannot bear dissatisfaction or discomfort (pain, conflict, or overexertion) and he behaves like a spoiled child.
Happy Child
The individual feels loved, satisfied, protected, understood, and validated. He is self-confident and feels competent, appropriately autonomous, and in control. He can react spontaneously, is adventurous and optimistic, and plays like a happy, young child.
Compliant Surrender
The individual devotes himself to the desire of others in order to avoid negative consequences. He suppresses his own needs or emotions and bottles up his aggression. He behaves subserviently and passively, and hopes to gain approval by being obedient. He tolerates abuse from other people.
Detached Protector
The individual cuts off strong feelings because he believes that such feelings are dangerous and can get out of hand. He withdraws from social contacts and tries to cut off his feelings (sometimes this leads to dissociation). The individual feels empty, bored, and depersonalized. He may adopt a cynical or pessimistic attitude to keep others at arm’s length.
Detached Self-Soother
The individual seeks distraction in order not to feel negative emotions. He achieves this by self-soothing behavior (e.g. sleeping or substance abuse) or by self-stimulating activities (being fanatical or occupied with work, the Internet, sport, or sex).
Self-Aggrandizer
The individual believes that he is superior to others and entitled to special rights. He insists that he should be able to do or have what he wants, regardless of what others think. He shows off and denigrates others to augment his self-esteem.
Bully and Attack
The individual wants to prevent being controlled or hurt by others, and therefore he tries to be in control of them. He uses threats, intimidation, aggression, and force to this end. He always wants to be in a dominant position, and takes sadistic pleasure in hurting others.
Punitive Parent
The individual is aggressive, intolerant, impatient, and unforgiving toward himself. He is always self-critical and feels guilty. He is ashamed of his mistakes and believes he has to be punished severely for them. This mode is a reflection of what (one of) the parents or other educators used to say to the individual in order to belittle or punish him.
Demanding Parent
The individual feels that he must fulfill rigid rules, norms, and values. He must be extremely efficient in meeting these. He believes that whatever he does is never good enough and that he must strive harder. Therefore, he pursues his highest standard until it is perfect, at the expense of rest and pleasure. He is also never satisfied with the result. These rules and norms are also internalized by (one of) the parents.
Healthy Adult
The individual has positive and neutralized thoughts and feelings about himself. He does things that are good for him and this leads to healthy relationships and activities. The Healthy Adult mode isn’t maladaptive.
Angry Protector**
The individual uses a wall of anger to protect himself against others, considered to be a threat. He keeps others at a safe distance with great displays of rage. However, his anger is more under control than that in the Angry or Enraged Child.
Obsessive Over-Controller**
The individual tries to protect himself against supposed or actual threats by keeping everything under extreme control. He uses repetitions or rituals to achieve this.
Paranoid**
The individual tries to protect himself against supposed or actual threats by containing others and exposing their real intentions.
Conning and Manipulative**
The individual cheats, lies, or manipulates in order to achieve a specific aim, the purpose of which is to victimize others or to avoid punishment.
Predator**
The individual eliminates threats, rivals, obstacles, or enemies in a cold, ruthless, calculating way.
Attention-Seeker**
The individual tries to obtain the approval and attention of others by exaggerated behavior, erotomania, or grandiosity.
** These modes have not (yet) been added to the Schema Mode Inventory (SMI-1).
Appendix II-C
Schema and Modes Worksheet
| Name:…………………………. | |
| Schema 1:…………………….. | Mode 1:…………………….. |
| Schema 2:…………………….. | Mode 2:…………………….. |
| Schema 3:…………………….. | Mode 3:…………………….. |
The sheets are used to rate schema mindfulness scores on a weekly basis, graded on a scale from 0 to 10 (0 = schema not at all mindfully observed, 10 = schema observed with full mindfulness).
| Score Week1 |
Score Week2 |
Score Week3 |
Score Week4 |
Score Week5 |
Score Week 6 |
Score Week 7 |
Score Week 8 |
|
| Schema 1 | ||||||||
| Schema 2 | ||||||||
| Schema 3 |