Schemas as Memories: Implications for Treatment
James, Ian A., Reichelt, F. Katharina, Freeston, Mark H., Barton, Stephen B., Journal of Cognitive Psychotherapy
Schemas are usually viewed as core dysfunctional beliefs, lying dormant until activated by a salient trigger (i.e., the diathesis-stress model). It is suggested that they are long-standing, stable themes that are specific to the individual. They are formed during childhood in an attempt by the person to cope with life events and environmental situations. Once schemas are active, they become the engine room of negative automatic thoughts and serve to bias information negatively. This prototypical description has a number of implications. Indeed, it clearly suggests that schemas are stored units of information that can be activated at some future time under the "appropriate" cueing conditions-in other words, they are memories. Developing this perspective, this article argues that therapists should have a broader concept of the nature of schemas and, rather than viewing them solely as cognitions, therapists should view them as stored multisensory representations. As such, schemas can be adequately described as representations of past experiences that are composed of cognitions and sensory features (olfactory, tactile, taste, etc.) that are both stored and retrieved as coherent units. Hence, when treating someone with depression, in addition to assessing the cognitions, one should determine whether there are sounds, tastes, body postures, and/or other sensory features associated with the patient's experience of his/her depression. If such features are found to be present, they need to be assessed appropriately and duly targeted with suitable intervention strategies.
Keywords: memory; information processing; intervention; assessment
In the case of an Axis I disorder, a schema is thought to represent a vulnerability factor predisposing the individual to distress in situations where the environment reinforces the belief (i.e., the cognitive diathesis-stress model; Beck, Brown, Steer, Eidelson, & Riskind, 1987). According to the theory, a schema formed in childhood can lie dormant, not manifesting itself until triggered by a salient event (e.g., breakdown of relationship, loss of job, etc.), and once activated it can lead to the manifestation of a psychological disorder. Thus, in CBT for Axis I disorders, schemas can be represented as binary entities, which are either active or dormant. When operative, they will drive the negative automatic thoughts and influence the way in which the person behaves, interacts with others, and copes with her distress (e.g., use of avoidance). Schemas are sometimes viewed as unconditional beliefs ("I am incompetent"), conditional beliefs ("If I make a mistake, then people will lose respect for me"), or rules of behavior ("I must always do things perfectly"). However, despite a wealth of literature on the topic, in truth, schemas are a poorly defined concept (see James, Southam, & Blackburn, 2004).
Over recent years the first author of the present article has suggested a revision of the concept of the schema as used in CBT, reconnecting its links with the memory literature and the manner in which information about life experiences is stored (see James, 2001, 2003; James et al., 2004). There are two aspects to the revision. The first, and perhaps the less contentious, is that the diathesis-stress model leads one logically to the view that schemas are memories. This is because they are features that have been encoded in the past, are being stored, and will be activated at some future date in the presence of an appropriate cue. The second aspect of the revised perspective builds on clinical observations informing us that once a person has been depressed, future episodes are likely to share many characteristics with the first. For example, in future episodes there will be characteristic cognitive themes, behavioral strategies, sensitivities relating to noise and sounds, and so on. Mindful of this phenomenon, it is argued that multisensory information relating to the person's depression is stored as some form of unitary concept, and it is the multimodal representation that is reactivated during subsequent episodes of depression. …