Early maladaptive schemas in depressed patients: stability and relation with depressive symptoms over the course of treatment

Background: Early maladaptive schemas (EMSs) are hypothesized to be stable, trait-like, enduring beliefs underlying chronic and recurrent psychological disorders. We studied the relation of EMSs with depressive symptom severity and tested the stability of EMSs over a course of evidence-based outpatient treatment for depression in a naturalistic treatment setting.

Methods: The sample consisted of depressed outpatients (N=132) treated at a specialized mood disorders treatment unit in The Netherlands. Participants completed measures of depressive symptom severity and maladaptive schemas before treatment and 16-weeks after starting with treatment.

Results: Specific maladaptive schemas (failure, emotional deprivation, abandonment/instability) were cross-sectionally related to depressive symptom severity. Moreover, the schema domain impaired autonomy & performance at pre-treatment related positively to depression levels at the 16-week follow-up assessment, whereas the schema domain overvigilance & inhibition at pre-treatment related negatively to depression levels at the follow-up assessment when controlling for pre-treatment depression severity. Finally, all EMSs demonstrated good relative stability over the course of treatment.

Conclusions: Our results suggest that specific EMSs are related to depressive symptom severity in clinically depressed patients, that specific schema domains predict treatment outcome, and that schemas are robust to change over time, even after evidence-based outpatient treatment for depression.