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THE EVIDENCE

Schema Therapy Is Not Just Clinically Compelling. It Is Empirically Supported.

The research base for schema therapy spans randomized clinical trials, longitudinal outcome studies, and qualitative investigations across populations, settings, and applications. What follows is a selected overview of the published evidence supporting the model, along with the key books and chapters that have shaped its development and clinical practice.

PEER REVIEWED RESEARCH

The Evidence Base

Schema therapy has been tested in randomized clinical trials for borderline personality disorder, personality disorders broadly, complex trauma, and forensic populations. The studies below represent a selection of the published evidence supporting its effectiveness across clinical settings.

SELECTED PUBLICATIONS

Arntz, A., Jacob, G. A., Lee, C. W., Brand de-Wilde, O. M., & Farrell, J. M. (2022). Effectiveness of predominantly group schema therapy and combined individual and group schema therapy for borderline personality disorder: A randomized clinical trial. JAMA Psychiatry, 79(4), 287-299. https://doi:10.1001/jamapsychiatry.2022.0010

Bach, B., & Farrell, J. M. (2018). Schemas and modes in borderline personality disorder: The mistrustful, shameful, angry, impulsive, and unhappy child. Psychiatry Research, 259, 323-329. https://doi: 10.1016/j.psychres.2017.10.039

Bamelis, L. L., Evers, S. M., Spinhoven, P., &  Arntz, A. (2016). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal Psychiatry, 171(3), 305-22. https://doi.org/10.1176/appi.ajp.2013.12040518

Bastick, E., Bot, S., Verlagen, S., Zarbock, G., Farrell, J., Brand, O., Arntz, A., & Lee, C. (2018, September). The Development and Psychometric Evaluation of the Group Schema Therapy Rating Scale-Revised. Behavioral and Cognitive Psychotherapy, 46(5), 601-608. DOI: 10.1017/S1352465817000741

Bernstein, D. P., Keulen-de Vos, M., Clercx, M., de Vogel, V., Kersten, G. C. M., Lancel, M., Jonkers, P. P., Bogaerts, S., Slaats, M., Broers, N. J., Deenen, T. A. M., & Arntz, A. (2021). Schema therapy for violent PD offenders: A randomized clinical trial. Psychological Medicine, 53(1), 88-102. https://doi.org/10.1017/S0033291721001161

de Klerk, N., Abma, T., Barnelis, L., & Arntz, A. (2017). Schema therapy for personality disorders: A qualitative study of patients’ and therapists’ perspectives. Behavioral and Cognitive Psychotherapy, 45(31).

Farrell, J.M. & Shaw, I.A. (1994). Emotional Awareness Training: a prerequisite to effective cognitive-behavioral treatment of borderline personality disorder. Cognitive and Behavioral Practice, 1(1), 72-92.

Farrell, J.M., Shaw, I.A. & Webber, M. A. (2009, June). A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: A randomized controlled trial. Journal of Behavior Therapy & Experimental Psychiatry, 40(2), 317-28.

Fassbinder, E., Schweiger, U., Jacob, G., & Arntz, A. (2016, April) The schema mode model for personality disorders. Psychiatrie, 11(2), 78-86. https://doi:10.1055/s-0038-1670748

Fassbinder, E., Schuetz, M., Wedemeyer, N., Marten, E., Kranich, A., Sipos, V., Hohagen, F., Shaw, I., Farrell, J., Jacob, G., Arntz, A., & Schweiger, U. (2016, November). Feasibility of group schema therapy for outpatients and severe borderline personality disorder in Germany: A pilot study with three-year follow-up. Frontiers in Psychology, 7.

Fassbinder, E., Schuetze, M., Wedemeyer, N., Marten, E. Kranich, A., Sipos, V., Hohagen, F., Shaw, I., Farrell, J., Jacob, G., Arntz, A., &  Schweiger, U. (2016, November). Feasibility of group schema therapy for outpatients with severe borderline personality disorder in Germany: A pilot study with three-year follow-up. Frontiers in Psychology, 7.

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., Kremers, I., Nadort, M., & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: Randomized trial of schema-focused therapy vs. transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658. https://doi:10.1001/archpsyc.63.6.649

Karantzas, G., Younan, R., & Pilkington, P. (2022). The associations between early maladaptive schemas and adult attachment styles: A meta-analysis. Clinical Psychology: Science and Practice, 30(1), 1-20. https://doi.org/10.1037/cps0000108

Kasyanik, P., Romanova, H., Farrell, J., & Shaw, I. (2012). Schema Therapy [In Russian]. Journal of the Clinical Psychology Association. Bekterev Institute.

Kavros, P., Albert S., Weber C., Del Bene M., Rowland L. (2000, November). Impact of spirituality and religiousness on outcomes in patients with ALS. Neurology, 28 (55), 1581-4.

Kavros P., Clarke T., Strug L., Halperin J., Dorta N., Pal D. (2008).  Attention impairment in rolandic epilepsy: systematic review. Epilepsia, 49(9), 1570-80.

King, R., Grenyer, B., Gurtman, C., & Younan, R. (2020). A clinician’s quick guide to evidence-based approaches: Narcissistic personality disorder. Clinical Practice Guidelines, 24(1). https://doi.org/10.1111/cp.12216

Lacy, E. (2024). STAT: schema therapy for addiction treatment, a proposal for the integrative treatment of addictive disorders. Frontiers Psychology, 15, 1266617. https: doi.org/10.3389/fpsyg.2024.1366617

Lazarus, G. & Rafaeli, E. (2023). Modes: Cohesive personality states and their interrelationships as organizing concepts in psychopathology. Journal of Psychopathology and Clinical Science, 132(3), 238-248. https://doi.org/10.1037/abn0000600

Lowenstein, J.A., Stickney, J. & Shaw, I. (2020). Implementation of a schema therapy awareness group for adult male low secure patients with comorbid personality difficulties: Reflections and challenges. Journal of Forensic Practice, 22(2), 41-56    https://doi.org/10.1108/JFP-10-2019-0045

May, T., Pilkington, P., Younan, R., & Williams, K. (2021). Overlap of autism spectrum disorder and borderline personality disorder: A systematic review and meta-analysis. Autism Research, 16, pp.2688-2710. https://DOI: 10.1002/aur.2619

May, T., Younan, R., & Pilkington, P. (2021). Adolescent maladaptive schemas and childhood abuse and neglect: A systematic review and meta-analysis. Clinical Psychology and Psychotherapy, 29, 1159-1171. https://doi.org: 10.1002/cpp.2712

Pilkington, P., Bishop, A., & Younan, R. (2020). Adverse childhood experiences and early maladaptive schemas in adulthood: A systematic review and meta-analysis. Clinical Psychology and Psychotherapy, 28(3), 569-584. https://doi.org/10.1002/cpp.2533

Pilkington, P., Younan, R., & Karantzas, G. (2022). Identifying the research priorities for schema therapy: A delphi consensus study. Clinical Psychology and Psychotherapy, 30(2), 344-356. https://doi.org/10.1002/cpp.2800

Pilkington, P. D., Spicer, L., & Wilson, M. (2022). Schema therapists’ perceptions of the influence of their early maladaptive schemas on therapy. Psychotherapy Research, 32(7), 833-846. https://doi.org/10.1080/10503307.2022.2038804

Reiss, N., Lieb, K., Arntz, A., Shaw, I., & Farrell, J. (2016, May). Responding to the Treatment Challenge of Patients with Severe BPD: Results of Three Pilot Studies of Inpatient Schema Therapy. Behavioural and Cognitive Psychotherapy, 42(3), 355-367. https://DOI: 10.1017/S1352465813000027

Roediger, E., Zarbock, G., Frank-Noyon, E., Hinrichs, J., & Arntz, A. (2020). Sexual and Relationship Therapy, 35(3), 320–337. https://doi.org/10.1080/16681994.2018.1529411

Roelofs, J., Muris, P., van Wesemael, D., Broers, M., Shaw, I. & Farrell, J. (2016). Group-schematherapy for adolescents: Results from a naturalistic multiple case study. Journal of Child and Family Studies, 25, 2246-2257. https://DOI: 10.1007/s10826-016-0391-z

Simpson, S., Simionato, G., Smout, M., van Vreeswijk, M. F., Hayes, C., Sougleris, C., & Reid, C. (2018). Burnout amongst clinical and counselling psychologist: The role of early maladaptive schemas and coping modes as vulnerability factors. Clinical Psychology Psychotherapy, 26(1), 1-12. https://doi.org/10.1002/cpp.2328

Straarup, N. S., Renneberg, H. B., Farrell, J., & Younan, R. (2022). Group schema therapy for patients with severe anxiety disorders. Journal of Clinical Psychology, 78, 1590-1600. https://doi.org/10.1002/jclp.23351

Tan, Y., Lee, C., Averbeck, L., Brand-deWilde, O., Farrell, J., Fassbinder, E., Jacob, G., Martius, D., Wastiaux, S., Zarbock, G., & Arntz, A. (2018, November).  Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions. PLoS One, 21(13). doi: 10.1371/journal.pone.0206039. eCollection 2018

ten Napel-Schutz, M. C., Abma, T. A., Bamelis, L. L., & Arntz, A. (2017). How to train experienced therapists in a new method: A qualitative study into therapists’ views. Clinical Psychology & Psychotherapy, 24(2), 359-372. https://doi:10.1002/cpp.2004

Wetzelaer, P., Farrell, J., Evers, S., Jacob, G., Lee, C., Brand, O., van Breukelen, G., Fassbinder, E., Fretwell, H., Harper, R., Lavender, A., Lockwood, G., Malogiannis, J., Schweiger, U., Startup, H., Stevenson, T., Zarbock, G., & Arntz, A. (2016, November 18). Design of an international multicentre RCT on group schema therapy for borderline personality disorder. BMC Psychiatry, 16(319).

Younan, R., Farrell, J. M., & May, T. (2017). Teaching me to parent myself: The feasibility of an in-patient group schema therapy program for complex trauma. Behavioural and Cognitive Psychotherapy, 46(4), 463-478. https://doi:10.1017/S1352465817000698

books

Behary, W. T. (2021). Disarming the narcissist: Surviving & thriving with the self-absorbed (3rd ed.) New Harbinger Publications, Inc.

Behary, W. T., Farrell, J. M., Vaz, A., Rousmaniere, T. (2023). Deliberate practice in schema therapy. American Psychological Association.

Brockman, R. N., Simpson, A., Hayes, C., van der Wijngaart, R., & Smout, M. (2023). Cambridge guide to schema therapy. Cambridge University Press.

Farrell, J. M., & Shaw, I. A. (2012). Group schema therapy for borderline personality disorder: A step-by-step treatment manual with patient workbook. Wiley-Blackwell.

Farrell, J. M., Reiss, N., & Shaw, I. A. (2016). The schema therapy clinician’s guide: A complete resource for building and delivering individual, group, and integrated schema mode treatment programs. John Wiley & Sons, Ltd.

Farrell, J. M., & Shaw, I. A. (2018). Experiencing schema therapy from the inside out: A self-practice/self-reflection workbook for therapists. The Guilford Press.

Rafaeli, E., Bernstein, D., & Young, J. (2011). Schema Therapy: Distinctive features. Routledge.

Simeone-DeFrancesco, C., Roediger, E., & Stevens, B. (2015). Schema therapy with couples: A practitioner’s guide to healing relationships. Wiley Blackwell.

Simpson, S., & Smith, E. (2020). (Eds.) Schema therapy for eating disorders: Theory and practice for individual and group settings. Routledge.

Skeen, M. (2011). The critical partner: How to end the cycle of criticism and get the love you want. New Harbinger Publications.

Stevens, B., & Roediger, E. (2017). Breaking negative relationship patterns: A schema therapy self-help and support book. Wiley Blackwell.

van der Wijngaart, R. (2021a). Imagery rescripting: Theory and practice. Pavilion Publishing and Media Ltd.

van der Wijngaart, R. (2021b). Chairwork: Theory and Practice. Pavilion Publishing and Media Ltd.

van der Wijngaart, R., & van Genderen, H. (2024). Schema therapy for cluster c personality disorders: Treating dependent, avoidant, and obsessive-compulsive clients. Pavilion Publishing and Media Ltd.

van Vreeswijk, M., Broersen, J., & Nadort, M. (2012). The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice. Wiley-Blackwell.

Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. Professional Resource Press.

Young, J. E. (1994). Cognitive therapy for personality disorders: A schema-focused approach, (2nd Ed.) Professional Resource Press.

Young, J. E., & Klosko, J. S. (1994). Reinventing your life: The breakthrough program to end negative behavior and feel great again. Plume.

Young, J. E. (1999). Cognitive therapy for personality disorders: A schema-focused approach, (3rd Ed.) Professional Resource Press.

Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. The Guilford Press.

CHAPTERS

Atkinson, T. (2012). Schema therapy for couples: Healing partners in a relationship. In van Vreeswijk, M., Broersen, J., & Nadort, M. (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice (pp. 323-335). Wiley-Blackwell.

Atkinson, T., & Perris, P. (2020). Schema therapy for couples: Interventions to promote secure connection. In Heath, G., & Startup, H. (Eds), Creative methods in schema therapy: Advances and Innovation in Clinical Practice (pp. 210-224). Routledge.

Behary, W. (2011). Schema Therapy for Narcissism. In Campbell, W.K., & Miller, J.D. (Eds.), The Handbook of Narcissism and Narcissistic Personality Disorder. Wiley Publications.

Behary, W. (2012). Schema therapy for narcissism: A case study. In van Vreeswijk, M., Broersen, J., & Nadort, M. (Eds.), The Wiley-Blackwell handbook of schema therapy: Theory, research, and practice (pp.81-90). Wiley-Blackwell.

Behary, W. (2013). The Art of Adaptive Re-Parenting in the Treatment of Narcissism. In Ogrodniczuk, J. (Ed.), Treating Pathological Narcissism. American Psychological Association Publications.

Behary, W. (2016, October). Narcissistic Personality Disorder. In Beck, A.T., Davis D., & Freeman, A. (Eds.), Cognitive Therapy of Personality Disorders (3rd ed.). Guilford Press.

Behary W. (2020). The art of empathic confrontation and limit setting. In Heath, G., & Startup, H. (Eds.), Creative Methods in Schema Therapy: Advances and Innovation in Clinical Practice (pp. 227-236).  Routledge Press.

Dieckmann, E., & Behary, W. (2010), Schematherapie: Ein Ansatz zur Behandlung narzisstischer Persönlichkeitsstörungen [Pattern Therapy: A Beginning for the Treatment of Narcissistic Personality Disturbances].

Farrell, J.M., & Shaw, I.A. (2010). Schema Therapy Groups for Borderline Personality Disorder. In Roediger, E., & Jacobs, G. (Eds.) Fortschritte der Schematherapie [Advances in Schema Therapy]. Göttingen: Hogrefe.

Farrell, J.M., & Shaw, I.A. (2013). Empathic Confrontation in Group Schema Therapy [in German].  In Empathic Confrontation in Schema Therapy. Beltz.

Farrell, J.M., & Shaw, I.A. (2016). Highlights of Group Schema Therapy for Personality Disorder [in Danish]. In Larsen, B., & Nyland, T., Cognitive Group Therapy.  Hans Reitzels Forlag.

Farrell, J.M., & Shaw, I.A. (2019). Mode dialogues with Vulnerable Child and Dysfunctional Critics. In Heath, G., & Startup, H. (Eds.). Creative Methods in Schema Therapy: Advances and Innovation in Clinical Practice, Routledge.

Farrell, J.M., & Shaw, I.A. (2022). Schema Therapy. In Huprich, S. K., Personality disorders and pathology: Integrating clinical assessment and practice in the DSM-5 and ICD-11 Er. American Psychological Association Press.

Farrell, J.M., Shaw, I.A., & Reiss, N. (2012). Group Schema Therapy for Borderline Personality Disorder. In Van Vreeswick, M.,  Broersen, J., & Nadort, M. (Eds.), Handbook of Schematherapy: Theory, research and practice (pp. 341-358). Wiley-Blackwell.

Kavros, P. M. (2025). How strengthening the healthy adult and happy child increases satisfying experiences of intimacy [submitted for publication], In L. Naves, & A. Guimarães (Eds.) Manual for couples, families, and relationships therapy.

Lockwood, G. & Shaw, I.A. (2012) Schema Therapy and the Role of Joy and Play. In Van Vreeswick, M., Broersen, J. & Nadort, M. (Eds.), Handbook of Schematherapy: Theory, research and practice (pp. 209-227). Wiley-Blackwell.

Perris, P., Fretwell, H. & Shaw, I. (2012). Therapist self-care in the context of limited reparenting. In Van Vreeswick, M., Broersen, J. & Nadort, M. (Eds.), Handbook of schematherapy: Theory, research and practice (pp. 473-491). Wiley-Blackwell.

Reiß, N., Jacob, G. & Farrell, J. M. (2012). Inpatient Schema Therapy for Patients with Borderline Personality Disorder – a case study. In Van Vreeswick, M., Broersen, J. & Nadort, M. (Eds.), Handbook of schematherapy: Theory, research and practice pp. 301-109). Wiley-Blackwell.

Shaw, I.A. (2019). Spontaneity & Play in Schema Therapy. In Heath, G., &  Startup, H., Creative methods in schema therapy: Advances and innovation in clinical practice (pp.167-177). Routledge

Young, J., and Behary, W. (1998). Schema-Focused Therapy for Personality Disorders. In Tarrier, N., Wells, A., & Haddock, G. (Ed.), Treating complex cases: The cognitive behavioural therapy approach. Wiley Series in Clinical Psychology.

Zangwill, W., Young, J., & Behary, W. (2002). Integrating Schema Therapy with EMDR. In Shapiro, F. (Ed.), EMDR as an integrative psychotherapy approach, American Psychological Association.

OTHER REFERENCES

Behary, W. (2008, March/April). The art of empathic confrontation, case studies. The Psychotherapy Networker.

Behary, W. (2010, May/June). The way to say it… taking on some of the most challenging moments in the treatment room, in consultation. The Psychotherapy Networker.

Behary, W. (2013, July/August). Challenging the Narcissist: How to find pathways to empathy. Psychotherapy Networker.

Farrell, J.M., Fretwell, H., Reiss, N. (2011). Group Schema Therapy and Schema Therapy. In Seel, N. (Ed.), Encyclopedia of Learning. Springer.

Kavros P. (2009, February). Hypnosis & healing. New York (NY): Life Upon the Sacred Stage. Available from: http://uponthesacredstage.blogspot.com.

Kavros P. (2009, Summer). Hypnosis & healing. Official Newsletter of the American Society of Clinical Hypnosis.

Kavros, P. (2010). Religion. In Lemming, D., Madden, K., & Marlan, S.  (eds.) Encyclopedia of psychology & religion (pp. 764-766). Springer.

Kavros, P. (2010). Religious. In Lemming, D., Madden, K., & Marlan, S. (eds.) Encyclopedia of psychology & religion (pp. 770-771). Springer.

Kavros, P. (2010). Religiosity. In Lemming, D., Madden, K., & Marlan, S. (eds.) Encyclopedia of psychology & religion (pp. 768-770).  Springer.

Kavros, P. (2016). Religion. In Lemming, D. (ed.) Encyclopedia of psychology & religion (2nd ed., pp. 1692-1695). Springer.

Kavros, P. (2016). Religious. In Lemming, D. (ed.) Encyclopedia of psychology & religion (pp. 1509-1510). Springer.

Kavros, P. (2016). Religiosity. In Lemming, D. (ed.) Encyclopedia of psychology & religion (pp. 1505-1508). Springer.

Kavros, P. (2020). Religion. In Lemming, D. (ed.) Encyclopedia of psychology & religion (3rd ed., pp.1968-1971). Springer.

Kavros, P. (2020). Religious. In Lemming, D. (ed.) Encyclopedia of psychology & religion (3rd ed., pp. 1987-1989). Springer.

Kavros, P. (2020). Religiosity. In Lemming, D. (ed.) Encyclopedia of psychology & religion (3rd ed., pp. 1984-1987).  Springer.

Kavros, P. M. (2021). Case conceptualization with transgender and gender non-conforming people. Schema Therapy Bulletin: the official publication of the International Society of Schema Therapy, 22, 26-32. https://schematherapysociety.org/page-19646

Kavros, P. M. (2023). The grief of lost time and opportunity. Schema Therapy Bulletin: the official publication of the International Society for Schema Therapy, 29, 21-24. https://schematherapysociety.org/page-19796 .

Kavros, P., Beach, T., & Klinger, D. (2022). Why schema therapy? The Integrative Therapist: the official publication of the Society for Exploration of Psychotherapy Integration, 8(4).

Parry, L. (2018, December). Schema therapy and dreams: Accessing the vulnerable child mode. Schema Therapy Bulletin: The Official Publication of the International Society for Schema Therapy.  https://schematherapysociety.org/Schema-Therapy-and-Dreams-by-Lynda-Parry

Perris, P., Parry, L., Farrell, J., & Kavros, P. (2022) The Ethics of Reparenting. Schema Therapy Bulletin: the official publication of the International Society of Schema Therapy, 26.

RESEARCH

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