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Schema Based Cognitive Therapy at Behavioral Wellness Recovery
Schema therapy is a relatively newer form of therapy developed by Jeffrey Young in the 1980s and has since become a useful therapeutic modality utilized by counselors in drug and alcohol rehabs. It is based on the core beliefs that one has about themselves, others, and the world. These thoughts lead to emotions which ultimately trigger a behavior, whether it be internal or external. The emotions and behaviors may either be positive for the person and others (adaptive), or negative (maladaptive). A maladaptive behavior can manifest as acting-out or acting-in. Either of these defense mechanisms can lead to substance dependence.

Core beliefs are ingrained, and the thoughts that trigger emotions are automatic. It can be difficult for one to change his/her pattern of thinking because a well-developed array of defense mechanisms has been constructed.

Schema-Based Cognitive Therapy vs Traditional Cognitive Therapy

Schema based cognitive therapy is different than traditional cognitive therapy because it probes deeper into life-long patterns of behavior and looks more closely at the events and experiences of early childhood. This type of insight can prove to be invaluable when a drug or alcohol dependent person embarks on a journey to recovery from addiction. No longer using mood-altering substances as a coping skill, the patient will begin to look at the origins of his/her core beliefs, thoughts, emotions, and behaviors. This, in turn, can help in the development of positive defense mechanisms and coping skills that are useful in dealing with everyday triggers.

How Schema-Based Cognitive Therapy Works

It is important to note that one may have a positive (adaptive) schema or a negative (maladaptive) schema. In schema therapy, a professional counselor attempts to break through defense mechanism to identify the underlying schema and help one to change their viewpoints. Maladaptive (negative) defense mechanisms are typically unconscious behaviors that are exhibited due to an activating event and attempt to protect one from suffering from painful thoughts and emotions that may arise due to the event.

Although it has been scientifically proven that drug and alcohol addiction have a strong genetic influence, certain life events and the environment, including how one develops a discrete personality and learns coping skills while young can determine the “activation” of addiction. Substance abuse is multifactorial, meaning it is caused by many different factors, such as genetics, social, psychological, and physiologic elements. Because of this, it is critical to evaluate schemas and their likely origins when treating patients who are participating in drug and alcohol rehab. It is also important that it be processed in a safe environment because the thoughts and feelings that emerge will likely be triggering in the initial stages of treatment.

List of Common Schemas

  1. Emotional deprivation is the core belief that one will not experience the necessary emotional support.
  2. Defectiveness and shame is the core belief that one is eternally imperfect and that when others find-out they will leave the relationship.
  3. Mistrust is the core believe that others will always attempt to take advantage of oneself.
  4. Abandonment is the core belief that those who are closest to the person will always leave.
  5. Dependence is the core belief that one must have others to help them because they lack the ability to be self-sufficient.
  6. Entitlement is the core belief that one can exhibit any behaviors that they want, regardless of the effects on others.
  7. Subjugation is the core belief that one must always do what others want and be under their control in order to avoid negative consequences.
  8. Unrelenting standards is the core believe that one is never good enough and must always work harder to get status in life.
The list of schemas above is not complete and are given as a reference to better understand the core beliefs upon which schema therapy is based. One’s core beliefs will then lead to the formation of defense mechanisms that prevent the beliefs from being challenged by oneself or others.

Common Defense Mechanisms

One’s core beliefs will then lead to the formation of defense mechanisms that prevent the beliefs from being challenged by oneself or others. Defense mechanisms can either be positive or negative. The utilization of defense mechanisms attempt to prevent anxiety and depression, and painful thoughts and is unconscious.

  1. Tolerance is when one allows something to occur that they approve of.
  2. Humility is when one has the ability to see their own areas of improvement.
  3. Gratitude is when one is able to be thankful for the things in their life, such as people, places, and things, as well as the intangible, such as spiritual experiences.
  4. Acceptance is when one internalizes the reality of a situation.
  5. Intellectualization is when one uses intellect to avoid emotions.
  6. Repression is when one attempts to resist desirable instincts, either emotional or physical.
  7. Withdrawal is when one purposefully removes themselves from events, or other interactions and environmental situations in order to avoid painful thoughts and emotions.
  8. Acting-out is when one exhibits a behavior due to emotions that they are unaware of.
  9. Projection is when one transfers their unwanted emotions, thoughts, or behaviors to another.
  10. Wishful thinking is when one makes decisions based on imaginary and pleasing thoughts, rather than reality.

To recap, cognitive behavioral therapy can certainly assist a drug user or alcoholic in changing his/her behavior due to a change in mood. Schema therapy will attempt to identify the origins of one’s beliefs, which can trigger automatic thoughts. For example, one who has been subjected to extreme control as a child may develop a subjugated schema, in which either emotions are needs are suppressed. This in turn, can lead to internal anger and withdrawal of affection. At a certain point, the substance abuser may seek relief by using substances to manage his/her feelings.

It is no small task for a drug addict or alcoholic to undergo this type of intensive treatment. Experienced and professional staff will be able to guide the patient through this difficult time of introspection and the resultant emotional turmoil. Great benefits will be garnered through intensive and serious internal therapeutic work in a drug and alcohol rehab.

If you or a loved one is ready to embark on a journey of self-exploration and healing, you may contact Behavioral Wellness and Recovery at 800-683-4457.


Behavioral Wellness & Recovery is a Joint Commission accredited program. The Joint Commission recognizes excellence in health care organizations and programs.


Behavioral Wellness & Recovery is a Joint Commission accredited program. The Joint Commission recognizes excellence in health care organizations and programs.

Your decision to regain your life helps and heals your entire family. Do it for them. Do it for you.


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West Chester, PA 19380
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