Relationships Between Attachment Styles and Early Maladaptive Schemas (EMS)

Early maladaptive schemas (EMS) refer to negative beliefs and perceptions about oneself and relationships that originate in childhood and perpetuate psychological problems in adulthood.

The concept of EMS in schema therapy was influenced by and shares similarities with the idea of internal working models from attachment theory. These refer to positive and negative schemas people hold about themselves and others shaped by early experiences.

Attachment theory originally focused more on the emotional outcomes of early experiences but, over time, incorporated more cognitive elements like internal working models and scripts.

Attachment theory focuses on relational behavior, while schema theory focuses on conscious thoughts. The visible schemas can be seen as manifestations of the internal working models conceptualized in attachment theory.

Schema therapy proposes there are 18 early maladaptive schemas (EMS) that can be grouped into 5 higher-order domains, including: (1) disconnection rejection, (2) impaired autonomy, (3) impaired limits, (4) other-directedness, and (5) overvigilance/inhibition.

Schema therapy acknowledges attachment insecurity likely relates to endorsing maladaptive schemas, especially within the disconnection rejection domain.

Karantzas, G. C., Younan, R., & Pilkington, P. D. (2023). 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

Key Points

• The meta-analysis aimed to quantitatively review the associations between adult attachment styles (secure, anxious, avoidant, fearful) and early maladaptive schemas, integrating attachment theory with schema therapy.
• Insecure attachment styles (anxious, avoidant, fearful) were positively associated with overall early maladaptive schemas and across all schema domains (disconnection/rejection, impaired autonomy, impaired limits, other-directedness, overvigilance/inhibition), while secure attachment was negatively associated.
• Anxious attachment had larger associations than avoidant attachment with the disconnection/rejection and other-directedness domains, and with abandonment, subjugation, and self-sacrifice schemas.
• All insecure styles had larger associations than secure attachment across 9 schemas like emotional deprivation and social isolation.

Rationale

Schema therapy proposes that EMS underlie many characterological issues that bring people into treatment. Research exploring links between adult attachment styles and endorsement of certain EMS can provide insights into the cognitive architecture related to attachment insecurity.

Originally schemas were organized into 5 domains: disconnection/rejection, impaired autonomy/performance, impaired limits, other-directedness, and overvigilance/inhibition.

Existing research has typically only examined EMS in relation to broad “models of self and others” rather than exploring associations with specific adult attachment style dimensions (Brummet, 2007; De Paoli et al., 2017; Young et al., 2003).

Understanding connections between attachment styles and EMS can help clinicians formulate case conceptualizations for clients with relationship problems. It can also inform treatment planning by identifying which schemas may be relevant to target for different attachment styles.

No systematic review has quantified associations between attachment styles and schemas across domains using meta-analysis.

Method

• 15 studies using self-report measures of adult attachment and early maladaptive schemas.
• Extracted effect sizes converted to Pearson’s r correlations.
• Meta-analysis was conducted, calculating overall effects and effects for each attachment style.

Sample

• 15 studies with total N = 3339, varied samples including general community, universities, clinical, and forensic.
• Age range from 18.5 to 47 years old.
• 13 studies had male and female participants.

Statistical Analysis

• Random effects meta-analysis models.
• Study set as unit of analysis to account for dependence from multiple effect sizes per study.
• Between-study variance assessed with I2 and T2.
• Subgroup analyses compared domains and schemas.

Results

• Insecure styles are positively associated with overall schemas; secure attachment is negatively.
• Anxious attachment had higher associations than avoidant for disconnection/rejection and other-directedness domains.
• Abandonment schema had a higher association with anxious versus avoidant and fearful attachment.

Finds attachment anxiety relates to wider array of schemas than previously theorized:

• Confirms hypothesized links between attachment anxiety and disconnection/rejection schemas.
• However, also found meaningful positive associations with schemas like enmeshment, approval-seeking, and difficulty regulating impulses.
• Suggests cognitive architecture underlying anxious attachment may be more multifaceted than dominant focus solely on abandonment fears implies.
• Identification of broader array of relevant schemas has implications for more targeted treatment planning for anxiously attached clients.

Insight

Attachment theory offers an explanation for how early experiences shape internal working models about self and others. Schema therapy provides a framework for classifying and addressing the problematic beliefs and coping behaviors that may persist from those early experiences.

Quantifying the empirical links between adult attachment dimensions and maladaptive schema endorsement integrates these two theories in a novel way to advance clinical science and practice.

The findings illustrate potential value for therapists to assess clients’ attachment styles to formulate relevant schemas that may be driving presenting problems and tailor interventions accordingly.

The findings warrant future research on attachment-schema links in clinical groups and with interview measures. Research taking a micro and macro analysis approach could further unpack these associations.

Strengths

• First meta-analysis quantifying these associations.
• Thoughtful integration of theory to inform predictions.
• Rigorous search, selection and analysis.

Limitations

• Modest number of studies restricted some subgroup comparisons.
• Self-report measures may limit generalizability to clinical settings.
• Did not include assessment of disorganized attachment.

Implications

Can help therapists case formulate and tailor interventions:

• Assessment of client’s attachment style can aid in hypothesizing which schemas may be driving presenting problems.
• This informs more targeted treatment planning to address those relevant schemas and behavioral coping responses.
• For example, approval-seeking beliefs may be addressed differently in anxiously versus avoidantly attached clients.
• Allows therapist to provide a coherent narrative linking early experiences to current relationship struggles via schema perpetuation.

Differences in schema associations suggest presentation and coping may vary:

• Findings imply endorsement of similar schemas may still be expressed differently depending on client’s attachment pattern.
• This could translate to differences in behavioral coping that require nuanced clinical responses.
• For instance, abandonment schema in anxious clients may manifest as clinging behaviors rather than avoidance seen in dismissive clients.
• Tailoring therapeutic techniques like empathy and limit-setting to these differences can improve outcomes.

References

Primary reference

Karantzas, G. C., Younan, R., & Pilkington, P. D. (2023). 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

Other references

Brummet, B. R. (2007). Attachment style, early maladaptive schemas, coping self-efficacy, therapy alliance and their influence on addiction severity in methadone-maintenance treatment [Doctoral dissertation, Fordham University]. https://research.library.fordham.edu/dissertations/AAI3286413

De Paoli, T., Fuller-Tyszkiewicz, M., & Krug, I. (2017). Insecure attachment and maladaptive schema in disordered eating: The mediating role of rejection sensitivity. Clinical Psychology & Psychotherapy, 24(6), 1273–1284. https://doi.org/10.1002/cpp.2092

Johnson, B. N. (2023). Maladaptive schemas and attachment styles are two parts of the same iceberg: A commentary on Karantzas et al. (2022). Clinical Psychology: Science and Practice, 30(1), 24–25. https://doi.org/10.1037/cps0000126

Mercer, J. (2023). “Nothing either good or bad but thinking makes it so”: Commentary on “The association between early maladaptive schemas and adult attachment styles: A meta-analysis”. Clinical Psychology: Science and Practice, 30(1), 21–23. https://doi.org/10.1037/cps0000124

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

Keep Learning

1. How might therapists practically apply knowledge about clients’ attachment styles in formulating case conceptualizations and treatment plans? What benefits or challenges might this knowledge provide?
2. Could the associations found between attachment styles and schemas be explained by factors other than early experiences with caregivers? What third variables might influence these relationships over time?
3. Would the nature of the attachment-schema associations found here be expected to change across developmental periods of the lifespan? Why or why not?
4. What self-report or interview-based measures could be developed to capture the early onset of maladaptive schemas in childhood and adolescence? What challenges might arise in assessing schemas at early developmental stages?
5. Why might the type of attachment measure (dimensional vs. categorical) influence the strength of associations found with schemas? What are the merits and limitations of each approach to attachment assessment?