Differences between Men and Women Regarding Early Maladaptive Schemas in an Australian Adult Alcohol Dependent Clinical Sample

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Differences between Men and Women Regarding
Early Maladaptive Schemas in an Australian Adult
Alcohol Dependent Clinical Sample
Diana L. Janson, Craig A. Harms, Ross C. Hollett & Robert D. Segal
To cite this article: Diana L. Janson, Craig A. Harms, Ross C. Hollett & Robert D. Segal (2019)
Differences between Men and Women Regarding Early Maladaptive Schemas in an Australian
Adult Alcohol Dependent Clinical Sample, Substance Use & Misuse, 54:2, 177-184, DOI:
10.1080/10826084.2018.1480038
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ORIGINAL ARTICLE
Differences between Men and Women Regarding Early Maladaptive Schemas
in an Australian Adult Alcohol Dependent Clinical Sample
Diana L. Jansona, Craig A. Harmsb, Ross C. Hollettb, and Robert D. Segalc
aSchool of Psychology and Speech Pathology, Curtin University, Perth, WA, Australia; bSchool of Arts and Humanities, Psychology and
Criminology, Edith Cowan University, Perth, WA, Australia; cHollywood Private Hospital, Nedlands, WA, Australia
ABSTRACT
Background: Recent research indicates that there are widespread differences between men
and women’s Early Maladaptive Schemas (EMSs) in alcohol dependent populations. This
study examined this claim. Objective: The purpose of this study was to examine differences
between men and women’s EMSs in an Australian clinical sample who had sought treat-
ment specifically for alcohol dependence. Methods: A total of 111 men and 114 women
completed the Young Schema Questionnaire—Long Form (YSQ-L3) between 2012 and 2015
in order to assess them on 18 EMSs. Results: Despite previous findings suggesting that
women report higher levels across a number of EMSs, the strongest evidence pointed to
women scoring significantly higher than men on the EMS of self-sacrifice (the tendency to
excessively help others whilst continually sacrificing one’s own needs). Smaller differences
between men and women were noted for the subjugation and failure EMSs. Conclusions/
Importance: With the exception regarding the finding that woman scored higher on the
self-sacrifice EMS than men, the homogeneity of the remaining EMS scores across men and
women found in this study support the use of inter-gender group Schema Therapy (ST)
with alcohol-dependent adults in Australia.
KEYWORDS
Early Maladaptive Schemas;
alcohol dependence; gender
The harmful use of alcohol is a widespread concern
worldwide, and has been reported to be the third
leading risk factor for poor health (World Health
Organization [WHO], 2010). International research
has shown that men (26%) are two times more likely
to exceed lifetime risk guidelines for alcohol use than
women (10%) (Australian Institute of Health and
Welfare [AIHW], 2013; Roerecke & Rehm, 2013;
WHO, 2015). Although reviews continue to point to
the Cognitive Behavioral Therapy (CBT) as one of the
most effective forms of psychological treatment for
alcohol dependency (Baker, Hiles, Thornton, Hides, &
Lubman, 2012; Ball, 2007; Beck & Haigh, 2014; Butler,
Chapman, Forman, & Beck, 2006; Tolin, 2010), there
is growing interest in the utility of Schema Therapy
(ST) as a psychotherapeutic intervention for treating
alcohol dependency (Rafaeli, Bernstein, & Young,
2011; Young, Klosko, & Weishaar, 2003).
One aspect of ST are Early Maladaptive Schemas
(EMSs). EMSs have a number of features (Rafaeli
et al., 2011; Young et al., 2003). EMSs are self-defeat-
ing patterns of cognition and affect that are typically
learned in childhood or adolescence and are aug-
mented throughout an individual’s lifetime. According
to ST, when environmental events are encountered,
EMSs are responsible for the activation of intense
negative emotions, cognitions, memories and bodily
sensations. EMSs can present with different degrees of
intensity and pervasiveness; and, once activated, EMSs
are then maintained through cognitive distortions,
self-defeating patterns of behavior and unhealthy cop-
ing techniques.
EMSs have been measured using different versions
of the short and long forms of the Young Schema
Questionnaire (YSQ). The most recent long-from ver-
sion of the (YSQ-L3: Young & Brown, 2003) contains
232 self-report items that assess 18 EMSs which are
categorized into five broad schema domains (see
Table 1). The most recent version of the short form
of the YSQ (YSQ-S3: Young & Brown, 2005) assesses
the 18 most recent EMS, but has only 5 items for
each EMS.
Some EMSs have been implicated in the develop-
ment and maintenance of addictive disorders,
CONTACT Craig A. Harms c.harms@ecu.edu.au School of Arts and Humanities, Psychology and Criminology, Edith Cowan University, 270
Joondalup Drive, Joondalup, WA 6065, Australia.
� 2018 Taylor & Francis Group, LLC
SUBSTANCE USE & MISUSE
2019, VOL. 54, NO. 2, 177–184
https://doi.org/10.1080/10826084.2018.1480038
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including alcohol dependency. Subjugation (Rafaeli
et al., 2011) as well as defectiveness, emotional depriv-
ation, and insufficient self-control (Young et al., 2003)
are EMS that have been proposed as personal risk fac-
tors for the development of substance dependency.
Further, high levels of alcohol consumption have been
proposed as a coping mechanism for reducing the
negative affect elicited when EMSs are triggered by
environmental events (Ball, 2007; Young et al., 2003).
Research indicates that, compared to non-clinical
groups, EMS such as self-sacrifice, unrelenting stand-
ards, insufficient self-control, punitiveness, subjuga-
tion, mistrust/abuse, abandonment, defectiveness,
emotional deprivation and vulnerability EMSs are
reported at higher levels in clinical groups that
included some alcohol dependent participants
(Brotchie, Hanes, Wendon, & Waller, 2007;
Decouvelaere, Graziani, Gacki�ere-Eraldi, Rusinek, &
Hautek�eete, 2002; Roper, Dickson, Tinwell, Booth, &
McGuire, 2010). Research also indicates that the tar-
geting of EMSs as part of the implementation of ST
has been linked with improved treatment outcomes
for alcohol dependent individuals (Roper et al., 2010;
Shorey, Stuart, Anderson, & Strong, 2013).
Researchers have begun to focus on differences in
the presentation of EMS between men and women
seeking treatment of alcohol abuse because distin-
guishing consistent differences between men and
women regarding specific EMSs could impact on the
delivery of therapy. In studies of clinical groups that
included some alcohol dependent individuals using
the YSQ-S (an earlier version of the YSQ-S3 that
assessed 15 schemas),no (Roper et al., 2010) or minor
(women scored higher than men for dependence and
emotional inhibition: Brotchie, Meyer, Copello,
Kidney, & Waller, 2004) differences were found
between men and women. In contrast, more extensive
differences for EMS have been found between men
and women when the longer versions of the YSQ was
used. Pauwels et al. (2013) found that women scored
significantly higher on nearly half (7: abandonment,
defectiveness, social undesirability, failure, depend-
ence, subjugation and self-sacrifice) of the 15 schemas
measured by the YSQ-L2. While using a different
scoring system than is typically used for scoring the
YSQ-L3, Shorey, Elmquist, Stuart, and Anderson
(2015) found that women scored higher on four of
the five schema domains (excluding Impaired Limits)
associated with 16 of the 18 schemas assessed by the
YSQ-L3.
Only one study has examined gender differences
for men and women specifically in those seeking
treatment for alcohol dependence using the long
form. Shorey, Anderson, and Stuart (2012) examined
the responses of 854 patients who had attended a resi-
dential 12 step program for alcohol dependency over
a five year period in the United States. Women scored
significantly higher than menon14ofthe 18 EMS
assessed in the YSQ-L3: emotional deprivation, aban-
donment, mistrust/abuse, social isolation, defective-
ness, failure, dependence, vulnerability, enmeshment,
insufficient self-control, subjugation, self-sacrifice,
approval seeking and negativity/pessimism. However,
most of the effect sizes (when assessed using Cohen’s
d [Cohen, 1992]) were small in nature, with the larg-
est differences (ranging from small to medium effects)
observed for the subjugation (where the effect size
approached the medium criteria established Cohen),
enmeshment, emotional deprivation and self-sacri-
fice EMSs.
While the effects may be generally small in nature,
the results of the study by Shorey et al. (2012) suggest
Table 1. Early maladaptive schemas (EMS).
Domain EMS Description
Disconnection and Rejection Emotional Deprivation One’s emotional needs will not be fulfilled by others.
Abandonment All relationships will imminently end.
Mistrust/Abuse People will intentionally harm, abuse, exploit and manipulate others.
Social Isolation One is different from others, secluded from the world and doesn’t fit in.
Defectiveness One is inwardly defective, bad and subordinate to others.
Impaired Autonomy and Performance Failure One will never be capable of performing as well as others.
Dependence One needs the assistance of others to handle day to day responsibilities.
Vulnerability Catastrophic events are likely to occur and cannot be prevented.
Enmeshment A pattern of over emotional involvement with others.
Impaired Limits Entitlement One is superior and can do whatever they want even to the detriment of others.
Insufficient Self-Control The inability to restrain one’s impulses or feelings.
Other Directedness Subjugation One must surrender control to others to avoid negative consequences.
Self-Sacrifice Always helping others whilst continually sacrificing one’s own needs.
Approval Seeking An excessive emphasis on seeking the approval of others often at the expense of oneself.
Over-Vigilance and Inhibition Emotional Inhibition One must supress emotions to avoid retaliation, harming others or being embarrassed.
Unrelenting Standards Whatever one does is not good enough.
Negativity/Pessimism An excessive focus on the negative facets of life whilst minimizing the positive aspects.
Punitiveness Everyone, including themselves should be harshly punished for making mistakes.
178 D. L. JANSON ET AL.
that, for those individuals who present for alcohol
dependence, women are more likely to score higher than
men on many EMSs. These findings by Shorey et al.
(2012) a real so consistent with other research with other
clinical groups that included some alcohol dependent
individuals (Pauwels et al., 2013; Shorey et al., 2015).
However, further research is needed to replicate
these results in other settings in order to determine
the general is ability of the findings by Shorey et al.
(2012). Australia has one of the highest alcohol con-
sumption rates in the world (WHO, 2014) and recent
demand for alcohol treatment programs has been ris-
ing (AIHW, 2015). As such, an Australian clinical
alcohol-dependent sample provides an appropriate
opportunity to determine if the gender differences in
EMSs found by Shorey et al. can be replicated.
Therefore, the purpose of this study was to deter-
mine if differences exist on EMSs between treatment-
seeking alcohol dependent men and women in
Australia. Basedon largest effects reported Shorey
et al., it was expected that women would report sig-
nificantly elevated levels compared to men on the fol-
lowing EMSs: emotional deprivation, abandonment,
mistrust/abuse, social isolation, defectiveness, failure,
dependence, enmeshment, insufficient self-control,
subjugation, self-sacrifice, and approval seeking.
Method
Participants
In total, 225 patients who presented with alcohol
dependency at a private psychiatric hospital in
Western Australia participated in this study as part of
a recurring group schema therapy program. Of the
total sample, 111 (49%) were men aged 22–71 years of
age (M¼ 47.96, SD¼ 12.83) and 114 were women
(51%) aged 20–78 years of age (M¼ 48.57,
SD¼ 11.82). The overall mean age of the participants
was 48.29 years (SD¼ 12.28). After referral by a treat-
ing psychiatrist or general practitioner, eligibility for
the program was determined following an interview
with the coordinator of the alcohol dependency pro-
gram at the hospital regarding the type of alcohol
consumed, amount, symptoms (e.g., tremors, nausea,
agitation, seizures, etc.). The coordinator of the alco-
hol dependency program is a mental health expert
with specialized training and experience in the area of
substance abuse. The programme itself is overseen by
a director, who is a consultant psychiatrist. The pro-
gram director provides direct supervision to the
coordinator, and who ensured criteria for admission
to the programme were met, as per current
Diagnostic and Statistical Manual that was current at
the time the study was conducted (American
Psychiatric Association, 2000; 2013). Patients were
also screened for admission to the Clinic for a stabil-
ization or “dry out” period before commencement.
Of the 160 participants where marital status could
be determined (71% of the total sample), 32 (14.2%)
identified as single, 75 (33.3%) were married, 21
(9.4%) were divorced, and 32 (14.2%) identified as
‘other’. Using the Socio-economics Indexes for Areas
(SEIFA), postcodes were rated using a decile number
(1–10), with the lowest socio-economic areas given a
decile number of one and the highest socio-economic
areas given a decile number of ten (ABS, 2011). Only
16 participant’s postcodes were not available. As can
be seen in Table 2, the majority of participants in the
current study had greater than average levels of edu-
cation, income, and socio-economic status as 70% of
the remaining participants resided in areas with a
decile number of eight, nine, or ten.
Measures
Young Schema Questionnaire—Long Form
(YSQ-L3: Young & Brown, 2003)
The YSQ-L3 is a 232 item self-report measure that
appraises Young and Brown’s (2003) 18 EMSs. The 18
EMSs are scored using a 6 point Likert scale with
higher scores indicative of specific EMSs (range 1 ¼
completely untrue of me to 6 ¼ describes me perfectly).
The number of questions associated with each EMS
ranges from 9 (emotional deprivation) to 17 (aban-
donment, mistrust/abuse, and self-sacrifice). Following
the example of Shorey et al. (2012), the EMS score for
each participant was calculated by summing the
responses where the participant had responded with a
four, five or six on the six-point scale. The YSQ-L3
subscales have been found to possess high test-retest
reliability and internal consistency (a¼ .83 to .96), good
Table 2. Participants postcodesranked by decile number as
an indicator of socio-economic status in accordance with
SEIFA (ABS, 2011).
Decile No Number of Participants Percent
Decile 1 0 0.0%
Decile 2 4 1.9%
Decile 3 8 3.8%
Decile 4 0 0.0%
Decile 5 24 11.5%
Decile 6 19 9.1%
Decile 7 9 4.3%
Decile 8 20 9.6%
Decile 9 45 21.5%
Decile 10 80 38.3%
TOTAL 209 100.0%
SUBSTANCE USE & MISUSE 179
factor structure and high convergent and discriminant
validity (Cockram, Drummond, & Lee, 2010; Lee,
Taylor, & Dunn, 1999; Young & Brown, 2003).
Procedure
Data collection took place between August 2012 and
June 2015 during recurring schema group therapy
intakes. The program required participants to attend
daily group sessions for two weeks at the psychiatric
hospital, with a maximum of six to eight patients per
group. The program includes five core modules to
educate participants about the underlying function of
alcohol and substance dependency and facilitates
patients in adopting positive coping strategies.
Patients are encouraged to attend weekly relapse pre-
vention support groups run at the hospital at the end
of the group program. All participants completed the
YSQ L3 and some demographic questions (age, gen-
der, post code, and marital status) under clinical
supervision at the beginning of the second session of
the schema group program.
Data analysis
All statistical analyses were conducted using IBM
SPSS Statistical V22.0 (Statistical Package for the
Social Sciences).Multiple one-way ANOVA’s were
conducted to compare each EMS score for men and
women (Table 3). Descriptive data was reported; and
effect sizes (Cohen’s d) were also calculated and inter-
preted using Cohen’s, 1992 guidelines (Cohen, 1992).
In order to compare if the proportion of scores falling
within score bands and procedures established by
Young and Brown (2003) were consistent with the
results found by Shorey et al. (2012), clinical interpre-
tations were conducted for men and women for each
EMS. Each score for each EMS was classified as low,
medium, high or very high. Scores falling in the high
to very high range were indicative of the presence of
EMSs; medium scores indicate that specific EMSs may
be present and require further investigation whilst low
scores indicate specific EMSs are unlikely.
Results
Differences between men and women’s EMSs
As can be seen in Table 4, the only statistically signifi-
cant difference between men and women (when a was
set at .01) was found for the self-sacrifice EMS, with
women scoring significantly higher on this subscale
than men. Using an unadjusted alpha level for each
comparison (i.e., a ¼ .05), then women also scored
higher on the emotional deprivation and failure EMSs
than the men. Small to medium effects were observed,
with the largest effect (.42) observed with women
scoring higher on the self-sacrifice subscale than men.
Clinical interpretations for YSQ-L3 scores
As can be seen in Table 4, clinical interpretation
scores indicated that both men and women endorsed
similar EMSs as high or very high (indicating the
presence of the schema). For both men and women,
Table 3. Results of the analysis of variance for differences between men and women’s on the 18 early maladaptive schema’s
assessed by the young’s schema questionnaire—long form (YSQ-L3).
Men Women
Early Maladaptive Schemas Items Range M SD M SD d F p
Disconnection and Rejection Emotional Deprivation 9 0-54 15.55 16.78 20.96 17.39 .32 5.65 .018
Abandonment 17 0-102 26.16 20.42 28.94 24.63 .12 0.85 .358
Mistrust/Abuse 17 0-102 28.44 23.83 28.71 26.28 .01 0.01 .936
Social Isolation 10 0-60 19.94 17.66 19.06 18.96 .05 0.13 .720
Defectiveness 15 0-90 21.67 22.13 25.48 25.38 .16 1.44 .230
Impaired Autonomy and Performance Failure 9 0-54 11.72 15.27 16.22 17.38 .28 4.25 .040
Dependence 15 0-90 19.07 21.36 18.56 22.06 .02 0.03 .860
Vulnerability 12 0-72 15.82 15.62 16.25 16.36 .03 0.04 .839
Enmeshment 11 0-66 8.79 12.46 11.68 15.58 .20 2.36 .125
Impaired Limits Entitlement 11 0-66 16.93 14.53 13.98 15.71 .19 2.13 .146
Insufficient Self-Control 15 0-90 35.68 21.31 36.03 25.04 .02 0.01 .912
Subjugation 10 0-60 16.81 15.10 19.95 16.70 .20 2.18 .141
Other Directedness Self-Sacrifice 17 0-102 42.14 26.35 53.55 27.58 .42 10.06 .002*
Approval Seeking 14 0-84 26.63 21.08 26.04 20.59 .03 0.05 .833
Emotional Inhibition 9 0-54 16.66 14.11 16.36 14.58 .02 0.02 .876
Over-Vigilance and Inhibition Unrelenting Standards 16 0-96 37.91 24.93 39.95 25.63 .08 0.37 .546
Negativity/Pessimism 11 0-66 21.12 17.96 21.22 18.11 .01 0.00 .966
Punitiveness 14 0-84 27.51 21.99 27.44 20.59 .00 0.00 .979
Note: d ¼ Cohen’s d; �p < .01. Items in boldface are significant at p < .05. Welch’s corrected F ratio (Welch, 1951) was applied for all comparisons
except for EMSs (abandonment, defectiveness, failure, enmeshment and insufficient self-control) were the assumption for homogeneity of variance
was violated.
180 D. L. JANSON ET AL.
more than 50% of all participants were rated as high
or very high were for self-sacrifice, unrelenting stand-
ards and insufficient self-control. Between 45% and
50% of participants (also independent of gender) were
rated as high or very high for the abandonment, mis-
trust/abuse, approval seeking, and negativity/pessim-
ism EMSs. For women only, 50% of the participants
were rated as high or very high on the Emotional
Deprivation EMS, whereas 45% and 50% of the women
were rated as high or very high for the subjugation and
punitiveness EMSs. Other than the enmeshment schema
for males, 20% of the men and women scored high or
very high for each of the 18 schemas.
Discussion
This study compared EMS scores for a sample of
Australian men and women attending group therapy
for alcohol dependence. The results of this study
revealed, that the largest difference between women
and men was observed for the self-sacrifice EMS with
women scoring significantly higher than men. While
this finding is consistent with Shorey et al. (2012)
findings, the size of the effect was larger in this study.
Self-sacrifice epitomizes a disproportionate focus on
voluntarily meeting the needs of others whilst denying
one’s own needs, wants or desires (Young et al.,
2003). Individuals presenting with a self-sacrifice EMS
often have an empathic predisposition as they dislike
others feeling pain, feel morally obligated to help
others, to preserve relationships with those they dis-
cern as being disadvantaged and to avoid feelings of
guilt (Rafaeli et al., 2011). The EMS of self-sacrifice
often assume the parental role from a nearly ageand
develop a perceived sense of over-responsibility in
helping others. The constant care of others can result
Table 4. Early maladaptive schemas (YSQ-L3): Clinical interpretation scores for men and women.
Schema Men % Women % Total % Schema Men % Women % Total %
Emotional Deprivation Entitlement
Low 48.6 35.1 41.8 Low 36.0 49.1 42.7
Medium 16.2 14.9 15.6 Medium 18.0 19.3 18.7
High 14.4 16.7 15.6 High 27.9 18.4 23.1
Very High 20.7 33.3 27.1 Very High 18.0 13.2 15.6
Abandonment Insufficient Self-Control
Low 29.7 30.7 30.2 Low 15.3 16.7 16.0
Medium 23.4 21.9 22.7 Medium 18.0 28.9 23.6
High 21.6 16.7 19.1 High 27.0 11.4 19.1
Very High 25.2 30.7 28.0 Very High 39.6 43.0 41.3
Mistrust/Abuse Subjugation
Low 31.5 37.7 34.7 Low 40.5 34.2 37.3
Medium 22.5 14.9 18.7 Medium 18.9 18.4 18.7
High 17.1 16.7 16.9 High 17.1 19.3 18.2
Very High 28.8 30.7 29.8 Very High 23.4 28.1 25.8
Social Isolation Self-Sacrifice
Low 36.9 47.4 42.2 Low 18.0 9.6 13.8
Medium 17.1 11.4 14.2 Medium 10.8 9.6 10.2
High 12.6 12.3 12.4 High 21.6 14.0 17.8
Very High 33.3 28.9 31.1 Very High 49.5 66.7 58.2
Defectiveness Emotional Inhibition
Low 45.0 42.1 43.6 Low 40.5 38.6 39.6
Medium 20.7 18.4 19.6 Medium 15.3 22.8 19.1
High 10.8 10.5 10.7 High 22.5 18.4 20.4
Very High 23.4 28.9 26.2 Very High 21.6 20.2 20.9
Failure Unrelenting Standards
Low 59.5 49.1 54.2 Low 20.7 15.8 18.2
Medium 16.2 14.0 15.1 Medium 14.4 16.7 15.6
High 8.1 12.3 10.2 High 19.8 18.4 19.1
Very High 16.2 24.6 20.4 Very High 45.0 49.147.1
Dependence Approval Seeking
Low 55.0 56.1 55.6 Low 31.5 36.8 34.2
Medium 13.5 15.8 14.7 Medium 19.8 14.0 16.9
High 10.8 12.3 11.6 High 23.4 21.1 22.2
Very High 20.7 15.8 18.2 Very High 25.2 28.1 26.7
Vulnerability Negativity/Pessimism
Low 44.1 41.2 42.7 Low 31.5 31.6 31.6
Medium 22.5 18.4 20.4 Medium 20.7 22.8 21.8
High 11.7 22.8 17.3 High 15.3 14.0 14.7
Very High 21.6 17.5 19.6 Very High 32.4 31.6 32.0
Enmeshment Punitiveness
Low 64.0 64.9 64.4 Low 27.9 24.6 26.2
Medium 18.0 10.5 14.2 Medium 28.8 27.2 28.0
High 11.7 7.9 9.8 High 17.1 16.7 16.9
Very High 6.3 16.7 11.6 Very High 26.1 31.6 28.9
SUBSTANCE USE & MISUSE 181
in a lack of emotional fulfilment, exploitation by
others, psychosomatic complaints and lead to feelings
of anger or resentment (Young et al., 2003) and the
use of avoidant coping strategies (such as alcohol or
drug use) as a way of blocking out the distressing
emotions associated with the emotional fall out associ-
ated with the self-sacrifice pattern (Rafaeli
et al., 2011).
The women in this study also scored higher than
men on two other EMS—emotional deprivation and
failure, if a more liberal alpha (given the number of
comparisons) was retained. The size of the effects
were similar in this study than were observed for the
self-sacrifice EMS. According to Young et al. (2003)
the self-sacrifice EMS is almost invariably accompa-
nied by an emotional deprivation EMS. The emotional
deprivation EMS involves the belief that one’s needs
for security, protection, nurturance, love, acceptance
and empathy will not be met in a predictable manner.
The Failure EMS involves the conviction that one will
never be capable of performing as well as others often
resulting in a reduction of individuals ability to func-
tion independently, survive or be successful without
help from others (Young et al., 2003). The failure
EMS is associated with an avoidance coping style,
including substance abuse which may have interfered
with the ability to achieve (Young et al., 2003).
While women scored higher (near to or greater
than moderate effect size) than men on the self-sacri-
fice, emotional deprivation, and failure EMSs for both
this study and the Shorey et al. (2012) study, fewer
differences between men and women on the EMSs
were found in this study compared to the findings
reported by Shorey et al. Unlike the findings of the
Shorey et al., no differences (with adjusted or
unadjusted a) between men and women were found
for the following EMSs in this study: abandonment,
mistrust/abuse, social isolation, defectiveness,
dependence, vulnerability, enmeshment, insufficient
self-control, subjugation, approval seeking, and
negativity/pessimism.
There are several possible reasons for these differ-
ences in findings between this study and those find-
ings reported by Shorey et al. (2012). First, the study
by Shorey et al. was overpowered to detect differences
between men and women on EMSs due to the large
size of the sample. Second, the lack of significant gen-
der differences in the current study may have
occurred because Australian men are amongst the
highest consumers of alcohol worldwide (top 10%)
(WHO, 2014) and a number of studies have shown
evidence for a relationship between alcohol
dependency and a high endorsement of EMSs (Ball &
Cecero, 2001; Brotchieetal., 2004; Shoreyetal., 2012).
Third, studies have shown that higher socio-economic
status is positively associated with increased alcohol
consumption (French et al., 2014; Grittner, Kuntsche,
Gmel, & Bloomfield, 2012). The current study was
conducted at a private psychiatric hospital and the
majority of participants came from areas of socio-eco-
nomic advantage. As Shorey et al. (2012) did not test
for socio-economic status amongst his participants it
is unclear how the characteristics of the two samples
compared on this feature.
The observations from the clinical interpretations
from this study also indicated relatively few differen-
ces on the EMS between women and men with more
than one in two men and women scoring high or
very high (indicating the presence of the schema) on
the self-sacrifice, unrelenting standards, and insuffi-
cient self-control EMSs. This finding was relatively
similar to what was reported by Shorey et al. (2012)
study. Some differences between the twostudies were
notedwiththe womenand meninthis study commonly
endorsing emotional deprivation and social isolation
respectively whereas punitiveness was one of the four
mostly endorse EMSs reported by Shorey et al. Of
interest was that (other than the enmeshment schema
for males), 20% of the men and women scored high
or very high for each of the 18 schemas assessed in
this study. This figure is higher than what was
reported by Shorey et al. who found that 10%
of the men and women in their study scored high or
very high on the 18 schemas.
The findings from this study, however, should be
interpreted within the context of several limitations.
Firstly, the sample was not necessarily representative
of the general population of Australians as a large per-
centage of participants populate areas of high socio-
economic advantage. Secondly, participants were not
screened for co-morbid psychological disorders which
may have impacted on results as research has shown
an association between depression, anxiety, personality
disorders, PTSD, psycho-somatic disorders an dele-
vated levels of EMSs and substance dependency
(Cockram et al., 2010; Kienast, Stoffers, Bermpohl, &
Lieb, 2014; Rafaeli et al., 2011; Shorey, Anderson, &
Stuart, 2014a; Young et al., 2003). Thirdly, partici-
pants were not screened for the length of their
dependency; and no evaluations regarding the severity
of alcohol use were conducted with the participants.
Dependency duration and severity of alcohol con-
sumption have been found to exacerbate psychological
182 D. L. JANSON ET AL.
disorders and maladaptive behaviors (Ball, 2007;
Rafaeli et al., 2011; Young et al., 2003).
While acknowledging the limitations, the current
study was the first to be conducted in Australia using
a moderately large clinical sample, applied strict statis-
tical control for Type I error associated with multiple
comparisons, and employed a comprehensive assess-
ment of EMSs. However, further research should be
conducted to determine if the results of this study can
be replicated across different age groups, therapeutic
settings, and in countries.
The results of this study and that of Shorey et al.
(2012) can help practitioners prepare more effectively
for the ST interventions for alcohol dependent indi-
viduals. As elevated EMSs were relatively homoge-
neous between men and woman across the entire
sample, other the self-sacrifice EMS, as well as being
highly prevalent, these findings provide preliminary
support for the suitability of inter-gender Schema
Group Therapy as an intervention to assist those with
alcohol dependency in Australia. However, therapists
should consider how the differences between men and
women that were common across both this study and
the Shorey et al. (2012) study—that women scored
higher for the self-sacrifice, emotional deprivation,
and failure than men—may impact on group dynam-
ics when ST for alcohol dependent individuals is pre-
sented in a group format. For example, because
women have been found to endorse higher levels of
the self-sacrifice schema, they may beat risk of
neglecting their own needs in therapy when hearing
about the stories of the others in groups. As women
tend to report higher levels of the emotion depriv-
ation schema, they may at be more at risk of disen-
gaging from group because the group does not
provide the degree of emotional support that they
were hoping for or expecting. Finally, women who
score highly on the failure schema may be more vul-
nerable than men to experience the triggering of this
schema in a group setting as participants are more
likely to see progress on therapeutic goals for others
in a group setting than in individual therapy.
In conclusion, the current studywas the first study
in Australia to examine the differences between men
and women’s EMSs in an Australian adult alcohol
dependent clinical sample. In contrast to Shorey et al.
(2012), few differences were found in this study
between men and women on EMS. Future research
should continue to examine differences between men
and women on EMS to determine the universality of
differences in EMS between men and women
presenting for alcohol dependence and the associated
implications for practice.
Declaration of Interest
The authors report no conflicts of interest. The
authors alone are responsible for the content and
writing of the article.
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	Abstract
	Method
	Participants
	Measures
	Young Schema QuestionnaireLong Form (YSQ-L3: Young Brown, 2003)
	Procedure
	Data analysis
	Results
	Differences between men and womens EMSs
	Clinical interpretations for YSQ-L3 scores
	Discussion
	Declaration of Interest
	References