Longstanding Emotional and Behavioral Patterns

Schema Therapy began as an extension of cognitive-behavioral therapy (CBT). While CBT is highly effective for many people, it doesn’t always reach the deeper, more entrenched patterns that often develop from early life experiences. Over time, Schema Therapy evolved into its own integrative approach, still grounded in CBT’s structure and skills, but expanded to include attachment theory, emotion-focused work, and experiential techniques that help people change not just how they think, but how they feel and relate.

At its core, Schema Therapy focuses on understanding and meeting unmet core emotional needs. All people share a set of basic emotional needs that support healthy development, emotional regulation, and secure relationships. When these needs are consistently met, individuals tend to develop flexible, adaptive ways of thinking, feeling, and connecting with others. When they go unmet, particularly during childhood or adolescence, deep, enduring patterns can form that continue to shape emotional and behavioral responses well into adulthood.

These patterns are known as schemas. A schema is a deeply ingrained life theme that influences how you see yourself, how you expect others to treat you, and how you interpret the world around you. Schemas are made up of memories, emotions, thoughts, and even physical sensations. They often develop as understandable adaptations to early environments, ways of coping, surviving, or making sense of difficult experiences. Over time, however, they can become rigid and self-perpetuating, acting as an unhelpful "lens" in which you take in information that aligns with it, and rejecting information that does not. Ultimately, these schemas limit peoples' potential for growth and keeps people stuck in familiar but painful patterns.

In Schema Therapy, we organize these patterns around five core emotional needs. When a particular need is not adequately met early in life, predictable schemas often emerge. Below is an overview of these needs and the schemas that commonly develop when they are unmet.

Linking Core Emotional Needs to Schemas

1. Secure Attachment to Others: Safety, stability, love, nurturance, and acceptance. 

When this Core Emotional Need is unmet, possible schemas that develop:

• Abandonment / Instability: fear that people you depend on will leave.
• Mistrust / Abuse: expectation that others will hurt, manipulate, or take advantage of you.
• Emotional Deprivation: belief that your emotional needs will never be met.
• Defectiveness / Shame: feeling inherently flawed or unlovable.

2. Autonomy, Competence, and a Sense of Identity: Feeling capable, independent, confident in your identity. 

When this Core Emotional Need is unmet, possible schemas that develop:

• Dependence / Incompetence: belief you can’t manage everyday responsibilities without help.
• Vulnerability to Harm: fear that catastrophe is imminent (e.g., illness, accidents, financial ruin).
• Enmeshment / Undeveloped Self: difficulty developing a separate identity from significant others.
• Failure: belief you’re inadequate and will inevitably fail.

3. Freedom to Express Valid Needs and Emotions: Permission/safety to express feelings, needs, preferences. 

When this Core Emotional Need is unmet, possible schemas that develop:

• Subjugation: putting others’ needs ahead of your own to avoid conflict or rejection.
• Self-Sacrifice: excessive focus on meeting others’ needs at your own expense.
• Approval-Seeking / Recognition-Seeking: prioritizing external validation over authentic self-expression.
• Emotional Inhibition: suppressing emotions to avoid disapproval, shame, or loss of control.

4. Spontaneity and Play: Opportunities for joy, play, creativity, and relaxation. 

When this Core Emotional Need is unmet, possible schemas that develop:

• Negativity / Pessimism: focus on the negative aspects of life while downplaying the positive.
• Unrelenting Standards / Hypercriticalness: belief you must meet extremely high standards to avoid criticism.
• Punitiveness: belief that people should be harshly punished for mistakes (including yourself).

5. Realistic Limits and Self-Control: Guidance in setting boundaries, respecting others, practicing self-control. 

When this Core Emotional Need is unmet, possible schemas that develop:

• Entitlement / Grandiosity: belief you’re superior and not bound by the same rules as others.
• Insufficient Self-Control / Self-Discipline: difficulty tolerating frustration or delaying gratification

Schema Therapy also helps explain why these patterns persist. When schemas are activated, people tend to cope in one of three ways: surrendering to the schema, avoiding anything that might trigger it, or overcompensating by pushing against it in rigid or extreme ways. While these strategies may reduce distress in the short term, they often reinforce the very patterns someone is trying to change.

Schema Therapy is especially well-suited for people who understand their patterns and where they came from, but still feel pulled into reactions that are automatic, intense, or hard to control. These patterns aren’t just habits of thinking, they are beliefs about safety, worth, closeness, and trust that were often learned in deeply emotional ways, that simply don’t shift through insight or reasoning alone. Schema Therapy works to identify and heal the unmet emotional needs driving these patterns, by combining understanding with corrective emotional experiences that help change beliefs that "feel" true. If you’ve ever thought, “I know better, but I still can’t seem to do better,” Schema Therapy was designed with you in mind.

Dialectical Behavior Therapy (DBT) was developed for individuals whose emotions "heat up" quickly, intensely, and frequently, and take a longer time to return to baseline compared to others. For these individuals, emotions can feel entirely overwhelming, uncontrollable, and difficult to manage, often leading to impulsive behaviors aimed solely at ending emotional pain as quickly as possible. Behaviors like self-harm, lashing out, avoiding important but difficult situations, and emotionally shutting down, may all be common. While these behaviors can make sense in the moment given how painful emotions can feel for these individuals, their behaviors unfortunately but predictably cause problems over time in relationships, work, health, or self-worth, often contributing to ongoing cycles of distress, damaged relationships, and increased shame.

DBT understands these emotional and behavioral patterns as arising from a combination of a highly sensitive nervous system and learned responses shaped by early environments where intense feelings were met with invalidation, inconsistency, or inadequate support. Rather than viewing these struggles as failures of willpower or motivation, DBT recognizes them as true skill deficits in emotional regulation, where patients need to learn more effective strategies for managing overwhelming feelings and responding more adaptively.

DBT is a synthesis of fostering acceptance of things as they are, while simultaneously building skills to change. Many people entering DBT are motivated and self-aware but feel overwhelmed by emotions that seem to hijack their ability to respond differently. DBT offers clear structure, practical tools, and repeated practice, guiding patients to respond more effectively to emotional distress, interpersonal challenges, and internal experiences, all without judgment.

Skills are taught across four core skills modules, typically taught in a structured group setting and reinforced in individual therapy:

• Mindfulness: Cultivating present-moment awareness of thoughts, feelings, and body sensations without judgment, enabling intentional and thoughtful responses instead of impulsive reactions.
• Distress Tolerance: Learning techniques to endure and survive emotional crises without making them worse, focusing on grounding and acceptance when immediate change isn’t possible.
• Emotion Regulation: Building the ability to understand, manage, and shift intense emotions to prevent spirals and promote resilience.
• Interpersonal Effectiveness: Developing skills to communicate clearly, set healthy boundaries, manage conflict, and maintain respectful, balanced relationships.

At CBTTexas, DBT is delivered with fidelity to the evidence-based model while being tailored to each individual’s unique needs and goals. The focus is not just on acquiring skills but on applying them effectively in moments when old patterns typically emerge. Over time, DBT fosters greater emotional stability, behavioral flexibility, and a stronger sense of agency in navigating life’s challenges. DBT does not aim to eliminate emotions or impose rigid emotional control. Instead, it helps individuals experience emotions fully without being controlled by them, ultimately building a life that feels more stable, meaningful, and worth living.

Some people simply have too much of a good thing. Not all emotional suffering comes from a lack of self-control. For many individuals, especially those with restrictive eating disorders, distress stems from excessive self-control: perfectionism, emotional inhibition, rigid routines, and a tendency to keep feelings tightly contained. Over time, these patterns can narrow a person’s world and lead to profound emotional loneliness.

RO DBT is an evidence-based treatment designed specifically for individuals who struggle with overcontrol. It is particularly helpful for people experiencing restrictive anorexia nervosa, chronic or treatment-resistant depression, obsessive-compulsive personality disorder (OCPD), autism spectrum disorder, social anxiety, treatment resistant anxiety, or long-standing patterns of perfectionism and emotional restraint.

RO DBT is grounded in the understanding that while self-control is often valued, too much of it can interfere with flexibility, emotional openness, and the ability to form close, supportive relationships. Many individuals who benefit from RO DBT describe themselves as responsible, composed, or high achieving on the outside, yet disconnected, unseen, or misunderstood on the inside.

In treatment, clients learn to:

• Express emotions more openly and authentically
• Increase psychological flexibility and comfort with uncertainty
• Strengthen social connection and healthy communication
• Loosen rigid, rule-governed behavior
• Move toward a life guided by values instead of perfectionism or fear

RO DBT focuses on openness, social signaling, and the capacity to connect with others. This approach is particularly effective for people who appear calm and capable externally but struggle internally with emotional shutdown or chronic isolation.

If you are highly self-disciplined yet still suffering, or if your eating disorder is intertwined with perfectionism, rigidity, and emotional overcontrol, RO DBT may provide a new way forward, helping you build a life marked by connection, authenticity, and ease.

Persistent Depressive Disorder (PDD) isn’t just feeling sad. It’s a long-standing pattern of low mood, hopelessness, emotional numbness, and disconnection that can stretch across years, or even decades. Many people with PDD describe feeling stuck: unchanged by prior therapy, different medications, or well-meaning advice to “think more positively.”

At CBTTexas, we provide Cognitive Behavioral Analysis System of Psychotherapy (CBASP) for individuals with chronic depression, the only psychotherapy specifically developed and empirically supported for persistent depressive disorder.

Chronic depression is not simply major depression that lasts longer. Over time, it reshapes how a person experiences themselves and relates to others. Many people with longstanding depression withdraw emotionally, avoid closeness, or comply rather than assert themselves. They may come to believe that their actions don’t matter, that nothing they do will change outcomes, or that engagement leads to disappointment or harm. These patterns are often rooted in early experiences of neglect, invalidation, or interpersonal trauma that taught the person, explicitly or implicitly, that relationships are unsafe or unresponsive. 

Rather than focusing primarily on symptoms or thought content, CBASP helps patients re-enter the interpersonal world and relearn cause-and-effect in relationships. Through structured, real-life learning, patients begin to experience, often for the first time, how their behavior impacts others and how different ways of engaging can lead to different outcomes. Over time, this process increases agency, a fuller range of emotions, and deeper connection with others. For individuals whose depression feels ingrained, relational, and resistant to standard approaches, CBASP offers a path forward that is both practical and deeply human.