Schema therapy is an evidence-based psychological treatment designed to help people understand and change long-standing patterns in how they think, feel, and relate to others. It was developed by Dr Jeffrey Young and integrates principles from cognitive behavioural therapy (CBT), attachment theory, psychodynamic therapy, and emotion-focused approaches.

It is particularly effective for individuals who have not fully benefited from traditional CBT, especially when difficulties are longstanding, repetitive, and linked to early life experiences.

What Are “Schemas”?

Schemas are deeply held emotional and cognitive patterns that develop during childhood and adolescence. They form in response to unmet emotional needs such as safety, stability, nurturance, and validation.

When these needs are not consistently met, the brain develops adaptive strategies to cope. Over time, these strategies become rigid and self-defeating.

Common early maladaptive schemas include:

• “I am not good enough”

• “People will leave me”

• “My needs don’t matter”

• “I will be hurt if I trust others”

These beliefs are often not consciously held but are reflected in emotional reactions and relationship patterns.

Schema Modes

Schema therapy also works with “modes,” which are moment-to-moment emotional states. These include:

• Vulnerable Child (hurt, lonely, anxious states)

• Angry Child (rage, frustration)

• Detached Protector (emotional shutdown, avoidance)

• Punitive Parent (self-criticism)

• Healthy Adult (balanced, reflective self)

Therapy aims to strengthen the Healthy Adult mode while reducing the intensity of unhelpful coping modes.

How Schema Therapy Works

Schema therapy is typically longer-term than CBT because it targets entrenched emotional patterns rather than surface-level symptoms.

Treatment includes:

• Identifying core schemas and coping styles

• Linking current difficulties to early life experiences

• Emotional processing of past experiences

• Cognitive restructuring of unhelpful beliefs

• Experiential techniques (e.g., imagery rescripting)

• Behavioural pattern-breaking exercises

A strong therapeutic relationship is central, as it provides a corrective emotional experience that supports change.

What Conditions Does It Help With?

Research supports schema therapy for:

• Personality disorders, including borderline personality disorder

• Chronic depression

• Trauma-related difficulties

• Eating disorders

• Longstanding relationship difficulties

Meta-analyses suggest schema therapy can be particularly effective for complex, treatment-resistant presentations.

What Does a Session Look Like?

Sessions may include talking through recent life events, identifying schema activation, and exploring emotional responses in real time. Therapists may also guide imagery exercises or role plays to help process earlier experiences.

Homework is often used to help clients recognise patterns outside of sessions.

Is Schema Therapy Right for You?

Schema therapy may be helpful if you:

• Notice repeated patterns in relationships

• Struggle with intense emotions or emotional numbness

• Have experienced childhood adversity or emotional neglect

• Feel stuck in long-term patterns despite previous therapy

Summary

Schema therapy helps people understand not just what they are feeling, but why those emotional patterns exist and how they can be changed at a deep, lasting level.

If you would like support exploring these patterns, schema therapy may offer a structured and compassionate framework for change.

Telehealth psychology has become a widely used form of mental health care, particularly following the COVID-19 pandemic. It involves receiving psychological therapy via secure video conferencing platforms rather than attending in-person sessions.

A growing body of research now supports telehealth as an effective and evidence-based mode of psychological treatment for a range of mental health conditions.

Is Telehealth as Effective as In-Person Therapy?

Overall, research indicates that telehealth psychology is comparable in effectiveness to face-to-face therapy for many common mental health presentations.

Meta-analyses and systematic reviews have found similar outcomes between telehealth and in-person therapy for conditions such as:

• Anxiety disorders

• Depression

• Post-traumatic stress disorder (PTSD)

• Eating disorders (including binge eating disorder)

• Adjustment disorders

In many cases, symptom reduction and treatment engagement rates are equivalent across delivery formats.

Why Telehealth Works

Telehealth is effective because the core mechanisms of psychological therapy remain the same, regardless of delivery format. These include:

• Therapeutic alliance (the relationship between client and psychologist)

• Evidence-based treatment models (e.g., CBT, DBT, schema therapy)

• Emotional processing and cognitive restructuring

• Behavioural change strategies

Research consistently shows that the therapeutic alliance can be just as strong in telehealth as in person, provided the client has privacy and a stable connection.

Benefits of Telehealth Psychology

Telehealth offers several practical and clinical advantages:

1. Increased Accessibility

Clients can access therapy regardless of geographic location, including rural and regional areas.

2. Reduced Barriers to Care

Telehealth reduces barriers such as travel time, childcare arrangements, mobility limitations, and work constraints.

3. Improved Consistency

Clients are often more likely to attend sessions consistently due to reduced logistical barriers.

4. Comfort and Safety

Some individuals feel more comfortable discussing sensitive topics from their own environment.

Is Telehealth Suitable for Everyone?

While telehealth is effective for many people, it may not be suitable in all situations. In-person care may be preferred when:

• There is acute risk requiring immediate intervention

• A client has significant cognitive or communication difficulties that affect video engagement

• There are severe environmental distractions that limit privacy or safety at home

• A client strongly prefers in-person interaction

Clinical judgement is always used to determine the most appropriate mode of care.

Evidence for Specific Conditions

Anxiety and Depression

Strong evidence supports telehealth CBT as effective for reducing symptoms of anxiety and depression.

Trauma and PTSD

Telehealth-delivered trauma-focused therapies, including EMDR and CBT, show comparable outcomes to in-person treatment when delivered with appropriate structure and safety planning.

Eating Disorders

Research suggests telehealth can be effective for eating disorder treatment, particularly when combined with structured monitoring and multidisciplinary care.

Limitations of Current Research

While evidence is strong, ongoing research continues to explore:

• Long-term outcomes of telehealth compared to in-person therapy

• Effectiveness across different age groups and presentations

• Optimal models for complex or high-risk populations

Despite these limitations, current findings strongly support telehealth as a legitimate and effective mode of care.

Summary

Telehealth psychology is not a “lesser” form of therapy—it is an evidence-based and effective way of delivering psychological treatment. When delivered using structured, validated approaches and a strong therapeutic relationship, outcomes are comparable to traditional in-person therapy for many conditions.

For many clients, telehealth also increases accessibility and consistency, making it a practical and sustainable option for ongoing psychological care.

Diet culture refers to a set of beliefs and social norms that equate thinness with health, morality, and worth. It promotes the idea that body weight is the primary indicator of wellbeing and often encourages restrictive eating, food rules, and weight control behaviours as a path to health or happiness.

While often normalised in media, fitness industries, and everyday conversation, research shows that diet culture can play a significant role in the development, maintenance, and relapse of eating disorders.

What Is Diet Culture?

Diet culture is not a single diet—it is a broader system of beliefs that includes:

• “Smaller bodies are healthier and more disciplined”

• “Weight loss is always positive, regardless of method”

• “Foods can be categorised as ‘good’ or ‘bad’”

• “Willpower determines body size”

• “You must earn food through exercise or restriction”

These beliefs can become internalised and shape eating behaviours, body image, and self-worth.

The Link Between Dieting and Eating Disorders

A strong body of research has identified dieting as one of the most consistent risk factors for the development of disordered eating and eating disorders.

Restrictive dieting can lead to:

• Increased preoccupation with food

• Heightened cravings and binge episodes

• Loss of internal hunger and fullness cues

• Cycles of restriction and overeating

• Increased body dissatisfaction

For some individuals, this cycle can develop into clinically significant eating disorders such as binge eating disorder, bulimia nervosa, or restrictive eating patterns consistent with anorexia nervosa.

Psychological Mechanisms Involved

From a clinical perspective, diet culture interacts with several psychological processes:

1. Cognitive Restriction

Rigid rules about food increase cognitive load and make eating more preoccupying and emotionally charged.

2. Reward System Dysregulation

Restriction increases the salience of food, particularly highly palatable foods, which can contribute to binge episodes.

3. Shame and Self-Criticism

Diet failure is often interpreted as personal failure, reinforcing cycles of shame and further restriction.

4. Emotional Regulation

Food may become a primary strategy for managing stress, anxiety, or emotional discomfort.

How Diet Culture Maintains Eating Disorders

Even after an eating disorder develops, diet culture can reinforce symptoms by:

• Encouraging ongoing restriction

• Promoting weight-focused recovery goals

• Validating harmful food rules as “discipline”

• Reinforcing body dissatisfaction as motivation

This can make recovery more difficult without targeted psychological intervention.

Evidence-Based Treatment Approaches

Effective treatment for eating disorders focuses on breaking the cycle of restriction, bingeing, and shame, while addressing underlying psychological processes.

Common evidence-based approaches include:

Cognitive Behavioural Therapy (CBT-E)

The enhanced form of CBT for eating disorders focuses on:

• Normalising eating patterns

• Reducing dietary restraint

• Addressing body image concerns

• Challenging unhelpful beliefs about food and weight

Schema Therapy

Targets deeper emotional patterns such as:

• Shame and defectiveness schemas

• Emotional deprivation

• Overcontrol or perfectionism modes

Dialectical Behaviour Therapy (DBT)

Helps develop skills in:

• Emotion regulation

• Distress tolerance

• Reducing impulsive eating behaviours

Multidisciplinary Care

Best outcomes often occur when psychology is combined with:

• Dietetics support

• Medical monitoring

• Psychiatric input when required

A Weight-Inclusive Approach to Recovery

Modern evidence-based practice increasingly supports a weight-inclusive and health-focused approach, which prioritises:

• Regular, flexible eating patterns

• Psychological recovery over weight change

• Reduction in eating disorder behaviours

• Improved quality of life and functioning

This approach recognises that recovery is not defined by body size.

Who Is Most Affected by Diet Culture?

While diet culture can affect anyone, increased vulnerability is seen in individuals who:

• Have perfectionistic traits

• Experience anxiety or emotional dysregulation

• Have a history of trauma or attachment disruption

• Engage in high self-criticism

• Have a family history of dieting or body dissatisfaction

Summary

Diet culture is often normalised, but its psychological impact can be significant. It contributes to the development and maintenance of eating disorders by reinforcing restrictive behaviours, body dissatisfaction, and shame.

Effective treatment involves moving away from rigid food rules and toward a more flexible, compassionate, and evidence-based relationship with food and the body.

Recovery is not about achieving a particular body shape—it is about restoring psychological, emotional, and physical wellbeing.

Complex trauma refers to exposure to repeated or prolonged traumatic experiences, often occurring in childhood or within important relationships. Unlike single-incident trauma, complex trauma tends to shape how a person views themselves, others, and the world.

Why Complex Trauma Is Often Missed

Many individuals with complex trauma do not recognise their experiences as “trauma” because:

• The experiences were chronic rather than one-off events

• There may not have been overt physical harm

• Emotional neglect or inconsistency was normalised

• They adapted by becoming highly functional or independent

As a result, symptoms are often misattributed to anxiety, depression, or personality traits.

Common Signs of Complex Trauma

1. Emotional Dysregulation

Intense emotions, difficulty calming down, or emotional numbness.

2. Persistent Shame or Self-Criticism

A deep sense of being flawed, “too much,” or unworthy.

3. Relationship Difficulties

Patterns of:

• Fear of abandonment

• Difficulty trusting others

• People-pleasing or avoidance

• Intense attachment or withdrawal

4. Dissociation or Emotional Numbness

Feeling detached from emotions, memories, or one’s sense of self.

5. Hypervigilance

Constant scanning for threat, rejection, or disapproval.

6. Difficulty Identifying Needs

Many individuals report not knowing what they want or need emotionally.

The Role of Attachment

Research consistently shows that complex trauma is closely linked to early attachment disruptions. When caregivers are inconsistent, emotionally unavailable, or frightening, children adapt by prioritising survival over emotional development.

These adaptations often persist into adulthood.

How It Affects the Nervous System

Complex trauma impacts the stress response system, making it more reactive or more shut down. This can result in alternating states of:

• Hyperarousal (anxiety, anger, panic)

• Hypoarousal (numbness, fatigue, disconnection)

Evidence-Based Treatment

Effective approaches include:

• Schema Therapy (identifying and changing core emotional patterns)

• EMDR (processing traumatic memories)

• Trauma-focused CBT

• DBT for emotional regulation skills

Treatment focuses not only on symptom reduction but on rebuilding a stable sense of self.

Can Complex Trauma Be Treated?

Yes. Research shows that with consistent, structured therapy, individuals can significantly reduce symptoms and improve functioning. Treatment often involves building emotional awareness, developing self-compassion, and processing past experiences in a safe therapeutic environment.

Summary

Complex trauma is often hidden beneath long-standing emotional and relational patterns. Recognising these signs is an important step toward understanding your experiences and accessing appropriate support.