It is through the cognitive strategies that the patient first recognizes that the schema is inaccurate—either untrue or greatly exaggerated. The therapist and patient begin by agreeing to regard the schema as open to question. Rather than an absolute truth, it is a hypothesis to be tested. They then subject the schema to logical and empirical analyses. They examine the evidence supporting and refuting the schema in the patient’s life; they go through the evidence the patient has used to uphold the schema, and they find alternative interpretations of these same events; they conduct debates between the “schema side” and the “healthy side”; and they list the advantages and disadvantages of the patient’s current coping styles. Based on this work, the patient and therapist generate healthy responses to the schema. They write these responses on schema flash cards and read the flash cards whenever the schema is triggered. Finally, patients practice responding to schemas on their own using the Schema Diary form.
When the cognitive strategies are effective, patients gain a heightened appreciation of how distorted the schema actually is. They have gained more psychological distance from the schema and no longer view it as an absolute truth. They have some insight into how the schema twists their perceptions. They begin to wonder whether the schema really has to run—and ruin—their lives. They realize they might have a choice.
Successfully treated patients have internalized the cognitive work as part of a Healthy Adult mode that actively counters the schema with rational arguments and empirical evidence. After completing the cognitive component of schema therapy, patients are usually no longer dependent on the therapist’s assistance in challenging the schema. When a schema is triggered in their lives outside of therapy, they are able to fight the schema using the cognitive techniques. Even though patients may still feel as though the schema is true, they know that it is not factually true. They have a heightened intellectual awareness that the schema is false.