In the behavioral pattern-breaking stage of treatment, patients attempt to replace their schema-driven patterns of behavior with healthier coping styles. Behavioral pattern-breaking is the longest and, in some ways, the most crucial part of schema therapy. Without it, relapse is likely. Even if patients have insight into their Early Maladaptive Schemas, and even if they have done the cognitive and experiential work, their schemas will reassert themselves if patients do not change their behavioral patterns. The progress they have made will erode, and eventually they will fall back under the sway of their schemas. For patients to achieve and maintain full gains, it is essential that they change their behavioral patterns.
Of the four main change components in schema therapy, behavioral pattern-breaking is usually the final one that the therapist focuses on. If the patient has not progressed adequately through the cognitive and experiential stages, the patient is unlikely to achieve lasting changes in schema-driven behavior. The other parts of treatment prepare the patient for the task of behavioral change. They give the patient psychological distance from the schema, helping him or her to view the schema as an intruder rather than as a core truth about the self. The cognitive and experiential stages strengthen the healthy side of the patient, especially the ability of the healthy side to fight the patient’s schemas. Once the behavioral part of treatment is underway, they help the patient overcome blocks to behavioral change.
Thus the behavioral stage of treatment takes place within the framework of the schema model and incorporates the other schema strategies, such as flash cards, imagery, and dialogues. Where relevant, the therapist also uses traditional behavioral techniques, such as relaxation training, assertiveness training, anger management, self-control strategies (i.e., self-monitoring, goal-setting, self-reinforcement) and graduated exposure to feared situations. (We assume that readers are familiar with these standard techniques from behavior therapy, so we will not elaborate on them in this book.)