J. Behav. Ther. & Exp. Psychiat.

41 (2010) 389e396

Contents lists available at ScienceDirect

Journal of Behavior Therapy and

Experimental Psychiatry
journal homepage: www.elsevier.com/locate/jbtep

Stability of dysfunctional attitudes and early maladaptive schemas: A 9-year

follow-up study of clinically depressed subjects
Catharina E.A. Wang*, Marianne Halvorsen, Martin Eisemann, Knut Waterloo
Department of Psychology, University of Tromsø, N-9037 Tromsø, Norway

a r t i c l e i n f o a b s t r a c t

Article history: The Dysfunctional Attitude Scale (DAS) and the Young Schema Questionnaire (YSQ) have been suggested
Received 2 July 2009 as relatively stable vulnerability markers for depression and entrenched psychological disorders,
Received in revised form respectively. One-hundred-and-forty-nine clinically depressed (CDs), previously depressed (PDs) and
30 March 2010
never-depressed subjects (NDs) completed the DAS, the YSQ and the Beck Depression Inventory in the
Accepted 13 April 2010
index study and were followed-up nine years later. Results showed: (1) Elevated scores in CDs and PDs as
compared to NDs; (2) Some stability of depressive symptoms; (3) Significant moderate testeretest
Keywords:
correlations for DAS scales and YSQ scales Disconnection and Impaired Limits, also after controlling for
Cognitive vulnerability
Depression
depression severity; (4) A significant reduction in mean score for DAS total, Approval by Others and YSQ
Dysfunctional attitudes scales Disconnection and Impaired Limits; (5) Significant correlations between DAS and YSQ scales. Our
Early maladaptive schemas results support a state-trait vulnerability model of depression comprising stable differences in avail-
ability of dysfunctional attitudes and early maladaptive schemas, but also fluctuating differences in
accessibility of those schemas during the course of depression. The findings point to the significance of
the YSQ scales as vulnerability markers for depression in addition to the more established DAS scales.
Ó 2010 Elsevier Ltd. All rights reserved.

1. Introduction
Since major depression is a highly prevalent, recurrent, and
often chronic disorder (Andrade et al., 2003; Kessler et al., 2003) it
is imperative to increase our knowledge about vulnerability factors
in order to prevent and treat depression.
According to Beck’s (1967, 1987) cognitive theory of depression,
vulnerability may develop in individuals with a history of loss or
adversity in childhood contributing to the formation of negative
self-schemas, containing dysfunctional attitudes. Dysfunctional
attitudes, frequently assessed with the Dysfunctional Attitude Scale
(DAS; Weissman & Beck, 1978), include core beliefs such as that
one’s happiness depends on being perfect, being in control, or on
other people’s approval (Beck, Hollon, Young, Bedrosian, & Budenz,
1985). Furthermore, the core beliefs are according to Beck’s theory
assumed to be relatively stable cognitive characteristics that confer
vulnerability to stress which subsequently may lead to the onset of
depression.
Numerous studies have examined the stability of negative
schemas operationalized by means of the DAS. Fairly consistently,
* Corresponding author. Tel.: þ47 97 43 42 60; fax: þ47 77 64 56 10.
E-mail address: catharina.wang@uit.no (C.E.A. Wang).
DAS scores have been found to fluctuate with the clinical state,
indicating that dysfunctional attitudes may rather be a state than
a trait characteristic. State-dependent effects of dysfunctional
attitudes have been reported both in cross-sectional (Clark & Beck,
1999; Ingram, Miranda, & Segal, 1998; Power, Duggan, Lee, &
Murray, 1995) and in treatment studies (Beevers & Miller, 2004;
Hamilton & Abramson, 1983; Zuroff, Blatt, Sanislow, Bondi, &
Pilkonis, 1999). However, some studies have found DAS scores of
remitted depressed patients still elevated after treatment as
compared to non-depressed controls (Beevers & Miller, 2004;
Peselow, Robins, Block, Baraouche, & Five, 1990; Zuroff et al., 1999).
Moreover, research has consistently shown that vulnerable as
compared to less vulnerable individuals, report more dysfunctional
attitudes during negative mood-states (Scher, Ingram, & Segal,
2005). Such findings have made several researchers to claim that
it is a simplification of a more complex causality to explain elevated
DAS scores solely with either state or trait factors. For example,
Person and Miranda (1992), in line with Beck et al.’s theory have
hypothesized that putative vulnerability factors are present in
vulnerable individuals, but are more or less accessible depending
on mood-state. Accordingly, Zuroff et al. (1999) proposed a state-
trait vulnerability model comprising both stable differences in
availability of cognitive-affective structures, and fluctuating
differences in accessibility of those structures dependent on

0005-7916/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jbtep.2010.04.002
390 C.E.A. Wang et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 389e396
current levels of depressive symptoms. In an 18 months follow-up
study of depressed patients they found evidence of trait-like
properties of DAS scores, although mood-state dependent effects
were evident.
More recently, similar findings have been obtained in a treat-
ment study by Beevers and Miller (2004) who assessed cognitive
bias, dysfunctional attitudes and depression severity in 121
subjects who were hospitalized for depression and followed-up
during a 6-months outpatient treatment and one year after its
completion. Mean score change, testeretest correlation, and path
analysis both demonstrated relative stability over time, but also
that fluctuations in mood-state influenced dysfunctional attitudes
and cognitive bias. Otto et al. (2007) as well, found in a three-year
prospective study of a large, community-based sample of 750
women, an association between DAS scores and subsyndromal
levels of depressive symptoms indicating mood-state effects on
dysfunctional attitudes. However, they also found dysfunctional
attitudes as predictive of future episodes of depression in women,
but only when a history of depression was ignored.
Young (1990, 1999) has elaborated on the schema concept to
reflect themes of adverse relational experiences in childhood.
Young (1990) hypothesized that connectedness, autonomy,
worthiness, reasonable expectations and realistic limits, are five
primary objectives that the child has to fulfill in order to pursue
a healthy development. When caregivers make it difficult for the
child to achieve one or more of these five objectives, Young
proposed that Early Maladaptive Schemas (EMSs) will develop.
Young (1990) originally identified sixteen schemas, which are
grouped into five domains reflecting the childhood objectives
mentioned above: Disconnection, Impaired Autonomy, Undesir-
ability, Restricted Self-Expression, and Impaired Limits. In this way,
Young assumed the EMS domains to represent predisposing factors
for the development and maintenance of clinical symptom states,
and to explain various types of interpersonal and personality
related problems. To assess the EMSs, Young (1990) developed the
Young Schema Questionnaire (YSQ; Young & Brown, 1990).
Beck (1967, 1987) and Young (1990) both suggested that the most
important etiological pathways of developing dysfunctional atti-
tudes and EMSs are related to adverse experiences during childhood.
Young also, influenced by the work of Ainsworth and Bowlby (1991)
on attachment theory, emphasized that EMSs refer to the deepest
level of cognitive structures representing the self in relation to other
persons and the environment. Accordingly, EMSs are suggested to be
more persistently activated compared to dysfunctional attitudes,
which require the presence of certain stressors or conditions
(Schmidt & Joiner, 2004). Because Young (1999) explicitly empha-
sized the highly stable and enduring themes of the EMSs, the issue of
stability is probably even more crucial to Young’s theory. Few studies
have investigated the long-term stability of EMSs. However, Riso
et al. (2006) examined 55 depressed outpatients over a 2.5e5-
years interval and found moderate to good levels of relative stability
also after controlling for severity of depression at both assessments.
Further, they found that the mean-scores of the majority of the EMSs
did not drop significantly in spite of a significant decrease in
depression severity at follow-up.
The clinical relevance of demonstrating the relative stability of
dysfunctional attitudes and EMSs is essential due to the assumption
raised by Beck and Young that dysfunctional attitudes and EMSs
may predict the development and maintenance of clinical
symptom states including depression. Accordingly, to be regarded
as clinically meaningful predictors of vulnerability, also some
relative stability is warranted. Several studies have found
dysfunctional attitudes as predictive of depression severity, first-
onset, relapse and recurrence of major depression (e.g., Alloy et al.,
2006; Hankin, Abramson, Miller, & Haeffel, 2004; Iacoviello, Alloy,
Abramson, Whitehouse, & Hogan, 2006; Segal, Gemar, &
Williams, 1999, 2006; Zuroff, Igreja, & Mongrain, 1990). Compa-
rably fewer studies have investigated EMSs as predictors of
depression severity (Harris & Curtin, 2002; Hoffart et al., 2005;
Schmidt, Joiner, Young, & Telch, 1995). More recently, however,
the authors of the present paper found that YSQ scales emerged as
significant predictors of concurrent depression severity and
depression severity and episodes of Major Depression nine years
later in a sample of 149 currently and previously depressed indi-
viduals, and never-depressed controls (Halvorsen, Wang,
Eisemann, & Waterloo, 2009).
Previous work on the stability of dysfunctional attitudes has
illustrated the importance of both examining changes in mean
scores, i.e., absolute stability and examining relative stability by
using correlational analyses (Santor, Bagby, & Joffe, 1997). Zuroff
et al. (1999), when investigating the stability of DAS scores, argued
that “It is possible for a group to show large, significant changes in
mean scores on a trait in the presence of perfect stability in the
participants’ relative standing on the trait” (p. 77). However,
research on the stability of schemas has primarily been carried out
with cross-sectional and treatment designs. Accordingly, little
knowledge exists concerning the stability of both schemas and
depressive symptoms in a natural course of major depression. The
present study attempts to replicate and extend previous findings by
including the YSQ as a second measure of schemas in addition to the
DAS in a sample of clinically depressed (CDs), previously depressed
(PDs) and never-depressed subjects (NDs), who were followed-up
after nine years without any treatment intervention.
Four aims were addressed: (1) to compare groups of CDs, PDs,
and NDs on dysfunctional attitudes and EMSs, (2) to investigate the
conceptual overlap between dysfunctional attitudes and EMSs in
a cross-sectional design, and (3) to examine the relative and (4)
absolute stability of dysfunctional attitudes, EMSs, and depressive
symptoms after nine years.
2. Method
2.1. Participants and procedure
The analysis is based on a sample of 149 subjects taking part in
a study on depression and cognitive vulnerability in the years
1997e1999, i.e., the index study (T1) (Wang, Brennen, & Holte,
2005). In the years 2006e2007 (T2) totally 115 participants from
the index study were followed-up. Among the 34 participants who
were not part of the follow-up study, one had died, 15 were
untraceable and 18 were not willing to take part due to various
reasons. The mean period of time from the T1 to T2 was nine years
(M ¼ 8.94, Mdn ¼ 9.00, SD ¼ .99).
The 149 participants in the index study (T1) comprised both
undergraduate students at the University of Tromsø and patients
consulting their general practitioner, also in Tromsø, Norway. They
were diagnosed according to the Diagnostic and Statistical Manual
of Mental Disorders (DSM-IV; American Psychiatric Association
(APA), 1994), using “The Structured Clinical Interview for DSM-IV,
Axis I disorders” (SCID-CV) (First, Spitzer, Gibbon, & Williams,
1997). Based on the information given in the clinical interview,
the participants were grouped as a) being clinically depressed (CDs;
N ¼ 61), b) having experienced a depressive episode during the past
five years and having fully recovered for at least 8 weeks or longer
(PDs; N ¼ 42) or c) having never been clinically depressed (NDs;
N ¼ 46). Subjects with ongoing manic, hypo-manic or psychotic
symptoms were excluded. None of the participants was treated as
inpatient at the time of assessment. For further description of the
sampling and group-classification reliability, see Wang et al. (2005).
 C.E.A. Wang et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 389e396
Demographic and clinical characteristics of the participants are
presented in Table 1.
In the index study (T1), the Dysfunctional Attitude Scale (Form A,
DAS; Weisman & Beck, 1978), the Young Schema Questionnaire
(YSQ; Young & Brown, 1990), and the BDI e First Edition (BDI-I; Beck,
Rush, Shaw, & Emery, 1979) were administered and completed by all
149 participants on the same occasion as the diagnostic interview. At
the follow-up assessment (T2) the DAS and the YSQ were completed
on separate occasions as the participants took part in a larger study
over two days on depression and vulnerability (Halvorsen et al.,
2009). Accordingly, the DAS was administered first and completed
by all 115 participants, while the YSQ was completed by 82 partici-
pants some days later. The Beck Depression Inventory e Second
Edition (BDI-II; Beck, Steer, & Brown, 1996) was administered
separately in relation to both the DAS and the YSQ.
Among the 115 participants who completed the DAS, there were
47 CDs, 39 PDs, and 29 NDs from the index study. Of the 82
participants who completed the YSQ, there were 35 CDs, 27 PDs,
and 20 NDs. The T2 DAS and YSQ sample had a mean age of 37.55
years (SD ¼ 9.49 years) and 38.12 years (SD ¼ 9.62 years), respec-
tively and was predominantly comprised of females (n ¼ 97; 84%;
n ¼ 70; 85%). There were no significant differences on any of the
demographic variables between the original T1-sample of 149
participants and the two T2-samples of 115 participants and 82
participants, respectively. Slightly fewer never-depressed partici-
pants from T1 took part in the follow-up study at T2.
Also at T2, all participants were re-diagnosed and a history of
major depressive episodes between T1 and T2 was taken according
to the criteria of the DSM-IV-TR (APA, 2000). Of the totally 86 CDs
and PDs entering the study at T1, 61 (71%) had experienced
a recurrent major depressive episode. Twenty-six (30%) subjects
had experienced two or more depressive episodes and seven (8%)
were chronically depressed. Three individuals (10%), who had
never experienced a major depressive episode at T1, had a first-
onset episode between the two points of time (Halvorsen et al.,
2009). For further description of the group-classification reli-
ability, see Halvorsen et al. (2009).
The study was approved by the Regional Medical Research
Ethics Committee. All participants gave written informed consent
before entering the study.
2.2. Measures
2.2.1. The Dysfunctional Attitude Scale (Form A)
The Dysfunctional Attitude Scale (Form A) (DAS; Weissman &
Beck, 1978) is a 40-item self-report inventory to be rated along
a seven-point Likert scale ranging from “totally agree” to “totally
disagree”, designed to assess the presence of dysfunctional atti-
tudes that may relate to cognitive vulnerability to depression
(Oliver & Baumgart, 1985). Scores on the DAS can range from 40 to
280, with higher scores indicating more dysfunctional attitudes.
Two major factors, Performance Evaluations and Approval by
Others, have been found to account for a large proportion of the
variance in the total DAS score (Cane, Olinger, Gotlib, & Kuiper,
Table 1
Demographic and clinical characteristics at T1 for the three groups of subjects (N ¼ 149).
Variable CD (n ¼ 61)
M SD
Gender (f/m) 52/9
Age 30.89 10.33
Single/recurrent episode 24/37
Antidepressant 9 1
Note: T1 ¼ Time 1; CD ¼ clinically depressed; PD ¼ previously depressed; ND ¼ never depressed.
391
1986). A full description, including psychometric properties is
provided by Chioqueta and Stiles (2004), Dobson and Breiter (1983)
and Oliver and Baumgart (1985). In the present study, the Cron-
bach’s alphas for the total scores at the two different assessments
were .94 and .92, respectively. The Cronbach’s alphas for Perfor-
mance Evaluations and Approval by Others were .91 and .82 at T1,
and .92 and .78 at T2, respectively.
2.2.2. The Young Schema Questionnaire
The Young Schema Questionnaire (YSQ; Young & Brown, 1990) is
a 205-item self-report inventory to be rated along a six-point Likert
scale ranging from “completely untrue of me” to “describes me
perfectly” designed to assess the presence of Early Maladaptive
Schemas (EMS) that may relate to vulnerability to clinical symptom
states and personality related problems. The 205 items are grouped
within 16 subscales which in turn are subsumed into five domain
scales: 1) Disconnection: Emotional Deprivation, Abandonment/
Instability, Mistrust/Abuse, Social Isolation/Alienation; 2) Impaired
Autonomy: Dependence/Incompetence, Vulnerability to Harm/
Illness, Enmeshment/Undeveloped Self, Subjugation; 3) Undesir-
ability: Defectiveness/Shame, Social undesirability, Failure to Ach-
ieve; 4) Restricted Self-Expression: Emotional Inhibition, Self-
Sacrifice, Unrelenting Standards; 5) Impaired Limits: Entitlement/
Grandiosity and Insufficient Self-Control. In the present study,
scores for individual EMSs were obtained by summing items for
each subscale and dividing by the number of items in the scale. The
YSQ has been subjected to psychometric evaluation, and the
majority of the EMSs have been confirmed in student and clinical
samples (Lee, Taylor, & Dunn, 1999; Schmidt et al., 1995; Hoffart
et al., 2005). Factor-analytic studies on clinical samples have
provided good support for the scales with the exception of ‘Social
Undesirability’ (Hoffart et al., 2005; Lee et al., 1999). Cronbach’s
alphas for the various subscales at the two different assessments
varied from .85 to .95.
2.2.3. The Beck Depression Inventory e First Edition and Second
Edition
The Beck Depression Inventory e First Edition (BDI-I; Beck et al.,
1979) and The Beck Depression Inventory e Second Edition (BDI-II;
Beck et al., 1996) are versions of a 21-item self-report inventory
designed to assess the presence and severity of depressive symp-
toms. Both are rated on a four-point Likert-type scale ranging from
0 to 3, reflecting the severity of each item. These scales were
included in the study to assess depression severity when answering
the DAS and the YSQ at T1 and T2, respectively. Beck and Steer
(1987) classified BDI-I scores as follows: 0e9 normal range;
10e18 mild-moderate; 19e29 moderate-severe; and 30e63 severe.
The BDI-II scores are classified somewhat different: 0e13 minimal;
14e19 mild; 20e28 moderate; and 29e63 severe (Beck et al., 1996).
A full description of the two inventories including psychometric
properties can be found in Beck, Steer, and Garbin (1988), and in
Steer, Ball, Ranieri, and Beck (1999). In the present study, the
Cronbach’s alpha for the BDI-I total score was .92, and for the BDI-II
total score .94 and .95, respectively.
PD (n ¼ 42) ND (n ¼ 46) Significance test and p value
M SD M SD
35/7 35/11 c2 (2) ¼ 1.57, ns
27.00 8.25 26.93 9.45 F (2,146) ¼ 3.06, p ¼ .05
18/24 c2 (1) ¼ .13, ns
c2 (1) ¼ 4.34, p ¼ .037
392 C.E.A. Wang et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 389e396

3. Results
3.1. Response patterns of DAS, YSQ and BDI-I
To address the first aim of the study, i.e., to compare groups of
CDs, PDs, and NDs on the DAS and YSQ domains and subscales,
Multivariate analysis of covariance (MANCOVA), with age as cova-
riate, were calculated followed by univariate post hoc analyses when
an overall difference between groups occurred (Bonferroni adjust-
ment: P < .006 e .05/3 comparisons/3 scales for the DAS scales and
P < .001 e .05/3 comparisons/21 scales for the YSQ scales). Because
the YSQ scales of the three groups were not normally distributed and
the groups had heterogeneous variances, these data were trans-
formed. Multivariate analyses were conducted with the transformed
and untransformed variables. The comparisons showed equivalent
results. Consequently, parametric tests with the untransformed YSQ
scales were used for group comparisons.
As concerns DAS, a one-way analysis of covariance (ANCOVA),
with age as covariate, indicated significant group differences on the
DAS total score (F(2,145) ¼ 19.72, p < .001, partial eta
squared ¼ .214) (Table 2). Moreover, a highly significant main effect
for group (ND, PD, and CD) was found in the MANCOVAs, with age
as covariate, both for the DAS subscales Approval by Others and
Performance Evaluation (F(2,145) ¼ 11.56, p < .001, partial eta
squared ¼ .138) and for the YSQ scales (F(2,145) ¼ 3.70, p < .001,
partial eta squared ¼ .313). Post hoc ANOVAs indicated that the
three groups differed significantly on the DAS scales (see Table 2).
The effect size (partial eta squared) in the ANOVAs was .184 for
Performance Evaluation and .211 for Approval by Others. When
applying a Bonferroni adjusted alpha level of .006, PDs did not
remain significantly different from NDs on the DAS subscale
Performance Evaluation.
Furthermore, post hoc ANOVAs showed that the groups differed
significantly on all YSQ scales (see Table 2). The effect size (partial eta
squared) in the ANOVAs for all the scales was between .048 for Enti-
tlement and .414 for Disconnection. When applying a Bonferroni
adjusted alpha level of .001, CDs remained significantly different from
PDs on the YSQ domains Disconnection, Impaired Autonomy, Unde-
sirability and the subscales Abandonment/Instability, Social Isolation/
Alienation, Dependence/Incompetence, Subjugation, Vulnerability to
Harm/Illness, and Social Undesirability. CDs remained significantly
different from NDs on all the scales with the exception of Entitlement/
Grandiosity. PDs remained significantly different from NDs on the
YSQ domain Disconnection, and the subscales Abandonment/Insta-
bility, Mistrust/Abuse, and Social Isolation/Alienation.
To test for differences between CDs, PDs and NDs with respect to
depressive symptoms, an ANCOVA, with age as a covariate, was con-
ducted on the BDI-I, which indicated that the three groups differed
significantly, with CDs and PDs showing elevated scores compared to
NDs, (F(2,145) ¼ 78.33, p < .001, partial eta squared ¼ .519) (Table 2).
Because obtained group differences on the DAS and the YSQ might
be related to differences in depression severity, bivariate correlations
were calculated between the BDI-I and the DAS scales, and the BDI-I
and the YSQ scales, respectively. While no significant correlations
were found for the ND-group, some significant positive correlations
were found for the PD-group (r between .33 and .47, p < .05). For the
CD-group, the majority of the correlations were significant (r between
.26 and .62, p < .05). Accordingly, depression severity may partly
account for group differences on the DAS and YSQ scales.
3.2. Conceptual overlap between DAS and EMSs at T1
To address the second aim of the study, i.e., to investigate
conceptual overlap between the DAS and the YSQ scales, zero-order

Table 2
Means and standard deviations for the BDI-I, the DAS and the YSQ at T1 for the total sample and for three sub-groups (N ¼ 149).

Variable Total (n ¼ 149) CD (n ¼ 61) PD (n ¼ 42) ND (n ¼ 46) Post hoc univariate ANOVA
controlling for age

M SD M SD M SD M SD F (2,146) Contrasts
BDI-I 8.58 8.61 15.70 8.50 6.40 4.05 1.13 1.68 78.33** CD > PD > ND

DAS total 117.03 35.07 133.20 38.17 116.62 30.44 95.98 21.27 19.72** CD > PD > ND
DAS approval 36.22 10.81 39.75 10.59 38.19 10.60 29.74 8.32 16.33** CD, PD > ND
DAS performance 40.12 16.44 48.03 18.33 38.95 13.71 30.70 9.63 19.40** CD > PD > ND

Disconnection 1.93 .81 2.45 .86 1.92 .54 1.26 .26 51.19** CD > PD > ND
Emotional deprivation .96 .97 2.45 1.06 1.98 .85 1.29 .38 25.52** CD > PD > ND
Abandonment/instability 2.01 .92 2.55 1.00 1.99 .71 1.31 .32 39.09** CD > PD > ND
Mistrust/abuse 1.85 .83 2.28 .95 1.85 .67 1.26 .26 30.57** CD > PD > ND
Social isolation/alienation 1.92 1.03 2.52 1.22 1.88 .56 1.17 .33 36.34** CD > PD > ND

Impaired autonomy 1.72 .67 2.15 .77 1.63 .34 1.23 .21 38.92** CD > PD > ND
Dependence/incompetence 1.56 .73 1.95 .95 1.44 .35 1.15 .16 22.23** CD > PD, ND
Vulnerability to harm/illness 1.80 .70 2.20 .81 1.75 .47 1.31 .28 30.13** CD > PD > ND
Enmeshment/undeveloped self 1.52 .74 1.90 .95 1.42 .45 1.11 .20 18.90** CD > PD, ND
Subjugation 2.00 1.00 2.57 1.20 1.89 .61 1.34 .42 25.17** CD > PD > ND

Undesirability 1.84 .86 2.35 1.00 1.77 .56 1.23 .25 34.31** CD > PD > ND
Defectiveness/shame 1.75 .85 2.20 1.06 1.68 .48 1.21 .29 25.26** CD > PD > ND
Social undesirability 2.00 1.01 2.56 1.20 1.89 .69 1.36 .39 28.03** CD > PD > ND
Failure to achieve 1.78 .97 2.30 1.16 1.74 .70 1.12 .17 26.30** CD > PD > ND

Restricted self-expression 2.37 .78 2.76 .89 2.36 .60 1.86 .37 24.14** CD > PD > ND
Emotional inhibition 2.02 .98 2.49 1.15 2.04 .75 1.37 .40 22.79** CD > PD > ND
Self-sacrifice 2.83 .89 3.22 .98 2.82 .72 2.35 .64 14.91** CD > PD > ND
Unrelenting standards 2.25 .88 2.56 1.00 2.23 .77 1.86 .61 11.09** CD > PD, ND

Impaired limits 1.95 .63 2.12 .70 2.03 .58 1.66 .46 11.81** CD, PD > ND
Entitlement/grandiosity 1.86 .67 1.87 .65 2.04 .76 1.69 .57 3.67* PD > ND
Insufficient self-control 2.04 0 .76 2.38 .88 2.02 .59 1.63 .48 20.06** CD > PD > ND

Note: T1 ¼ Time 1; CD ¼ clinically depressed; PD ¼ previously depressed; ND ¼ never depressed; BDI ¼ Beck Depression Inventory; DAS ¼ Dysfunctional Attitude Scale;
YSQ ¼ Young Schema Questionnaire. Welch’s F. *p < .05; **p < .001. Post hoc tests were generated from Bonferroni at the level of p < .05 (Two-tailed).
 C.E.A. Wang et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 389e396 393

and partial correlations controlling for depression severity were
calculated (Table 3). As shown, significant moderately to highly
positive correlations were found between a majority of the DAS and
the YSQ scales (r between .29 and .74, p < .001). However, when
controlling for depression severity the correlations decreased (r
between .26 and .59, p < .001). The strongest correlation was found
between the DAS total score and the YSQ domain scale Undesir-
ability whereas the weakest correlation was found between the
DAS total score and the YSQ domain scale Impaired Limits. In
general, the correlations between the Performance Evaluation and
the YSQ subscales were stronger than the correlations between the
Approval by Others and the YSQ subscales. When using the trans-
formed rather than the YSQ scale’s raw scores, the above analyses
revealed a similar pattern.
3.3. Relative stability of DAS, EMSs and BDI between T1 and T2
To address the third aim of the study, i.e., the examination of the
relative stability of the DAS and the YSQ scales from T1 to T2, zero-
order and partial correlations controlling for depression severity at
both time points were calculated. Although similar to the BDI-I, the
BDI-II for instance replaces previous items relating to changes in
body image, somatic preoccupation, and work difficulty with other
depressive symptoms such as worthlessness, concentration diffi-
culties and loss of energy (Beck et al., 1996). Because of differences
in psychometric characteristics of these two versions of the BDI, we
used the scoring adjustment recommended in the BDI-II manual
(Beck et al., 1996, pp. 32e34). That is, when controlling for
depression severity at T1, we used a converted BDI-I to BDI-II total
score. Testeretest correlations for scores of the DAS and the YSQ
scales are presented in Table 4.
As shown, DAS total and the two subscales, showed significant
testeretest correlations also after controlling for depression
severity both at T1 and T2 (r between .52 and .63, p < .001).
Approval by Others was least affected by depression severity. When
excluding currently depressed participants (N ¼ 19) at T2 and re-
running the analyses, the results revealed a similar pattern.
Furthermore, YSQ domain scales showed significant testeretest
correlations for all the domain scales (r between .48 and .72,
p < .001). When controlling for depression severity, both at T1 and
T2, correlations remained significant at .001-level only for the
domain scales Disconnection and Impaired Limits (r between .50
and .59, p < .001). Moreover, the YSQ subscales that showed
significant moderate testeretest correlations also after controlling
for depression severity, both at T1 and T2, were: Mistrust/Abuse,
Social Isolation/Alienation, Social Undesirability, Entitlement/
Grandiosity, and Insufficient Self-control (r between .50 and .60,
p < .001). Accordingly, while some domains and subscales were
strongly affected by depression severity, others were only margin-
ally so. When excluding currently depressed participants (N ¼ 13) at
T2 and re-running the analyses, the results revealed a similar
pattern, i.e., the domain and subscales that showed to be most
affected by depressive symptoms (when controlling for BDI), were
also most affected by excluding currently depressed subjects at T2.
When using the transformed rather than the YSQ scale’s raw scores,
the above analyses revealed a similar pattern.
To explore the relative stability of the BDI, from T1 to T2,
bivariate correlations were calculated for the DAS and the YSQ
sample using the converted BDI-I to BDI-II total score at T1 and BDI-
II total score at T2. As shown in Table 4, significant moderate
testeretest correlations were found for the DAS sample and for the
YSQ sample. However, when excluding participants who were
currently depressed at T2, the testeretest correlations were
reduced for the DAS sample (r ¼ .35, p < .01) and the YSQ sample
(r ¼ .28, p < .05).
Additionally, when using the original BDI-I total score at T1
rather that the converted score, the above analyses revealed
a similar pattern.
3.4. Absolute stability of DAS, EMSs and BDI between T1 and T2
To address the fourth aim of the study, i.e., to examine the
absolute stability of the DAS and YSQ scales, from T1 to T2, t-tests

Table 3
Correlations between the YSQ and the DAS at T1 (N ¼ 149).

YSQ DAS

DAS total (control BDI-I) DAS approval (control BDI-I) DAS performance (control BDI-I)
Disconnection .69*** .51*** .59*** .41*** .68*** .49***
Emotional deprivation .53*** .34*** .49*** .32*** .51*** .30***
Abandonment/instability .66*** .49*** .61*** .47*** .63*** .43***
Mistrust/abuse .63*** .43*** .46*** .25** .63*** .44***
Social isolation/alienation .58*** .37*** .47*** .26** .60*** .39***

Impaired autonomy .68*** .48*** .60*** .43*** .66*** .44***

Dependence/incompetence .65*** .45*** .55*** .36*** .63*** .41***
Vulnerability to harm/illness .58*** .34*** .50*** .29*** .55*** .31***
Enmeshment/undeveloped self .36*** .13 ns .38*** .20* .37*** .13 ns
Subjugation .68*** .50*** .58*** .41*** .65*** .45***

Undesirability .74*** .57*** .61*** .43*** .73*** .56***

Defectiveness/shame .74*** .59*** .58*** .41*** .74*** .58***
Social undesirability .65*** .44*** .57*** .38*** .63*** .40***
Failure to achieve .64*** .43*** .52*** .30*** .64*** .43***

Restricted self-expression .71*** .57*** .62*** .48*** .69*** .54***

Emotional inhibition .60*** .40*** .48*** .27** .60*** .40***
Self-sacrifice .53*** .38*** .50*** .36*** .50*** .33***
Unrelenting standards .68*** .57*** .61*** .50*** .66*** .55***

Impaired limits .49*** .38*** .44*** .34*** .45*** .33***

Entitlement/grandiosity .29*** .29*** .27** .26*** .26** .26**
Insufficient self-control .56*** .39*** .50*** .35*** .52*** .34***

Note: T1 ¼ Time 1; BDI ¼ Beck Depression Inventory; DAS ¼ Dysfunctional Attitude Scale; YSQ ¼ Young Schema Questionnaire.
*p < .05; **p < .01; ***p < .001 (Two-tailed).
394 C.E.A. Wang et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 389e396

Table 4 (t(68) ¼ 2.02, p ¼ .047), and Vulnerability to Harm/Illness (t

Means, standard deviations and correlations between T1 and T2, for the BDI, the DAS (68) ¼ 2.38, p ¼ .020). However, when using a Bonferroni adjusted
(N ¼ 115) and the YSQ (N ¼ 82).
alpha level of .002, no significant differences in mean scores of the
Not control M-T1/ SD-T1/ scales remained. Subsample analyses revealed that only PDs’ mean
BDI/(Control M-T2 SD-T2 scores were significantly reduced in the same manner as for the total
BDI  2)
sample, in addition to a significant reduction in a few more
BDI e DASa .52*** 9.7/8.5 9.4/9.8
subscales. This pattern remained after excluding currently
BDI e YSQa .50*** 10.0/8.3 9.5/10.0
depressed participants at T2 and using a Bonferroni adjusted alpha
DAS total .71*** (.61***) 116.1/106.3 33.9/37.1 level of .002. When using the transformed rather than the YSQ
DAS approval .67*** (.63***) 36.5/34.1 10.7/9.8
DAS performance .66*** (.52***) 39.5/39.2 15.9/14.6
scale’s raw scores, the above analyses revealed a similar pattern.
Finally, we examined in a similar way, mean-level stability of
Disconnection .72*** (.50***) 1.9/1.8 .8/.8
scores on the BDI for the follow-up samples, as BDI-II were
Emotional deprivation .66*** (.45***) 1.9/2.0 .9/1.0
Abandonment/instability .56*** (.34**) 2.0/1.9 1.0/.8 administrated in relation to both DAS and YSQ at T2 (Table 4). We
Mistrust/abuse .73*** (.60***) 1.9/1.7 .8/.7 used the converted BDI-I to BDI-II total score when comparing BDI
Social isolation/alienation .67*** (.52***) 1.9/1.8 .9/1.0 at T1 and T2. The mean scores on the BDI-II, administrated both
Impaired autonomy .48*** (.21 ns) 1.7/1.6 .6/.6 with the DAS and YSQ, respectively, were not significantly different
Dependence/incompetence .27** (.04 ns) 1.5/1.4 .5/.6 at retest for the total sample. However, when excluding currently
Vulnerability to harm/illness .56*** (.47***) 1.8/1.7 .7/.7 depressed participants at T2, mean scores on BDI were significantly
Enmeshment/undeveloped self .20 ns (.16 ns) 1.6/1.5 .8/.6
reduced at T2 in relation to both re-assessments (t(95) ¼ 3.15,
Subjugation .54*** (.18 ns) 2.0/2.0 .9/1.0
p ¼ .002; t(68) ¼ 2.83, p ¼ .006), respectively. Subsample analyses
Undesirability .60*** (.27*) 1.8/1.8 .8/.8 revealed: (1) a significant reduction in mean-scores for CDs at both
Defectiveness/shame .64*** (.30**) 1.7/1.7 .8/.9
re-assessments, (2) a significant elevation of mean scores at the
Social undesirability .67*** (.50***) 2.0/1.9 .9/1.0
Failure to achieve .42*** (.22*) 1.6/1.7 .9/.9 DAS assessment at T2 for NDs, and finally (3) no significant change
in mean scores for PDs at T2. These results persisted when
Restricted self-expression .59*** (.34**) 2.4/2.3 .7/.7
Emotional inhibition .54*** (.35**) 2.0/1.8 .9/.8
excluding currently depressed participants at T2.
Self-sacrifice .57*** (.45***) 2.8/2.9 .9/.9
Unrelenting standards .57*** (.41***) 2.2/2.3 .9/.9 4. Discussion
Impaired limits .58*** (.59***) 2.0/1.8 .6/.7
Entitlement/grandiosity .53*** (.56***) 1.9/1.8 .7/.7 The present study sought to increase our knowledge about
Insufficient self-control .54*** (.51***) 2.0/1.9 .7/.8 cognitive characteristics that may predispose to depression by
Note: T1 ¼ Time 1; T2 ¼ Time 2; BDI ¼ Beck Depression Inventory; examining the relative and absolute stability and conceptual
DAS ¼ Dysfunctional Attitude Scale; YSQ ¼ Young Schema Questionnaire. overlap between dysfunctional attitudes and early maladaptive
*p < .05; **p < .01; ***p < .001 (Two-tailed). schemas (EMSs).
a
Converted BDI-I to BDI-II total score.
First, to begin with the stability of depressive symptoms,
a significant relative and absolute stability was found over the time
span of nine years, but the testeretest correlation decreased in
for paired samples were used to examine mean-level stability of addition to a significant reduction in mean-level scores, when
scores of the DAS (N ¼ 115) and the YSQ scales (N ¼ 82) for the excluding currently depressed participants at T2. This finding was
follow-up samples (Table 4). T-tests were first performed on the not surprising, given the fact that subjects diagnosed with a major
total sample and next on each subsample of CDs, PDs, and NDs (i.e., depression usually report high scores on the BDI. Subsample
the subsamples reflecting diagnostic status at T1). In order to analyses indicated however, stable and elevated level of depressive
correct for multiple testing, a Bonferroni adjusted alpha level was symptoms in PDs. Since several researchers have pointed out that
used (P ¼ .017 e .05/3 scales for the DAS and P ¼ .002 e .05/21 scales a negative mood-state may increase accessibility of putative
for the YSQ scales). vulnerability factors in vulnerable individuals (Person & Miranda,
In relation to the DAS scales, mean scores on DAS total 1992; Zuroff et al., 1999), this finding is important. Accordingly,
(t(114) ¼ 3.85, p < .001) and Approval by Others (t(114) ¼ 2.99, our results indicate that vulnerable individuals (i.e., PDs and CDs),
p ¼ .003) were significantly reduced at retest but not Performance although going in and out of major depressive episodes, may
Evaluation. Also, when excluding participants who were currently display some stability of depressive symptoms.
depressed (N ¼ 19) at T2 and re-running the analyses, the results With regard to the stability of schemas characterizing individ-
were equivalent. Subsample analyses revealed that only CDs’ mean uals vulnerable to depression, we found significant relative stability
scores were significantly reduced in the same manner as for the of dysfunctional attitudes and several EMSs, also after controlling
total sample. Furthermore, when also excluding currently for depression severity at both assessments, indicating that an
depressed participants at T2, PDs showed the same pattern of mean elevation of these schemas are not merely a consequence of
score reduction as CDs. increased levels of depressive symptoms, but may also constitute
Concerning the YSQ scales, mean scores for the vast majority of traits. In general, the testeretest correlations of the DAS, and
the domains and subscales were not significantly different at retest especially the DAS Approval by Others, were moderate significant
for the total sample with the exception of a significant reduction on and little influenced by depression severity. Analyses on absolute
the following subscales: Abandonment/Instability (t(81) ¼ 2.02, stability, however, revealed the opposite pattern, i.e., Approval by
p ¼ .047), Mistrust/Abuse (t(81) ¼ 2.70, p ¼ .009), and Emotional Others, in addition to the DAS total, showed a significant reduction
Inhibition (t(81) ¼ 2.40, p ¼ .019) at T2. Also, when excluding in mean score from T1 to T2, whereas this was not the case for
participants who were currently depressed (N ¼ 13) at T2 and re- Performance Evaluation.
running the analyses the results were equivalent in addition to Furthermore, testeretest correlations of the YSQ scales indi-
a significant reduction in mean scores on the domain scales of cated moderate significant relative stability for the domain scales
Disconnection (t(68) ¼ 2.46, p ¼ .016) and Impaired Limits (t Disconnection and Impaired Limits, also after controlling for
(68) ¼ 2.03, p ¼ .046), and the subscales of Social Isolation/Alienation depression severity at both assessments. Analyses on absolute
 C.E.A. Wang et al. / J. Behav. Ther. & Exp. Psychiat. 41 (2010) 389e396
stability, however, showed the opposite pattern. That is, only three
subscales showed a significant reduction in mean scores, of which
two from the domain scale of Disconnection. After excluding
currently depressed at T2, a significant reduction in mean score was
also evident for the domain scale Impaired Limits. Accordingly, the
DAS Approval by Others, and the YSQ domain scales Disconnection
and Impaired Limits, were the most stable scales on relative
stability, but least stable on absolute stability.
Regarding the other three YSQ domains, i.e., Impaired
Autonomy, Undesirability, and Restricted Self-Expression, the
testeretest correlations were moderately significant, but dropped
considerable when controlling for depression severity. While the
Enmeshment/Undeveloped Self subscale showed no stability at all,
the Dependence/Incompetence and Subjugation subscales seemed
to be especially mood sensitive. Previous research has reported that
themes of dependence, incompetence and subjugation may be
considered as cognitive characteristics, which increase vulnera-
bility to depression (Beck, 1983; Blatt, 1974; Dunkley, Sanislow,
Grilo, & McGlashan, 2004). However, our findings indicate that
these schemas may be highly state dependent and more charac-
teristic of the depressive state rather than being a predisposing
vulnerability factor.
As concerns conceptual overlap between the DAS and the YSQ
scales, cross-sectional analyses revealed significant positive corre-
lations, especially between the DAS total and the YSQ domain
Undesirability. Also, our findings indicate that core beliefs
embedded in the subscale of DAS Performance Evaluation were
more strongly related to the EMSs as compared to core beliefs
comprised in the subscale of DAS Approval by Others. This is
especially true for the EMSs included in the YSQ subscales of
Defectiveness/Shame and Unrelenting standards, where the
correlation to Performance Evaluation remained strong also after
controlling for depression severity. Generally, these scales reflect
themes related to having a negative self-concept, being highly
perfectionistic or self-critical, and/or sensitive to performance
evaluation, which have shown to be cognitive characteristics pre-
disposing to depression (Zuroff, Mongrain, & Santor, 2004).
The weakest correlations between the DAS and YSQ scales were
obtained for the two YSQ subscales Enmeshment/Undeveloped Self
and Entitlement/Grandiosity. While the first one was highly mood-
dependent, i.e., showing no significant correlation when controlling
for depression severity, the subscale of Entitlement/Grandiosity was
the only scale that did not show a significant difference between CDs
and NDs, indicating no mood-state effect. According to Young,
Klosko, and Weishaar’s theory (2003), the Entitlement/Grandiosity
reflects overcompensation for the EMSs of Emotional Deprivation
and may be regarded as the counterpart of a depressive reaction.
This is an interestingly point of view given the fact that PDs scored
significantly higher on this schema compared to NDs. A possible
interpretation of this finding to be tested in further studies may
be that in PDs, the Entitlement/Grandiosity schema is activated as
self-defence against negative core beliefs and other maladaptive
schemas which may be more present when currently depressed.
Taken together, our findings indicate that the construct of EMSs, as
reflected in the YSQ, has unique conceptual bearings and may be
fruitful in the understanding of depression-prone cognitive char-
acteristics in future studies.
Limitations of this study should be mentioned. Since our sample
comprised of mainly female and mildly depressed subjects, future
studies are necessary to investigate in clinical samples the gener-
alizability of our findings to both more severely depressed and male
individuals. Furthermore, due to the fact that almost all of the YSQ
domains and subscales were elevated in the depression-prone
individuals, it is elusive whether any of the EMSs is representing
a unique vulnerability factor to depression. Accordingly, further
395
research is needed to investigate the specificity of the EMSs in
depression by including a control group with psychological disor-
ders different from major depression. Finally, explorative analyses
showed now differences in demographic variables between those
who were followed-up compared to those who did not participate
at T2. However, as parameter estimates can be inflated by list-wise
deletion, the withdrawal of participants from T1 to T2 may still be
considered as a limitation of the study.
In conclusion, the results from the present study support a state-
trait vulnerability model of depression comprising stable differ-
ences in availability of dysfunctional attitudes and EMSs, but also
fluctuating differences in accessibility of those schemas during the
course of depression. Furthermore, the findings point to the
significance of the YSQ scales as vulnerability markers for depres-
sion in addition to the more established DAS scales.
Acknowledgements
The authors would like to thank the participants and the
research assistants who contributed in the data collection and
Professor Mick Power for his valuable comments on the statistical
analyses and on an early draft of the paper. The project has been
financially supported by the Norwegian Research Council, the
Norwegian Foundation for Health and Rehabilitation, the Norwe-
gian Council for Mental Health, and the Psychiatric Research Centre
of Northern Norway.
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