Relationship between Early Maladaptive Schemas and Anxiety in Adolescence and Young Adulthood: A systematic review and meta-analysis

Background: : Early maladaptive schemas (EMS) are self-perpetuating dysfunctional cognitive structures that have been linked with youth psychological health and play a significant role in developing and maintaining psychological distress, including anxiety symptoms. Method: : The present meta-analysis synthesises the existing literature to evaluate the strength of association between EMS and anxiety symptoms among adolescents and young adults (aged 10-29 years). The systematic literature search was carried out in October 2019 using six different databases. Results: : Our systematic search has identified 15 studies, comprising of 9515 participants (Mean age = 18.95, SD = 5.30). All the studies assessed were either cross-sectional or longitudinally designed. The random effect estimate for overall EMS with anxiety was r = 0.59 (95% Cl = 0.50 to 0.68, Z = 9.69, p < 0.0001), indicating a strong association between EMS and anxiety. When different schema domains were investigated separately, anxiety was shown to have significantly stronger associations with the schema domains of disconnection/ rejection (r = 0.50), impaired autonomy/performance (r = 0.47) and other-directedness (r = 0.49). Further, females were found to have higher schemas of hypervigilance and other-directedness and associated anxiety symptoms compared to males. Limitations: : Meta-analytical results were limited to articles published in peer-reviewed journals in English language, inducing an upward publication bias and limiting the generalizability of the findings. Conclusions: : The findings highlight schemas related to disconnection/rejection, impaired autonomy/performance and other-directedness as particularly salient precursors of anxiety symptoms, providing evidence for clinicians to target these particular schemas during prevention, intervention, and management of anxiety disorder.