Primenjena psihologija
Vol. 15, No. 4, pp.435-452, 2022
Research Article
Role of Mindfulness between Early
Maladaptive Schemas and Post-Partum
Depression: a Ray of Hope
Rida Fatima1 , Alishba Hania1 and Momal Zafar1
1 Department of Psychology, Institute of Southern Punjab, Multan, Pakistan
Mothers of a newborn face a lot of physical and psychological challenges and early
maladaptive schemas play a significant part in determining long-term negative
consequences such as post-partum depressive symptoms. This research proposed
that mindfulness could play a positive role between the early schemas and post-
partum depressive symptoms among new mothers. Data was collected from a
sample of 170 mothers who gave birth from February 2020 to August 2020. The
young schema questionnaire-SF, Edinburgh postnatal depression scale, and the
Kentucky inventory for mindfulness scale were administered. Study findings show
mindfulness mediates the association between five sub-domains of maladaptive
schemas namely impaired autonomy, impaired limits, disconnection, over-vigilance,
other-directedness, and post-partum depression. Findings indicate that mindfulness
could be a contributing factor against postpartum symptoms and play significant
role in mother and infant’s well-being during the challenging time of transition.
: early maladaptive schemas, mindfulness, postpartum depression
UDC: 364.624.2:618.4:159.9
DOI: 10.19090/pp.v15i4.2374
Received: 09.10.2021.
Revised: 04.04.2022.
Accepted: 14.06.2022.
Copyright © 2022 The Author(s).
This is an open access article distributed
under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author
and source are credited.
Corresponding author email:
Fatima et al.
PP (2022) 15(4), 435-452
Buddhism proposed the fundamental idea that life is primarily defined
by imperfections. Consequently, our psychological capacity to remember
positive things and fight negative experiences is futile. Giving birth is a
potentially stressful and critical experience and event for mothers, entailing
different changes at the interpersonal and individual levels. This can cause
various types of distress running in force and span (e.g., Guzzo & Hayford, 2020).
Both carrying a child and giving birth can be considered traumatic and potentially
stressful experiences requiring mothers to deal with several adjustments in their
habits, priorities, lifestyles, self-image, and personal identity (Molgora et al., 2018).
Even though most women overcome numerous challenges in the time of
pregnancy and postpartum, it has additionally been seen that a proportionate
number of mothers think that it is hard to recuperate from post-partum
depression (e.g., Nagy et al., 2011).
Early maladaptive schemas can be explained as broad, self-perpetuating,
and maladaptive life events starting from hostile social encounters with
important characters in both childhood and teenage years. It was also purported
that the main reason behind the development of maladaptive cognitive schemas
is repeated neglect of childs’ universal core psychological needs (autonomy,
spontaneity and play, secure attachment, realistic limits, freedom to express his
needs and emotions). Maladaptive schemas are unavoidable and stable over the
long run and significantly influence general information processing (Young et al.,
2003). Once a schema gets activated, a person experiences disturbing negative
emotions and feelings like shame, fear, and disgust. Some intrapsychic facets
could be significantly activated during the process of becoming a mother, for
instance, early relational experiences with significant figures in life. According to
Merle-Fishman (2010), the intricate psychological process of being transformed
into the role of a mother includes the re-organization of oneself. The outcome
of this process and experience are influenced by the mother's early social
encounters, portrayals, and re-lived memories.
PP (2022) 15(4), 453-472
Early Maladaptive Schemas and Post-Partum Depression
Headed for the cognitive theory of depression, early schemas proposed
precious addition to the idea of dysfunctional attitudes and automatic thoughts.
It is known that maladaptive schemas like failure, defectiveness, and self-
sacrifice were associated to the gravity of depressive symptoms in non-clinically
depressed samples (Calvete & Cardeñoso, 2005). According to Colodro-Conde
et al. (2018), childbirth is a stressful life event than can trigger the underlying
diathesis, resulting in symptoms of depression. Moreover, the diathesis-stress
model of depression purports that certain individuals are highly predisposed to
depression in the context of adverse life events. The empirical outcomes
proposed cognitive vulnerability as a particular diathesis for depression
symptomatology (Kenny et al., 1993). Renner et al. (2012) suggested specific
maladaptive schemas like emotional deprivation, instability, and failure were also
related to the severity of depressive symptoms. Likewise, the disconnection
domain has been related to depression prospectively and cross-sectionally (Van
Vlierberghe et al., 2010).
Research results also indicate that the schema domain of impaired
autonomy, disconnection, and other-directedness, is related to the level of social
anxiety and depressive symptoms and the stability of depressive symptoms with
time (Calvete et al., 2015). The schema of self-sacrifice and social isolation,
mistrust and social isolation, and other-directedness facilitated the relation
between depressive symptoms and estrangement from peers, trust in parents,
and quality of attachment relationships, respectively (Roelofs et al., 2011).
Depressive symptoms and impaired autonomy association had also been found
in prior literature (Shih, 2006). The schema domain of other-directedness that
focuses on others, such as approval, sociology, social evaluation concern, and
neediness forecast depressive symptoms (Rudolph & Conley, 2005).
During the transition of motherhood, a woman’s encounters with a
significant change in life might be triggered accompanied by serious uneasiness,
vulnerability, emotional fluctuation, and uncertainty related to parenthood.
Considering postpartum depression, some studies validate a significant
connection between insecure attachment style and depressive indicators (Ikeda
et al., 2014). Though these findings provide empirical evidence that mothers’ early
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PP (2022) 15(4), 435-452
social experiences affect the adjustment level post-partum. Consequently,
considering the predisposition of post-partum symptoms, this research intends
to highlight a protective factor that is hypothesized to intervene between two
negatively influencing variables called early maladaptive schemas and post-
partum depressive symptoms. This protective factor is supposed to have the
potential of becoming a ray of hope in a time of despair.
Mindfulness is characterized as a state of mind in which an individual
focuses on experience in the current moment in a non-judgmental manner
(Miller et al., 1995). The concept of mindfulness originated from Buddhist practice
(Van Gordon et al., 2016). Prior studies have revealed that positive significant
relationships exist between mental health and mindfulness (Desrosiers et al.,
2013) and the positive outcomes of applying mindfulness-based techniques for
mental distress (Eberth & Sedlmeier, 2012; Khoury et al., 2013). Cecero et al. (2008)
studied the relationships between maladaptive schemas and mindfulness. The
researcher found a negative relationship between maladaptive schemas and
psychological mindfulness except for the abandonment schema (Bishop et al.,
Mindfulness whether enhanced and learned through meditation
intervention or dispositional, is constantly related to lower rates of depression
and anxiety (Tran et al., 2014). Improved mindfulness skills are known to diminish
depressive symptoms later in the prenatal period (Nyklíček et al., 2018), prevent
depression relapse (Kuyken et al., 2016), and promote mother and infant well-
being (Guo et al., 2020). Previous literature shows mindfulness has a negative
relationship with several depressive disorders and their predictors (Carmody &
Baer, 2008; Radford et al., 2014). Additionally, if mindfulness increases, the usage
of maladaptive schemas would decrease (Arpaci, 2019; Hosseinzadeh et al., 2019;
Martin et al., 2018; Yalcin et al., 2017). Grigorian et al. (2020) revealed that the early
schemas of disconnection and over-vigilance are negatively related to acting
with awareness. Furthermore, mindfulness is reported to be negatively related
to impaired limits, however, describing and observing experience (sub-levels of
mindfulness) are related to disconnection/rejection.
PP (2022) 15(4), 453-472
Early Maladaptive Schemas and Post-Partum Depression
According to Janovsky et al. (2019), some sides of mindfulness may
partially operate the relationship between maladaptive schemas and
interpersonal difficulties. A significant relationship was observed between the
mindfulness levels of females and the early maladaptive schemas except for the
enmeshment, emotional deprivation, pessimism, abandonment emotional
inhibition, and entitlement schemas (Shorey, Anderson, et al., 2015). On the
contrary, (Shorey, Brasfield, et al., 2015) among males there is a strong negative
relationship between mindfulness and early maladaptive schemas, except for
entitlement, unrelenting standards, and emotional deprivation. Early
maladaptive schemas can be activated when the individuals as adults are unable
to enact the healthy adult mode and their mindfulness levels supposedly
decrease due to triggered schemas (Thimm, 2017).
As suggested by positive psychology, constructive characteristics in a
person should be emphasized rather than negative, in order to bring long-term
psychological strength. Likewise, it is essential not to activate individuals' early
maladaptive schemas and improve their level of mindfulness. People need
understanding and empathy, instead of being criticized harshly, their self needs
should be improved, as they need advice to make up for their deficiency, and
decrease unrelenting standards. All these factors consequently improve
mindfulness (Young et al., 2009). We hypothesized that the negative schemas
and postpartum depressions are two negatively influencing factors and the
disputing variable that could be enlightened as a positive ray of light in between
them could be the mindfulness level of a person. This research intends to spread
awareness among researchers and victims of postpartum depression that
mindfulness can play an intervening role between two connecting negative
factors in a time of despair.
The current study involved 170 mothers who gave birth from February
2020 to August 2020. The demographic characteristics of respondents were
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PP (2022) 15(4), 435-452
noted and later on converted to categorical variables to explain the sample
characteristics. Respondents’ age ranged from 18 years to 43 years old (
= 25.73;
= 4.94). Some other demographic properties that were noted, were level of
education (8.8% were illiterate, 5.4% were primary graduates, 41.4% were middle
school graduates, 44.6% were college graduates), duration after childbirth (1 to
12 weeks passed for 49.50%, 13 to 25 weeks passed for 14.10% and 26 to 36 weeks
passed for 36.90%, Duration of marriage (11 to 53 months for 40.00%, 54 to 96
months for 40.20%, 97 to 139 months for 11.40% and 140 to 180 months for 7.50%,
and the type of birth (43% C-section delivery and 58% vaginal delivery).
Data was collected in person through the paper and pencil method using
purposive sampling. To ensure validity, all measure items had been translated
using the forward-backward method of translation.
Edinburgh Postnatal Depression scale (Naveed et al., 2015)
Edinburgh Postnatal Depression Scale (EPDS) is a renowned self-report
10-item scale. It was constructed for examining postpartum depression.
Respondents were asked to answer the questions using a four-point scale that
ranges from 0 to 3 (
as much as I always could to not at all
). The total score of the
scale was taken by the sum of scores of 10 items (Cox et al., 1987). The composite
reliability for Urdu translated scale was .86.
The Young Schema Questionnaire-Short Form (Young et al., 2003)
The Young Schema Questionnaire-Short Form (Young et al., 2003) is a
75-item self-report scale that is used to assess the severity of early maladaptive
schemas, which are grouped into five domains. Each of the 15 sub-schemas
consists of five items and every item is rated on a six-point Likert- scale that
ranged from 1 -
completely untrue of me
to 6 -
describes me perfectly
. The sub-
scales composite reliability (Over vigilance/Inhibition, Disconnection/Rejection,
Impaired autonomy/Performance, Impaired Limits, Other Directedness) for the
current study was .881, .876, .765, .897, and .773 respectively.
PP (2022) 15(4), 453-472
Early Maladaptive Schemas and Post-Partum Depression
Disconnection/rejection is comprised of social isolation, mistrust, and emotional
deprivation. Impaired autonomy is explained by dependence, enmeshment, or
vulnerability to harm. Impaired limit is defined by entitlement and insufficient
self-control. Other directedness is explained by subjugation and self-sacrifice.
Lastly, over-vigilance is explained by schemas of emotional inhibition and
unrelenting standards.
Kentucky Inventory of Mindfulness Skills (KIMS) (Baer et al., 2004)
Kentucky Inventory of Mindfulness Skills is 39 items scale that measures
the four components of mindfulness including acting with awareness,
describing, accepting without judgment, and observing (Baer et al., 2004). The
scale ranged from 1 -
never or rarely true
to 5 -
always or almost always true
Internal consistency of scale in the current study found overall .781 and .605 to
.797 across subscales.
Study data analysis was carried out using SMART-PLS 3.2.8 (Ringle et al.,
2015) to check the indirect effect of early maladaptive schemas on post-partum
depression through mindfulness. Early maladaptive schemas domains (Impaired
Limits, Impaired autonomy/Performance, Over-vigilance/Inhibition, Other
Directedness, and Disconnection/ Rejection,) were considered as explanatory
variables and postpartum depression was measured as the criterion variable in
the path analysis. Data analysis included the measurement and structural model.
Measurement model
A measurement model was run to assess the convergent validity of the
tools used for research and the evaluation was conducted through average
variance extracted (AVE). The outer model was validated via a path weighing
scheme as suggested by (Garson, 2012; Hair et al., 2012). The outer loading was
considered to be significant with a score of .6 (Hair et al., 2011). The psychometric
effectiveness was improved by excluding the items with outer loadings lesser
than .6. the composite reliability was accepted with a value greater than .6. As
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PP (2022) 15(4), 435-452
shown in Table 1, AVE, as well as composite reliability, appeared to be
satisfactory in the measurement model.
Table 1
The measurement model test
Composite Reliability
Average Variance
Postpartum Depression
Early Maladaptive Schemas
Impaired autonomy or
Disconnection and rejection
Impaired limits
Over vigilance/ inhibition
Structural Model
Direct and indirect relationships were analyzed through bootstrapping
technique (Preacher & Hayes, 2008). Dimension vise results have been presented
in Figure 1 and comprehensive results are explained in Table 2.
PP (2022) 15(4), 453-472
Early Maladaptive Schemas and Post-Partum Depression
Figure 1. Specific indirect effect
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PP (2022) 15(4), 435-452
Table 2
Mediation through Mindfulness on Early Maladaptive Schemas and Postpartum
Impaired autonomy or Performance ->
Mindfulness -> Post-Partum Depression
Other-directedness -> Mindfulness -> Post-
Partum Depression
Disconnection and rejection -> Mindfulness ->
Post-Partum Depression
Impaired limits -> Mindfulness -> Post-Partum
Over vigilance/ inhibition -> Mindfulness -> Post-
Partum Depression
. β standardized beta coefficient; M Mean; SD Standard deviation; t t-test; p
p value.
Five domains of early maladaptive schemas namely (Impaired
autonomy/Performance, Other Directedness, Disconnection/ Rejection, and
Over-vigilance/Inhibition, and Impaired Limits,) showed significant mediation
through mindfulness to postpartum depression. Thus, from these results, we can
say that mindfulness mediates the relationship between early maladaptive
schemas and post-partum depression.
Nurturing an infant is significant life stress and a critical time for mothers.
Some mothers encounter trouble adapting to this significant life changes
(Sheinkopf et al., 2006). Though most women are resilient towards stress
(Holopainen & Hakulinen, 2019), some of them face some psycho-social
challenges that threaten their subjective well-being. Consequently, it can disturb
daily personal and occupational functioning (Diorgu et al., 2016). This research
contributes to existing research related to maternal health.
PP (2022) 15(4), 453-472
Early Maladaptive Schemas and Post-Partum Depression
The current research focused on examining the intervening function of
mindfulness between predisposed early maladaptive schemas and post-partum
depression in women after giving birth. This conclusion supported prior research
(Grigorian et al., 2020) that the EMSs domains of disconnection/rejection, and
over-vigilance and inhibition are negatively associated with a sub-level of
mindfulness called acting with awareness. Additionally, disconnection/rejection
are negatively related to unfolding experiences, and observing encounters and
impaired limits are associated to the other four mindfulness facets.
Current study outcomes were supported because five domains of
predisposed early maladaptive schemas namely (Other Directedness,
Disconnection/ Rejection, Impaired autonomy/Performance, Impaired Limits,
and Over-vigilance/Inhibition,) showed significant mediation through
mindfulness to post-partum depression. These findings are backed by the
propositions of Shorey, Brasfield, et al. (2015) in which early maladaptive schemas
and mindfulness separately for females and male substance users are studied.
The association between mindfulness and predisposed early schemas is
consistent because the occurrence of maladaptive schemas is intervened the
level of mindfulness.
A massive body of literature suggests that self-compassion and
mindfulness are key methods in appeasing depressive symptoms which might
have adverse effects on both the infant and the mother (Luberto et al., 2018;
Malis et al., 2017). Improved maternal mindfulness may strengthen positive
experience before and after giving birth. Mindfulness may decrease adverse
outcomes of unavoidable difficult events and enhance productive coping from
these circumstances (Bergomi et al., 2013). Aligned with these propositions, a
qualitative study outcome proves that mothers who attend an ante-natal
mindfulness based childbirth training program stay more confident during
childbirth and after (Fisher et al., 2012). Although, as far we know, no quantitative
study investigated the impact of motherly dispositional mindfulness on
subjective childbearing experience and postpartum symptoms.
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PP (2022) 15(4), 435-452
These findings provide significance on the potential advantages of
mindfulness-based practices in health advancement outreach endeavors
designed for such a population. It could influence mothers' and mothers-to-be’
intentions to seek mindfulness-based practices. Developing mental health
facilities and intervention and compassion-based approaches that are effective
in persuading and motivating mothers to explore the possible benefits from such
practices as mindfulness meditation may help the mothers to develop positive
attitudes that can provide lifelong mental and physical health benefits. Thus, the
present study can be useful in order to enhance subjective well-being by
developing mindfulness competency during pregnancy.
Limitations and Future directions
Despite the current study's contributions, few barriers exist that should
be addressed. The study outcomes were derived from a small sample of mothers
after childbirth from Pakistan. Future researchers should replicate the study with
samples from other countries to ensure that the study findings can be
generalized across samples. An experimental study can test whether
mindfulness-based intervention during pregnancy help to reduce the risk of
post-partum depression.
Conflict of interest
We have no conflicts of interest to disclose.
Data availability statement
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
PP (2022) 15(4), 453-472
Early Maladaptive Schemas and Post-Partum Depression
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