Neurocognitive Model of Schema-Congruent and -Incongruent Learning in Clinical Disorders: Application to Social Anxiety and Beyond

Abstract

Negative schemas lie at the core of many common and debilitating mental disorders. Thus, intervention scientists and clinicians have long recognized the importance of designing effective interventions that target schema change. Here, we suggest that the optimal development and administration of such interventions can benefit from a framework outlining how schema change occurs in the brain. Guided by basic neuroscientific findings, we provide a memory-based neurocognitive framework for conceptualizing how schemas emerge and change over time and how they can be modified during psychological treatment of clinical disorders. We highlight the critical roles of the hippocampus, ventromedial prefrontal cortex, amygdala, and posterior neocortex in directing schema-congruent and -incongruent learning (SCIL) in the interactive neural network that comprises the autobiographical memory system. We then use this framework, which we call the SCIL model, to derive new insights about the optimal design features of clinical interventions that aim to strengthen or weaken schema-based knowledge through the core processes of episodic mental simulation and prediction error. Finally, we examine clinical applications of the SCIL model to schema-change interventions in psychotherapy and provide cognitive-behavior therapy for social anxiety disorder as an illustrative example.

Keywords: anxiety/stress disorders; memory; mental simulation; neuroscience; social cognition; treatment.

Fig. 1.

Proposed schema-congruent and -incongruent learning (SCIL) model illustrating the neurocognitive processes of mental simulation, schema processing, and schema updating. When an individual is cued to remember or simulate an event, the ventromedial prefrontal cortex (vmPFC) activates a schema that guides how the hippocampus constructs a mental simulation of this event (blue arrows). Interconnected regions (in red) between these structures provide the emotional component (amygdala) and evaluations (orbitofrontal cortex [OFC]) of the schema and event that affect the nature of schema- and event-simulation processes. An active dominant schema will drive the connected hippocampus to access and associate content in the posterior neocortex that is congruent with the schema (blue arrows). When an active schema is challenged and the posterior cortical event details included in a mental simulation are schema-incongruent, a prediction error is signaled and detected by hippocampal and associated regions, including those in the lateral prefrontal cortex, and this prediction error drives updating of the schemas represented in the vmPFC (green arrows).

Fig. 2.

Illustration of schema-congruent learning processes within the proposed neurocognitive schema-congruent and -incongruent learning (SCIL) model, focusing on the roles of the hippocampus and ventromedial prefrontal cortex (vmPFC). When a cue triggers the recovery or imagination of an event, (1) an associated schema will be activated by the vmPFC to direct the construction of the detailed episodic mental simulation of the event by the hippocampus (blue arrows). (2) Driven by the vmPFC schema, the hippocampus will associate event details processed in the posterior neocortex that are congruent with the schema. (3) This episodic mental simulation constructed with only schema-congruent event details will confirm the predictions of the schema and thus strengthen the associated representation.

Fig. 3.

Illustration of schema-incongruent learning processes within the proposed neurocognitive schema-congruent and -incongruent learning (SCIL) model, focusing on the roles of the hippocampus and ventromedial prefrontal cortex (vmPFC). When a cue triggers the recovery or imagination of an event, (1) an associated schema will be activated by the vmPFC to direct the construction of the detailed episodic mental simulation of the event, which is supported by the hippocampus (blue arrow). (2) Driven by the vmPFC schema, the hippocampus will access and associate event details processed in the posterior neocortex that are congruent with the schema but also incongruent schema details. (3) When a mental simulation of an event is constructed with salient schema-incongruent details that violate schema-congruent expectancies, a prediction error will be detected by the hippocampus and other brain regions (e.g., lateral prefrontal cortex). (4) The prediction error will lead to updating or weakening of the activated schema.

Fig. 4.

Therapeutic application of the neurocognitive schema-congruent and incongruent learning (SCIL) model to facilitate schema-incongruent learning in social anxiety disorder for the purpose of weakening the influence of negative or maladaptive schemas. In this example, a negative or maladaptive schema is active. Elements of the mental simulation that are schema-incongruent are highlighted in red, and schema-congruent elements are highlighted in blue.

Fig. 5.

Therapeutic application of the neurocognitive schema-congruent and incongruent learning (SCIL) model to facilitate schema-congruent learning in social anxiety disorder for the purpose of strengthening the influence of positive or adaptive schemas. In this example, a positive or adaptive schema is active. Elements of the mental simulation that are schema-incongruent are highlighted in red, and schema-congruent elements are highlighted in blue.