s (1995) Early Maladaptive Schemas (EMS) are assumed to be highly stable and enduring beliefs that are responsible for the persistence and poor treatment response of a variety of clinical problems. EMS are now the basis for a growing number of specialized "schema-focused" treatments. However, the critical assumption that they are stable constructs remains largely unexamined and open to question. This study examined the long-term stability of Young's EMS in 55 depressed outpatients over a 2.5 to 5-year interval. EMS exhibited moderate to good levels of stability, even after controlling for severity of depression and neuroticism at both time points, and moderate levels of discriminant validity. A comparison of these results with existing literature revealed that the stability and discriminant validity of EMS are quite similar to the stability and discriminant validity of personality disorder features. Additional work is needed to examine the stability of EMS across greater fluctuations in mood and in different clinical populations. Our findings for the stability of EMS may be generalizable to the more general notion of core beliefs. Future work needs to focus on further theoretical development and improved measurement of EMS.

ve been depressed as long as I can remember." "Everyone says I'm a depressive." "I'm not sure what you mean by normal mood. I've always been this way." "Somehow I've managed to get by at work, but deep down I am always depressed and unhappy.""Over the past 10 years, I haven't been without my depression for more than a week or two. It's always there in the background." Chronic depression is common (19% of depressed patients; Keller & Hanks, 1995), difficult to treat (Rowland, 2004;Keitner & Cardemil, 2004), and a significant public health problem (Howland, 1993). Once of limited interest to psychiatry and psychology, chronic depression is now a problem receiving considerable attention in the literature. For instance, a computerized PsycINFO search revealed more than 400 journal articles addressing some aspect of chronic depression and three edited books focusing on chronic depression specifically (Akiskal & Cassano, 1997; Alpert & Fava, 2004;Kocsis & Klein, 1995). In this chapter, we describe the different forms of chronic depression, review the distinction between chronic depression and nonchronic depression, and present the rationale, tools, and techniques for a schema-focused approach for chronic patients. A case presentation at the end of the chapter illustrates how to conceptualize and treat an individual with chronic depression using a schema-focused approach. Although major depressive disorder was discussed in chapter 2 (this volume), a separate 41