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Abstract Aim and Background: the aim of this study was to evaluate effectiveness of schema therapy in reducing symptoms and adjusting early maladaptive schemas in patients with bipolar disorder. The purpose was to identify patient’s maladaptive schemas and attempt to modify or change them. Methods and Materials: Subjects included 30 patients, 10 men and 20 women that were chosen by convenience sampling from visitors of Nour Medical Center, two mental health clinics in Isfahan and Baran ‘e’ Mehr counselling center in Shahin Shahr. They were diagnosed with bipolar disorder (type I or II) by a psychiatrist using DSM-IV-TR and receiving medical treatment, were randomly put in two groups. Test group received medical treatment with schema therapy and the control group received only medical treatment. Young mania rating scale (YMRS), bipolar depression rating scale (BDRS) and Young schema questionnaire (YSQ3) were used before and after treatment. Data were analyzed by multivariate analysis of variance and covariance using SPSS 18.0. Findings: Controlling the covariate variable, differences between two groups after the intervention were significant for all three variables of symptoms of mania and depression and early maladaptive schemas (P<0.01). Conclusions: schema therapy as an adjuvant psychological treatment with medication can be effective in reducing symptoms and adjusting the early maladaptive schemas in patients with bipolar disorder, therefore providing regular protocols for schema therapy and adding it to medical treatment is suggested.  

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Aim and Background: Depression is one of the most common comorbidities of chronic pains such as chronic back pain and is the cause of limitations in the efficacy of cognitive-behavioral therapies (CBTs) in individuals with chronic pain. The existence of similar limitations and problems in cognitive-behavioral programs for the treatment of depression has caused a growing trend in the use of schema therapy by researchers in this regard. The aim of the present study was to compare the effectiveness of CBT and schema therapy on the reduction of depression in Iranian patients with chronic low back pain. Methods and Materials: The present clinical trial was conducted with a quasi-experimental design, pretest-posttest, fallow-up, and control group. In this study, 35 patients with chronic low back pain who were referred to pain specific clinics or neurosurgery clinics of Akhtar Hospital and Imam Hussein Hospital (AS) in Tehran, Iran, were selected through purposive sampling method. All patients completed the Chronic Pain Questionnaire, and Depression Subscale of the Depression Anxiety Stress Scales (DASS-21) in the pretest, posttest, and 2 months follow-up stages. Moreover, the schema therapy group completed the 90-Item Short Form of Young Schema Questionnaire (YSQ-SF) in addition to the mentioned questionnaires. Mixed effect regression model was used in SPSS software to investigate the efficacy of the two therapy methods on the reduction of depression in patients with chronic back pain.   Findings: Results showed that CBT (P < 0.005) and schema therapy (P < 0.033) had significant impacts on depression in patients with chronic low back pain in the 2 months follow-up stage. However, there was no significant difference between the two groups in terms of depression reduction in this stage (P < 0.519). Conclusions: Both CBT and schema therapy are effective in improving symptoms of depression in patients with chronic low back pain and can be used as appropriate treatment methods in patients with chronic pain and depression.

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Aim and Background: Addiction and its unpleasant consequences are one of the most important public health problems worldwide. Initial maladaptive schemas are related to addiction. The purpose of this study was to compare the effectiveness of admission and commitment therapy (ACT) and schema therapy on early maladaptive schemas in addicted people. Methods and Materials: The research method was pre-test, post-test experimental study with control group. The statistical population included 1500 people. A sample of 60 people was selected and randomly assigned to 3 groups, one control group (n = 20), and two experimental groups (n = 20, each). Young schema questionnaire short form (YSQ-SF) was used to measure early maladaptive schemas. The experimental groups participated in 12 sessions of the treatment group weekly for two 90-minute sessions. Descriptive statistics including mean and standard deviation, and inferential statistics were analyzed using covariance analysis, homogeneity and uniformity tests of variance and post hoc test. Findings: ACT and schema therapy were effective on the components of early maladaptive schemas. Conclusions: The group-based ACT and schema therapy have been able to reduce early maladaptive schemas and can be used in the treatment of patients with this disorder.

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Aim and Background: Somatic symptoms make a significant part of admittances to health centers. Since clinical observations have linked these symptoms with emotions, the present study was conducted to investigate the effectiveness of emotional schema therapy on decreasing negative emotional schemas, Alexithymia And Signs of Patients with somatic Symptoms. Methods and Materials: The present study was a type of semi-experimental research with pre-test post-test design with control group. The population of this study was all female patients with somatic symptoms of Isfahan province and sample included 30 referents from counseling centers of Isfahan and Khomeini shahr with somatic symptoms that were selected based on Judgment sampling and with psychiatrist's and psychologist's discriminant and divided into two experimental (15) and control (15) groups. The experimental group received 12 sessions of emotional schema therapy approach. The Leahy Emotional Schematic Scale (LESS), Toronto Alexithymia Scale (TAS_20), and the B-Score Somatic Symptom Inventory (SSD-12) were used for participants. Data were analyzed using descriptive statistics and multivariate analysis of covariance in SPSS 24. Findings: After the implementation of emotional schema therapy, there was a significant difference in the negative emotional schemas (F: 8. 24, P<0. 008), alexithymia (F: 250. 89, P<0. 001) and somatic symptoms (F: 374. 59, P<0. 001) in the experimental group compared to the control group and the mean scores of the experimental group were significantly lower than the control group. Conclusions: The results of this study showed The Emotional Schema Therapy Model, based on the existence of a relationship between negative emotional schemas and alexithymia with somatic symptoms, by modifying the underlying emotional processes and improving the maladaptive strategies of individuals toward emotions, reduced the negative emotional schema and alexithymia and somatic Symptoms.

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Aim and Background: Anxiety can lead to heart disease in a 10-year interval, and heart disease, in turn, leads to anxiety; death anxiety. The purpose of this study was to determine the effectiveness of group schema therapy on reducing the death anxiety in cardiovascular patients. Methods and Materials: The statistical population included all patients with cardiovascular disease referred to Tehran heart center. The sampling method was of convenience and the research design was semi-experimental with the experimental and control groups including pre-test and post-test. Initially, the data from the Templer death anxiety scale were collected from 113 individuals and after a primary evaluation 30 individuals (18 women and 12 men) from the participants who had the highest marks in the test were involved in the research and assigned randomly to two experimental and control groups. It was previously considered that the participants did not suffer from a nervous condition disturbing consciousness, such as head injury and dementia. Then, the members of the experimental group were intervened for 12 sessions of 90 minutes by group schema therapy and after that, they were evaluated again in terms of the degree of death anxiety. Data were analyzed by SPSS version 23. Findings: The results showed that after the implementation of the schema therapy, the death anxiety level of the experimental group significantly decreased (p< 0.05, F= 147.4). Therefore, the hypothesis of the research on the effectiveness of group schema therapy on reducing death anxiety is confirmed. Conclusions: This finding may contribute to the current research vacuum regarding death anxiety in cardiovascular patients as well as to clinical applications in the face of this phenomenon.

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Aim and Background: The research aimed to investigate the effectiveness of emotional schema therapy on the mood symptoms and impulsivity of women with bipolar disorder (I, II).

Methods and Materials: Present research was semi-experimental study with pretest-posttest design and follow-up with control group that was performed on 30 female patients with bipolar disorder referring to the Farabi hospital in Isfahan in 2016. Participants were selected by available sampling, then they were randomly assigned to experimental (n=15) and control group (n=15). Participants responded to Barratt Impulsiveness Scale (2004), Hamilton Questionnaire and Young Mania Scale in three steps pretest, posttest and follow-up. Experimental group in addition to medication, they received emotional schema therapy in group method during 14, 90-minute sessions while the control group did not received any cognitive intervention. Descriptive statistics methods and analysis of multivariate Covariance and were used for analyzing the data

Findings: Findings showed that emotional schema therapy had impact on the dimensions of impulsivity and mood symptoms (depression and mania) of bipolar patients and this effectiveness continued to be sustained in fallow up 3 months later.

Conclusions: Applying emotional schema therapy along with drug therapy can be effective intervention for treatment of mood symptoms and impulsivity in patients with bipolar disorder.

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Aim and Background: One of the common problems in the couple's relationship is marital conflict that can lead to depression, addiction, and spousal abuse, verbal or physical conflict between married couples. The aim of this study was to determine the efficacy of an integrated approach of schema therapy based Acceptance and commitment therapy (ACT) on reduction of marital conflicts and divorce tendency in divorce applicant couples.
Methods and Materials: This study was quasi experimental with pretest, posttest and control group. The data statistical population includes all of divorce applicant couples to intervention crisis center of Mashhad in winter 2019. The sample include 30 couples (15 couples in group control and 15 couples in experimental group) were voluntary selected by convenience sampling with replacement. The experimental group underwent 10 sessions of 90 minutes educated by Schema therapy based Acceptance and commitment therapy protocol and control group was not under any intervention. Both groups were requested to answer marital conflict and divorce tendency questionnaire. Data were analyzed using MANCOVA covariance analysis and SPSS software.
Findings: The results showed that the schema therapy based acceptance and commitment therapy led to significant differences in the post test of the experimental group and the comparison of the meanings showed an decrease marital conflicts (ƞ 2 =0.52, p= 0.001, F= 67.03) and divorce tendency (ƞ 2 =0.54, p= 0.001, F= 66.18) in the experimental group (P<.01).
Conclusions: The findings of this study indicate the beneficial effects schema therapy based acceptance and commitment therapy (ACT) on marital conflicts and divorce tendency in divorce applicant couples.Counselors and family therapists can use this effective integrated approach to slove marital conflicts and help people to improve their marital relationships.

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Aim and Background: Research has shown that resilience and self-control are associated with marital boredom; In this regard, various therapeutic approaches have been used by researchers; therefore, this study was conducted to compare the effectiveness of emotion-focused and schema therapy approaches on ambiguity resilience, and self-control of women with marital burnout.
Methods and Materials: The research method was applied in terms of purpose and quasi-experimental in terms of implementation method with pretest-posttest design of two experimental groups and a control group with follow-up test. From the community of women suffering from marital burnout in district three of tehran, 45 people were selected by the convenient sampling method and were replaced in three groups using the random method. Ambiguity resilience questionnaire (Freison et al., 1994) and self-control questionnaire (Gramisk et al., 1993) were used. Research data were analyzed by ANOVA using repeated measures and bonferroni's post hoc test.
Findings: Findings showed that both emotion-focused and schema therapy approaches have a significant and lasting effect on increasing the resilience of ambiguity and self-control of women with marital burnout (p=0.001). Also, the result of comparing the two approaches showed that the effect of schema therapy approach on self-control of women with marital burnout is more than the emotion-focused approach (p=0.001). But the difference between the two approaches on the resilience of ambiguity was not significant.
Conclusions: According to the obtained results, it seems that the use of both schema therapy and emotion-focused approaches to improve self-control and resilience of ambiguity in women with marital burnout is effective and it is recommended to be used as therapeutic approaches.

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Aim and Background: Binge eating disorder (BED) is one of the most common eating disorders. Numerous factors such as aggression, rumination, anger, and anger rumination are associated with BED. The main purpose of this study was to investigate the effectiveness of schema therapy on anger rumination and aggression in men with binge eating disorder.
Methods and Materials: This quasi-experimental study was a pre-test and post-test design with a control group. The statistical population consisted of all men with BED who are members of the Mashhad Overeaters Anonymous (OA) association in 2020. Twenty four of them were selected by convenience sampling method and randomly placed in two groups (experiment and control groups). Pre-test was performed for both groups, including anger rumination scale (ARS) and aggression questionnaire (AQ). The control group did not receive any intervention. Post-test was completed for both groups and the results were analyzed by multivariate analysis of covariance.
Findings: The results showed that schema therapy reduces anger rumination and aggression in people with BED in the experimental group compared to the control group. (p <.01).
Conclusions: Based on the results of the present study, it can be said that therapists can use this treatment to reduce anger rumination and aggression in people with BED.

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Aim and Background:In recent years in Iran, several studies have examined the effectiveness of Dialectical Behavior therapy and Schema therapy  in the field of conflict resolving  and enriching the couple's .relationship.The purpose of this study is to integrate the results of previous research and compare the effectiveness of these interventions on marital quality components.
Materials and Methods:For this purpose, meta-analysis was used as a statistical technique to determine, collect, combine and summarize research findings related to the effectiveness of Dialectical Behavior therapy and Schema therapy on the components of marital quality of couples.The statistical population of the study includes researches conducted in Iran in the field of mentioned psychotherapies . The statistical sample includes research conducted in this field inside Iran. For this purpose, 19 studies were selected.After reviewing 17 researches that were methodologically acceptable, they were analyzed.The research tool was a meta-analysis checklist and CMA software was used to analyze the data.
Results:The results showed the magnitude of the combined effect of the treatments(P <0.01) was equal to r = 0.629, which is equivalent to z_r = 0.739 and g = 1.557, and according to Cohen's interpretation table means the size of the effect is large or high. Also, the results did not show a significant difference between the effect size of Dialectical Behavior therapy and Schema therapy.                                                                   
Conclusion:Based on the results of this meta-analysis, dialectical behavior therapy and schema therapy are effective in improving the marital quality components of couples.

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Aim and Background: Depression, as the most serious disease of the century, whose underlying factors play an important role in its formation and continuation, requires the design of treatments that have lasting effects. Based on this, the present study was conducted with the aim of investigating the effectiveness of Analytical Schema Therapy (AST) in reducing depression symptoms and modulating early emotional needs
Methods and Materials: The current research was conducted as a semi-experimental type with a pre-test-post-test design and a control group with a three-month follow-up. The statistical population of this research was selected students of Tehran in 2020. The sample size included 24 people who were selected by a targeted method from among those who volunteered for treatment and were randomly assigned to two experimental (12 people) and control (12 people) groups. AST therapeutic intervention was performed for the experimental group during thirty sessions, one session of 60 minutes per week. People in the control group did not receive treatment at this time. The questionnaires used in this research included the Beck depression questionnaire (Beck, 1961) and the early emotional needs questionnaire (Ghaderi et al, 2021). The data obtained from this research were analyzed by the method of variance analysis with repeated measurement and using SPSS 25.0 software.
Findings: The results showed that AST treatment has a significant effect on reducing depression symptoms and modulating emotional needs (p<0.001).
Conclusions: According to the obtained results, it can be concluded that AST treatment, with the development of techniques aimed at adjusting emotional needs, can be used as an effective intervention to reduce depression symptoms and adjust early emotional needs.

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Aim and Background: Cancer is a chronic disease that, despite medical advances and the development of treatments, this disease is still unique in terms of the feeling of helplessness and deep fear it creates in a person, and the psychological and physical effects on many aspects of their lives, such as the quality of life. Disrupt life and sense of agency. In this research, the aim of the study was the effectiveness of emotional schema therapy on the quality of life and the sense of agency of breast cancer patients.
Methods and Materials: The research method is a randomized clinical trial with a pre-test-post-test design with a control group. The statistical population included all patients diagnosed with breast cancer in government cancer treatment centers located in Isfahan. The sample includes 36 patients with breast cancer from Seyed al-Shohda Hospital (AS) in Isfahan and Ala Cancer Prevention and Control Center, who were selected through available sampling and randomly divided into two experimental groups (18 people) and control groups (18 people). The experimental group underwent emotional schema therapy by Leahy (2012) in 9 sessions of 60 minutes. The data in this research, by Arnson quality of life questionnaire (1987) and Palito and et al (2013) sense of agency questionnaire was compiled in three stages: pre-test, post-test and follow-up. And it was done using analysis of variance with repeated measurements in SPSS-23 software.
Findings: The results of variance analysis with repeated measurements showed that emotional schema therapy significantly improved the quality of life and sense of agency of the experimental group (P<0.01).
Conclusions: The results of the present study showed that the effectiveness of emotional schema therapy on increasing the quality of life and sense of agency was confirmed in the present study. It is suggested to use this type of treatment to help breast cancer patients with death anxiety.
 

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Aim and Background: Breast cancer is the most common malignancy in women, and despite medical advances and the development of treatments, this disease continues to cause psychological and physical effects on the life dimensions of many affected people, such as the attitude to death and tolerance of distress, which should be taken into account. Therefore, the aim of this research was the effectiveness of emotional schema therapy on attitude towards death and distress tolerance of breast cancer patients.
Methods and Materials: The research method is semi-experimental with a pre-test-post-test design and follow-up with a control group. The statistical population included all patients diagnosed with breast cancer in government cancer treatment centers located in Isfahan. The sample consisted of 36 patients with breast cancer from Seyed al-Shohda Hospital (AS) in Isfahan and Alaa Cancer Prevention and Control Center, who were selected through targeted sampling and randomly divided into two experimental groups (18 people) and control groups (18 people). The experimental group was treated with emotional schema. The data in this research was collected The Death Attitude Profile (DAP-R) –Revised (Wang, Racker & Gasser,1994) and the Distress Tolerance Scale (DTS) by (Simons& Gaher, 2005), in three stages: pre-test, post-test and follow-up, and it was done using proportional statistical tests and SPSS-26 software.
Findings: The results of the analysis of variance with repeated measurements showed that emotional schema therapy improved the attitude towards death and distress tolerance of the experimental group at a significant level (P<0.05).
Conclusions: The results of the present study showed that the effectiveness of emotional schema therapy can have a significant impact on the psychological characteristics of breast cancer patients, including the attitude towards death and distress tolerance, so it is suggested that this type of treatment be used to help breast cancer patients.

 

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Aim and Background: The aim of this study was to investigate the effectiveness of emotional schema therapy on emotion regulation and reduction of high-risk behaviors in female adolescents.
Methods and Materials: This was a semi-experimental with pretest-posttest design and control group .in which 30 people, as a sample, were randomly selected from 14- to 18-year-old junior high school girls in Mashhad who had high-risk behaviors and problems in Emotion regulation and have been referred to the Education Counseling Center of Khorasan Razavi Province, and were randomly divided into experimental (n = 15) and control (n = 15) groups. In this study, the clinical interview form of children and adolescents, the Grass Emotion Regulation Strategies Questionnaire (ERQ) and the Iranian Adolescents Risk Scale (IARS) were used.
Findings: The results of multivariate analysis of covariance showed that there was a significant difference between the experimental and control groups in all components of high-risk behaviors except tendency to violence, so that the mean post-test scores of the experimental group were significantly less than that of the control group. In addition, there was a significant difference between the experimental and control groups in emotion regulation strategies, so that in the reappraisal strategy, the mean scores of the experimental group were significantly higher than that of the control group, and in the suppression strategy, the mean scores of the experimental group were significantly less than that of the control group.
Conclusions: In conclusion, emotional schema therapy was effective in regulating emotions and reducing high-risk behaviors in female adolescents.

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Aim and Background: This study compares emotion-oriented schema therapy and transactional analysis's effectiveness in addressing marital conflict communication beliefs, aiming to improve effectiveness and reduce recovery time.
Methods and Materials: The research method is semi-experimental, with a pre-test-post-test design and a control group with a follow-up stage. The statistical population of this research consisted of all couples who referred to Abadan counseling centers and Abadan judicial service offices in 2022. The statistical sample consisted of 30 couples who were randomly divided into two experimental groups and one control group based on the criteria for entering the research. The research tool was Eidelson and Epstein (1982) Communication Beliefs Questionnaire. Research protocols included emotional schema therapy written by Leahy, Tirch and Napolitano (2011) and interactional behavior analysis by Eric Byrne (2011). Multivariate covariance analysis and Bonferroni post hoc test were performed using SPSS version 26 statistical software at a significance level of 0.05 for data analysis.
Findings: The findings show that in the groups of emotion-oriented schema therapy and transactional analysis, there is a significant difference in all variable components of communication beliefs in the pre-test, post-test and follow-up phases (p≤0.05), but There is no significant difference in between the post-test and follow-up (p≥0.05). Also, there is no significant difference between the two experimental groups in the post-tests and follow-up group comparison (p≥0.05); But there is a significant difference between the control group and the two experimental groups (p<0.05).
Conclusions: According to the results of the research, it can be said that both treatments are effective on the variable of communication beliefs and its components in couples with marital conflict.

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Aim and Background: Depression is one of the most common disorders among women. Various approaches have been developed for the treatment of depression, but in recent studies, a high correlation has been seen between schemas and various variables related to depression. This study was conducted with the aim of comparing the effectiveness of schema therapy in online versus in-person counseling on improving depression, interpersonal relationships, and maladaptive schemas in the domain of disconnection and rejection among women.
Methods and Materials: This study was conducted in a quasi-experimental way with a pre-test-post-test design and a control group. 45 people participated in this study. The statistical population of the current study included all women suffering from depression who contacted the psychology clinic for treatment. First, 45 people were selected based on the criteria for entering the study and using the available method. Then the participants were randomly placed in three control groups: online and face-to-face counseling, and each group of 15. Before and after the intervention, all participants filled out a depression questionnaire, a primary maladaptive schema, and an interpersonal problems questionnaire. The data were analyzed using descriptive statistics and the covariance method.
Findings: The findings showed that the changes in grades were more in the face-to-face group, and the effectiveness of face-to-face schema therapy on depression variables, interpersonal relationships, deficit/shame schemas, mistrust/abuse, emotional deprivation, abandonment/instability, and social isolation/alienation were greater than in the online group (<0.01).
Conclusions: According to the research findings, face-to-face and online schema therapy are effective on depression, interpersonal relationships, and schemas.