Comparison of the Effectiveness of Schema Therapy and Cognitive Behavioral Therapy on Emotion Regulation and Metacognitive Beliefs in Patients with Obsessive-Compulsive Disorder
Keywords:
Schema therapy, cognitive, behavioral therapy, emotion regulation, metacognitive beliefs, obsessive, compulsive disorderAbstract
Introduction and Aim: Obsessive-compulsive disorder is frequently associated with emotion-regulation difficulties and dysfunctional metacognitive beliefs that contribute to the development and persistence of obsessive thoughts and compulsive behaviors. This study aimed to compare the effectiveness of schema therapy and cognitive behavioral therapy in improving emotion regulation and reducing dysfunctional metacognitive beliefs among patients with obsessive-compulsive disorder.
Methodology: This quasi-experimental study employed a pretest, posttest, and two-month follow-up design with a control group. The statistical population consisted of patients with obsessive-compulsive disorder attending counseling centers, psychological clinics, and mental health centers in Tehran during 2025–2026. Using purposive sampling, 45 eligible patients were selected and randomly assigned to schema therapy, cognitive behavioral therapy, and control groups, with 15 participants in each group. The intervention groups received ten weekly 90-minute sessions of schema therapy or cognitive behavioral therapy, whereas the control group received no psychological intervention. Data were collected using the Gross and John Emotion Regulation Questionnaire and the Wells Metacognitions Questionnaire. Two-way repeated-measures analysis of variance and Bonferroni post-hoc comparisons were conducted using SPSS version 26.
Findings: A significant group-by-time interaction was observed for emotion regulation (F=34.28, p<0.001, η²=0.620). The group-by-time interaction was also significant for metacognitive beliefs (F=36.74, p<0.001, η²=0.636). Both schema therapy and cognitive behavioral therapy produced significantly greater improvements in emotion regulation and reductions in dysfunctional metacognitive beliefs than the control condition (p<0.001). Direct comparison of the interventions indicated that schema therapy was significantly more effective in enhancing emotion regulation (p=0.041), whereas cognitive behavioral therapy was significantly more effective in reducing dysfunctional metacognitive beliefs (p=0.034). The therapeutic improvements were largely maintained at the two-month follow-up.
Conclusion: Both interventions effectively improve emotional and metacognitive processes in patients with obsessive-compulsive disorder. Schema therapy may be particularly appropriate for patients whose predominant difficulties involve emotion regulation, unmet emotional needs, and deeply rooted maladaptive patterns, whereas cognitive behavioral therapy may be preferable when dysfunctional beliefs about thoughts, mental control, danger, and certainty are more prominent.
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Copyright (c) 2025 Shaghayegh Naeimi , Mehri Jedari Heidarzade (Author); Ozra Bolandraftar
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