The Effectiveness of Schema Therapy on Experiential Avoidance, Intolerance of Uncertainty, and Cognitive Flexibility in Patients with Major Depressive Disorder

Abstract

Introduction and Aim: Major Depressive Disorder is associated with experiential avoidance, intolerance of uncertainty, and cognitive inflexibility, all of which play significant roles in the persistence and severity of depressive symptoms. The present study aimed to investigate the effectiveness of Schema Therapy on experiential avoidance, intolerance of uncertainty, and cognitive flexibility in patients with Major Depressive Disorder.

Methodology: This study employed a quasi-experimental design with pretest, posttest, and two-month follow-up assessments alongside a control group. The statistical population included patients diagnosed with Major Depressive Disorder who attended counseling centers and psychological clinics in Tehran in 2024. A total of 40 participants were selected through purposive sampling and randomly assigned to experimental and control groups. The research instruments included the Acceptance and Action Questionnaire-II, the Intolerance of Uncertainty Scale, and the Cognitive Flexibility Inventory. The experimental group received twelve 90-minute sessions of Schema Therapy, while the control group remained on a waiting list. Data were analyzed using mixed repeated-measures ANOVA and Bonferroni post hoc tests in SPSS-27.

Findings: The results of repeated-measures ANOVA demonstrated significant effects of time, group, and time-by-group interaction for experiential avoidance, intolerance of uncertainty, and cognitive flexibility (P<0.001). The findings indicated that Schema Therapy significantly reduced experiential avoidance and intolerance of uncertainty while significantly increasing cognitive flexibility in the experimental group compared to the control group. Bonferroni post hoc analyses also revealed significant differences between pretest and posttest as well as between pretest and follow-up stages, whereas differences between posttest and follow-up were not significant, indicating the stability of treatment effects over time.

Conclusion: The findings suggest that Schema Therapy can be considered an effective intervention for reducing experiential avoidance and intolerance of uncertainty while enhancing cognitive flexibility in patients with Major Depressive Disorder. By modifying early maladaptive schemas and promoting emotional acceptance, this therapeutic approach may facilitate sustainable improvements in emotional and cognitive functioning.