Effectiveness of Emotional Schema Therapy and Cognitive-Behavioral Therapy Focused on Intolerance of Uncertainty on Referential Thinking, Thought-Action Fusion, and Cognitive Avoidance in Patients with Generalized Anxiety Disorder: A Quasi-Experimental Study
Keywords:
Schema therapy, cognitive behavioral therapy, intolerance of uncertainty, referential thoughts, thought-action fusion, generalized anxiety disorderAbstract
The aim of this study was to investigate the effectiveness of Emotional Schema Therapy and Cognitive-Behavioral Therapy focused on intolerance of uncertainty on referential thinking, thought-action fusion, and cognitive avoidance in patients with Generalized Anxiety Disorder (GAD). This study employed a quasi-experimental pre-test/post-test design with a control group. The statistical population consisted of all patients diagnosed with GAD who attended 30 psychological counseling centers in District 17 of Tehran in 1404 (2025–2026). From this population, 36 patients were selected through convenience sampling and then randomly assigned to two experimental groups (Emotional Schema Therapy and Cognitive-Behavioral Therapy focused on intolerance of uncertainty) and a control group. The Generalized Anxiety Disorder 7-item scale (Spitzer et al., 2006), Intolerance of Uncertainty Scale (Freeston et al., 1994), Referential Thinking Questionnaire (Ehring, 1990), Thought-Action Fusion Questionnaire (Shafran et al., 1996), and Cognitive Avoidance Questionnaire (Sexton & Dugas, 2009) were used. The experimental group received Emotional Schema Therapy (Young, 1990) for 8 sessions of 90 minutes each, while Cognitive-Behavioral Therapy based on Dugas’s model (Dugas & Chouinard, 2007; Chouinard, Colberson, & Bitto, 2019) was conducted for 12 sessions of 90 minutes each. The control group was placed on a waiting list. Post-test assessments were conducted for both experimental groups following the treatment period. Data were analyzed using multivariate analysis of covariance (MANCOVA) with SPSS version 24 in both descriptive and inferential statistical sections. Results indicated that, based on the post-test mean scores of the experimental group, Emotional Schema Therapy and Cognitive-Behavioral Therapy focused on intolerance of uncertainty were effective in reducing referential thinking, thought-action fusion, and cognitive avoidance in patients with GAD. Based on the findings of this study, both Cognitive-Behavioral Therapy focused on intolerance of uncertainty and Emotional Schema Therapy can be effectively utilized in therapeutic and health centers to improve referential thinking, thought-action fusion, and cognitive avoidance.
Downloads
References
Berle, D., & Starcevic, V. (2015). Thought-action fusion: Review of literature and future directions. Clinical psychology review, 25, 263-284.
Bhat, N. A., Hassan, R., Shafiq, M., & Sheikh, S. (2015). Sociodemographic factors: A major predictor of anxiety and depression among pregnant women. Delhi Psychiatry Journal, 1, 86-94.
Bomyea, J., Ramsawh, H., Ball, T. M., Taylor, C. T., Paulus, M. P., Lang, A. J., & Stein, M. B. (2015). Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. Journal of anxiety disorders, 33, 90-94. https://doi.org/10.1016/j.janxdis.2015.05.004
Borza, L. (2017). Cognitive-behavioral therapy for generalized anxiety. Dialogues in clinical neuroscience, 19(2), 203-208. https://doi.org/10.31887/DCNS.2017.19.2/lborza
Dehghani Soltani, M., & Razaei Nasab, F. (2022). Effectiveness of schema therapy on metacognitive beliefs, cognitive fusion, and rumination in patients with generalized anxiety disorder. Journal of New Psychological Research, 17(66), 121-130.
Dugas, M. J., Hedayati, M., Karavidas, A., Buhr, K., Francis, K., & Phillips, N. A. (2005). Intolerance of uncertainty and information processing: Evidence of biased recall and interpretations. Cognitive therapy and research, 29, 57-70. https://doi.org/10.1007/s10608-005-1648-9
Fassbinder, E., Brand-de Wilde, O., & Arntz, A. (2019). Case formulation in schema therapy: Working with the mode model. Academic Press. https://doi.org/10.1016/B978-0-12-813521-1.00005-9
Günther, V., Jahn, S., Webelhorst, C., Bodenschatz, C. M., Bujanow, A., Mucha, S., & Suslow, T. (2022). Coping with anxiety: brain structural correlates of vigilance and cognitive avoidance. Frontiers in Psychiatry, 13, 869367.
Hebert, E. A., & Dugas, M. J. (2019). Behavioral experiments for intolerance of uncertainty: Challenging the unknown in the treatment of generalized anxiety disorder. Cognitive and Behavioral Practice, 26(2), 421-436. https://doi.org/10.1016/j.cbpra.2018.07.007
Heffernan, M., Wilson, C., Keating, K., & McCarthy, K. (2021). "Why Isn't it going away?": A qualitative exploration of worry and pain experiences in adolescents with chronic pain. Pain Medicine, 22(2), 459-469. https://doi.org/10.1093/pm/pnaa245
Hosseini, S. M. D., Amiri, S., Namdari, K., & Molavi, H. (2021). The effectiveness of cognitive therapy based on dogas model of morbid morbidity, severity of symptoms and causative factors of diffuse anxiety disorder in patients with diffuse anxiety disorder. Journal of Psychological Science, 19(94), 1267-1279.
Marchetti, I., Mor, N., Chiorri, C., & Koster, E. H. (2018). The brief state rumination inventory (BSRI): Validation and psychometric evaluation. Cognitive therapy and research, 42, 1-14.
Mokhaddam, M., Abolghasemi, S., & Khanekeshi, A. (2024). Effectiveness of schema therapy on anxiety symptoms and uncertainty in individuals with generalized anxiety disorder. Journal of Psychological Sciences, 23(144), 83-95.
Ranney, R. M., Bing-Canar, H., & Behar, E. (2021). Effortful control moderates relationships between worry and symptoms of depression and anxious arousal. British Journal of Clinical Psychology, 60(3), 400-413. https://doi.org/10.1111/bjc.12289
Shah, A. Q., Prasad, D., Caropreso, L., Frey, B. N., & de Azevedo Cardoso, T. (2023). The comorbidity between Borderline Personality Disorder (BPD) and Generalized Anxiety Disorder (GAD): A systematic review and meta-analysis. Journal of psychiatric research, 164, 304-314. https://doi.org/10.1016/j.jpsychires.2023.06.009
Straarup, N. S., Renneberg, H. B., Farrell, J., & Younan, R. (2022). Group schema therapy for patients with severe anxiety disorders. Journal of Clinical Psychology, 78(8), 1590-1600. https://doi.org/10.1002/jclp.23351
Vafadar, A., Mirzamani Baghchi, S. M., & Jafari Roshan, M. (2021). Comparison of effectiveness of acceptance and commitment therapy and schema therapy on attention bias, uncertainty, and cognitive avoidance in patients with generalized anxiety disorder. Studies on Disability, 11(194), 1-8.
Wahlund, T., Andersson, E., Jolstedt, M., Perrin, S., Vigerland, S., & Serlachius, E. (2020). Intolerance of uncertainty–focused treatment for adolescents with excessive worry: A pilot feasibility study. Cognitive and Behavioral Practice, 27(2), 215-230. https://doi.org/10.1016/j.cbpra.2019.06.002
Downloads
Published
Issue
Section
License
Copyright (c) 1404 سمیه ویسی , عاطفه بهرامی , معصومه غفاری (نویسنده); مصطفی احمدیفر (نویسنده مسئول); آرزو رمضان پور , کامران پورمحمدقوچانی (نویسنده)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
