Comparison of the Effectiveness of Schema Therapy and Cognitive–Behavioral Therapy on Distress Tolerance in Maladjusted Couples
Keywords:
Schema therapy, Cognitive–behavioral therapy, Distress tolerance, Maladjusted couplesAbstract
The present study aimed to compare the effectiveness of schema therapy and cognitive–behavioral therapy (CBT) on distress tolerance in maladjusted couples. This applied research was conducted using a quasi-experimental design with pretest–posttest and a control group. The statistical population consisted of all couples who referred to psychology clinics in District 2 of Tehran during the first half of 2025. A sample of 45 couples was selected through convenience sampling and randomly assigned to three groups: schema therapy, cognitive–behavioral therapy, and control. Following the withdrawal of one couple from the cognitive–behavioral therapy group, data analysis was conducted on 44 couples. Research instruments included the Emotional Distress Tolerance Questionnaire, which was administered at three stages: pretest, posttest, and a two-month follow-up. The schema therapy group received ten intervention sessions based on Young’s model, including identification of maladaptive schemas, coping styles, and emotional restructuring techniques (Young, 2003). The cognitive–behavioral therapy group participated in ten sessions focusing on communication skills training, cognitive restructuring, stress management, and modification of dysfunctional patterns (Beck, 2011). No intervention was implemented for the control group. Data were analyzed using repeated measures analysis of variance. The results indicated that both interventions significantly improved couples’ distress tolerance; however, schema therapy demonstrated significantly greater effectiveness than cognitive–behavioral therapy, and its effects remained more stable at the follow-up stage. Based on these findings, it can be concluded that the deeper, emotion-focused, and core-level interventions characteristic of schema therapy play a more substantial role in enhancing distress tolerance among maladjusted couples.
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Alwhaibi, R. M., Almuwais, A. K., Alotaibi, M., AlTaleb, H. M., Alsamiri, S. M., & Khan, R. (2024). Health beliefs of unmarried adult Saudi individuals toward safe marriage and the role of premarital screening in avoiding consanguinity: a nationwide cross-sectional study. Frontiers in Public Health, 12, 1379326. https://doi.org/10.3389/fpubh.2024.1379326
Bach, B., Lockwood, G., & Young, J. E. (2018). A new look at the schema therapy model: organization and role of early maladaptive schemas. Cognitive behaviour therapy, 47(4), 328-349. https://doi.org/10.1080/16506073.2017.1410566
Bamelis, L. L., Renner, F., Heidkamp, D., & Arntz, A. (2011). Extended schema mode conceptualizations for specific personality disorders: An empirical study. Journal of personality disorders, 25(1), 41-58. https://doi.org/10.1521/pedi.2011.25.1.41
Bodenmann, G., Kessler, M., Kuhn, R., Hocker, L., & Randall, A. K. (2020). Cognitive-behavioral and emotion-focused couple therapy: Similarities and differences. Clinical psychology in Europe, 2(3). https://pmc.ncbi.nlm.nih.gov/articles/PMC9645475/
Bouchard, K. N., Bergeron, S., & Rosen, N. O. (2024). Feasibility of a cognitive-behavioral couple therapy intervention for sexual interest/arousal disorder. The Journal of Sex Research, 1-11. https://doi.org/10.1093/jsxmed/qdae054.018
Bunt, S., & Hazelwood, Z. J. (2017). Walking the walk, talking the talk: Love languages, self‐regulation, and relationship satisfaction. Personal Relationships, 24(2), 280-290. https://doi.org/10.1111/pere.12182
Doherty, W. J., Harris, S. M., & Mussa, K. (2024). Relationship Undermining in Couple Therapy. Contemporary Family Therapy, 1-6. https://doi.org/10.1007/s10591-024-09702-2
Gkintoni, E., & Nikolaou, G. (2024). The cross-cultural validation of neuropsychological assessments and their clinical applications in cognitive behavioral therapy: A scoping analysis. International journal of environmental research and public health, 21(8), 1110. https://doi.org/10.3390/ijerph21081110
Jiang, M., Zhao, Q., Li, J., Wang, F., He, T., Cheng, X., & Fu, G. (2024). A generic review of integrating artificial intelligence in cognitive behavioral therapy arXiv preprint. https://arxiv.org/abs/2407.19422
Joshua, P. R., Lewis, V., Kelty, S. F., & Boer, D. P. (2025). Applications of schema therapy in young people: a systematic review. Cognitive behaviour therapy, 1-23. https://doi.org/10.1080/16506073.2025.2522375
Kellogg, S. H., & Young, J. E. (2006). Schema therapy for borderline personality disorder. Journal of Clinical Psychology, 62(4), 445-458. https://doi.org/10.1002/jclp.20240
Mahmoudpour, A., Farahbakhsh, K., & Baloochzadeh, E. (2018). Predicting women's marital commitment based on attachment styles, self-compassion, and distress tolerance. Family Counseling and Psychotherapy, 8(1), 65-84. https://fcp.uok.ac.ir/article_60857.html?lang=en
Mason, E. C., Grierson, A. B., Sie, A., Sharrock, M. J., Li, I., Chen, A. Z., & Newby, J. M. (2022). Co-occurring insomnia and anxiety: a randomized controlled trial of internet cognitive behavioral therapy for insomnia versus internet cognitive behavioral therapy for anxiety. Sleep, 46(2). https://doi.org/10.1093/sleep/zsac205
Pilkington, P. D., & Karantzas, G. C. (2024). A bibliometric analysis of the quantitative schema therapy literature. Clinical Psychology & Psychotherapy, 31(2), e2963. https://doi.org/10.1002/cpp.2963
Rauf, U., Fatima, H., & Mushtaq, M. (2023). Distress tolerance, mental health problems and marital satisfaction among married couples. Pakistan Journal of Social Research, 5(01), 559-567. https://doi.org/10.52567/pjsr.v5i01.1377
Salimi, H., & Soudani, M. (2023). The effectiveness of brief solution-focused couple therapy on increasing marital self-regulation and emotional distress tolerance among couples. Journal of Clinical Psychology and Counseling, 13(1), 5-24. https://doi.org/10.22067/tpccp.2023.76695.1287
Taheri, Z., & Mahvash Shirazi, M. (2019). The relationship between expectations from marriage and distress tolerance with marital adjustment in women. Women's Research Journal, 10(27), 99-116. https://womenstudy.ihcs.ac.ir/article_4031.html
Tavares, L. P., & Aassve, A. (2013). Psychological distress of marital and cohabitation breakups. Social science research, 42(6), 1599-1611. https://doi.org/10.1016/j.ssresearch.2013.07.008
Veenstra-Spruit, M. S., Bouman, R., van Dijk, S. D., van Asselt, A. D., van Alphen, S. P., Veenstra, D. H., & Oude Voshaar, R. C. (2024). Group schema therapy combined with psychomotor therapy for older adults with a personality disorder: an open-label, multicentre, randomised controlled trial. The Lancet Healthy Longevity, 5(4), e245-e254. https://doi.org/10.1016/S2666-7568(24)00001-1
Vuijk, R., Turner, W., Zimmerman, D., Walker, H., & Dandachi‐FitzGerald, B. (2024). Schema therapy in adults with autism spectrum disorder: A scoping review. Clinical Psychology & Psychotherapy, 31(1), e2949. https://doi.org/10.1002/cpp.2949

