Comparison of the Effectiveness of Schema Therapy and Cognitive Behavioral Therapy on Treatment Adherence in Women with Breast Cancer
Keywords:
Cognitive behavioral therapy, schema therapy, treatment adherence, breast cancerAbstract
The aim of the present study was to compare the effectiveness of schema therapy and cognitive behavioral therapy on treatment adherence in women with breast cancer. The research method was quasi-experimental with a pretest–posttest control group design and a two-month follow-up period. The statistical population consisted of all women with breast cancer who referred to the Comprehensive Cancer Center of Sari in 2025. A total of 24 participants were selected using purposive sampling and were randomly assigned to two experimental groups and one control group. The research instrument was the Treatment Adherence Questionnaire developed by Modanloo (2013). Cognitive behavioral therapy and schema therapy interventions were implemented in eight weekly 90-minute group sessions for the first and second experimental groups. The data were analyzed using mixed analysis of variance. The results of analysis of variance showed that there was a significant difference among the groups in treatment adherence at the posttest and follow-up stages (p < 0.05). The results also indicated that cognitive behavioral therapy was significantly more effective in improving treatment adherence among women with breast cancer, and a significant difference was observed between the two treatments (p < 0.05). It can therefore be concluded that there is a significant difference between schema therapy and cognitive behavioral therapy.
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References
1. World Health O. Cancers. 2022.
2. Grantzau T, Mellemkjaer L, Overgaard J. Second primary cancers after adjuvant radiotherapy in early breast cancer patients: A national population-based study under the Danish Breast Cancer Cooperative Group (DBCG). Radiotherapy and Oncology. 2020;106(1):9-42. doi: 10.1016/j.radonc.2013.01.002.
3. Sharpe L, Curran L, Butow P, Thewes B. Fear of cancer recurrence and death anxiety. Psycho-Oncology. 2018;27(11):2559-65. doi: 10.1002/pon.4783.
4. Hong Y, Yuhan L, Youhui G, Zhanying W, Shili Z, Xiaoting H. Death anxiety among advanced cancer patients: A cross-sectional survey. Supportive Care in Cancer. 2022;4(2):1-9. doi: 10.1007/s00520-022-06795-z.
5. Teo I, Krishnan A, Lee GL. Psychosocial interventions for advanced cancer patients: A systematic review. Psycho-Oncology. 2019;28(7):1394-407. doi: 10.1002/pon.5103.
6. Bellver-Perez A, Peris-Juan C, Santaballa-Beltran A. Effectiveness of therapy group in women with localized breast cancer. International Journal of Clinical and Health Psychology. 2019;19(2):107-14. doi: 10.1016/j.ijchp.2019.02.001.
7. Wirkner J, Weymar M, Loew A, Hamm C, Struck AM, Kirschbaum C, et al. Cognitive functioning and emotion processing in breast cancer survivors and controls: An ERP pilot study. Psychophysiology. 2017;54(8):1209-22. doi: 10.1111/psyp.12874.
8. Pressler SJ, Kim J, Riley P, Ronis DL, Gradus-Pizlo I. Memory dysfunction, psychomotor slowing, and decreased executive function predict mortality in patients with heart failure and low ejection fraction. Journal of Cardiac Failure. 2019;16:750-60. doi: 10.1016/j.cardfail.2010.04.007.
9. Seyedfatemi N, Rafii F, Hajizadeh E, Modanloo M. Design and psychometric evaluation of the Treatment Adherence Questionnaire in patients with chronic disease: A mixed-method study. Koomesh. 2018;20(2):179-91.
10. Jafarzadeh N, Mirzahosseini H, Monirpour N. Self-efficacy-based motivational interviewing intervention for increasing treatment adherence in patients with diabetes. Applied Family Therapy. 2022;3(3):508-19. doi: 10.61838/kman.aftj.3.3.29.
11. Hall DL, Jimenez RB, Perez GK, Rabin J, Quain K, Yeh GY. Fear of cancer recurrence: A model examination of physical symptoms, emotional distress, and health behavior change. Journal of Oncology Practice. 2019;15(9):e787-e97. doi: 10.1200/JOP.18.00787.
12. Yang H, Wang Z, Yu W, Gu Y, Shao J, Zhang Y. Structural equation model of factors related to death anxiety for Chinese patients with cancer. Omega: Journal of Death and Dying. 2022;8(1):148-57.
13. Amin D, Nasrollah E, Mohammad EE, Tina H. The prediction of fear of death based on early maladaptive schemas (failure, vulnerability) and psychosocial flexibility in master degree students of Islamic Azad University, Hamadan Branch. Journal of Psychology and Psychotherapy. 2021;S4(005):1-6.
14. Salicru S. The healthy adult in schema therapy: Using the octopus metaphor. Psychology. 2023;14(6):1-10. doi: 10.4236/psych.2023.146050.
15. Ghasemi M, Hatami M, Moradi A, Hasani J. Comparison of the effectiveness of face-to-face and online cognitive behavioral therapy on treatment adherence in individuals with bulimia nervosa. Health-Oriented Research. 2020;6(2):169-83.
16. Naim R, German RE, White J, Pandya U, Dombek K, Clayton M, et al. Treatment adherence, therapeutic alliance, and clinical outcomes during an exposure-based cognitive-behavioral therapy for pediatric irritability. BMC psychiatry. 2025;25(1):181. doi: 10.1186/s12888-025-06601-0.
17. Grossman CH, Brooker J, Michael N, Kissane D. Death anxiety interventions in patients with advanced cancer: A systematic review. Palliative Medicine. 2018;32(1):172-84. doi: 10.1177/0269216317722123.
18. Arab S, Mohammadi A. The effectiveness of cognitive behavioral therapy on sleep disorder and death anxiety in older adults. Psychology of Aging. 2023;9(1):89-102.
19. Mehrparvar M, Karimi SB. The effectiveness of cognitive behavioral group therapy on stigma and death anxiety in patients with epilepsy in Bukan. Health Psychology. 2022;11(42):67-84.
20. Roza D, Yanti N, Suryarinilsih Y, Alfitri A, Sasmita H. Cognitive Behavior Therapy (CBT) to reduce death anxiety (thanatophobia) in HIV/AIDS patients. Jurnal Aisyah: Jurnal Ilmu Kesehatan. 2022;7(4):1131-8. doi: 10.30604/jika.v7i4.1320.
21. Saki M, Khoshnood S, Mohammadipour F, Ebrahimzadeh F, Rezaei F. The effect of cognitive-behavioral intervention on hope and death anxiety level in patients undergoing hemodialysis. The Journal of Mental Health Training, Education and Practice. 2022;17(3):181-90. doi: 10.1108/JMHTEP-08-2020-0059.
22. Nemati Chalabi B, Babaei Jamkhaneh L, Rezaei Moghadam P, editors. The effectiveness of cognitive behavioral therapy on death anxiety in patients with cancer. Third International Conference on Psychology, Counseling, Education, and Training; 2020; Mashhad.
23. Hobbs MJ, Mahoney AE, Andrews G. Integrating iCBT for generalized anxiety disorder into routine clinical care: Treatment effects across the adult lifespan. Journal of Anxiety Disorders. 2017;51:47-54. doi: 10.1016/j.janxdis.2017.09.003.
24. McFarlane FA, Allcott-Watson H, Hadji-Michael M, McAllister E, Stark D, Reilly C, et al. Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series. European Journal of Paediatric Neurology. 2019;23(2):317-28. doi: 10.1016/j.ejpn.2018.12.002.
25. Selvapandiyan J. Status of cognitive behaviour therapy in India: Pitfalls, limitations and future directions: A systematic review and critical analysis. Asian Journal of Psychiatry. 2019;41:1-4. doi: 10.1016/j.ajp.2019.02.012.
26. Peters L, Romano M, Byrow Y, Gregory B, McLellan LF, Brockveld K, et al. Motivational interviewing prior to cognitive behavioural treatment for social anxiety disorder: A randomised controlled trial. Journal of Affective Disorders. 2019;256:70-8. doi: 10.1016/j.jad.2019.05.042.
27. Esmaeili S, Nazari G, Barati AM. The effectiveness of cognitive behavioral therapy on experiential avoidance and emotional expression in women involved in emotional divorce. Biannual Journal of Adolescent and Youth Psychological Studies. 2023;4(2). doi: 10.61838/kman.jayps.4.2.1.
28. Gharehhasanloo Z, editor The effectiveness of cognitive behavioral therapy on death anxiety and loneliness in older adults. Twelfth International Educational Conference on Psychology, Educational Sciences, and Lifestyle; 2023.
29. Togluk S, Budak FK. The effect of cognitive behavioral therapy-based psychoeducation on anger management and death anxiety in individuals receiving chemotherapy: A randomized controlled trial. Omega: Journal of Death and Dying. 2024:302228241237279. doi: 10.1177/00302228241237279.
30. Xiang L, Wan H, Zhu Y. Effects of cognitive behavioral therapy on resilience among adult cancer patients: a systematic review and meta-analysis. BMC Psychiatry. 2025;25(1):204. doi: 10.1186/s12888-025-06628-3.
31. Abbas Q, Nisa M, Khan MU, Anwar N, Aljhani S, Ramzan Z, et al. Brief cognitive behavior therapy for stigmatization, depression, quality of life, social support and adherence to treatment among patients with HIV/AIDS: A randomized control trial. BMC Psychiatry. 2023;23(1):539. doi: 10.1186/s12888-023-05013-2.
32. Braunewell E, Stanton AM, Fitch C, McKetchnie SM, Westphal L, Hart TA, et al. Cognitive Behavioral Therapy for Trauma and Self-Care to Treat Posttraumatic Stress Symptoms and Support HIV Care Engagement Among Men With HIV Who Have Sex With Men: A Case Series. Cognitive and Behavioral Practice. 2024. doi: 10.32920/25461127.v1.
33. Edwards DJA. Using schema modes for case conceptualization in schema therapy: An applied clinical approach. Frontiers in Psychology. 2022;12:763670. doi: 10.3389/fpsyg.2021.763670.
34. Mirbagheri SR, Khosravi S, Akrami M. Investigating the effectiveness of group schema therapy on death anxiety and emotional distress in patients with breast cancer. Journal of Cognitive Psychology and Psychiatry. 2022;9(5):16-28. doi: 10.32598/shenakht.9.5.16.
35. Loose C, Graaf P, Armour K, Holt R. Schema therapy for pre-school aged children. Schema Therapy for Children and Adolescents: A Practitioner's Guide Book2020.
36. Ahmadzadeh Samani S, Dehghani A, Kalantari M, Rezaei Dehnavi S. The effectiveness of schema therapy on cognitive avoidance in female students with early maladaptive schemas. Empowering Exceptional Children. 2021;12(2):56-65.
37. Nazarandaz Korandeh S, Abolghasemi S, Vatankhah HR. Comparison of the effectiveness of schema therapy and acceptance and commitment therapy on experiential avoidance in patients with dysthymia. Disability Studies. 2021;11(1).
38. Hokmabadi ME, Bigdeli I, Asghari Ebrahimabad MJ, Vasadi J. Comparison of the effectiveness of schema therapy and acceptance and commitment therapy on type D personality symptoms and treatment adherence in patients with coronary heart disease. Clinical Psychology. 2020;12(1):25-36.
39. Hokmabadi ME, Lobnani SP, Khaneghaee R, Momeni NS, Taghavi A. Effectiveness of schema therapy techniques on working and prospective memory, personality and medication adherence in cardiac patients. Religacion Revista de Ciencias Sociales y Humanidades. 2019;4(13):406-18.
40. Cherry MG, Salmon P, Byrne A, Ullmer H, Abbey G, Fisher PL. Qualitative evaluation of cancer survivors' experiences of metacognitive therapy: A new perspective on psychotherapy in cancer care. Frontiers in Psychology. 2019;10:949. doi: 10.3389/fpsyg.2019.00949.
41. Menzies RE, Julien A, Sharpe L, Menzies RG, Helgadottir FD, Dar-Nimrod I. Overcoming death anxiety: A phase I trial of an online CBT program in a clinical sample. Behavioural and Cognitive Psychotherapy. 2023;51(4):374-9. doi: 10.1017/S135246582300005X.
42. Rezaei R, Mousavi SA, editors. The effectiveness of cognitive behavioral therapy in treating women with death anxiety in Kangan. Second National Conference on Applied Ideas in Educational Sciences, Psychology, and Cultural Studies; 2022; Bushehr.
43. Sarmad Z, Bazargan Harandi A, Hejazi E. Research methods in behavioral sciences: Agah Publishing; 2023.
44. Taghipour R, Siahpoosh S, Kazemi Delivand F, Sadeghi P, Farjad Tehrani T. The effectiveness of cognitive behavioral therapy and narrative therapy on improving death-related disturbances and psychological hardiness in female patients with breast cancer. Journal of Mashhad University of Medical Sciences. 2019;62.
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Copyright (c) 2026 Mona Maghhoori, Hosseinali Ghanadzadegan, Alireza Chamani (Author)
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