The Effectiveness of Attachment-Based Cognitive Integrative Therapy on Early Maladaptive Schemas, Dysfunctional Beliefs, and Depression
Keywords:
Early maladaptive schemas, Dysfunctional beliefs, DepressionAbstract
Purpose: The present study aimed to investigate the effectiveness of attachment-based cognitive integrative therapy on early maladaptive schemas, dysfunctional beliefs, and depressive symptoms in individuals with depression.
Methods and Materials: This study employed a quasi-experimental design with pre-test, post-test, and two-month follow-up, including an experimental group and a control group. The statistical population consisted of individuals with depressive symptoms who referred to psychological counseling centers in Tehran. A total of 40 participants were selected through purposive sampling and randomly assigned into two groups of 20 (experimental and control). The experimental group received 12 sessions of attachment-based cognitive integrative therapy, while the control group remained on a waiting list. Data were collected using the Young Schema Questionnaire–Short Form (YSQ-SF), Dysfunctional Attitude Scale (DAS), and Beck Depression Inventory-II (BDI-II). Data analysis was conducted using repeated measures analysis of variance (ANOVA) and Bonferroni post-hoc tests in SPSS-27.
Findings: The results of repeated measures ANOVA indicated significant effects of time, group, and the interaction between time and group on early maladaptive schemas, dysfunctional beliefs, and depression (p < 0.001). The experimental group showed significant reductions in all three variables compared to the control group, with large effect sizes observed across outcomes. Bonferroni post-hoc tests revealed that the differences between pre-test and post-test, as well as pre-test and follow-up, were statistically significant (p < 0.001), while no significant differences were found between post-test and follow-up, indicating the stability of treatment effects over time.
Conclusion: Attachment-based cognitive integrative therapy is an effective intervention for reducing early maladaptive schemas, dysfunctional beliefs, and depressive symptoms, with sustained effects over time, suggesting its potential as a comprehensive therapeutic approach targeting both cognitive and relational dimensions of depression.
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References
Akers, N., Berry, K., & Taylor, C. D. J. (2025). Do Cognitive Behavioural Therapy Interventions Lead to Schema Change in People With Psychosis? A Systematic Review and Meta‐Analysis. Clinical Psychology & Psychotherapy, 32(2). https://doi.org/10.1002/cpp.70049
Asadi, A., Sadeghi, J., Farashzadeh Jaloudar, R., & Araei, O. (2025). Comparison of the effectiveness of cognitive-behavioral therapy and schema therapy in reducing exam anxiety and improving academic performance. International Maher Publications, 2(2). http://193.36.85.187:9110/index.php/ecp/article/view/220
Çelikbaş, Z., & Yalçınkaya-Alkar, Ö. (2022). The Relationship Between Attachment Styles, Ruminative Response Styles, Dysfunctional Attitudes and Major Depression Diagnosis. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 1-23. https://doi.org/10.1007/s10942-022-00446-2
Egli, S., Badenbach, T., Emmerik, A. v., Stefan, A. M., & Kopf‐Beck, J. (2024). Emotion Regulation and Attachment as Mechanisms of Change in Schema Therapy and Cognitive Behaviour Therapy for Depression. https://doi.org/10.31219/osf.io/67vhn
Ghanavati, M. (2024). Comparing the Effectiveness of Emotion-Based and Attachment-Based Family Therapy on Emotional Distress Tolerance, Self-Differentiation and Alexithymia in Adolescent Girls With Psychosomatic Disorders. PDMD, 3(4), 139-152. https://doi.org/10.61838/kman.pdmd.3.4.10
Ghanavati, M., Talebzadeh, M., Safarzadeh, S., Bavi, S., & Bakhtiarpour, S. (2024). Comparing the effectiveness of cognitive-analytic therapy and emotional schema therapy on cognitive regulation of emotion and worry in patients with generalized anxiety disorder. Psychological Dynamics in Mood Disorders, 3(4), 114-128. https://doi.org/10.61838/kman.pdmd.3.4.8
Haghiri, S., Molayi, H., & Khosropour, F. (2025). Comparing the Effectiveness of Attachment-Based Therapy and Cognitive-Behavioral Therapy on Cognitive Distortion in Mothers with Elementary School or Preschool Children. Journal of Pediatric Nursing, 11(2), 10-20. https://jpen.ir/browse.php?a_id=762&sid=1&slc_lang=en
Jafari Goloche, A., Yousefi, E., & Khajepoor, L. (2024). Comparing the effectiveness of cognitive-behavioral therapy and emotional schema therapy on anxiety sensitivity and ambiguity intolerance in students with anxiety disorders. Iranian Evolutionary Educational Psychology Journal, 6(1), 208-231. https://doi.org/10.22034/6.1.208
Kashani Vahid, S., Mohammadi Aria, A., & Abolmaali Alhosseini, K. (2024). Structural Relationship of Metacognitive Beliefs, Stress, Attachment Styles with Anorexia Nervosa Mediated by Self-Image. Applied Family Therapy Journal (AFTJ), 5(3), 66-75. https://doi.org/10.61838/kman.aftj.5.3.7
Montajabian, Z., & Rezai Dehnavi, S. (2021). Study of the Effectiveness of Meta Cognitive Interpersonal Therapy on Improving Dysfunctional Communication Patterns Couples and Increase of Marital Adjustment. frooyesh, 10(8), 135-148. http://frooyesh.ir/article-1-2770-en.html
Salmani, B., Hasani, J., Hassanabadi, H., Mohammad-Khani, S., & Ahmadvand, A. (2019). Comparing efficacy of cognitive behavioral therapy with or without metacognitive techniques and Zolpidem 10 mg. on dysfunctional cognitions & metacognitions in people with chronic insomnia disorder: a multiple baseline single case. Clinical Psychology Studies, 9(35), 71-95. https://doi.org/10.22054/jcps.2019.42283.2136
Seyed Mousavi, F., Talebzadeh Shoushtari, M., & Safarzadeh, S. (2024). Attachment-based Therapy on Emotional Autonomy, Emotion Regulation and Rumination in Adolescents With Depression Symptoms. Caspian Journal of Health Research, 9(2), 115-124. https://doi.org/10.32598/CJHR.9.2.1082.1
Shamsabadi, F., Mirzaian, B., & Abbasi, G. (2024). Comparison of the Effectiveness of Attachment-Based Play Therapy and Cognitive-Behavioral Therapy on Emotional Regulation and Quality of Life in Children with Separation Anxiety Disorder. KMAN Counseling & Psychology Nexus, 2(2), 220-229. https://journals.kmanpub.com/index.php/psychnexus/article/view/3488
Strand, E. R., Anyan, F., Hjemdal, O., Nordahl, H. M., & Nordahl, H. (2024). Dysfunctional Attitudes Versus Metacognitive Beliefs as Within-Person Predictors of Depressive Symptoms Over Time. Behavior therapy, 55(4), 801-812. https://doi.org/10.1016/j.beth.2023.12.004
Tay-Karapas, K., Guzmán-González, M., Gómez, F., Comino, P., Salaberría, K., & Bahamondes, J. (2024). An Attachment-Based Pilot Program to Promote Adolescent Adjustment to Parental Divorce. Child and adolescent psychiatry and mental health, 18(1). https://doi.org/10.1186/s13034-024-00729-9
Thakral, M., Von Korff, M., McCurry, S. M., Morin, C. M., & Vitiello, M. V. (2020). Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: a systematic literature review and meta-analysis. Sleep Medicine Reviews, 49, 101230. https://www.sciencedirect.com/science/article/pii/S1087079219301984
Walter, I., Quehenberger, J., Landers, S., & Brisch, K. H. (2024). Attachment-Based Prevention Program Involving Mothers and Fathers: Seven-Year Post-Intervention Outcomes of a Randomized Control Trial. Journal of Child and Family Studies, 33(2), 538-553. https://doi.org/10.1007/s10826-023-02762-2
Wittkowski, A., Crompton, C., & Wan, M. W. (2024). Manualised attachment-based interventions for improving caregiver-infant relationships: A two-stage systematic review. Clinical Child and Family Psychology Review, 1-30. https://doi.org/10.1007/s10567-024-00497-0
Zarei, R., Firouzbakht, M., Shirazi, T., & Khoshnavis, J. (2024). The Impact of Cognitive Behavioral Therapy and Schema Therapy in Reducing Negative Thoughts and Worry: A Comparative Study. Scientific Quarterly Journal of Tabriz University, 10(2), 95-107.
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Copyright (c) 2026 Somayeh Motejadded (Corresponding author); Fatemeh Karimzadeh, Shima Soltani Razavi (Author)
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