Effectiveness of Schema Mode Therapy on Ambivalence in Emotional Expression and Defense Styles in Individuals with Narcissistic Personality Disorder
Keywords:
Schema mode therapy, emotional ambivalence, defense styles, narcissistic personality disorder, emotional expressionAbstract
Purpose: Objective: This study aimed to investigate the effectiveness of schema mode therapy on ambivalence in emotional expression and defense styles in individuals with narcissistic personality disorder.
Methods and Materials: This semi-experimental study employed a pretest-posttest design with a control group and follow-up. The statistical population consisted of individuals with narcissistic personality disorder who referred to counseling centers in Shiraz during 2023-2024. A total of 60 participants were selected through convenience sampling and randomly assigned to an experimental group (30) and a control group (30). The research instruments included the Emotional Expressivity Questionnaire (EEQ), the Defense Style Questionnaire (DSQ-40), and structured clinical interviews. The experimental group underwent 12 weekly 90-minute sessions of schema mode therapy, while the control group received no intervention. Data were analyzed using covariance analysis and Bonferroni post hoc tests.
Findings: The results indicated that schema mode therapy significantly increased positive emotional expression and intimacy while decreasing negative emotional expression in the experimental group (P<0.01). Additionally, a significant increase in mature defense styles and a reduction in neurotic and immature defense styles were observed in the experimental group (P<0.01).
Conclusion: Schema mode therapy is an effective approach for improving emotional expression ambivalence and transitioning from maladaptive to adaptive defense styles. This therapeutic method can be considered a suitable clinical intervention for individuals with narcissistic personality disorder.
Downloads
References
Arntz, A., Rijkeboer, M., Chan, E., Fassbinder, E., Karaosmanoglu, A., Lee, C. W., & Panzeri, M. (2021). Towards a Reformulated Theory Underlying Schema Therapy: Position Paper of an International Workgroup. Cognitive therapy and research, 45(6), 1007-1020. https://doi.org/10.1007/s10608-021-10209-5
Besharat, M. A., Ranjbar Shirazi, F., & Dehghani Arani, F. (2019). The mediating role of early maladaptive schemas on the relationship between attachment styles and defense mechanisms [Research]. Journal of Psychological Science, 17(72), 859-872. http://psychologicalscience.ir/article-1-324-en.html
Boecking, B., Stoettner, E. M., Brueggemann, P. G., & Mazurek, B. (2024). Emotional Self-States and Coping Responses in Patients with Chronic Tinnitus: A Schema Mode Model Approach. Frontiers in Psychiatry, 15, 1257299. https://doi.org/10.3389/fpsyt.2024.1257299
Dimaggio, G. (2022). Treatment principles for pathological narcissism and narcissistic personality disorder. Journal of Psychotherapy Integration, 32(4), 408-425. https://doi.org/10.1037/int0000263
Edwards, D. (2022). Using Schema Modes for Case Conceptualization in Schema Therapy: An Applied Clinical Approach. Frontiers in psychology. https://doi.org/10.3389/fpsyg.2021.763670
Farmanbar, F., Maredpour, Alireza, Malekzadeh, Mohammad. (2023). The Effectiveness of Schema Therapy on Ambivalence in Emotional Expression and Mentalization in Patients with Borderline Personality Disorder. Islamic Life Journal, 7(no), 218-228. https://islamiclifej.com/cgi-sys/suspendedpage.cgi
Hadiyan, N., Mottaghi, S., & Rezapour Mirsaleh, Y. (2023). Investigating the mediating role of maladaptive schemas and emotional expression in the relationship between childhood trauma and sexual intimacy in women from low-income families. Applied Family Therapy Journal (AFTJ), 4(5), 610-632. https://doi.org/10.61838/kman.aftj.4.5.35
Jazayeri, S. M., Vatankhah, H. R., & Badi'i, M. M. (2013). The Relationship Between Defensive Styles and Early Maladaptive Schemas with Resilience in Students. Journal of Andisheh and Raftar, 8(30). https://elmnet.ir/article/150191-41911
Khodabandelow, S., Najafi, M., & Rahimian Boogar, I. (2018). The Effectiveness of Schema Mode Therapy on the Self-Esteem in Narcissistic Personality Disorder: A Single-Subject Research. Clinical Psychology Studies, 8(30), 65-101. https://doi.org/10.22054/jcps.2018.8579
Khosravani, V., Seidisarouei, M., & Alvani, A. (2016). Early maladaptive schemas, behavioral inhibition system, behavioral approach system, and defense styles in natural drug abusers. Polish Annals of Medicine, 23(1), 6-14. https://doi.org/10.1016/j.poamed.2015.12.003
Koppers, D., Van, H., Peen, J., & Dekker, J. J. M. (2021). Psychological symptoms, early maladaptive schemas and schema modes: predictors of the outcome of group schema therapy in patients with personality disorders. Psychotherapy Research, 31(7), 831-842. https://doi.org/10.1080/10503307.2020.1852482
Letafati Beris, R., Ghamari Kivi, H., Kiani, A. R., & Sheykholslamy, A. (2021). Comparison of the effectiveness of the schema mode therapy and Emotional-focused therapy on styles of conflict resolution, in new married couples with conflict [Applicable]. Rooyesh-e-Ravanshenasi Journal(RRJ), 10(9), 186-192. http://frooyesh.ir/article-1-2882-en.html
Malekzadeh, l., Emadi, S. Z., & naghsh, z. (2024). The Effectiveness of Group Schema Therapy on Cognitive Emotion Regulation and Emotional Behavior Regulation in Mothers with Children with Learning Disabilities. Psychology of Exceptional Individuals, 14(53), 201-227. https://doi.org/10.22054/jpe.2023.71499.2524
Mertens, Y., Yılmaz, M., & Lobbestael, J. (2020). Schema modes mediate the effect of emotional abuse in childhood on the differential expression of personality disorders. Child abuse & neglect, 104, 104445. https://www.sciencedirect.com/science/article/pii/S0145213420301009
Namavari, Z. (2023). Investigation of Differences in Early Maladaptive Schemas and Defense Mechanisms in Individuals With Gender Identity Disorder Compared to Normal Individuals. Hn, 1(2), 87-93. https://doi.org/10.61838/kman.hn.1.2.12
Nejadian, A. B., Babamiri, M., & Fard, R. J. (2017). The Association Between Defensive Styles and Early Maladaptive Schemas in Patients With Migraine Headaches. Iranian journal of psychiatry and behavioral sciences, 11(3). https://doi.org/10.5812/ijpbs.7592
Nowzari, A., & Naziri, G. (2021). Comparing Identity Styles, Defense Styles and Emotional Schemas between Normal People and People with Allergy Disease. Psychological Models and Methods, 12(44), 37-54. https://doi.org/10.30495/jpmm.2021.26596.3250
Peeters, N., Stappenbelt, S., Burk, W. J., van Passel, B., & Krans, J. (2021). Schema therapy with exposure and response prevention for the treatment of chronic anxiety with comorbid personality disorder. British Journal of Clinical Psychology, 60(1), 68-76. https://doi.org/10.1111/bjc.12271
Peeters, N., van Passel, B., & Krans, J. (2022). The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda. British Journal of Clinical Psychology, 61(3), 579-597. https://doi.org/10.1111/bjc.12324
Phillips, K., Brockman, R., Bailey, P. E., & Kneebone, I. I. (2020). Schema in older adults: does the schema mode model apply? Behavioural and Cognitive Psychotherapy, 48(3), 341-349. https://doi.org/10.1017/S1352465819000602
Safikhani, F. (2022). The effectiveness of grammatical mental imagery with cognitive processing on self-efficacy, emotional processing and spirituality in mothers of students with autism spectrum disorder. International Journal of Education and Cognitive Sciences, 3(2), 12-22. https://doi.org/10.22034/injoeas.2022.160609
Salgó, E., Bajzát, B., & Unoka, Z. (2021). Schema modes and their associations with emotion regulation, mindfulness, and self-compassion among patients with personality disorders. Borderline personality disorder and emotion dysregulation, 8(1), 19. https://doi.org/10.1186/s40479-021-00160-y
Stavropoulos, A., Haire, M., Brockman, R., & Meade, T. (2020). A schema mode model of repetitive negative thinking. Clinical Psychologist, 24(2), 99-113. https://doi.org/10.1111/cp.12205.
Vos, M. K.-d., Giesbers, G., & Hülsken, J. (2023). Relationships Between Early Maladaptive Schemas and Emotional States in Individuals With Sexual Convictions. Sexual Abuse, 36(2), 233-250. https://doi.org/10.1177/10790632231153635
Yousefi, R., Hashemi, S. G. S., Sohrabi, L., & Abadi, M. H. (2018). The Association Between Early Maladaptive Schemas and Defense Styles With Hoarding Behaviour Among University Students. Practice in Clinical Psychology. https://doi.org/10.32598/jpcp.6.4.223
Downloads
Published
Submitted
Revised
Accepted
Issue
Section
License
Copyright (c) 2025 Mohammad Gholami (Author); Alireza Maredpour (Corresponding author); Ghader Zadehbagheri, Fatemeh Gholami (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.