Comparing the Effectiveness of Schema Therapy and Cognitive-Behavioral Therapy on Ego Strength and Worry in Women with Generalized Anxiety Disorder

Abstract

This study aimed to compare the effectiveness of schema therapy and cognitive-behavioral therapy in improving ego strength and reducing worry among women with generalized anxiety disorder. This applied study used a quasi-experimental pretest–posttest design with a two-month follow-up and a control group. The statistical population consisted of women with generalized anxiety disorder who attended the Seraj Counseling Office in Mashhad during the first half of 2024. Forty-five eligible participants were selected through purposive sampling and assigned to three groups of 15: schema therapy, cognitive-behavioral therapy, and control. The diagnosis of generalized anxiety disorder was confirmed using the Structured Clinical Interview for Axis I Disorders. Data were collected using the Psychosocial Inventory of Ego Strengths and the Penn State Worry Questionnaire. Repeated-measures analysis of variance and Bonferroni post hoc comparisons were used to analyze the data. Repeated-measures analysis of variance indicated significant effects of time, group, and the time-by-group interaction on both ego strength and worry (p<0.001). For ego strength, the effect sizes for time, time-by-group interaction, and group were 0.62, 0.46, and 0.31, respectively. For worry, the corresponding effect sizes were 0.66, 0.51, and 0.29. Bonferroni comparisons showed that both schema therapy and cognitive-behavioral therapy significantly increased ego strength and reduced worry from pretest to posttest and follow-up, whereas no significant changes were observed in the control group. The differences between posttest and follow-up scores were not statistically significant in either intervention group, indicating the relative stability of the treatment effects. Comparative findings further demonstrated that schema therapy was more effective in enhancing ego strength, whereas cognitive-behavioral therapy produced a greater reduction in worry. Both schema therapy and cognitive-behavioral therapy are effective interventions for improving psychological outcomes in women with generalized anxiety disorder. However, schema therapy may be preferable when the primary therapeutic objective is strengthening ego functioning, whereas cognitive-behavioral therapy may be more appropriate for the direct and targeted reduction of pathological worry.