Comparative Effectiveness of Cognitive Behavioral Therapy and Schema Therapy in Reducing Repetitive Negative Thoughts in Patients with Major Depressive Disorder

Giti  Shahbazi; Faramarz Sohrabi; Ghobad Bahamin

Authors

Giti Shahbazi Department of clinical psychology, Ki.c., Islamic Azad University, Kish, Iran. Author https://orcid.org/0000-0002-7036-8447
Faramarz Sohrabi Professor of Clinical Psychology, Faculty of Psychology and Education, Allameh Tabataba'i University, Tehran, Iran https://orcid.org/0000-0003-0293-6120
Ghobad Bahamin Department of Psychology, Payame Noor University, Tehran, Iran. Author https://orcid.org/0000-0002-0043-6600

Keywords:

Cognitive Behavioral Therapy, Schema Therapy, Repetitive Negative Thinking, Major Depressive Disorder

Abstract

Purpose: This study aimed to compare the effectiveness of cognitive behavioral therapy (CBT) and schema therapy in reducing repetitive negative thinking among patients with major depressive disorder (MDD).

Methods and Materials: This quasi-experimental study employed a pretest–posttest design with a control group. The statistical population comprised patients diagnosed with major depressive disorder who attended counseling and psychotherapy centers in Ilam, Iran, in 2026. Using convenience sampling, 45 eligible patients were selected and randomly assigned to three groups of 15 participants: a CBT group, a schema therapy group, and a control group. Data were collected using the Beck Depression Inventory-II (BDI-II) and the Automatic Thoughts Questionnaire developed by Hollon and Kendall. The CBT group received Beck’s cognitive behavioral intervention, while the schema therapy group received Young’s schema therapy intervention. Both interventions consisted of 12 sessions of 60 minutes each, whereas the control group received no therapeutic intervention during the study period. Following completion of the interventions, all three groups completed the posttest assessments. Data were analyzed using multivariate analysis of covariance (MANCOVA), with pretest scores controlled to examine between-group differences in posttest outcomes.

Findings: Inferential analysis indicated a significant difference among the three groups in posttest repetitive negative thinking after controlling for baseline scores. Both cognitive behavioral therapy and schema therapy produced significant reductions in repetitive negative thinking compared with the control condition. Pairwise comparisons further indicated that participants receiving schema therapy demonstrated a greater reduction in repetitive negative thinking than those receiving cognitive behavioral therapy. Thus, although both therapeutic approaches were effective in modifying maladaptive repetitive cognitive processes associated with major depressive disorder, the magnitude of improvement was greater in the schema therapy group.

Conclusion: Both cognitive behavioral therapy and schema therapy can be considered effective psychological interventions for reducing repetitive negative thinking in patients with major depressive disorder; however, schema therapy may provide greater benefits in addressing persistent maladaptive cognitive patterns. These findings support the clinical application of both approaches in counseling and psychotherapy settings and highlight the potential value of investigating integrative interventions combining CBT and schema therapy in future research.

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