Comparison of the Effectiveness of Cognitive Behavioral Therapy and Emotional Schema Therapy Based on Metacognitive Therapy on Repetitive Negative Thoughts in Patients with Generalized Anxiety Disorder

Kamran Pourmohammad Ghouchani; Faramarz Sohrabi; Mehrdad Sabet

Authors

Kamran Pourmohammad Ghouchani Department of Clinical Psychology, Ki.C., Islamic Azad University, Kish, Iran Author https://orcid.org/0000-0003-4590-0224
Faramarz Sohrabi Professor of Clinical Psychology, Faculty of Psychology and Education, Allameh Tabataba'i University, Tehran, Iran https://orcid.org/0000-0003-0293-6120
Mehrdad Sabet Department of Psychology, Ro.C., Islamic Azad University, Roudehen, Iran Author https://orcid.org/0000-0003-3890-4294

Keywords:

Repetitive Negative Thoughts, Emotional Schema Therapy, Metacognitive Therapy, Cognitive Behavioral Therapy, Generalized Anxiety Disorder

Abstract

Purpose: This study aimed to compare the effectiveness of Cognitive Behavioral Therapy (CBT) and Emotional Schema Therapy based on Metacognitive Therapy (EST-MCT) in reducing Repetitive Negative Thoughts among patients with Generalized Anxiety Disorder (GAD).

Methods and Materials: This quasi-experimental study employed a pretest–posttest control-group design with a follow-up assessment. The statistical population comprised all patients with GAD who attended counseling and psychotherapy centers in Mashhad, Iran, during 2025–2026. Based on DSM-5-TR diagnostic criteria and the Generalized Anxiety Disorder Scale, 45 eligible patients were selected through convenience sampling and randomly assigned to three groups of 15 participants: a CBT group, an EST-MCT group, and a control group. Data were collected using the Generalized Anxiety Disorder Scale developed by Spitzer, Kroenke, Williams, and Löwe (2006) and the Automatic Thoughts Questionnaire (1980). The interventions were implemented according to the emotional schema intervention based on metacognitive beliefs developed by Leahy et al. (2011) and the cognitive-behavioral treatment protocol developed by Heimberg and Becker (2002). Data were analyzed using multivariate analysis of covariance (MANCOVA).

Findings: Inferential analyses demonstrated that both CBT and EST-MCT produced statistically significant reductions in Repetitive Negative Thoughts compared with the control condition across posttest and follow-up assessments. Comparison of adjusted group differences further indicated a significant between-intervention difference, with participants receiving EST-MCT demonstrating a greater reduction in Repetitive Negative Thoughts than those receiving CBT. Thus, although both interventions showed significant therapeutic effects, the magnitude of improvement was greater in the EST-MCT group.

Conclusion: Both EST-MCT and CBT appear to be effective psychological interventions for reducing Repetitive Negative Thoughts in patients with GAD. However, the comparatively greater reduction observed following EST-MCT suggests that addressing emotional schemas together with metacognitive beliefs may provide additional therapeutic benefits for modifying persistent negative cognitive processes associated with generalized anxiety.

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