Comparing Schema Therapy and Dialectical Behavior Therapy on Body Image and Sexual Self-Concept in Women with Vaginismus
Downloads
Objective: This study aimed to compare the effectiveness of Dialectical Behavior Therapy (DBT) and Schema Therapy (ST) on improving multidimensional self–body relations and sexual self-concept in women with vaginismus.
Methods and Materials: A randomized controlled trial was conducted with 45 women diagnosed with vaginismus in Mashhad, Iran. Participants were randomly assigned to three groups: DBT (n = 15), ST (n = 15), and a waitlist control (n = 15). Both intervention groups received eight weekly sessions of treatment. Outcome measures included the Multidimensional Body–Self Relations Questionnaire (MBSRQ) and the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ), administered at pre-test, post-test, and a five-month follow-up. Data were analyzed using repeated measures ANOVA with Bonferroni post-hoc comparisons via SPSS-27.
Findings: Results indicated significant improvements in both self–body relations and sexual self-concept across time and group (p < .001). Schema Therapy demonstrated the greatest improvement in sexual self-concept from pre-test to follow-up (Mean Difference = 13.48), while DBT produced significant gains in self–body awareness and emotional regulation. The interaction effects of time × group were statistically significant for both outcome variables (p < .001), indicating differential treatment effects. Bonferroni post-hoc tests showed that both experimental groups outperformed the control group at post-test (p < .001), and Schema Therapy yielded significantly greater effects than DBT on sexual self-concept (p = .007) and self–body relations (p = .041).
Conclusion: Both Dialectical Behavior Therapy and Schema Therapy are effective interventions for enhancing body-related and sexual self-perceptions in women with vaginismus, with Schema Therapy showing more sustained effects on deeper identity-related domains.
Downloads
Amani, M., & Abolghasemi, A. (2017). The efficacy of Group Training of Dialectical Behavior Therapy Concepts on Improvement of Emotional Recognition Strategies and Decrease of Obsessive-Compulsive Disorder (OCD). Biannual Peer Review Journal of Clinical Psychology & Personality, 14(2), 125-134. https://www.magiran.com/paper/1796201
Asmand, P., Mami, S., & Valizadeh, R. (2014). Efficacy of dialectical behavior therapy in irrational belief and anxiety among young male prisoners with antisocial personality disorder in Ilam prison [Quazi-Experimental]. Medical Sciences Journal of Islamic Azad University, 24(3), 159-167. http://tmuj.iautmu.ac.ir/article-1-836-en.html
Bahadori, A., Golkar, M. K., & Pashang, S. (2022). The Effectiveness of Schema Therapy Intervention in Weight, Body Image, and Self-esteem of Obese People: A Randomized Controlled Trial. Hormozgan Medical Journal, 26(2), 82-87. https://doi.org/10.34172/hmj.2022.14
Chang, C. J., Halvorson, M. A., Lehavot, K., Simpson, T. L., & Harned, M. S. (2023). Sexual identity and race/ethnicity as predictors of treatment outcome and retention in dialectical behavior therapy. Journal of consulting and clinical psychology. https://doi.org/10.1037/ccp0000826
Cohen, J. M., Norona, J. C., Yadavia, J. E., & Borsari, B. (2021). Affirmative Dialectical Behavior Therapy Skills Training With Sexual Minority Veterans. Cognitive and Behavioral Practice, 28(1), 77-91. https://doi.org/10.1016/j.cbpra.2020.05.008
Damiris, I. K., & Allen, A. (2023). Exploring the Relationship between Early Adaptive Schemas and Sexual Satisfaction. International Journal of Sexual Health, 35(1), 13-29. https://doi.org/10.1080/19317611.2022.2155897
Erwini, K. R., McCarty, K., McKenzie, K. J., Pollet, T. V., Cornelissen, K. K., Toveé, M. J., & Cornelissen, P. L. (2019). Distorted body image influences body schema in individuals with negative bodily attitudes. Neuropsychologia, 122, 38-50. https://doi.org/10.1016/j.neuropsychologia.2018.11.015
GÜLer, K. (2024). The Mediating Role of Sexual Satisfaction and Anger in the Relationship Between Partner-Related Obsessive Compulsive Symptoms and Sexual Self-Schema. İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi(23), 522-537. https://doi.org/10.38079/igusabder.1492251
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. Aftj, 4(5), 610-632. https://doi.org/10.61838/kman.aftj.4.5.35
Harned, M. S., Schmidt, S. C., Korslund, K. E., & Gallop, R. J. (2021). Does Adding the Dialectical Behavior Therapy Prolonged Exposure (DBT PE) Protocol for PTSD to DBT Improve Outcomes in Public Mental Health Settings? A Pilot Nonrandomized Effectiveness Trial With Benchmarking. Behavior therapy, 52(3), 639-655. https://www.sciencedirect.com/science/article/pii/S0005789420301192
Hassani, F., Rezazadeh, M. R., Ghanbari Panah, A., & Khoshkhabar, A. (2023). The impact of schema therapy on sexual satisfaction, emotional regulation, and resilience in nurses experiencing marital burnout. Community Health Journal, 16(2), 71-81. https://doi.org/10.61838/kman.pdmd.2.4.8
Karimi Mohajeri, Z., Karbalaee Harfteh, F., Khalatbari, J., & Fardin, M. (2025). The effectiveness of integrating schema therapy and acceptance and commitment therapy on subjective well-being and body image concerns in women with breast cancer. Journal of Psychological Sciences, 24(145), 197-220. https://psychologicalscience.ir/browse.php?a_id=2564&sid=1&slc_lang=en
Karimi, S., Doostdari, F., Lotfabadi, N. B., Yosefi, R., Soleymani, M., Kianimoghadam, A. S., & Safari, F. (2023). The Role of Early Maladaptive Schemas in Predicting Legitimacy, Seduction, Normalization, Sexuality, Social Background, and Sensation Seeking in Marital Infidelity. Practice in Clinical Psychology, 11(3), 249-258. https://doi.org/10.32598/jpcp.11.3.848.2
Khoshini, F., Akbari, M., & Mohammadkhani, S. (2022). The structural relationship of body dysmorphic disorder (BDD) with early maladaptive schema and perceived emotional invalidation: the mediating Role of metacognition, body image, and distress tolerance. Clinical Psychology and Personality, 19(2), 101-119. https://cpap.shahed.ac.ir/article_3451_en.html?lang=en
Kok, B., & Kucukgoncu, S. (2024). Effects of Sexual Myths and Intimate Partner Violence on Women's Sexual Self-Schemas. Archives of Sexual Behavior, 53(1), 375-382. https://doi.org/10.1007/s10508-023-02729-w
Malekimajd, M., Ameri, F., Pivastehgar, M., & Farahbijari, A. (2024). Examining the effectiveness of schema therapy on alexithymia, dysfunctional relationship beliefs, and sexual intimacy in married women with persistent depressive disorder. Disability Studies, 13(1), 1-10. https://jdisabilstud.org/browse.php?a_id=3130&slc_lang=en&sid=1&printcase=1&hbnr=1&hmb=1
Mojtabaei, M., Saberi, H., & Alizadeh, A. (2015). The Role Of Sexual – Self Schema And Body Image On Women's Sexual Function. Health Psychology, 4(13), 21-40. https://hpj.journals.pnu.ac.ir/article_1601_0badd68a2bcee6f9e49b1cc04f0acebd.pdf
Nosrati, E., & Taklavi, S. (2020). The relation of emotional schemas and body image with the regulation woman’s athletic behavior. Journal of Sports Psychology, 12(1), 85-99. https://doi.org/10.29252/mbsp.5.1.85
Nourizadeh Mirabadi, M., Hosseinzadeh Taghvaei, M., Moloodi, R., Sodagar, S., & Bahrami Hidaji, M. (2022). The efficacy of schema therapy on coping styles and body image concerns in obese people with binge-eating disorder: A single-subject study. Journal-of-Psychological-Science, 21(120), 2501-2518. https://doi.org/10.52547/JPS.21.120.2501
Oettingen, J., Gierowski, J. K., Grabski, B., & Micek, A. (2023). A Discussion of Early Maladaptive Schemas in Men Convicted Sexual Offenders in Poland. Archives of Psychiatry and Psychotherapy, 26(2), 94-107. https://doi.org/10.12740/app/166604
Ostadian Khani, Z., Hassani, F., sepahmansour, s., & Keshavarziarshad, F. (2021). The comparison of the efficacy of therapy based on acceptance and commitment and schema therapy on body image flexibility of the body and impulsivity among women with Binge eating disorder. Journal of Applied Family Therapy, 2(4), 285-309. https://doi.org/10.22034/aftj.2021.307283.1215
Pakandish, S., Kraskyan, A., & Jomehri, F. (2020). Comparing the Effectiveness of Schema Therapy and Cognitive-Behavioral Therapy on Quality of Life and Body Image of Obese Women. Journal of Excellence in counseling and psychotherapy, 9(34), 20-32.
Rahmani Moghaddam, F., Bagherzadehgolmakani, Z., Touzandehjani, H., & Nejat, H. (2023). Exploring the Impact of Dialectical Behavior Therapy on Emotional Regulation and Rumination among the Physically Disabled People using the Services of the Welfare Organization of Mashhad. Research in Clinical Psychology and Counseling, 13(1), 123-138. https://doi.org/10.22067/tpccp.2023.75967.1269
Samakoush, A. N. (2023). Effectiveness of Schema Therapy on Marital Exhaustion, Sexual Self-Efficacy, and Women's Feeling of Loneliness in the Family. PWJ, 4(3), 19-27. https://doi.org/10.61838/kman.pwj.4.3.3
Sheikh, S., Alzackerini, S. M., Shirmahaleh, F. M., Zam, F., & Baseri, A. (2021). Investigating the effect of two methods of dialectic behavioral therapies and metacognitive therapy on the body mass index and emotional eating behavior in patients with type 2 diabetes. International Journal of Health Studies, 36-42. http://ijhs.shmu.ac.ir/index.php/ijhs/article/view/855
Sundgren, M., Allen, Andrew. (2023). The Role of Early Adaptive Schemas in Heterosexual Romantic Relationships. Sexuality & Culture, 27(2), 390-414. https://doi.org/10.1007/s12119-022-10018-2
Tabatabayi, A. S., Yosofi, Z., Motamedi, M., & Taheri, S. (2021). The Effectiveness of Dialectical Behavior Therapy on Self-Forgiveness and Depression in Teenager Girls with Self-injury History in Isfahan. Journal of Clinical Psychology, 13(1), 13-22. https://doi.org/10.22075/jcp.2021.18167.1699
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
Copyright (c) 2025 International Journal of Body, Mind and Culture
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
