Dialectical Behavior Therapy versus Schema Therapy for Enhancing Body Image, Emotion Regulation, and Sexual Quality of Life in Post-Mastectomy Women: A Randomized Controlled Trial

Objective: This study aimed to compare the effectiveness of Dialectical Behavior Therapy (DBT) and Schema Therapy (ST) in improving body self-image, meta-emotion, and sexual quality of life in women who had undergone mastectomy due to breast cancer.

Methods and Materials: A total of 90 women aged 30–55, at least six months post-mastectomy, were randomly assigned to one of three groups: DBT (n=30), ST (n=30), or a waitlist control (n=30). Participants in the intervention groups received 12 weekly individual therapy sessions tailored to their respective modality. Standardized instruments—the Body Image Scale, Meta-Emotion Scale, and Sexual Quality of Life–Female (SQoL-F)—were administered at baseline, post-treatment, and 8-week follow-up. Data were analyzed using repeated measures ANOVA.

Findings: Both DBT and ST groups exhibited statistically significant improvements across all three domains compared to the control group (p < .001). DBT consistently outperformed ST in enhancing body image satisfaction, emotional awareness and regulation, and sexual well-being. The time × group interaction effect was significant for all outcomes, indicating more robust and sustained gains in the DBT group. The control group demonstrated minimal change.

Conclusion: DBT emerged as the more effective psychotherapeutic intervention for improving psychological and sexual outcomes in women following mastectomy. Its structured, skills-based focus on emotion regulation and mindfulness uniquely addresses the multifaceted challenges of post-mastectomy adjustment. Incorporating DBT into routine psycho-oncological care is recommended for comprehensive survivorship support.