Comparison of the Effectiveness of Cognitive-Behavioral Therapy and Schema Therapy on Mental Health and Social Adjustment in Individuals with Gender Dysphoria
Keywords:
cognitive-behavioral, gender dysphoria, Psychological health, Social adjustment, schema-therapyAbstract
The present study aims to compare the effectiveness of cognitive-behavioral therapy (CBT) and schema therapy on mental health and social adjustment in individuals with gender dysphoria. This applied research utilized a quasi-experimental design with pretest-posttest control group and a three-month follow-up. The statistical population included all individuals with varying degrees of gender dysphoria who had referred to treatment centers and clinics across Shiraz between 2021 and 2023. The research sample was selected using convenience sampling from individuals with gender dysphoria who had visited therapeutic clinics in Shiraz. Initially, individuals aged 18 to 40 who self-identified with gender dysphoria and had sought help at three psychiatric centers were invited to attend one of the city’s counseling and psychotherapy centers. A clinical interview was conducted by a psychiatrist and a clinical psychologist to confirm the diagnosis of gender dysphoria. From those who met the inclusion criteria, 60 individuals were selected using convenience sampling and randomly assigned to three groups: experimental group 1 (CBT, 20 participants), experimental group 2 (schema therapy, 20 participants), and a control group (20 participants). The experimental groups received intervention programs, while the control group received no interventions and was placed on a waitlist. The results of the study indicated that cognitive-behavioral therapy was more effective than schema therapy in improving mental health and social adjustment in individuals with gender dysphoria. Based on the findings of the present study, the use of cognitive-behavioral therapy, in comparison to schema therapy, is emphasized for supporting individuals with gender dysphoria in enhancing mental health and social adjustment.
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Aflakian, M., Atashpour, H., & Khayatan, F. (2023). Comparison of the effectiveness of the schema therapy package based on psychosocial issues of obsessive-compulsive patients with cognitive-behavioral therapy on early maladaptive schemas and anxiety in patients with obsessive-compulsive disorder. Journal of Adolescent and Youth Psychological Studies (JAYPS), 4(5), 129-137. https://doi.org/10.61838/kman.jayps.4.5.12
Afshari, A., Esmaeli, A., & Asadnia, S. (2024). Cognitive - Behavioral Therapy in Reducing Pathological Anxiety and Worry Levels among Patients with Multiple Sclerosis with Symptoms of Generalized Anxiety Disorder. Health Psychology, 12(48), 49-60. https://doi.org/10.30473/hpj.2024.66450.5704
Arvind, A., Pandya, A., Amin, L., Aggarwal, M., Agrawal, D., Tiwari, K., & Agarwal, P. (2022). Social strain, distress, and gender dysphoria among transgender women and Hijra in Vadodara, India. International Journal of Transgender Health, 23(1-2), 149-163. https://doi.org/10.1080/26895269.2020.1845273
Austin, A., & Craig, S. L. (2015). Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications. Professional psychology: Research and practice, 46(1), 21. https://doi.org/10.1037/a0038642
Balochi, D., Atashpour, H., & Golparor, M. (2018). The effectiveness of cognitive-behavioral therapy on interpersonal problems of people with gender identity disorder. Quarterly Journal of Cognitive Analytical Psychology, 10(38), 59-49. https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=17354013&AN=161591733&h=%2FCK1LRXtAhB65PXpXMMHT0CIWxsURuXBqalgfAj2T6kWVyNkuKMaLZ1J%2FX14bfD4Z7Ue%2FrivuveoFjDVxr9Iwg%3D%3D&crl=c
Beck, A. T. (1964). Thinking and depression: II. Theory and therapy. Archives of General Psychiatry, 10(6), 561-571. https://doi.org/10.1001/archpsyc.1964.01720240015003
Berke, D. S., Liautaud, M. M., Chen, D., & Sloan, C. A. (2022). Applying Cognitive Behavioral Principles to Promote Health in Transgender and Gender Diverse Individuals. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2022.05.002
Bretherton, I., Thrower, E., Zwickl, S., Wong, A., Chetcuti, D., Grossmann, M., & Cheung, A. S. (2021). The health and well-being of transgender Australians: a national community survey. LGBT Health, 8(1), 42-49. https://doi.org/10.1089/lgbt.2020.0178
Busa, S., Wernick, J., Kellerman, J., Glaeser, E., McGregor, K., Wu, J., & Janssen, A. (2022). A Descriptive Case Study of a Cognitive Behavioral Therapy Group Intervention Adaptation for Transgender Youth With Social Anxiety Disorder. The Behavior therapist, 45(4), 135. https://pmc.ncbi.nlm.nih.gov/articles/PMC9236272/
Butler, R. M., Horenstein, A., Gitlin, M., Testa, R. J., Kaplan, S. C., Swee, M. B., & Heimberg, R. G. (2019). Social anxiety among transgender and gender nonconforming individuals: The role of gender-affirming medical interventions. Journal of abnormal psychology, 128(1), 25. https://doi.org/10.1037/abn0000399
Campbell, F., Blank, L., Cantrell, A., Baxter, S., Blackmore, C., Dixon, J., & Goyder, E. (2022). Factors that influence mental health of university and college students in the UK: a systematic review. BMC public health, 22(1), 1778. https://doi.org/10.1186/s12889-022-13943-x
Cibich, M., & Wade, T. D. (2019). Treating bulimia nervosa in the context of gender dysphoria using 10‐session cognitive behavior therapy. International Journal of Eating Disorders, 52(5), 602-606. https://doi.org/10.1002/eat.23068
Conron, K. J., Scott, G., Stowell, G. S., & Landers, S. J. (2012). Transgender health in Massachusetts: results from a household probability sample of adults. American Journal of Public Health, 102(1), 118-122. https://doi.org/10.2105/AJPH.2011.300315
de Freitas, L. D., Léda‐Rêgo, G., Bezerra‐Filho, S., & Miranda‐Scippa, Â. (2020). Psychiatric disorders in individuals diagnosed with gender dysphoria: A systematic review. Psychiatry and clinical neurosciences, 74(2), 99-104. https://doi.org/10.1111/pcn.12947
Eisazadeh, F., Heidary, S., Agajanbaglu, S., & Saffarinia, M. (2020). Study of the effectiveness of Schema Therapy on improving social adjustment and psychological capital in transsexual persons. Social Psychology Research, 10(37), 13-28. https://doi.org/10.22034/spr.2020.109694
El Khoury, S. J. (2024). Factors that impact the sociocultural adjustment and well-being of Syrian refugees in Stuttgart, Germany. https://doi.org/10.4324/9781032633503-7
Grant, J. M., Mottet, L. A., Tanis, J. J., & Min, D. (2011). Transgender discrimination survey. https://dataspace.princeton.edu/handle/88435/dsp014j03d232p
Heathcote, C., Taylor, J., Hall, R., Jarvis, S. W., Langton, T., Hewitt, C. E., & Fraser, L. (2024). Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2023-326347
Kausar, N., Mumtaz, S., & Shoaib, M. (2024). Lived Experiences of Individuals with Gender Dysphoria: A Qualitative Analysis. Sexuality & Culture, 28(2), 692-709. https://doi.org/10.1007/s12119-023-10140-9
Kopf-Beck, J., Zimmermann, P., Egli, S., Rein, M., Kappelmann, N., Fietz, J., & Keck, M. E. (2020). Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT. BMC psychiatry, 20(1), 1-19. https://doi.org/10.1186/s12888-020-02880-x
Lampis, J., De Simone, S., Lasio, D., & Serri, F. (2023). The role of family support and dyadic adjustment on the psychological well-being of transgender individuals: An exploratory study. Sexuality Research and Social Policy, 20(4), 1328-1344. https://doi.org/10.1007/s13178-023-00817-z
Lomash, E. F., Brown, T. D., & Galupo, M. P. (2018). "A WholeBunch of Love the Sinner Hate the Sin": LGBTQ Microaggressions experienced in religious and spiritual context. Journal ofHomosexuality, 66(10), 1-17. https://doi.org/10.1080/00918369.2018.1542204
Mozafaripour, M., Kurd Mirza, E., & Sedaghat, M. (2015). The relationship between mothers' social adjustment and children's gender identity. Journal of Mazandaran University of Medical Sciences, 26(145). https://doi.org/10.18869/acadpub.pbr.1.1.26
Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive-behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine, 15(1), 16. https://doi.org/10.1186/s13030-021-00219-w
Namavari, Z., Jalil, M., Khashei, S., Sanaei, S. S., & Sadeghi, E. (2023). Investigation of Differences in Early Maladaptive Schemas and Defense Mechanisms in Individuals with Gender Identity Disorder Compared to Normal Individuals. Health Nexus, 1(2), 87-93. https://doi.org/10.61838/kman.hn.1.2.12
Park, B. R., & Choi, J. S. (2014). Emotionally Focused Therapy (EFT) for the Family of an Adolescent with Suicidal Ideation: A Case Study. Family and Family Therapy, 22(3), 275-300.
Paz-Otero, M., Becerra-Fernández, A., Pérez-López, G., & Ly-Pen, D. (2021). A 2020 review of mental health comorbidity in gender dysphoric and gender non-conforming people. J Psychiatry Treat Res, 3(1), 44-55. https://doi.org/10.36959/784/425
Peeters, N., Van Passel, B., & Krans, J. (2022). The effectiveness of schema therapy for patients with anxiety disorders, OCD, or PTSD: A systematic review and research agenda. British Journal of Clinical Psychology, 61(3), 579-597. https://doi.org/10.1111/bjc.12324
Pourpashang, M., & Mousavi, S. (2021). The effects of group schema therapy on psychological wellbeing and resilience in patients under substance dependence treatment. Journal of Client-Centered Nursing Care, 7(2), 159-166. https://doi.org/10.32598/JCCNC.7.2.366.1
Qazvini, F. (2018). Investigating the Relationship between Mental Health and Social Adjustment (Case Study: Ayatollah Rouhani Hospital in Babol). Iranian Journal of Social Sciences and Humanities Research Vol, 6(2). http://uctjournals.com/archive/ujsshr/2018/June/1.pdf
Qurbani Vanajmi, M., Ajei, J., & Gholamli Lavasani, M. (2018). The effectiveness of documentary retraining on the mental health of children of divorced boys in the first secondary level. Journal of Knowledge and Research in Applied Psychology, 20(1), 26-34. https://journals.iau.ir/article_663539.html
Salaam, B., & Mounts, N. S. (2016). International note: Maternal warmth, behavioral control, and psychological control: Relations to adjustment of Ghanaian early adolescents. Journal of adolescence, 49, 99-104. https://doi.org/10.1016/j.adolescence.2016.03.006
Savafi, S., Bazzazian, S., & Sirtori, C. R. (2024). The effectiveness of mindfulness training on social adjustment, self-esteem, and hope among transgender individuals in Tehran. Journal of Neurology, Neurological Science and Disorders, 10(1), 001-008. https://doi.org/10.17352/jnnsd.000057
Shelemy, L., Cotton, S., Crane, C., & Knight, M. (2024). Systematic review of prospective adult mental health outcomes following affirmative interventions for gender dysphoria. International Journal of Transgender Health, 1-21. https://doi.org/10.1080/26895269.2024.2333525
Shleyaust, A., & Craig, N. L. (2019). Transgender affirmative cognitive-behavioral therapy. https://doi.org/10.1093/med-psych/9780190669300.001.0001
Zemestani, M., Hassannejad, L., & Nejadian, A. (2012). Comparing the quality of life, sleep quality and social adaptation of cancer patients and normal people in Ahvaz city. Urmia Medical Journal, 24(17). https://umj.umsu.ac.ir/article-1-1844-fa.html
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Copyright (c) 2025 Elham Bahadori, Kazem Khorram Del, Zahra Ehsaei (Author)
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