Document Type : Scientific Research
Authors
1 Ph.D. Student in Psychology, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran.
2 Associated Professor, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran.
3 Assistant of Professor, Department of Psychology, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran.
Abstract
Objective: The management of Type 2 diabetes mellitus (T2DM), a highly prevalent chronic metabolic disorder, necessitates a biopsychosocial framework that addresses its significant psychological comorbidities alongside physical health. The continuous burden of self-care, lifestyle modification, and treatment adherence can lead to chronic stress, anxiety, depression, and diminished general health. Underlying these challenges, maladaptive cognitive schemas and pervasive self-criticism are recognized as key vulnerability factors that exacerbate psychological distress and impede effective glycemic control. To target these core mechanisms, Mode-Based Schema Therapy (MBST) has been established as an effective intervention for modifying dysfunctional schemas and enhancing emotional regulation. In a complementary fashion, self-compassion training aims to mitigate self-criticism and foster emotional acceptance and kindness toward the self. While the separate efficacy of each approach has been documented, their synergistic potential within an integrated treatment model remains largely unexamined. Crucially, there is a lack of empirical research investigating whether combining these interventions yields superior outcomes that span both psychological well-being and objective physiological markers. This gap limits the development of holistic treatment protocols that can simultaneously target the cognitive, emotional, and behavioral facets of diabetes distress. Therefore, the present study aimed to evaluate and compare the effectiveness of MBST alone versus MBST integrated with self-compassion training on improving general health and reducing glycated hemoglobin (HbA1c) levels in patients with T2DM. This comparative approach seeks to determine if augmenting schema-focused work with compassion-based strategies provides added value for comprehensive patient care. Method: This quasi-experimental study employed a pretest-posttest design with a control group. The statistical population included 2,400 patients with type 2 diabetes who were members of the Iranian Diabetes Association in Mashhad in 2024. After initial screening and Considering the criteria for entry and exit from research, 36 eligible participants were selected and randomly assigned to three groups: (1) Mode-Based Schema Therapy, (2) Mode-Based Schema Therapy combined with self-compassion training, and (3) a control group receiving no psychological intervention. Both intervention groups participated in 10 weekly group sessions, each session lasting 90 minutes. Mode-Based Schema Therapy sessions were conducted according to the protocol developed by Farrell et al. (2012), while self-compassion training followed Desmond (2015). Interventions aimed to modify maladaptive schemas, enhance healthy adult status, cultivate self-compassion, and learn adaptive coping with diabetes-related stress. Data collection tools included the General Health Questionnaire (GHQ-28) and HbA1C blood test. Data were analyzed using analysis of covariance (ANCOVA), controlling for pretest scores. Normality assumptions were checked with the Shapiro-Wilk test, and effect sizes were reported. The significance level was set at p<0.05. Results: Data analysis indicated significant improvements in general health and reductions in HbA1c levels in both intervention groups, whereas the control group showed no considerable changes. Results from a multivariate analysis of covariance (MANCOCOVA), controlling for pretest scores, revealed statistically significant differences among the three groups on the combined dependent variables (Wilks' Lambda = 76.14, p< .001). Follow-up univariate ANCOVAs confirmed that these differences were significant for both general health (F = 27.69, p < .001, η² = 0.634) and HbA1c (F = 16.29, p < .001, η² = 0.505). Pairwise comparisons with Bonferroni adjustment confirmed that both intervention groups performed significantly better than the control group. Furthermore, comparisons between the two active groups showed that the combined intervention group (MBST + self-compassion) demonstrated a statistically significant superiority over the MBST-only group in improving general health (p < .05). Regarding HbA1c, although the reduction was greater in the combined group, this difference approached marginal statistical significance (p = .052), indicating a strong trend in favor of the integrated intervention. Overall, this pattern of findings underscores the superior efficacy of the combined approach in achieving optimal psychological and physiological outcomes. Conclusion: The findings of this study demonstrate that Mode-Based Schema Therapy (MBST) is an effective intervention for improving general health and glycemic control (as measured by HbA1c) in patients with type 2 diabetes. Statistical analyses revealed significant and robust differences between the intervention groups and the control group, with the large effect sizes (η² = 0.634 for general health and η² = 0.505 for HbA1c) underscoring the clinical importance of these interventions. Notably, while both active interventions led to improvement, the combination of MBST with self-compassion training demonstrated statistically significant superiority in both psychological and physiological domains. This enhanced efficacy can be attributed to the complementary mechanisms of the two approaches. While MBST directly targets the identification and modification of maladaptive schemas and the de-escalation of negative emotional modes (e.g., the Vulnerable Child or Punitive Parent), self-compassion training directly reduces internal self-criticism, increases non-judgmental acceptance, and fosters a kinder self-attitude. This creates a more favorable emotional foundation for sustained change. Together, this integrated protocol provides a dual framework: it restructures deeper cognitive-emotional structures while simultaneously modifying the patient's daily responses to illness-related stress and potential lapses in self-care management. The combined approach appears to not only reduce rumination and psychological distress but also, by enhancing emotional resilience, facilitates greater adherence to health-promoting behaviors, which is ultimately reflected in the objective reduction of HbA1c levels. Given the chronic and stressful nature of diabetes, these findings emphasize the necessity of integrating deep, multi-dimensional psychological interventions into standard treatment protocols. Combining schema therapy modalities with mindfulness and compassion-based approaches can offer a powerful treatment model for achieving concurrent improvement in psychological and somatic indicators. Future research with larger sample sizes and longer follow-up periods is recommended to examine the sustainability of these effects and to elucidate the precise mediating mechanisms of change.
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