The Effectiveness of schema Therapy on Anxiety of Children with Can-cer in Online Method

Document Type : Research Paper


1 Department of Counseling, College of Humanities, Khomeinishahr Branch, Islamic Azad University, Kho-meinishahr,, Iran.

2 Department of Counseling, College of Humanities, Khomeinishahr Branch, Islamic Azad University, Khomeinishahr, Isfahan, Iran


The objective of this research endeavor was to assess the efficacy of online schema therapy in addressing anxiety among children diagnosed with cancer in Isfahan. Case study with a single experimental design involving ABA subjects and multiple baseline and follow-up assessments comprised the current investigation. The statistical population of the study comprised all children diagnosed with cancer attending Mahak Institute in Isfahan in 2021. For the purpose of this research, three children were intentionally selected and the Spans Child Anxiety Scale (SCAS) and Rijkeboer & de Boo’s Schema Inventory for Children (SIC) were performed on them during 3 baseline sessions (A). The subjects were then administered eight 60-minute schema therapy sessions via the Internet (B). One month subsequent to the intervention, they participated in three follow-up sessions (C). The SPSS-20 software was utilized to conduct a visual analysis of graphs containing trend, stability, Percentage of Non-overlapping Data (PND), Percentage of Overlapping Data (POD), Means Percentage Improvement (MPI), and Means Percentage Reduction (MPR). The mean anxiety scores of subjects 1, 2, and 3 exhibited a decreasing trend from the baseline to the intervention and follow-up stages, as indicated by the results. Furthermore, the percentages of anxiety score reduction and improvement were as follows: 9% and 8% for subject 1, 10% and 11% for subject 2, and 10% and 11% for subject 3. As a result, online schema therapy may be utilized as an intervention method to alleviate anxiety in cancer-afflicted children.


آقامیر محمدعلی، ز. (1397). اثربخشی طرحواره‌درمانی بر اضطراب مرگ در بیماران سرطانی. فصلنامۀ مطالعات روان‌شناسی و علوم تربیتی. 4(1)، 55-49.
آقایوسفی، ع. ر.، و امیرپور، ب. (1391). بررسی روایی و پایایی پرسشنامۀ طرحواره‌های ناسازگار اولیه در کودکان به روش تحلیل‌عاملی. مجلۀ پژوهنده. 17(5)، 271-265.
Aghamir Mohammadali, Z. (2018). The effectiveness of schema therapy on death anxiety in cancer patients. Journal of Studies of Psychology and Educational Sciences, 4(1), 49-55. (In Persian)
Agh Yousefi, A. R. A., & Amirpour, B. (2012). Validity and relaiblity of the early maladaptive schemas inventory in children, using factor analysis. Pajoohandeh Journal17(5), 265-271. (In Persian)
Aguilar, B. A. (2017). The Efficacy of Art Therapy in Pediatric Oncology Patients: An Integrative Literature Review. Journal of Pediatric Nursing, 36, 173-178.
Amicucci, M., Mastronuzzi, A., Ciaralli, I., Piccioni, F., Schiopu, A. C., Tiozzo, E., Gawronski, O., Biagioli, V., & Dall’Oglio, I. (2020). The Management of Children with Cancer during the COVID-19 Pandemic: A Rapid Review. Journal of Clinical Medicine, 9(11), 3756-3764.
Bredicean, A. C., Crainiceanu, Z., Oprean, C., Rivis, L. A., Papava, I., Secosan, I., Frandes, M., Giurgi-Oncu, C., & Grujic, D. (2020). The influence of cognitive schemas on the mixed anxiety-depressive symptoms of breast cancer patients. BMC Womens Health, 20(1), 32.
Chester, R., Jerosch-Herold, C., Lewis, J., & Shepstone, L. (2018). Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. British Journal of Sports Medicine, 52(4), 269-275.
Dickhaut, V., & Arntz, A. (2014). Combined group and individual schema therapy for borderline personality disorder: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 242-251.
Fassbinder, E., Assmann, N., Schaich, A., Heinecke, K., Wagner, T., Sipos, V., Jauch-Chara, K., Hüppe, M., Arntz, A., & Schweiger, U. (2018). PRO*BPD: effectiveness of outpatient treatment programs for borderline personality disorder: a comparison of Schema therapy and dialectical behavior therapy: study protocol for a randomized trial. BMC Psychiatry, 18(1), 341.
Gong, J., & Chan, R. C. (2018). Early maladaptive schemas as mediators between childhood maltreatment and later psychological distress among Chinese college students. Psychiatry Research, 259, 493-500.
Harper, F. W., Peterson, A. M., Albrecht, T. L., Taub, J. W., Phipps, S., & Penner, L. A. (2014). Posttraumatic Stress Symptoms in Parents of Pediatric Cancer Patients: A Mediational Analysis. Journal of Traumatic Stress Disorders & Treatment, 3(4), 1000133.
Hoffart Lunding, S., & Hoffart, A. (2016). Perceived parental bonding, early maladaptive schemas and outcome in schema therapy of cluster c personality problems. Clinical Psychology & Psychotherapy, 23(2), 107-117.
Kakaje, A., Alhalabi, M. M., Ghareeb, A., Karam, B., Mansour, B., Zahra, B., & Hamdan, O. (2020). Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study. Scientific Reports, 10(1), 6756.
Kaye, E. C., Jerkins, J., Gushue, C. A., DeMarsh, S., Sykes, A., Lu, Z., ... & Baker, J. N. (2018). Predictors of Late Palliative Care Referral in Children with Cancer. Journal of Pain and Symptom Management, 55(6), 1550-1556.
Kim, D. H., & Im, Y. J. (2015). The influence of family management style on psychosocial problems of childhood cancer survivors in Korea. European Journal of Oncology Nursing, 19(2), 107-112.
Kindynis, S., Burlacu, S., Louville, P., & Limosin, F. (2013). Effect of schema-focused therapy on depression, anxiety and maladaptive cognitive schemas in the elderly. Encephale, 39(6), 393-400.
Leahy, R. L. (2011). Resistance: An emotional schema therapy approach. In: Simos G, Editor. Cognitive Behaviour Therapy: A Guide for the Practising Clinician. Abingdon, UK: Taylor & Francis.
Loose, C., Meyer, F., & Pietrowsky, R. (2018). The Dusseldorf Illustrated Schema Questionnaire for Children (DISC). Psicologia: Reflexão e Crítica, 31.
Madi, D., & Clinton, M. (2018). Pain and its Impact on the Functional Ability in Children Treated at the Children's Cancer Center of Lebanon. Journal of Pediatric Nursing, 39, e11-e20.
Mansano-Schlosser, T. C., & Ceolim, M. F. (2012). Factors associated with sleep quality in the elderly receiving chemotherapy. Revista Latino-Americana de Enfermagem, 20(6), 1100–1108.
Marcus, J. (2012). Psychosocial issues in pediatric oncology. Ochsner Journal, 12(3), 211-215. PMC3448242
Metzler, D. H., Mahoney, D., & Freedy, J. R. (2016). Anxiety Disorders in Primary Care. Primary Care: Clinics in Office Practice, 43(2), 245-261.
Mousavi, R., Moradi, A. R., Farzad, V., Mahdavi Harsini, S. E., Spence, S., & Navabinezhad, S. (2007). Psychometric Properties of the Spence Children__AWT_QUOTE__s Anxiety Scale with an Iranian Sample. International Journal of Psychology, 1(1), 1-16.
Renner, F., DeRubeis, R., Arntz, A., Peeters, F., Lobbestael, J. & Huibers, M. J. H. (2018). Exploring mechanisms of change in schema therapy for chronic ‌depression. Journal of Behavior Therapy and Experimental Psychiatry, 58, 97- 105.‌
Rijkeboer, M. M., & de Boo, G. M. (2009). Early maladaptive schemas in children: Development and validation of the schema inventory for children. Journal of Behavior Therapy and Experimental Psychiatry, 41(2), 102–109.
Schaap, G. M., Chakhssi, F., & Westerhof, G. J. (2016). Inpatient schema therapy for nonresponsive patients with personality pathology: Changes in symptomatic distress, schemas, schema modes, coping styles, experienced parenting styles, and mental well-being. Psychotherapy, 53(4), 402-412.
Shime, E. J., Lee, J. W., Cho, J., Jung, H. K., Kim, N. H., Lee, J. E., Min, J., Noh, W. C., Park, S. H., Kim, Y. S. (2020). Association of depression and anxiety disorder with the risk of mortality in breast cancer: A National Health Insurance Service study in Korea. Breast Cancer Research and Treatment, 179(2), 491–498.
Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36(5), 545–566.
Spence, S. H., Barrett, P. M., & Turner, C. (2003). Psychometric properties of the Spence Children Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17(6), 605-625.
Steliarova-Foucher, E., Colombet, M., Ries, L. A., Moreno, F., Dolya, A., Bray, F., ... & Tretarre, B. (2017). International incidence of childhood cancer, 2001–10: a population-based registry study. The Lancet Oncology, 18(6), 719-731.
Taylor, C. D., Bee, P., & Haddock, G. (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and Psychotherapy: Theory, Research and Practice, 90(3), 456-79.
Tomlinson, R. M., Keyfitz, L., Rawana, J. S., & Lumley, M. N. (2017). Unique contributions of positive schemas for understanding child and adolescent life satisfaction and happiness. Journal of Happiness Studies18(5), 1255-1274.
Trentacosta, C. J., Harper, F., Albrecht, T. L., Taub, J. W., Phipps, S., & Penner, L. (2016). Pediatric Cancer Patients’ Treatment-Related Distress and Longer-Term Anxiety: An Individual Differences Perspective. Journal of Developmental and Behavioral Pediatrics, 37(9), 753-761.
Yi, J. C., & Syrjala, K. L. (2017). Anxiety and Depression in Cancer Survivors. Medical Clinics of North America, 101(6), 1099-1113.