اثربخشی طرحواره‌درمانی بر نشخوار فکری و ناگویی هیجانی سالمندان

Background: Aging is a critical stage of life in which various dimensions of mental health warrant close attention. Rumination and alexithymia are psychological factors that can significantly affect emotional well-being in older adults. Accordingly, the present study aimed to investigate the effectiveness of schema therapy on reducing rumination and alexithymia among older adults in Ahvaz.
Method: This quasi-experimental study employed a pretest–posttest design with a control group. The statistical population included all individuals aged 65 to 75 residing in Ahvaz, Iran during the second half of 2024. A total of 30 participants were selected through convenience sampling and based on eligibility criteria, and randomly assigned to experimental and control groups. The experimental group received schema therapy based on Young et al.’s protocol in eight weekly 90-minute sessions. The measures included the Toronto Alexithymia Scale (TAS-20) and Nolen-Hoeksema’s Ruminative Response Scale. Data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS22.
Results: By controlling for pre-test scores, ANCOVA revealed statistically significant differences between the experimental and control groups in both rumination and alexithymia scores (p<.001), indicating that schema therapy led to significant reductions in these constructs.
Conclusion: Based on the findings of this study, schema therapy improves rumination and alexithymia in older adults, representing new horizons in clinical interventions. It can be considered an effective approach for reducing rumination and alexithymia among older adults.
EXTENDED ABSTRACT
 Introduction
Population aging is a global phenomenon that modern societies increasingly experience, carrying significant social implications. In Iran, according to the 2016 national census, individuals aged 60 and above constituted 9.3% of the population. Projections suggest that by 2041, this figure will rise to 25–30%, meaning that approximately one in every three or four citizens will be in later adulthood. Consequently, addressing psychological factors such as rumination and alexithymia during this life stage is crucial for promoting mental well-being. In recent years, various therapeutic approaches have been employed to improve emotional regulation skills and reduce rumination among older adults. Among these, schema therapy has garnered notable attention. Empirical studies have demonstrated its efficacy in reducing perceived stress, maladaptive schemas, worry, and anxiety symptoms in individuals in later adulthood. Given the limited research conducted in Iran on therapeutic interventions targeting psychological factors in this population, the present study aims to evaluate the effectiveness of schema therapy in reducing rumination and alexithymia among older adults.
Method
This was a quasi-experimental study with a pretest-posttest control group. The statistical population included all individuals aged 65 to 75 residing in Ahvaz, Iran, during the second half of 2024. Using convenience sampling, 30 participants who met the eligibility criteria were selected and randomly assigned to experimental and control groups. Inclusion criteria were (1) scoring above the mean on rumination and alexithymia scales, (2) aged 65 or older, and (3) a minimum education level of middle school. Exclusion criteria were (1) concurrent participation in other therapeutic interventions and (2) diagnosis of severe cognitive impairments. Data collection instruments included Bagby et al.’s Toronto Alexithymia Scale and Nolen-Hoeksema and Morrow’s Ruminative Response Scale. The intervention was based on the schema therapy protocol developed by Young et al. (2003), delivered in eight 90-minute weekly sessions by the researcher. Each session involved setting goals, topic introduction, discussion, and in-session exercises. Data were analyzed using univariate analysis of covariance (ANCOVA) in SPSS-23.
Results
To examine the main outcomes, ANCOVA was conducted. First, Levene’s test was used to assess the homogeneity of variances between groups at the post-test phase. The results indicated no significant differences, confirming the assumption of homogeneity. Additionally, the assumption of homogeneity of regression slopes was tested by examining the interaction between the independent variable and pre-test scores for each dependent variable. The F-values for rumination and alexithymia were not statistically significant (p>.05), thus supporting the assumption of homogeneity of regression slopes. The normality of the distribution was assessed using the Shapiro-Wilk test, which confirmed normal distribution for both dependent variables. Given that all ANCOVA assumptions were met, the analysis proceeded to evaluate the effectiveness of schema therapy on rumination and alexithymia scores. The results, presented in Table 1, indicate significant improvements in the experimental group compared to the control group.
The findings revealed statistically significant differences between the experimental and control groups in rumination and alexithymia. Specifically, schema therapy resulted in a significant reduction in both variables among participants in the experimental group, as indicated by lower post-intervention mean scores compared to those in the control group.
Conclusion
The results of this study suggest that schema therapy, by targeting early maladaptive schemas formed during childhood and addressing dysfunctional coping styles, offers a promising approach to psychological improvement among individuals in later adulthood. Through cognitive and behavioral techniques, schema therapy facilitates the replacement of ineffective coping strategies with more adaptive patterns of thinking and behavior. Experiential techniques employed in the intervention enabled participants to reorganize emotional experiences, engage in self-reflection, acquire new learning, regulate interpersonal affect, and develop self-soothing skills. These mechanisms contributed to the observed reductions in rumination and alexithymia. Given that the study was conducted in Dezful, caution is advised when generalizing the findings to other regions. Future research is recommended to replicate the study in diverse geographical contexts and compare the outcomes. Moreover, identifying more effective strategies for preventing psychological difficulties and enhancing support systems for individuals in later adulthood should be prioritized. Such efforts can inform targeted interventions aimed at mitigating both the severity and the long-term consequences of psychological distress in this population.
Ethical Consideration
Ethical Code
This article is derived from the first author's Master's thesis in Personality Psychology at Islamic Azad University, Dezful Branch.
Financial Support
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Authors’ Contributions
M.E: Conceptualization, Methodology, Software, Validation, Formal Analysis, Data Curation, Visualization; I.A.S: Conceptualization, Methodology, Software, Validation, Writing - Review & Editing, Visualization; H.H.R: Conceptualization, Methodology, Writing - Review & Editing, Project Administration, Supervision, Visualization.
Conflict of Interest
The authors declare no conflicts of interest
Acknowledgments
The authors express their sincere gratitude to all participants for their valuable contributions to this study.
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