اثربخشی طرحواره‌درمانی بر اضطراب مرگ و احساس تنهایی زنان سالمند مبتلا به خود بیمارانگاری

Background: Aging is a critical stage of human development that entails specific physical, cognitive, psychological, and social changes due to age-related decline. The present study aimed to investigate the effectiveness of schema therapy on death anxiety and loneliness among older women with hypochondriasis.
Method: This study employed a quasi-experimental pretest-posttest-follow-up design with a control group. The statistical population comprised all older women residing in the Mehrjouyan nursing home in Ahvaz in 2024 who exhibited clinical symptoms of hypochondriasis based on DSM-IV-TR criteria. Initially, 30 eligible older women were selected using convenience sampling and randomly assigned to either the experimental (n=15) or control (n=15) groups. The experimental group received eight weekly 60-minute sessions of schema therapy, while the control group was placed on a waiting list. Upon completion of the intervention, a posttest was administered to both groups, followed by a follow-up assessment three months later. Data were collected using the Templer Death Anxiety Scale and Dehshiri et al.’s Loneliness Scale. The obtained data were analyzed using mixed-design ANOVA in SPSS version 26.
Results: The results demonstrated that schema therapy significantly reduced death anxiety and loneliness scores in the experimental group at both the posttest and follow-up stages (p≤.05).
Conclusion: It can be concluded that this therapeutic approach can effectively improve the mental health of older women with hypochondriasis. Utilizing this treatment method is highly recommended for counselors and psychologists working with this population.
EXTENDED ABSTRACT
Introduction
According to data from the World Health Organization (WHO), the global population aged 60 and older is increasing at an unprecedented rate and is projected to rise from 12% to 22% by 2050. Among them, older women experience heightened vulnerability due to their longer life expectancy. Persistent preoccupation with the fear of illness is a common manifestation in later life, and an older adult with hypochondriasis interprets the slightest physical symptoms as signs of an incurable disease. This interpretation, in turn, increases their death anxiety and may contribute to developmental crises in later life. Therefore, therapeutic interventions are essential to overcome these challenges. In this regard, various approaches have been employed, including schema therapy. This intervention helps individuals recognize, challenge, and modify deeply rooted maladaptive patterns. Despite the potential of this approach in restructuring maladaptive schemas, a significant research gap exists regarding its effectiveness on death anxiety and loneliness in older women with hypochondriasis, making the present study necessary. The hypotheses of this study were (1) schema therapy training is effective in reducing death anxiety in older women with hypochondriasis, and (2) schema therapy training is effective in reducing loneliness in older women with hypochondriasis.
Method
The present study employed a quasi-experimental pretest-posttest control group design with a three-month follow-up. The statistical population consisted of all older women aged 65 and above residing in the Mehrjouyan nursing home in Ahvaz in 2024, diagnosed with hypochondriasis. From this population, 30 individuals were selected using convenience sampling and assigned into either experimental group (n=15) or control group (n=15). Inclusion criteria included: (1) diagnosis of illness anxiety disorder based on DSM-5-TR criteria, confirmed by a semi-structured clinical interview; (2) being female and age of 65 years or older; (3) residence in the Mehrjouyan nursing home in Ahvaz; (4) obtaining an acceptable score (≥22) on the Mini-Mental State Examination (MMSE) to ensure the capacity for comprehension and participation; (5) scoring above the predetermined cutoff score on the Death Anxiety Scale (score >30) and the Loneliness Scale (score >56); and (6) the ability and willingness to attend sessions regularly. Exclusion criteria were: (1) concurrent diagnosis of other major psychiatric disorders such as psychosis, severe major depression with suicide risk, or active substance use disorder; (2) having an acute or unstable physical illness that would impair participation; (3) receiving regular psychotherapy concurrently or major changes in psychiatric medications within the past three months; and (4) uncompensated severe sensory impairment or withdrawal from further participation. The experimental group received a structured therapeutic protocol consisting of eight 60-minute sessions, while the control group received no intervention. The evaluation of dependent variables (death anxiety and loneliness) was conducted in the subsequent posttest and three-month follow-up stages, and the data were analyzed using repeated measures ANOVA in SPSS version 26.
Results
Prior to conducting the analysis, the normality of the distribution of dependent variables was confirmed using the Shapiro-Wilk test (p>.05) for all groups across all three stages (pretest, posttest, and follow-up). The homogeneity of covariance matrices was evaluated using Box’s M test, yielding an F-value of 1.07, which was not significant; thus, the assumption of homogeneity of covariance matrices was met. The homogeneity of error variances was confirmed using Levene’s test, with a significance level greater than .05, indicating this assumption was satisfied. Given that Mauchly’s test of sphericity was not significant for either the death anxiety or loneliness variables, the assumption of sphericity was met.
Based on the findings, the interaction between the group and the repeated factor for the research variables (death anxiety and loneliness) was statistically significant. This result indicates that changes in the study variables over time differed significantly between the schema therapy and control groups. Specifically, the interaction between the group and the repeated factor was statistically significant for death anxiety (F=52.088, p<.01) with an effect size of .650, and for loneliness (F= 135.447, p<.01) with an effect size of .829. These findings demonstrate the effectiveness of schema therapy in reducing death anxiety and loneliness scores compared to the control group.
Conclusion
From a cognitive perspective, automatic negative thoughts and biases in interpreting events, which can lead to the onset of disorders such as death anxiety in older adults, are viewed as consequences of early maladaptive schemas. Anxious patients generally accept their schemas as undeniable truths and do not question them. By challenging these flawed schemas, schema therapy assists the patient in strengthening their Healthy Adult mode. As an integrative therapeutic approach, schema therapy has demonstrated considerable effectiveness in reducing loneliness across diverse populations, including older adults, divorced women, and couples experiencing conflict. This method aims to identify and modify early maladaptive schemas, which are deep-seated, dysfunctional mental patterns formed during childhood as a result of unmet basic emotional needs. By assisting patients in challenging and restructuring these profound beliefs, this therapy promotes a more realistic understanding of social relationships and equips them with the necessary skills to satisfy basic emotional needs, such as connection and intimacy.
Ethical Consideration
Ethical Code
This article is derived from the first author’s Ph.D. dissertation in General Psychology at Islamic Azad University and was approved under ethics code IR.IUA.TABRIZ.REC.1404-168. To uphold ethical principles, data collection was conducted only after obtaining informed consent from the participants. Furthermore, participants were assured of the strict confidentiality of their personal information and that the results would be published anonymously without disclosing their identities.
Financial Support
This study did not receive financial support.
Authors’ Contributions
Z.M: Conceptualization, methodology, data curation, software, formal analysis, writing - original draft; A.A: Conceptualization, methodology, validation, writing - review & editing, supervision; A.P: Conceptualization, methodology, writing - review & editing, supervision
Conflict of Interest
The authors had no conflicts of interest.
Acknowledgments
The authors hereby express their sincere gratitude to all the individuals who participated in this study.
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