الفهرس 
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Abstract
Schema Therapy (ST) is a kind of cognitive behavioral therapy (CBT) that relies on ideas from a range of disciplines in an attempt to regulate and develop mental processes as well as emotional states and outward displays of self-care. This is done in an effort to improve overall well-being.
The primary goal of this therapy is to guide patients in accurately assessing their own requirements and then to provide for those requirements in a way that is both timely and effective. It’s possible that an individual’s fundamental emotional needs were not met when they were an infant, a child, or a teenager, which led to the formation of reoccurring themes or patterns that are now known as Early Maladaptive Schemas (EMSs).
A clear description of the risk factors that put particular people at risk for a certain illness is provided by the idea of schema, which aims to offer this definition. These beliefs and expectations about oneself and the world are the result of a complex interaction between one’s interpersonal experiences of unfulfilled core emotional needs and one’s natural temperamental predispositions. These beliefs and expectations about oneself and the world are the result of this interaction. (Mark, 2010)
It was assumed that ST might be helpful for people with OCD because it tackles early trauma, fundamental core beliefs, concomitant personality disorders, and symptomatically unique functioning. This is because the work on EMSs and schema modes is of major importance (Young, 1990; Young & Klosko, 1993; Young, Klosko & Weishaar, 2003).
The present study aimed to Examine the efficacy of Schema Therapy on obsessive symptoms among patients with obsessive-compulsive disorder.
The study followed a quasi-experimental repeated measures research design. It was conducted at the psychiatric outpatient clinics of the Main University Hospital which is affiliated to the Faculty of Medicine, Alexandria University, and one other private clinic to complete study sample. Study subjects comprised 13 patients who were fulfilling the criteria of the study.
Tools for data collection included:
- Tool I: A Socio-Demographic and Clinical Data Structured Interview Schedule for Patients with OCD.
- Tool II: Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) developed by Goodman et al, (1989). The scale is regarded as the gold standard in the measurement of obsessive-compulsive disorder symptoms severity and treatment response. Eric, A, et al. (2010).
- Tool III: Young Schema Questionnaire–Long Form, Third Edition (YSQ-L3) developed by Young et al. (2003) to assess 18 early maladaptive schemas (EMSs).
Following the listed steps:
Administrative steps:
- Approval from the Research Ethics Committee, Faculty of Nursing, Alexandria University was obtained.
- Official written permissions for conducting the study were obtained from the director of day clinics at the Main University Hospital.
Training steps: The researcher completed trainings as follows: -
- An online training on schema therapy by the team of the International Society of Schema Therapy.
- CBT, online training on transformative science on cognitive behavioral therapy by Mr. Kain Ramsay on Udemy, and licenses was delivered.
- The researcher completed a training on cognitive behavior therapy and exposure and response prevention therapy, its application on obsessive compulsive patients by the Egyptian Association for Cognitive Behavior Therapy (EACBT) with Dr. Amara Yehia, Cairo university and license was delivered.
Pilot study and internal consistency steps:
9- A pilot study was carried out on 3 patients diagnosed with OCD to ensure the clarity of the tools (Tool II (Y-BOCS) and tool III (YSQ-L3). The pilot study subjects were excluded from the actual study.
10- Tool II (Y-BOCS) and tool III (YSQ-L3) proved to be internally consistent by using Cronbach’ alpha test method on 5 patients who met the inclusion criteria of the study subjects (Cronbach’s alpha0.72and 0.77 respectively).
Planning steps:
11- Schema therapy sessions were translated into Arabic language, the content of each session was revised and approved by the supervisors and the necessary required modifications were done.
Actual study:
The following steps were used to conduct the descriptive part of the study:
- The researcher visited the Main University Hospital 4 times / week during a whole month to select the available patients.
- Patients’ medical charts were reviewed to find out patients’ diagnosis and make sure that the patient is fulfilling the inclusion criteria.
- 13 patients with OCD (males and females) were recruited after screening the patient’s chart.
- One to two patients were interviewed daily to explain the purpose of the study, establish rapport, elicit severity of OCD symptoms, and early maladaptive schemas, using tools I, II and III.
The following steps were used to conduct the experimental part of the study:
- The G*Power Windows. 3.1.9.7 Program revealed a sample size of 10 patients minimum and 12 patients maximum. Accordingly, the study subjects comprised a convenience sample of 13 patients diagnosed with OCD according to the DSM-5, with no comorbidity. Each patient was met individually to be oriented him about the study.
- Oral consent about patients’ continuity and adherence to training were taken.
- A written plan for every session (time, meetings, and setting) was scheduled according to the patient and researcher time.
- Between sessions telephone guidance was conducted twice weekly with each patient.
- Patients’ responses, feedback about the most used skills, estimated time, and any obstacles in intervention were documented.
- The sessions of schema therapy were divided into 3 phases composed of 26 sessions
- For each homework assignment, the patient wrote, or asked others to write for him, and/or record the wanted information.
- Corrective feedback was given by the researcher to the patients to make the skills of sessions more efficient.
Evaluative step:
After completion of 4-6 months training intervention for each patient, each patient was interviewed using tool II, and III at the outpatient clinics to determine the effectiveness of schema therapy intervention.
The following is a list of the most important findings from this investigation:
• Eighty-four percent of the patients were between the ages of twenty and thirty, making up the majority of the patient population. Overall, there was a ratio of 92.3% of persons who were single.
• Patients with a degree equivalent to or more than a bachelor’s made up 92.3% of those polled, whereas 69.2% of unemployed patients participated in the study.
• All patients (100%) had family who looked for them, and seventy-six percent of the patients had ailments that had persisted for less than five years.
• A positive family history of mental illness was present in 92.3 percent of the people who were studied.
• One hundred percent of the patients who participated in the survey said that they felt loved and supported by both their personal families and their extended families (100 percent). One or more medications were administered to each and every patient. In addition to that, 53.84 percent of these patients had used antidepressants or antipsychotics at some point in their lives.
• In order to carry out a descriptive comparison study, the ratings that the patients received for the severity of their symptoms and their early maladaptive schemas were compared across four different tests.
• The average severity of OCD in the study group reduced after undergoing schema treatment, from 32.38±5.84 at the initial assessment before the intervention to 18.07±3.70. This difference was statistically significant (F=55.04, P=0.000), and the effect size was 82.1%.
• The impact size of the change in the mean score for the degree of emotional deprivation schema severity from the pre-intervention assessment (36.92±14.37) to the post-intervention assessment (22.30±8.66) (F =37.62, P=0.000) is 75.8%.
• In the fourth set of successive evaluations, a statistically significant difference was found between the research groups (F = 74.14, P = 0.000, effect size 86.1%). This was evaluated by the mean scores associated to the failure schema degree of severity (44.23±8.38, 36.77±8.56, 24.77±7.95, 20.69±5.75).
• The intensity of the danger of harm or sickness schema was measured using data, and it was found that the mean score for the study group was 47.39±16.61 before the schema treatment was applied, but it dropped to 39.07±148.33 after it was implemented. On the other hand, the third and fourth measurements revealed a statistically significant difference (F = 33.91, P = 0.000), with the acquired value coming in at 27.6±19.24 and the measured value coming in at 24.69±7.87, respectively. This difference was found between the third and fourth measurements.
• The obsessive-compulsive disorder, emotional inhibition, emotional deprivation, failure, and sensitivity to pain or disease severity of the research participants were statistically compared in a paired method.
• Between the first and third measures (P=0.003; 0.000), between the second and fourth measurements (P=6.541; 9.001.36), and between the fourth and first measurements (P=0.003; 0.000), there was a statistically significant difference. However, there was no change that could be considered statistically significant between the third and fourth readings.
• It was discovered that the first and third assessments of the emotional inhibition schema severity were statistically distinct from one another (8.46±1.47, 15.85±1.88, 21.92±1.69) (P=0.001, 0.000, respectively), and the second and fourth assessments followed a pattern that was very similar to that (7.38±1.05, 13.46±21.31, P=0.001, 0.000, respectively).
• There was a difference that was statistically significant (P=0.001) between the first and third measurements and between the second and fourth measurements for the emotional deprivation schema level of severity (7.38±1.74 and 9.23±1.63, respectively); and there was a difference that was statistically significant (P=0.001) between the first and second measurements that was 5.38.99; there was a difference that was statistically significant (P=0.001) between the first and third measurements that was 12.77±1.82; and there was a difference that was statistically significant.
• The mean differences in the vulnerability to harm or illness schema between the first and third measurements were 8.31±2.17, 19.77±3.15, and 22.69±3.33, with statistically significant differences (P=0.014, 0.000, and 0.000, respectively), and the mean differences in the same schema between the second and fourth measurements were 11.46±2.47 and 14.38±2.56, also with statistically significant differences (P=0.014, 0.000, and 0.000, respectively).
• The majority of persons who suffer from OCD have moderate to severe early maladaptive schemas, according to the findings of this study. These schemas include emotional limitation, emotional deprivation, failure, and susceptibility to harm or sickness. The severity of OCD symptoms and the number of early maladaptive schemas were both shown to improve as a direct result of participating in schema treatment sessions.
The following are the most important recommendations:
I. Recommendations geared toward Psychiatric out patients’ clinics:
• Psychiatric out patients’ clinics may consider the application of Schema Therapy’s (ST) intervention as an essential constituent in the care of patients with obsessive compulsive disorder. This can be associated with essential pharmacotherapy provided for those patients.
• A great awareness by the therapist of the patients’ core patterns may represent additional information for the therapist, information that is useful for a more accurate planning of the intervention project.
• At least one staff member in a psychiatric outpatient clinic can be trained in “schema therapy” (psychiatrist, clinical psychologist, Nurse).
II. Recommendations geared toward prevention of EMSs development:
• For those working in MCH centers, Families’ psychoeducational interventions can be developed to increase families’ awareness of child rearing problems that foster the development of early maladaptive schemas, and consequently affect future response and behavior of the individual.
• Parents continuous awareness about preschool and school stage.
III. Recommendations for future research:
• Further research is needed to investigate the effect of different psychiatric interventions as mindfulness skill training on improving early maladaptive schemas among patients with obsessive compulsive disorder.
• Due to the limitation of the number of patients in this study, further studies are needed to replicate with a larger cohort of patient, to establish the needed generalizability.
• Explore the extent to which improvement related to the program were sustained over time, by repeated assessment over longer periods.