Comparing the Effectiveness of Compassion focused therapy and Cognitive Behavioral Therapy on Emotional Schemas and Resilience in Patients with Diabetes

Document Type : Original Article


1 Department of Psychology, Islamic Azad University of Central Tehran Branch. Tehran, Iran.

2 Department of Psychology, Kharazmi University, Tehran, Iran.

3 Department of Psychology, Kharazmi University, Tehran. Iran.

4 Department of Psychology, Central Tehran Branch, Islamic Azad University, Tehran, Iran.


Background: Nowadays, comparing the effectiveness of treatment methods to reduce mental problems in patients with diabetes is of great interest to different psychologists.
Objectives: This study aimed to compare the effectiveness of compassion focused therapy and cognitive behavioral therapy on emotional schemas and resilience in patients with diabetes.
Materials & Methods: The research method was semi-experimental with pre-test, post-test, and follow-up design. The statistical population of this study included all diabetic patients referred to Pasteur Hospital in Bam in the second half of 2018 (152 patients). From the statistical population, 45 patients were selected by simple random sampling and randomly divided into three groups (cognitive behavioral therapy group, compassion-focused therapy, and control group). Before and after training, the subjects responded to Conor and Davidson's resilience questionnaires (2003) and Leahy's emotional schemas questionnaire (2009). Data were analyzed using Multivariate analysis of covariance by spss.22.
Results: The findings of this study showed that compassion-focused therapy and cognitive behavioral therapy improve emotional schemas (P<0.001) and increase resilience (P<0.001). The effect of compassion-focused therapy was greater than cognitive-behavioral and maintained its effectiveness over time (P<0.001).
Conclusion: It can be concluded that compassion-focused therapy had a greater effect on improving emotional schemas and increasing resilience in patients with type 2 diabetes. Compassion-focused therapy and cognitive-behavioral therapy can be used as effective psychological therapies to reduce the problems of patients with diabetes.


 1.Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga
S, Unwin N, Colagiuri S, Guariguata L, Motala AA,
Ogurtsova K, Shaw JE. Global and regional diabetes
prevalence estimates for 2019 and projections for 2030
and 2045: Results from the International Diabetes
Federation Diabetes Atlas. Diabetes research and clinical
practice. 2019 Nov 1;157:107843.
2.Bullard KM, Cowie CC, Lessem SE, Saydah SH,
Menke A, Geiss LS, Orchard TJ, Rolka DB, Imperatore
G. Prevalence of diagnosed diabetes in adults by
diabetes type—United States, 2016. Morbidity and
Mortality Weekly Report. 2018 Mar 30;67(12):359.
3.Wang L, Gao P, Zhang M, Huang Z, Zhang D, Deng
Q, Li Y, Zhao Z, Qin X, Jin D, Zhou M. Prevalence and
ethnic pattern of diabetes and prediabetes in China in
2013. Jama. 2017 Jun 27;317(24):2515-23.
4.Wiig S, Aase K, Billett S, Canfield C, Røise O, Njå O,
Guise V, Haraldseid-Driftland C, Ree E, Anderson JE,
Macrae C. Defining the boundaries and operational
concepts of resilience in the resilience in healthcare

Jalayer F et al.
Razavi Int J Med. 2022; 10(3):e1212. 39
research program. BMC health services research. 2020
5.Walker B. Resilience: what it is and is not. Ecology
and Society. 2020 May 4;25(2).
6.Masten AS, Lucke CM, Nelson KM, Stallworthy IC.
Resilience in development and psychopathology:
Multisystem perspectives. Annual Review of Clinical
Psychology. 2021 Feb 3;17.
7.West CP, Dyrbye LN, Sinsky C, Trockel M, Tutty M,
Nedelec L, Carlasare LE, Shanafelt TD. Resilience and
burnout among physicians and the general US working
population. JAMA network open. 2020 Jul
8.Conz E, Magnani G. A dynamic perspective on the
resilience of firms: A systematic literature review and a
framework for future research. European Management
Journal. 2020 Jun 1;38(3):400-12.
9.Shamsuddin S. Resilience resistance: The challenges
and implications of urban resilience implementation.
Cities. 2020 Aug 1;103:102763.
10.Feldman R. What is resilience: an affiliative
neuroscience approach. World Psychiatry. 2020
11.Novak LL, Baum HB, Gray MH, Unertl KM, Tippey
KG, Simpson CL, Uskavitch JR, Anders SH. Everyday
objects and spaces: How they afford resilience in
diabetes routines. Applied Ergonomics. 2020 Oct
12.Ryan AK, Pakenham KI, Burton NW. A pilot
evaluation of a group acceptance and commitment
therapy‐informed resilience training program for people
with diabetes. Australian Psychologist. 2020 Jun
13.Hadj-Abo A, Enge S, Rose J, Kunte H, Fleischhauer
M. Individual differences in impulsivity and need for
cognition as potential risk or resilience factors of
diabetes self-management and glycemic control. PloS
one. 2020 Jan 29;15(1):e0227995.
14.Kusnanto K, Arifin H, Widyawati IY. A qualitative
study exploring diabetes resilience among adults with
regulated type 2 diabetes mellitus. Diabetes & Metabolic
Syndrome: Clinical Research & Reviews. 2020 Nov
15.Imani E, Shahabizadeh F, Mahmoodirad A. The role
of anxiety and depression on acceptance and action,
considering emotional schemas in diabetics of Birjand
(Iran). Electronic physician. 2017 Oct;9(10):5551.
16.Namvar H, Ghasedi M. Interpersonal Dependency
and Social Support as the Predictors of Resilience among
Hypertensive Patients with the Mediating Role of Hope.
Qom University of Medical Sciences Journal. 2020 Oct
17.Hokmabadi ME, Lobnani SP, Khaneghaee R,
Momeni NS, Taghavi A. Effectiveness of Schema
Therapy Techniques on Working and Prospective
Memory, Personality and Medication Adherence in
Cardiac Patients. Religación.;4:406-18.
18.Choi SA, Hastings JF. Religion, spirituality, coping,
and resilience among African Americans with diabetes.
Journal of Religion & Spirituality in Social Work: Social
Thought. 2019 Jan 2;38(1):93-114.
19.Corathers SD, Kichler JC, Fino NF, Lang W,
Lawrence JM, Raymond JK, Yi-Frazier JP, Dabelea D,
Liese AD, Saydah SH, Seid M. High health satisfaction
among emerging adults with diabetes: Factors predicting
resilience. Health Psychology. 2017 Mar;36(3):206.
20.De Souza Ribeiro MD, Diniz CX, Perdomo SB, de
Souza Ribeiro JH, Barbosa OG, de Barros KM, da Silva
AB, da Costa Oliveira E. Self-esteem and resilience in
people with type 2 diabetes mellitus. Mundo da Saude.
2017 Apr 1;41(2):223-31.
21.Leahy RL. A model of emotional schemas. Cognitive
and behavioral practice. 2002 Jun 1;9(3):177-90.
22.Morvaridi M, Mashhadi A, Shamloo ZS, Leahy RL.
The effectiveness of group emotional schema therapy on
emotional regulation and social anxiety symptoms.
International Journal of Cognitive Therapy. 2019
23.Connor KM, Davidson JR. Development of a new
resilience scale: The Connor‐Davidson resilience scale
(CD‐RISC). Depression and anxiety. 2003 Sep;18(2):76-
24.Derakhshanrad SA, Piven E, Rassafiani M, Hosseini
SA, Mohammadi Shahboulaghi F. Standardization of
connor-davidson resilience scale in iranian subjects with
cerebrovascular accident. Journal of Rehabilitation
Sciences & Research. 2014 Dec 1;1(4):73-7.
25.Yeganeh Rad N, Toozandehjani H, Bagherzadeh
Golmakani Z. Comparing the Effectiveness of Schema
Therapy and Compassion-Focused Therapy in resiliency
and Ambiguity Tolerance in Divorce-Seeking
Women. 2020; 11(41): 89-112. [Persian]
26.Mohammad Aminzadeh D, Kazemian S, Esmaeily M,
Asmari Y. Prediction of perceived empathy based on
emotional schemas and resilience in mothers with
physically-disabled children. Archives of Rehabilitation.
2017 Jul 10;18(2):142-53.
27.Khoraminejad P, Khalatbari J, Seirafi MR.
Comparison of the effectiveness of acceptance and
commitment-based therapy and compassion-focused
therapy on the quality of life of mothers with gestational
diabetes. Razavi International Journal of Medicine. 2021
Jan 1;9(1):47-56.
28.Khalatbari A, Ghorbanshiroudi S, Zarbakhsh MR,
Tizdast T. Comparison of the Effectiveness of
Compassion-based Therapy and Acceptance-based
Therapy and Commitment to Self-care Behavior and
Glycosylated Hemoglobin in Patients With Type 2
Diabetes. Journal of Guilan University of Medical
Sciences. 2020 Oct 10;29(3):34-49.
29.Rafiee Z, Karami J, Rezaei M. The effectiveness of
self-compassion group training on raising hope in
diabetics. International Journal of Behavioral Sciences.
2019 Apr 1;13(1):40-5.
30.Charmchi N, Asgari P, Hafezi F, Makvandi B,
BakhtiarPour S. The effect of “Cognitive Behavior
Therapy” in method group on anxiety and psychological
resilience of menopausal women. Journal of Health
Promotion Management. 2016 Oct 10;5(5):15-22.

Jalayer F et al.
40 Razavi Int J Med. 2022; 10(3):e1212.
31.Rahmani S, Mansoobifar M, Sirifi MR, Ashayeri H,
Bermas H. Effectiveness of Family Empowerment
Therapy Based on Self-Compassion on Self-Care and
Glycosylated Hemoglobin in Female Patients with Type
2 Diabetes Mellitus: A Randomized Controlled Clinical
Trial. Women’s Health Bulletin. 2020 Apr 1;7(2):31-40