Comparing the Effectiveness of Schema Therapy, Metacognitive Therapy, and Interpersonal Therapy on Emotional Expressiveness in Students with Social Anxiety Symptoms

Document Type : Original Article

Authors

sara khoramifar ¹

Mohammadali Sepahvandi ²

Fazlollah Mirderikvand ³

¹ PhD student, of Psychology, Faculty of Literature and Humanities, Lorestan University, Khorramabad, Iran

² Associate Professor, Department of Psychology, Faculty of Literature and Humanities, , Lorestan University, Khorramabad, Iran

³ Professor, Department of Psychology, Faculty of Literature and Humanities, Lorestan University, Khorramabad, Iran

10.22067/tpccp.2026.94172.1802

Abstract

Extended Abstract
Introduction
Social Anxiety Disorder is among the most prevalent anxiety disorders, typified by an enduring apprehension of unfavorable evaluation in social contexts. This condition exerts a deleterious influence on individuals' functionality and quality of life (Ginat-Frolich et al., 2024; Ferber et al., 2024). Among the factors perpetuating this disorder, internalized shame, as a complex and painful self-conscious emotion, plays a key role (Matos et al., 2015). This construct has been associated with profound feelings of inadequacy, worthlessness, and fear of exposure. It has been demonstrated to exacerbate the vicious cycle of anxiety and avoidance by reinforcing core negative beliefs and distorting social perception (Ferreira et al., 2022). To address this issue, a range of psychotherapy approaches have been developed. Schema therapy with focusing on identifying and modifying early maladaptive schemas rooted in developmental experiences (Imanifar, 2021). Interpersonal therapy aims to enhance social relationships and resolve interpersonal conflicts (Marconi et al., 2023), and metacognitive therapy works by modifying dysfunctional metacognitive beliefs about thought processes such as worry and rumination (Wells, 2011). Despite the existence of independent evidence supporting the efficacy of each approach, direct comparative studies of these three treatment models in reducing internalized shame in populations with social anxiety are limited. Therefore, the main objective of this study was to investigate the comparative effectiveness of these three interventions on internalized shame symptoms (including shyness and self-esteem components) in students with social anxiety symptoms. This investigation was undertaken to address a research gap and provide practical guidance for treatment selection.
 
Method
The present study was of a quasi-experimental nature, employing a pretest-posttest design with a control group. The statistical population of this study included students with symptoms of social anxiety at Kashmar Higher Education Center during the academic year 2023-24. Following the administration of the Jerabak Social Anxiety Questionnaire, 60 individuals who attained a score above the cutoff point and satisfied the inclusion criteria were randomly allocated to four groups of 15 subjects: three experimental groups (schema therapy, interpersonal therapy, metacognitive therapy) and a control group. The research instruments included the Jerabak Social Anxiety Questionnaire and the Cook Internalized Shame Scale. The three experimental groups received, Schema Therapy (Gholamrezaei & Tehranchi, 2016), Interpersonal Therapy (O’Shea et al., 2015), and Metacognitive Therapy (Wells, 2009), whereas the control group received no intervention. Following a thorough review and verification of the statistical assumptions, including the normality assessed via the Shapiro-Wilk test and the homogeneity of variances evaluated using the Levene test, the data underwent analysis through multivariate analysis of covariance, complemented by the Bonferroni post hoc test, using SPSS software.
 
Findings
The findings from statistical analyses indicated that all three treatment methods led to a significant reduction in shyness (for all methods, p < 0.01) and an increase in self-esteem (schema therapy and metacognitive therapy, p < 0.05; interpersonal therapy only for self-esteem, p = 0.036) in comparison to the control group. However, a direct comparison of the three treatment methods with each other did not show a significant difference in reducing shyness or increasing self-esteem (for all pairwise comparisons, p > 0.05).
 
Discussion
The primary finding of this study indicates that schema therapy, interpersonal therapy, and metacognitive therapy are all effective in reducing internalised shame and social anxiety symptoms in college students, with no significant differences in effectiveness among the three methods. This finding aligns with the conclusions of studies that underscore the significance of shared therapeutic factors, such as a supportive therapeutic relationship and the facilitation of a process of re-evaluation of thought and emotional patterns (Di Pietro et al., 2024; Marconi et al., 2023). Each of these approaches accomplishes this objective by a unique method. Schema therapy centers on modifying deep and maladaptive beliefs that have developed from past experiences. Interpersonal therapy aims to enhance communication skills and alleviate social isolation. Metacognitive therapy involves acquiring skills for managing and regulating thought processes. This convergence of findings lends further credence to the notion that within the paradigm of social anxiety, variant mechanisms can culminate in the amelioration of a pivotal phenomenon such as internalized shame. This finding suggests that clinicians should take into account client preferences, the congruence of the intervention with the client's belief system, and the therapist's clinical skills when selecting a treatment for students with social anxiety, rather than relying on a preconceived notion of the "most effective" approach. Future investigations should prioritise the identification of individual characteristics that predict positive treatment response to specific modalities. Elucidating the mechanisms of change underlying each therapeutic approach may further enable the development of more personalised interventions. Such research avenues could facilitate the advancement of tailored and effective treatment strategies. In light of the present study's limitations—namely, its reliance on self-report instruments and the absence of longitudinal follow-up—replication with more rigorous methodologies is strongly recommended. Furthermore, the findings underscore the necessity of developing and promoting educational and support initiatives within academic contexts to improve awareness and treatment uptake.

Keywords

Schema Therapy

Metacognition

Interpersonal Therapy

Internalized Shame

Social Anxiety Disorder

Subjects

• Anxiety

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