Journal of health research in community

Introduction
Type 2 diabetes (T2D) is one of the most prevalent chronic diseases worldwide, affecting not only physical health but also patients’ mental well-being. Psychological disorders, particularly anxiety and depression, can reduce patients’ ability to manage their illness, adhere to medical treatments, and maintain their quality of life. Mindfulness-based schema (MBS) therapy, as an effective psychological intervention, helps patients manage their emotional reactions effectively by modifying maladaptive schemas and enhancing emotion regulation skills. Moreover, self-compassion training can reduce self-criticism and increase self-acceptance, thereby enhancing patients’ motivation for self-care.
The present study aimed to examine the combined effect of mindfulness-based schema therapy and self-compassion training on emotional schemas, self-actualization, and glycemic control (HbA1C) in patients with (T2D). The study hypothesizes that the simultaneous implementation of these two interventions can improve both the psychological and clinical outcomes in T2D patients.

Methods
This is a randomized controlled clinical trial with a pretest–posttest design. The study population included patients with T2D who were members of the Iranian Diabetes Association in Mashhad city and were covered by the Health Network of Khorasan Razavi Province in 2024. The total sample size was calculated to be 36 using G*Power software, by considering an effect size of 0.35, a test power of 80%, and significance level of 0.05. Participants were selected based on the Young Maladaptive Schema Questionnaire and inclusion criteria, including age 30–45 years, having diabetes for 6 months to 3 years, at least a high school education, absence of other chronic illnesses, and no use of psychiatric medications. Participants were randomly assigned using block randomization into three groups of 12: MBS therapy, MBS+self-compassion training, and control.
Interventions consisted of 10 weekly 90-minute group sessions conducted in similar settings, including schema education, mindfulness exercises, guided imagery, self-compassion practices, and coping strategies. For assessments, the Leahy Emotional Schema scale (LESS), Shostrom’ Personal Orientation Inventory (POI), and HbA1C tests were used. Data were analyzed in SPSS software, version 26 using multivariate analysis of covariance, univariate analysis, and Bonferroni post-hoc test. P<0.05 was considered statistically significant.

Results
The mean age of participants was 32.9 years in the MBS therapy group, 34.1 years in the combined intervention group, and 33.8 years in the control group. Overall, 75% were female and 25% were male, with educational levels ranging from a high school diploma to a master’s degree. Statistical analysis showed no significant differences between groups in demographic characteristics.
In the post-intervention phase, both intervention groups demonstrated significant improvements in emotional schemas, self-actualization, and HbA1C, while the control group showed no notable changes. The LESS scores decreased, reflecting enhanced ability to cope with negative emotions and stress, and the POI score increased, indicating improved self-esteem, self-acceptance, and perceived self-efficacy in disease management. Multivariate analysis of covariance confirmed that both interventions had significant effects on the two variables. Bonferroni’s post-hoc test results indicated that the combined intervention had a greater effect than MBS therapy alone in reducing emotional schemas and enhancing self-actualization. Regarding glycemic control, HbA1C decreased in both intervention groups, exceeding the minimum clinically important difference, whereas no significant changes were observed in the control group. 

Conclusion
The findings indicate that both psychological interventions—MBS therapy alone or in combination with self-compassion training— can reduce maladaptive emotional schemas, enhance self-actualization, and improve glycemic control in T2D patients. The combined intervention demonstrated greater effectiveness, highlighting the synergistic role of schema modification and self-compassion enhancement. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the University of Guilan (IR.GUILAN.REC.1402.034) and was registered by the Iranian Registry of Clinical Trials (ID: IRCT20230429058022N1). All participants provided informed consent.

Funding
This article was extracted from the doctoral dissertation of Javad Ayoubi at the Department of Psychology, Faculty of Literature and Humanities, University of Guilan. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for profit sectors.

Authors contributions
Conceptualization, methodology, investigation, and writing: Javad Ayoubi; Supervision, conceptualization, methodology, validation, writing, editing & review, and project administration: Iraj Shakerinia; Supervision, data analysis, editing & review: Azra Zebardast.

Conflicts of interest
The authors declare no conflicts of interest.

Acknowledgements
The authors would like to thank all patients who participated in this study.

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