Comparing Schema Therapy and Dialectical Behavior Therapy on Body Image and Sexual Self-Concept in Women with Vaginismus

Objective: This study aimed to compare the effectiveness of Dialectical Behavior Therapy (DBT) and Schema Therapy (ST) on improving multidimensional self–body relations and sexual self-concept in women with vaginismus. Methods and Materials: A randomized controlled trial was conducted with 45 women diagnosed with vaginismus in Mashhad, Iran. Participants were randomly assigned to three groups: DBT (n = 15), ST (n = 15), and a waitlist control (n = 15). Both intervention groups received eight weekly sessions of treatment. Outcome measures included the Multidimensional Body–Self Relations Questionnaire (MBSRQ) and the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ), administered at pre-test, post-test, and a five-month follow-up. Data were analyzed using repeated measures ANOVA with Bonferroni post-hoc comparisons via SPSS-27. Findings: Results indicated significant improvements in both self–body relations and sexual self-concept across time and group (p < .001). Schema Therapy demonstrated the greatest improvement in sexual self-concept from pre-test to follow-up (Mean Difference = 13.48), while DBT produced significant gains in self–body awareness and emotional regulation. The interaction effects of time × group were statistically significant for both outcome variables (p < .001), indicating differential treatment effects. Bonferroni post-hoc tests showed that both experimental groups outperformed the control group at post-test (p < .001), and Schema Therapy yielded significantly greater effects than DBT on sexual self-concept (p = .007) and self–body relations (p = .041). Conclusion: Both Dialectical Behavior Therapy and Schema Therapy are effective interventions for enhancing body-related and sexual self-perceptions in women with vaginismus, with Schema Therapy showing more sustained effects on deeper identity-related domains.