The effectiveness of Schema therapy on Alexithymia, Cognitive flexibility, Body image, and Food craving in individuals with type 2 diabetes: A randomized controlled trial

Abstract Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder accompanied by alexithymia, cognitive inflexibility, body image disturbances, and food craving. Schema therapy targets maladaptive cognitive-emotional schemas and may improve these psychosocial factors. We assessed group schema therapy for alexithymia, cognitive flexibility, body image, and food craving in adults with T2DM. Fifty adults were randomized to eight weekly 90-minute sessions of schema therapy or diabetes self-management education (DSMES), matched for therapist contact and format. Self-report measures (TAS-20, CFI, BICI, FCQ-T) were administered pre- and post-intervention. Data were analyzed using intention-to-treat with multiple imputation. ANCOVA adjusted for baseline scores. Schema therapy produced significant improvements over DSMES in alexithymia (adjusted means 49.31 vs 60.09; p < 0.001; η²p = 0.352), body image (32.92 vs 39.21; p < 0.001; η²p = 0.258), and food craving (92.30 vs 106.85; p < 0.001; η²p = 0.340). Cognitive flexibility total improved (100.81vs 94.47; p < 0.001; η²p = 0.085), but the Control subscale did not (p = 0.128). All subscales of alexithymia, body image, and food craving improved. Group schema therapy may be a useful adjunct for selected psychosocial barriers in T2DM, but sample size, no follow-up, and self-report measures limit conclusions. Trial registration: IRCT20251201068177N1 (registered 31 December 2025).