Volume 10, Issue 1 (Winter 2022)                   PCP 2022, 10(1): 33-44 | Back to browse issues page

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Sabzi N, Farah Bijari A, Khosravi Z. The Effectiveness of Group Schema Therapy-based Parenting Education of Mothers on Modifying Maladaptive Schemas of the Child and Improving the Quality of the Parent-Child Relationship. PCP 2022; 10 (1) :33-44
URL: http://jpcp.uswr.ac.ir/article-1-785-en.html
1- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran.
2- Department of Psychology, Faculty of Education and Psychology, Alzahra University, Tehran, Iran. , a.f.bidjari@alzahra.ac.ir
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1. Introduction
Family is the first and strongest station for connecting the child with the world and plays the main role in developing the child’s personality with its parenting style (Nili Ahmadabadi, Bagheri, & Salimi, 2019). Parenting style refers to parents’ attitudes toward children and their behavioral patterns to shape children’s behavior (Davids, Roman, & Schenck, 2018). Effective parenting is essential in preventing children’s mental health problems and psychological disorders (Hutchings, Owen, & Williams, 2018). Numerous studies have been conducted on the role of the family as a predisposing factor for individual vulnerability and have confirmed the role of parent-child relationships and parenting styles as the main family factors affecting a person’s mental health (Dalaei, Ashouri, & Habibi, 2015). The importance of this issue has led researchers to study parenting styles and provide different methods in this field (Amirsardari & Esmaali Kouraneh, 2014). Various researchers have worked in parenting and dealt with it from various aspects (Baumrind, 1971; Azimi, Vaziri, & Kashani 2012; Ardestani 2018; Yousefi, 1394; Isa Nejad, Saeedi & Alipour 2019; Nili Ahadabadi, Bagheri, & Salimi Bajestani, 2019; Bögels, et al., 2014).
Another researcher who has addressed this issue is Young. He examined parenting styles in schema therapy and proposed 9 styles: emotionally depriving style, overprotective style, belittling style, perfectionist style, pessimistic/fearful style, controlling style, emotionally inhibited style, punitive style, and conditional/narcissistic (Sheffield et al., 2005). He believed that parenting style is one of the most critical issues which can affect the formation of early maladaptive schemas in children (Darling, & Steinberg, 2017). Inspired by (Bach, Lockwood, and Young, 2018), Young emphasized that everyone is born with 5 basic emotional needs. If caregivers do not sufficiently meet these needs in the early years, it can result in the formation of early maladaptive schemas (Bach, Lockwood, and Young, 2018). Early maladaptive schemas are pervasive and stable themes that are formed in childhood or adolescence and continue throughout life and operate at the deepest level of cognition (Young, Klasko, and Weishaar, 2003).
Another important variable that can significantly affect the formation of early maladaptive schemas is the parent-child relationship (Moradi, & Faghihi, 2017). The parent-child relationship is a set of behaviors, emotions, and expectations that flow between parent and child in specific and unique ways, based on parent-child characteristics and circumstances (Mofrad, 2011). Parent-child relationship patterns are among the influential factors which can be corrected to prevent the formation of early maladaptive schemas in the child (Khorasani, et al., 2019). The quality of the parent-child relationship is a key factor in the growth and mental health of the child (Nauman, 2019), and this relationship is the first and most stable social relationship in life. It is one of the main factors in shaping a sense of worth, prosperity, and well-being in an individual (Khodam Hosseini, 2017).
The role of parents in children’s mental health is prominent, but nowadays, despite the profound cultural developments and lifestyle changes, many parents still lack the necessary skills to rear the child properly (Daneshmand, Khorasgani, & Yousefi, 2016). Because children are the assets of human society, it seems necessary for parents to be educated to apply effective parenting styles and establish healthy relationships with children. This healthy relationship prevents the formation of maladaptive schemas and promotes children’s mental health. It is especially important to pay attention to the education of mothers who spend the most with the child and are the main caregivers of the children. 
Numerous studies have been conducted on the effectiveness of parenting education with different approaches to improving the parent-child relationship, among which the research of Baladi, Johnson, & Law (2018), Li et al. (2013), Taheri et al. (2018), and Shiralinia, Izadi, & Aslani (2019) can be mentioned. However, in the literature, few studies have been done on schema therapy-based parenting. Considering that schema therapy-based parenting is one of the new approaches, two studies have been found in Iran, which focused on the effectiveness of educating mothers to meet the basic needs of children based on Young’s Schema Theory. These studies, conducted by Yaryari, Ayoubi, & Mantazeri (2018) and Khodam Hosseini (2017), examined the effectiveness of parents’ education on their parenting styles and the parent-child relationship. No study was found to assess the modification of the child’s maladaptive schemas. As reviewed, the first study was presented at a conference and used a short 7-session training package, and in the second study, only three sessions explained the schemas, needs, and behaviors that provide them. Therefore, this study was conducted to educate mothers with a complete educational package in 12 sessions. Also, in several studies that used the child schema questionnaire, the aim was to investigate the relationship between child schemas and childhood psychological disorders, and no research has evaluated child schemas after educating parents.
Therefore, considering the existing research gap and the importance of schemas that are the basis of a person’s psychological abilities in later periods (Inanloo Ganji, Monirpoor & Zargham Hajebi, 2018), the specific psychological content of each of them increases the individual’s vulnerability to certain types of mental disorders (Saritas-Atalar, & Altan-Atalay, 2018), as well as the efficiency of schema therapy-based parenting, which emphasizes on meeting the needs of children to prevent the formation and stabilization of maladaptive schemas. This study, as one of the pioneering studies in this field, was conducted to determine the effectiveness of schema therapy-based parenting education in modifying the early maladaptive schemas of the children and improving the quality of the parent-child relationship. In this study, among the different perspectives on the child, schema therapy was selected, which with the interactive approach in child-rearing, focuses on the interaction of different factors. This integrated approach by combining the models of psychodynamics, Gestalt, attachment, and cognitive and behavioral therapy has created a special model in parent-child interaction, and this complex interaction considers the basic needs and moods of the child and parent (Khodam Hosseini, 2017). Schema therapy-based parenting educates parents to recognize the basic needs of the child, the behaviors that meet those needs, and the behaviors that do not meet those needs, resulting in the formation of early maladaptive schemas in the child. This training is done objectively and operationally, in such a way that parents may frequently have heard that humiliation and blame hurt the child, and that parents should avoid such behaviors. However, when they are aware of this kind of training, which schemas do humiliation and blame create, how exactly these schemas manifest themselves in every situation of their child’s life, and exactly what harm do they do, they become more motivated to control their behavior and to manage their relationship with children. Therefore, given the above and the limited resources of the research, the present study evaluates the answer to this question, whether group schema therapy-based parenting education is effective in modifying maladaptive schemas of the child and improving the quality of the parent-child relationship.
This study hypothesizes that schema therapy-based parenting group education to mothers modifies maladaptive schemas of the child and that schema therapy-based group parenting education improves the parent-child relationship. 

2. Materials and Methods
The present study is quasi-experimental in terms of research method and applied in terms of purpose. It has a pretest-posttest research design with a control group. The study participants included all mothers and their daughters (8 to 10 years old, living in District 2 of Tehran City, Iran, who are students in 2020-2021). In quasi-experimental designs, the minimum sample size is 30 (Cozby, et al., 1977). Because of the possible drop in subjects, 30% was added to the number of original samples, and 40 mothers were recruited. Because of the coronavirus epidemic conditions and the problem of inaccessibility to the samples, we used the available sampling method. After informing the workshop on the Instagram page of two school counselors in District 2 of Tehran, 65 mothers called and announced their readiness to participate in the training course. Then, the parent-child questionnaire was completed by the mothers and the schema questionnaire by the children as the pretest. Finally, 40 mothers whose daughters had early maladaptive schema and had completed the informed consent form were selected. 
Considering the educational levels, they were randomly divided into two experimental and control groups of 20 people each. The criteria for parents to enter the study were literacy, completing the consent form to participate in the study, and having a daughter of 8 to 10 years old with the early maladaptive schema according to the children’s schema questionnaire. The exclusion criteria were participation in another training or treatment course simultaneously and having a child psychiatric record. Parenting education was performed on the experimental group virtually using WhatsApp messenger (due to the coronavirus pandemic), and after the posttest, data collection and statistical analysis of the results were performed.

Research tools 
Schema inventory for children 

This 40-item inventory was developed by Rijkeboer and de Boo (2010) to measure children’s early maladaptive schemas (Ghamkharfard, Amrollahinia, & Azadfallah, 2012; Khodam Hosseini, 2017). It includes issues related to life experiences of children aged 8 to 13 years, which is the result of factor analysis of the 75-question Young Schema Inventory. Eight of the 15 schemas of the Young Inventory were also identified in children. The combination of other schemas led to the design of three new schemas called loneliness, vulnerability, and submission (Rijkboar and Debo, 2010). In this inventory, 11 subscales have been considered to examine 11 schemas in children (Montazeri, et al., 2012). This inventory is scored on a 5-point Likert scale from 1 (completely incorrect) to 4 (completely correct). In Rijkeboer and de Boo’s research, the reliability of retest for schema scales was reported to be 0.67 to 0.79 (Rijkboar and Debo, 2010). This inventory was translated into Persian in Ghasemi’s study (2011). In this study, the total validity of this inventory was reported as 0.78 through the Cronbach α calculation, 0.67 through halving, and 0.81 through the retest method (Arefnia, Sarandi, Yousefi, 2012).

Child-Parent Relationship Scale
This 33-item scale was developed by Driscoll and Pianta (2011). It assesses parents’ views on their relationship with their children. This scale, which has been used to measure the parent-child relationship at all ages, includes the subscales of closeness (10 items), dependence (6 items), conflict (17 items), and total positive score (sum of all areas) (Tajrishi, et al., 2015). It is scored on a 5-point Likert-type scale from 1 (definitely true) to 5 (definitely not true). Driscoll and Pianta (2011) reported the Cronbach α of this scale in the areas of conflict, closeness, dependence, and total positive scores equal to 0.75, 0.74, 0.69, and 0.80, respectively (Varasteh, Aslani, & Amanullahi, 2016). In Iran, the content validity of this scale has been reported optimal by Abareshi, Tahmasian, Mazaheri, and Panaghi (2010), and the reliability of these areas has been reported at 0.60, 0.70, 0.84, and 0.86, respectively (Mofrad, 2011). In this study, the Cronbach α values were 0.71 in the field of closeness, 0.69 in the field of dependence, 0.73 in the field of conflict, and 0.75 in the field of the total positive score.

Schema therapy-based parenting program
This 12-session training program was designed by the researcher using the resources of Young et al. (2003) and Louis and Louis (2015). Three university professors evaluated its face validity.

3. Results
The descriptive results of the data collected showed that most of the sample had a Bachelor’s degree. About 70.58% in the experimental group and 76.47% in the control group hold a Bachelor’s degree. Also, the average age of participants in the study was about 34 to 36 years old. The minimum age was 29, and the maximum was 47 years. The training sessions were shown in Table 1.

Table 2 presents the mean and standard deviation of pretest and posttest scores of maladaptive schemas and parent-child relationship in the experimental and control groups.

To investigate the assumptions required to perform the multivariate analysis of covariance (MANCOVA), the normality of the distribution was investigated using the Shapiro-Wilk test. The results of the Shapiro-Wilk test showed that the values were not significant for the distribution of all variables at the level of P≤0.05 (except for the value of mistrust/abuse in the pretest of the experimental group and Insufficient self-control in the control group). Therefore, the distribution of variables is not significantly different from the normal distribution, and the distribution of most variables in both tests is normal. Examination of other assumptions was done separately in each hypothesis. To investigate the assumptions of MANCOVA, the homogeneity of variances was investigated using Levene’s test, and the F values showed that the difference in the variance of the groups was not significant at the level of P≤0.05. Therefore, the variance of the groups is not significantly different from each other, and the groups are homogeneous. The correlation of dependent variables was also investigated using the Pearson correlation coefficient. The analysis of correlation coefficients of the maladaptive schemas with each other showed that all coefficients, except for six cases, were significant at the level of P≤0.05. Therefore, there is a significant relationship between maladaptive schemas in children. The analysis of the correlation coefficients of the parent-child relationship with each other showed that all coefficients are significant at the P≤0.01. Therefore, there is a significant relationship between the components of the parent-child relationship. The assumption of homogeneity of regression slopes was also examined, and the results showed that the interactive effect of the group and the test was not significant on the dependent variable and the regression slopes were homogeneous. Thus, the use of MANCOVA is allowed.
Both Pillai’s Trace and Wilkes Lambda indices are significant at P≤0.01. Therefore, the dependent variables of the experimental and control groups are significantly different from each other.
The analysis of maladaptive schemas shows that the value of F in the maladaptive schemas of vulnerability, mistrust/abuse, failure, submission, unrelenting standards, self-sacrifice, and entitlement/grandiosity is significant at the level of P≤0. 01. Therefore, the difference between the experimental and control groups is significant in these dimensions. However, the value of F is not significant in maladaptive schemas of loneliness, defectiveness, enmeshment/undeveloped self, and insufficient self-control/self-discipline. Also, the analysis of the parent-child relationship shows that the value of F in the subscales of closeness and dependence and the total positive score is significant at the level of P≤0.05 but not in the conflict subscale.

4. Discussion
This study aimed to determine the effectiveness of schema therapy-based parenting group education for mothers in modifying the child’s maladaptive schemas and improving the quality of the parent-child relationship (Tables 3 and 4).

About the first hypothesis, the results of data analysis indicate that schema therapy-based parenting group education has a significant effect on modifying schemas of vulnerability, mistrust/abuse, failure, submission, unrelenting standards, self-sacrifice, and entitlement/grandiosity. Nevertheless, there was little change in the schemas of loneliness, defectiveness/shame, enmeshment/undeveloped self, and insufficient self-control/self-discipline, which was insignificant. These findings are in agreement with the research of Sundag et al. (2018), Haugh et al. (2017), Anbari, Mahdavian, & Naderi (2014), and Khorasanizadeh et al. (2018), which stated that parenting styles have a significant relationship with the formation of early maladaptive schemas. However, no research directly assessed children’s schemas after parental education.
In explaining these findings, it can be argued that parents are often unaware of the important role in shaping children’s personalities via their behavior and relationship with the children. They attribute the children’s maladaptive behaviors to themselves and ignore their own behaviors. This is where education can empower the parents with parenting skills. In light of education, parents achieve a clear image of the child’s world and, by recognizing his feelings and needs, find themselves closer to the child. In this way, by creating a warm and intimate environment, the child experiences a feeling of competency and love, and since the parents’ attitude infinitely influences the child’s attitude, he also looks at himself in a new way. Research shows that parental education is an effective tool in changing and directing children’s behavior (Abdollahi, 2018). In this study, the schema theory has been selected, in which the interaction of different factors is effective in child-rearing. The goal of this approach is to create behaviors that meet the basic needs of the child and prevent the formation or stabilization of early maladaptive schemas. Therefore, considering the importance of childhood experiences, it is reasonable to expect that with the parents’ awareness of efficient parenting methods and the using them, the child’s perspective, which is the same as his schemas, will change.
However, in explaining the schemas on which schema therapy-based parenting education has not had a significant effect, it can be argued that loneliness is a combination of emotional deprivation and social isolation schemas. That emotional deprivation schema is one of the deepest and most basic schemas formed in early childhood in this short training period does not have enough time to improve and requires more time and effort from parents to adjust. The social isolation schema also needed the presence and interaction of the child in society to be moderated. It was practically impossible due to the epidemic of coronavirus. Also about the schema of Defectiveness/Shame, due to the perfectionism of parents in Iran, they subconsciously conditioned the sense of worth and love on child's success and achievement. It takes a long time for parents to manage healthy communication consciously, and of course, it would be very difficult for parents to get rid of perfectionism without professional treatment. About the schema of enmeshment/undeveloped self, due to the existing cultural background in the collectivist society of Iran, it is prevalent that parents often do not provide the conditions for creating and maintaining individuality for the child. Therefore, to modify this schema, extensive cultural work is needed to create favorable conditions for developing an independent identity in the child. Also, insufficient self-control schema regarding the parenting style of parents in recent years and their thinking that because they have experienced a difficult life themselves, now they want their child to have a comfortable life. This objective needs an organized plan for parents to use in the long life process, which creates a sense of responsibility, self-control, and commitment in their children.
Also, about the second hypothesis, the results of data analysis indicate that schema therapy-based parenting education has led to a significant increase in closeness and total positive relationships and a significant decrease in dependency in the parent-child relationship but has no significant effect on the conflict subscale.
These findings are in agreement with the fondings of Baladi et al. (2018), Li et al. (2013), Nili Ahmadabadi et al. (2019), Khayamfar, Madani, Hejazi, & Poortaheri (2019), and Taheri et al. (2018), who reported that teaching parenting programs improve the parent-child relationship. Research shows that healthy family relationship has a significant impact on a child’s mental and social health. Given the importance of the role of parents in creating these relationships, education can strengthen their communication skills. In the present study, the subscales of closeness and dependence were addressed in the form of the need for secure attachment and autonomy. Therefore, it can be expected that with sufficient satisfaction of these needs, this part of the parent-child relationship will be positively affected. Considering the effectiveness of parenting education on the subscales of closeness and dependence, it can be expected that this educational program has also had a positive effect on the subscale of the total positive relationship. However, in explaining that parenting education did not significantly affect the conflict subscale, we can point to the importance of parental personality traits. Several evaluations show that in conflicting families, one or both parents show signs of histrionic, paranoid, obsessive, or narcissistic personality disorder, making them stubborn in relationships (Satourian, Tahmasian & Ahmadi, 2016). Considering that in the present study, the personality of the parents was not evaluated, and no therapeutic intervention was performed in the process of the work, maybe the underlying problems of the parents’ personality have prevented the resolution of the conflict effectively.
According to the present study’s findings, schema therapy-based parenting education is effective in modifying some maladaptive schemas of children and improving the quality of the parent-child relationship. Therefore, we can take steps by educating parents, especially from the early years of parenting, to prevent the formation of early maladaptive schemas in children and the problems caused by dysfunctional parent-child relationships.
Among the limitations of this research, we can mention the lack of sufficient time to perform the follow-up, run the training course virtually, and perform available sampling. It is suggested to research parents of the adolescent group to investigate the effects of this educational program on different age groups, follow-up, examine the mothers’ personalities at the beginning of the research to diagnose a personality disorder, and conduct training sessions for both mothers and fathers.

5. Conclusion
Promoting family mental health plays a critical role in community psychological care. Today, due to the reduction of costs, energy, and suffering of human beings, the prevention approach is considered more than the treatment approach, and the importance of promoting health and a healthy lifestyle as well as creating a supportive environment for children’s mental health is emphasized. Because the family as a child-rearing unit internalizes the feeling of belonging and love in the child and provides the opportunity for healthy emotional and social development by accepting the child and responding to his/her basic emotional needs and creating quality and healthy interaction. In this regard, according to the research findings, schema therapy-based parenting education is effective in modifying some of the maladaptive schemas of children and improving the quality of the parent-child relationship. Therefore, early parenting can prevent the formation of early maladaptive schemas in children and the problems caused by dysfunctional parent-child relationships.

Ethical Considerations
Compliance with ethical guidelines

The mothers voluntarily participated in this research, and they could leave the research at any stage. The names of the people were not mentioned in the questionnaires, and information from participating families was kept confidential. All study participants signed an informed consent form. This training course was also provided for the control group after the post-test to benefit from this research.

This research has not received any financial support from public or private organizations.

Authors' contributions
Conceptualization, Supervision review & editing: Azam Farah Bijari and Zohre Khosravi; Writing, implement & data collection: Narges Sabzi.

Conflict of interest
The authors declared no conflict of interest.

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Type of Study: Research | Subject: Cognitive behavioral
Received: 2021/09/23 | Accepted: 2021/12/14 | Published: 2022/01/1

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