Efficacy of Schema Therapy for Social Anxiety Disorder: A Systematic Review and Meta-Analysis

Abstract

Social Anxiety Disorder (SAD) is a prevalent condition marked by an overwhelming fear of social interactions, leading to avoidance behaviors and significant impairment in daily functioning. Traditional treatments, such as Cognitive Behavioral Therapy (CBT) and pharmacotherapy, have demonstrated effectiveness but often fail to address deep-rooted emotional patterns, particularly in individuals with comorbid personality disorders. Schema Therapy (ST), which targets maladaptive schemas formed in childhood, offers a promising alternative. This systematic review and meta-analysis aim to evaluate the efficacy of Schema Therapy in treating Social Anxiety Disorder. A comprehensive search of electronic databases, including PubMed, PsycINFO, Embase, and the Cochrane Library, two registries, and open-source DOAJ, was conducted to identify studies published between 2010 and 2025. Studies were selected based on inclusion criteria that required participants to be diagnosed with SAD and treated using Schema Therapy. Only Randomized Controlled Trials (RCTs) with sufficient data (mean, standard deviation) were included in the meta-analysis. Data extraction was performed using Covidence, and study quality was assessed using the Cochrane Risk of Bias Tool. The systematic review included 7 studies, comprising randomized controlled trials and quasi-experimental studies. The meta-analysis revealed a modest effect size for Schema Therapy in reducing SAD symptoms (Hedges' g = 0.050), with no significant differences when compared to other treatments like CBT. Despite heterogeneity across studies, Schema Therapy demonstrated potential efficacy, especially for individuals with comorbid personality traits. This study suggests that Schema Therapy is a promising intervention for Social Anxiety Disorder, particularly for those with additional personality traits. However, the modest effect size and significant heterogeneity across studies highlight the need for further research. Future studies should focus on larger sample sizes, longer follow-up periods, and direct comparisons with Cognitive Behavioral Therapy to better understand the role of Schema Therapy in the treatment of SAD.