Positive Schemas and Symptom Severity in Depressive and Anxiety Disorders: The Mediating Role of Schema Modes

This study aimed to examine patients diagnosed with depressive disorder and anxiety disorder from a transdiagnostic perspective, compare them with healthy controls with respect to positive schemas and schema modes and investigate the parallel mediating role of schema modes in the effect of positive schemas on symptom severity.

A total of 164 participants were included, comprising 110 patients diagnosed with depressive or anxiety disorder and 54 healthy volunteers. Psychiatric diagnoses were confirmed using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV). Participants completed the Young Positive Schema Questionnaire (YPSQ), the Schema Mode Inventory-Short Form (SMI-SF) and the Depression Anxiety Stress Scale (DASS-21). The simultaneous mediating role of four schema mode factors (dysfunctional child modes, dysfunctional parent modes, coping modes and healthy modes) in the effect of positive schemas on DASS total scores was tested using path analysis and bootstrap methodology.

Positive schema and healthy mode scores were significantly lower in the clinical group compared with controls, whereas dysfunctional child, dysfunctional parent and coping mode scores were significantly elevated (all p < 0.001; Cohen's d = 1.10-2.12). In the parallel mediation model constructed for the clinical group, the direct effect of positive schemas on DASS total scores was non-significant (β = -0.055, p = 0.634), whereas indirect effects operating through dysfunctional child modes (IE = -0.310), dysfunctional parent modes (IE = -0.117) and healthy modes (IE = -0.199) remained significant, indicating a full mediation pattern (R² = 0.520). In the control group, this four-path mediation mechanism was largely inoperative.

The association between positive schemas and lower symptom severity appears to be mediated not through a direct pathway but through schema modes, suggesting that this mechanism may act as a protective factor in the presence of a psychopathological substrate. These findings support the view that positive schemas warrant consideration as independent and functional components in clinical assessment and treatment planning.