# The Relationship Between Guilt and Self-Blame with Early Maladaptive Schemas in Patients with Cancer: A cross-sectional study

## TL;DR

This study shows that early maladaptive schemas are strongly linked to guilt and self-blame in cancer patients, even after considering overall psychological distress.

## Contribution

The study reveals the independent role of early maladaptive schemas in guilt and self-blame among cancer patients.

## Key findings

- EMSs are strongly correlated with guilt (r = 0.51) and self-blame (r = 0.314) in cancer patients.
- The correlation between EMSs and guilt/self-blame decreases after accounting for psychological distress.
- Schema-focused interventions may help reduce emotional distress in cancer patients.

## Abstract

Cancer is still one of the leading causes of death worldwide and a high percentage of patients with cancer face emotional challenges such as guilt and self-blame. Early maladaptive schemas (EMSs) can make these feelings even stronger. This study aimed to explore how guilt and self-blame relate to EMSs in individuals with cancer, while taking overall psychological distress into account.

This cross-sectional study was conducted at Rasoul-e-Akram and Firoozgar hospitals in Tehran, Iran, from October 2022 to June 2023. Patients with cancer answered the Early Maladaptive Schema Questionnaire-Short Form, Eysenck's Guilt Questionnaire (2007) and the Cognitive Emotion Regulation Questionnaire. Pearson correlation was used to examine the associations and partial correlation to control for psychological distress (Depression Anxiety-Stress Scale-21 [DASS-21] total score).

A total of 145 patients with cancer were included in this study; 69.7% were female and most were diagnosed with colon or breast cancer. After accounting for psychological distress measured by DASS-21, the analysis showed a clear link between EMSs and feelings of guilt (r = 0.51; P <0.001) and self-blame (r = 0.314; P <0.001). However, after accounting for psychological distress, the connections between EMSs appeared less intense.

These findings suggest that EMSs are closely linked to feelings of guilt and self-blame among patients with cancer, both before and after accounting for psychological distress. The adjustment reduced correlation, which illustrates how EMSs render emotional distress more relatable. These results suggest that schema-focused interventions can reduce these responses, improving psychological well-being and treatment effectiveness.