The effect of schema therapy and mindfulness-based cognitive therapy on coping strategies in individuals with stimulant substance use disorder

Objectives Substance use disorders (SUDs), especially stimulant-related, represent a significant global public health burden, where maladaptive coping mechanisms commonly impede recovery and increase relapse likelihood. This study compared Schema Therapy (ST) and Mindfulness-Based Cognitive Therapy (MBCT) in promoting adaptive coping strategies among individuals with stimulant SUD.Methods Conducted in 2024 at residential treatment centers in Ahvaz, Iran, the quasi-experimental investigation employed pretest, posttest, and three-month follow-up assessments. From an initial pool of 165 patients, 66 meeting DSM-5 criteria for stimulant use disorder were selected via convenience sampling and randomly allocated to three groups (n = 22 each): a 12-week ST condition, an 8-week MBCT condition, and a control group receiving only standard residential care without additional structured psychotherapy. Coping strategies were measured using the Ways of Coping Questionnaire and analyzed via repeated-measures ANOVA.Results Both interventions yielded significant improvements in adaptive coping (time×group interactions: p < 0.001, η2 = 0.58–0.62). ST produced larger immediate gains in problem-focused coping, whereas both therapies substantially reduced maladaptive emotion-focused coping (lower scores denoting improvement), with MBCT showing particularly strong effects at follow-up.Conclusion These distinct profiles underscore the complementary strengths of schema-focused and mindfulness-based approaches and support tailored treatment selection based on patients’ predominant maladaptive coping patterns to enhance long-term recovery from stimulant SUD.