Schema therapy for children and adolescents: a systematic review of individual, group, and parent-based interventions

Abstract

Schema therapy (ST) is an integrative psychotherapy targeting early maladaptive schemas formed in childhood. Recently, ST has been increasingly used to treat emotional, behavioral, and interpersonal difficulties in youth. This review synthesized evidence on ST interventions for individuals aged 5–18 across individual, group, and parent-focused formats. Following PRISMA 2020, a systematic search of PubMed, Cochrane Library, Scopus, Web of Science, and Ovid MEDLINE (2000–2025) identified studies using schema therapy or schema-informed interventions with quantitative outcomes from quasi-experimental or pre–post designs. Twenty-one studies met inclusion criteria: five individual, nine group, and eight parent- or family-based interventions (one overlapping). This review is registered with PROSPERO (CRD420251064229, May 30, 2025). Across modalities, schema therapy was associated with improvements in emotional regulation, depressive and anxiety symptoms, behavioral difficulties, and interpersonal functioning across studies. Group and individual formats reduced emotional and behavioral problems, enhanced coping, and improved social functioning. Even brief programs with few sessions were associated with meaningful improvements, with several studies showing maintained gains at short-term follow-up. Parent-focused interventions were associated with improvements in children’s emotional and behavioral outcomes while enhancing parental insight, self-efficacy, and family functioning. However, notable variability in treatment duration, outcome measures, and intervention structures remained across studies. Schema therapy shows promising efficacy for emotional, behavioral, and relational outcomes in youth, with parent involvement enhancing effects. Yet, heterogeneity in protocols and implementation underscores the need for standardization. Future studies should use standardized, randomized, and longitudinal designs to strengthen evidence for developmentally tailored schema therapy.