Unraveling the Mind's Blueprint Early Maladaptive Schemas as Crystal Balls for Preoperative Anxiety

Unraveling the Mind's Blueprint Early Maladaptive Schemas as Crystal Balls for Preoperative Anxiety | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Unraveling the Mind's Blueprint Early Maladaptive Schemas as Crystal Balls for Preoperative Anxiety Mira Naguib Abdelraze, Heba Mahmoud Mahmoud Mohamed, Ahmed Hashem El Monshed, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6941702/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Early maladaptive schema (EMS), as fundamental cognitive structures, may act as “crystal balls,” revealing how individuals with certain schemas are predisposed to experiencing heightened anxiety before surgery. Exploring how these early life experiences shape an individual's cognitive and emotional responses. Aim of the study : To investigate the predictive power of early maladaptive schemas as Crystal Balls for Preoperative Anxiety, and how these schemas may influence how individuals perceive and respond to anxiety related to surgery and hospitalization. Subjects and setting: This study was conducted at the Operations Department of Damanhur Medical National Institute. Data collection tools : Tool I: A Socio-demographic characteristics questionnaire; Tool II:, the Amsterdam preoperative Anxiety and Information Scale; and Tool III:,Young schema questionnaire. Results: Early maladaptive schemas (EMS) have demonstrated robust associations with anxiety symptoms, particularly in young adults and teens, with meta-analytical evidence revealing a strong overall correlation (r = 0.59) between EMS and anxiety. Key schema domain disconnection/rejection (e.g., Mistrust-Abuse, Defectiveness/Shame), Impaired Autonomy/Performance (e.g., Dependence/Incompetence), and Other-Directedness emerged as significant predictors of anxiety severity. Gender differences are notable, with females exhibiting heightened vulnerability to schemas involving hypervigilance and excessive focus on others’ needs. Specific schemas such as entitlement/grandiosity may paradoxically reduce anxiety in some contexts, potentially due to overconfidence. These findings underscore the utility of EMS assessment in clinical settings to tailor interventions, particularly for high-risk populations undergoing stressors such as medical procedures. Conclusion: EMS acts as a cognitive vulnerability that amplifies anxiety responses. For surgical patients, schemas tied to loss of control (e.g., impaired autonomy) or social evaluation (e.g., social isolation) may disproportionately drive preoperative distress. The titlement/grandiosity schema paradoxically reduced anxiety in some cases, possibly by fostering overconfidence. Early Maladaptive Schemas Preoperative Anxiety Highlights . Strong Overall Correlation: A meta-analysis revealed a significant association between EMS and anxiety symptoms (r = 0.59), particularly in adolescents and young adults. Critical Schema Domains . Disconnection/Rejection: Schemas such as Mistrust-Abuse and Defectiveness/Shame are linked to fear of abandonment and social isolation. Impaired Autonomy/Performance: Features Dependence / Incompetence and Vulnerability tied to perceived inability to cope with stressors: Other-Directedness: This involves putting other people's needs above one's own, which exacerbates anxiety. Paradoxical Role of Entitlement/ Grandiosity: This schema may reduce anxiety in some cases, potentially due to overconfidence. Introduction Anxiety is an emotional disorder characterized by worry about potentially dangerous situations, fear, and uneasiness, as well as restlessness, weariness, difficulty concentrating, and muscular tension (Almalki et al., 2017 ; Stamenkovic et al., 2018 ). Anxiety is a normal human feeling that prepares the mind and body to respond to threats, and is something everyone experiences on occasion. It is important to emphasize that anxiety is a normal element of human life. Anxiety, whether acute or chronic, can affect perioperative anesthetic management and the overall surgical results (Celik & Poudel, 2019; Celik & Edipoglu 2018 ). Surgery is a life-threatening procedure that increase tension, anxiety, and fear. Therefore, preoperative anxiety is a significant mental health problem in many surgical patients. (Nigussie et al., 2014 ; Lakhe et al., 2022 ). Preoperative anxiety is an uncomfortable sense of fear and worry about surgery, anesthesia, hospitalization, pain, unknown, or sickness. This condition affects many patients. (Jovanovic et al. 2021; Spanner and Sayer 2019 ). Preoperative anxiety is frequently cited as the most difficult aspect of treatment process (Walker et al., 2017). The perioperative phase is one of the most frightening procedures for most patients undergoing surgery. Most patients experience anxiety during the preoperative phase, which is usually considered a normal patient response (Sigdel, 2015 ; Boker et al., 2003). Physical symptoms, such like palpitations, dyspnea, sweating, frequent urination, abdominal pain, diarrhea, or disturbed sleep. Are often associated with this condition. (Stamenkovic et al., 2018 ). The prevalence of preoperative anxiety varies according to the type of surgery, sex, reasons for surgery, and nation, reaching 97% (Maheshwari & Ismail, 2015 ). Preoperative anxiety has been reported to affect between 60% and 92% of surgical patients globally. (Dhungana et al, 2019 ). Surgical complications, length and severity of post-procedure disability, general anesthesia and the resulting loss of control, and the possibility of waking up, pain, and discomfort during or after surgery are among the underlying fears of surgical patients. The degree of preoperative anxiety varies according to the invasiveness and nature of the procedure, which affects patient well-being and makes it difficult to understand patient care (Friedrich et al., 2022; Jawaid et al., 2007 ; Le Roy et al., 2016 ). Several factors have been found to correlate with elevated preoperative anxiety levels (Hernandez et al., 2015 ). One of the factors that has been suggested as a predictor of anxiety is early maladaptive schemas (EMS), which have been found to be a major underlying contributing factor to the development of anxiety disorders and other mental illnesses. According to research conducted in the field of cognitive development, schemas are mental representations used by humans to understand the world, organize information, and make decisions in various situations (Bartlett 1932 ). Schemas significantly influence thought processes, emotions, and behaviors, and their significance has been recognized since the beginning of scientific studies of mental health. It was found that schemas might be useful guides or blueprints for gaining awareness of oneself and the surrounding world. Individuals often have biases in their perceptions, preferring to accept things that align with their existing knowledge to feel comfortable in their surroundings. (Smith et al., 2015 ). Self-perpetuating dysfunctional cognitive frameworks that directly impact a person's thoughts, feelings, emotions, and behaviors are known as EMS (Young et al., 2006 ). EMS are pervasive, unhealthy thinking, emotions, and behavioral patterns that start in infancy or adolescence. When main caregivers fail to meet young people's basic emotional needs, they develop early maladaptive schemas. These needs are not weaned off, as children grow into adults. Individuals are constantly troubled by unrealistic expectations, which can lead to negative behaviors towards themselves and others. Early maladaptive schemas (EMSs) can emerge in children and adolescents struggling to receive emotional support. This can result in the formation of early maladaptive schemas. (Seavey & Moore, 2012 ). Early maladaptive schemas can lead to emotional and psychological issues, including anxiety disorders, as they are often associated with various mental health conditions. According to Young's hypothesis, schemas can influence how people perceive risk, manage emotions, and respond to stress, making them particularly important in the context of anxiety. The 18 maladaptive schemas identified Young et al. ( 2006 ) were divided into five groups: hypervigilance and inhibition, other-directedness, impaired autonomy and performance, and impaired limitations. (Wagoner, 2013 ; Stevens & Roediger, 2017 ). Some alter worldviews and are often connected with mental health disorders, including anxiety disorders (Faustino et al., 2022 ; Barazandeh et al., 2016 ). Stressful environmental situations and poor childhood interactions with significant adults are the causes of EMS. Nonetheless, they are believed to exist and change over the course of a person's life, preventing them from reaching their objectives (Gong & Chan, 2018 ).Negative or maladaptive schemas can cause maladaptive behaviors that frequently result in depression or anxiety. (Tariq et al, 2021 ). Early maladaptive schemas contribute significantly to the development and maintenance of psychological distress such as anxiety symptoms. Some people may develop dysfunctional ideas and negative environmental perspectives of the environment (James et al., 2004 ). These early maladaptive cognitive habits provide the foundation for the psychological reactions that have evolved throughout our lives. These early maladaptive cognitive schemas are activated by life-threatening events and can result in the development of emotions, such as fear, grief, rage, or shame. According to the Schema Therapy paradigm, numerous psychological disorders are influenced by EMS at both the onset and progression. Anxiety symptoms and EMS were strongly correlated in multiple studies, with schemas of vulnerability, lack of discipline, and mistrust serving as powerful predictors of anxiety. EMS symptoms, including depression, anxiety, and age are also linked to EMS(Halvorsen et al., 2009 ;Shahamat, 2011 ; Moradyan et al., 2013 ; Ang et al., 2025 ). This study aimed to investigate the role of early maladaptive schemas (EMS) in preoperative anxiety, with the aim of informing healthcare providers about strategies for managing preoperative distress and enhancing surgical experience. In addition, we aimed to evaluate the relationship between early maladaptive schemas (EMS) and preoperative anxiety. Understanding these schemas will help to anticipate potential schemas and inform targeted therapeutic interventions. Identifying schemas and symptoms can enhance therapy effectiveness, and treatment outcomes, and improve quality of life. Methods and materials Aim • To examine the connection between preoperative anxiety and early maladaptive schemas, this study used descriptive correlational methodology. Participants The participants in this study will be 310 patients scheduled for surgery. Inclusion Criteria Adults aged 18–65, scheduled for elective surgery, and able to provide informed consent. Patients with severe psychiatric disorders or cognitive impairment. Study setting The study was conducted at the Operations Department of the Damanhur Medical National Institute. Tools of the study : Data from the present study will be collected using the following tools. Tool I: Sociodemographic and clinical data questionnaire This was used to gather background and demographic data, such as age, sex, marital status, occupation, education, and medical history. Tool II : The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a validated tool designed to measure preoperative anxiety and the need for information in patients scheduled for surgery. It was developed to provide a simple, reliable, and rapid assessment of anxiety levels and information requirements that are crucial for effective preoperative care. The APAIS consists of six items, divided into two main components. Anxiety Related to Anesthesia and Surgery Anesthesia-related anxiety "I am worried about the anesthetic." "The anesthetic is on my mind continually." Surgery-related anxiety "I am worried about the procedure." "The procedure is on my mind continually." Information Desire: "I would like to know as much as possible about the anesthetic." "I would like to know as much as possible about the procedure." A 5-point Likert scale, with 1 denoting "not at all" and 5 denoting "extremely," was used to rate each item. A total anxiety score (sum C) was created by adding the scores for anxiety related to anesthesia (sum A) and anxiety related to surgery (sum S).The information desire component is assessed separately. The APAIS has been validated in multiple studies and languages, and has demonstrated good internal consistency and reliability. Moerman et al. ( 1996 ) found that the APAIS had a Cronbach’s α of 0.86 for the anxiety component and 0.68. (Moermanet al 1996 ; Berth et al 2007 ; Vergara et al 2017. Tool III: Young Schema Questionnaire- Short Form, Second Edition (YSQ-S2) Young et al. ( 2003 ) created the Young Schema Questionnaire (YSQ), which consists of 75 measures to evaluate 18 early maladaptive schemas (EMSs). Five domains are used to classify these schemas: Impaired Autonomy/Performance, which includes dependence/incompetence, susceptibility to injury or illness, entanglement/undeveloped self, and failure; Impaired Limits, which include entitlement/grandiosity and inadequate self-control/self-discipline; other-directedness, which includes subjugation, self-sacrifice, and approval-seeking/recognition seeking; and Disconnection and Rejection, which includes abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame, and social isolation/alienation, as well as over-vigilance and inhibition, which include punitiveness, unyielding standards/hyper-criticalness, emotional inhibition, and negativity/pessimism. Weishaar, Klosko, and Young (2003).It was reported that the Cronbach’s alpha of the YSQ-S-2 and the test-retest correlation coefficients of its domains were 0.83–0.96 and 0.50–80, respectively (Danaei, Manshaee, Hasanbadi& Ali, 2018 ). STUDY PROCEDURE. Ethical considerations Our work followed the rules and procedures specified by Helsinki (DoH-Oct2008) declarative formation. The study received ethical approval and permission from the Research Ethics Committee (Institutional Review Board = 110-j) of the Damanhur University Faculty of Nursing in Egypt. Written permission to conduct this study was obtained from the responsible authorities. The goal of the study and participants' freedom to decline participation were explained to them. The researchers also stressed that participants' privacy and anonymity would be strictly protected, and that they could leave the study at any moment, even after it had begun. These steps were taken to guarantee the study's ethical conduct and safeguard the participants' rights and welfare. Pilot study Following the necessary official permission from the responsible authorities, a pilot study was conducted on 10 patients who met the inclusion criteria to evaluate the objectivity, transparency, viability, and applicability of the research instruments. The study sample did not include patients in this category. Cronbach alpha “non-parametric statistical test” was used to test tools’ internal consistency. The Cronbach’s alpha reliability for Tool II ( MOCA ), Tool III ( BDI ), and Tool IV (MSPSS) was 0.885, 0.639 and 0.755 respectively While tools II and III were adopted, tool I was created by the researcher after careful analysis of the pertinent literature. Five mental health and psychiatric nursing specialists examined the instruments to ensure that they were culturally appropriate, complete, and had valid content for the Egyptian community. The necessary modifications were made to improve the appropriateness and quality of the instruments in response to their input. Results Table 1 Descriptive Statistics of the Study Measures ( N = 310) Study Measures Minimum Maximum Mean SD Age 19 40 28.75 6.638 APAIS 6 30 11.06 3.803 • Anesthesia-related anxiety 2 10 3.34 1.680 • Surgery-related anxiety 2 10 4.26 1.751 Maladaptive Schemas 116.00 375.00 239.39 54.559 • Emotional Deprivation 5 30 16.58 6.316 • Abandonment 5 28 15.67 5.469 • Mistrust/Abuse 5 29 16.02 5.434 • Social Isolation 6 28 16.81 6.037 • Defectiveness/Shame 6 27 15.45 5.860 • Failure 5 29 15.12 6.151 • Dependence/Incompetence 5 26 14.02 5.004 • Vulnerability to Harm & Illness 5 28 15.98 5.399 • Enmeshment 5 26 14.13 4.693 • Subjugation 5 29 14.95 5.426 • Self-Sacrifice 5 28 17.34 5.327 • Emotional Inhibition 6 29 16.65 5.253 • Unrelenting Standards 5 29 18.80 5.142 • Entitlement 7 29 15.94 4.934 • Insufficient Self-Control/Self-Discipline 5 27 15.92 4.952 SD = Standard Deviation, APAIS = Amsterdam Preoperative Anxiety and Information Scale Table 2 Gender Differences in Study Variables ( N = 310) Study Measures Male (N = 74) Female (N = 236) t p Mean (SD) Mean (SD) APAIS 10.03 (3.222) 11.39 (3.918) -2.708 .007 Maladaptive Schemas 245.65 (51.62) 237.43 (55.41) 0.570 .569 • Emotional Deprivation 16.95 (6.495) 16.47 (6.268) 0.501 .617 • Abandonment 15.95 (5.139) 15.58 (5.576) 0.501 .617 • Mistrust/Abuse 16.01 (5.548) 16.02 (5.410) -0.011 .992 • Social Isolation 17.05 (6.063) 16.74 (6.039) 0.393 .694 • Defectiveness/Shame 15.66 (5.604) 15.39 (5.948) 0.348 .728 • Failure 15.20 (6.325) 15.10 (6.109) 0.128 .898 • Dependence/Incompetence 14.86 (5.540) 13.75 (4.806) 1.671 .096 • Vulnerability to Harm & Illness 16.80 (5.361) 15.72 (5.396) 1.500 .135 • Enmeshment 14.42 (4.812) 14.04 (4.662) 0.602 .548 • Subjugation 15.01 (5.246) 14.94 (5.492) 0.106 .915 • Self-Sacrifice 17.18 (4.606) 17.39 (5.542) -0.295 .768 • Emotional Inhibition 17.66 (4.994) 16.33 (5.302) 1.905 .058 • Unrelenting Standards 18.78 (4.858) 18.81 (5.238) -0.037 .970 • Entitlement 17.14 (4.875) 15.56 (4.903) 2.409 .017 • Insufficient Self-Control/Self-Discipline 16.97 (4.814) 15.59 (4.958) 2.103 .036 SD = Standard Deviation, t = Independent Sample Test, APAIS = Amsterdam Preoperative Anxiety and Information Scale Table 3 Correlations Analysis Between the Study Measures ( N = 310) Study Measures Age APAIS APAIS r .025 1 P .666 Maladaptive Schemas r .045 − .125 * P .433 .027 Emotional Deprivation r .053 − .122 * P .353 .031 Abandonment r .072 − .101 P .207 .077 Mistrust/Abuse r .037 − .029 P .517 .617 Social Isolation r .054 − .042 P .341 .467 Defectiveness/Shame r .030 − .090 P .598 .114 Failure r .002 − .120 * P .968 .034 Dependence/Incompetence r − .007 − .079 P .903 .165 Vulnerability to Harm & Illness r .065 − .173 ** P .252 .002 Enmeshment r .073 − .052 P .202 .365 Subjugation r − .003 − .144 * P .959 .011 Self-Sacrifice r − .002 − .126 * P .966 .026 Emotional Inhibition r .082 − .043 P .149 .449 Unrelenting Standards r − .007 − .005 P .896 .930 Entitlement r .010 − .050 P .866 .376 Insufficient Self-Control/Self-Discipline r − .016 − .066 P .784 .250 r = Pearson correlation, APAIS = Amsterdam Preoperative Anxiety and Information Scale **Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed). Table 4 Regression Analysis Predicting APAIS Scores Predictors APAIS Unstandardized Coefficients Standardized Coefficients t P 95% CI for difference B SE ß Lower bound Upper bound Constant 11.290 1.223 9.231 .000 8.883 13.697 Emotional Deprivation − .020 .040 − .032 − .488 .626 − .098 .059 Failure − .015 .043 − .024 − .349 .727 − .099 .069 Vulnerability to Harm & Illness − .068 .051 − .097 -1.332 .184 − .169 .033 Subjugation − .045 .050 − .065 − .901 .368 − .145 .054 Self-Sacrifice − .009 .054 − .012 − .162 .872 − .116 .098 Gender 1.273 .501 .143 2.542 .012 .288 2.258 Effect (B) = Unstandardized Coefficient; ß = standardized coefficient beta; SE = Standard Error; t = Student t test for linear regression 95% CI for difference = 95% Confidence Interval for Difference R 2 = 0.056 ( Adj R 2 = 0.038), F- change =, F(6, 303) = 3.007, P = 0.007. Dependent variable: APAIS = Amsterdam Preoperative Anxiety and Information Scale The descriptive statistics for the study variables are presented in Table 1. The sample consisted of 310 participants, 19 to 40 years (M = 28.75, SD = 6.64). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores ranged from 6 to 30 (M = 11.06, SD = 3.80), indicating moderate levels of preoperative anxiety. The subscales of the APAIS, including anxiety about anesthesia (M = 3.34, SD = 1.68) and surgery (M = 4.26, SD = 1.75), also showed moderate levels of anxiety. The Early Maladaptive Schema (EMS) subscales demonstrated varying levels of endorsement, with the highest mean score for Unrelenting Standards (M = 18.80, SD = 5.14) and lowest for dependence/incompetence (M = 14.02, SD = 5.00). The total EMS score ranged from 116 to 375 (M = 239.39, SD = 54.56), indicating a wide range of schema endorsements among participants. Table 2 presents the results of the independent sample t-tests comparing males and females on the study variables, including the APAIS and EMS subscales. Females reported significantly higher levels of APAIS (M = 11.39, SD = 3.92) than males (M = 10.03, SD = 3.22), t(308) = -2.708, p = .007. Additionally, males scored significantly higher on entitlement (M = 17.14, SD = 4.88) than females (M = 15.56, SD = 4.90), t (308) = 2.409, p = .017, and Insufficient Self-Control (M = 16.97, SD = 4.81) than females (M = 15.59, SD = 4.96), t(308) = 2.103, p = .036. No significant sex differences were found for the remaining EMS subscales or total EMS scores (all p > .05). These findings highlight the role of sex in pre-operative anxiety and specific maladaptive schemas. As shown in Table 3, the correlation analysis examined the relationships among age, APAIS, and EMS subscales. Age showed no significant correlation with APAIS or any of the EMS subscales (all p > .05), indicating that age did not influence preoperative anxiety or maladaptive schema endorsement in this sample. However, significant negative correlations were found between the APAIS and several EMS subscales, including Emotional Deprivation (r = − .122, p = .031), failure (r = − .120, p = .034), Vulnerability to Harm & Illness (r = − .173, p = .002), subjugation (r = − .144, p = .011), and self-sacrifice (r = − .126, p = .026). These findings suggest that higher levels of preoperative anxiety are associated with a lower endorsement of these specific maladaptive schemas. Notably, Vulnerability to Harm & Illness had the strongest negative correlation with APAIS, highlighting its potential relevance in understanding pre-operative anxiety. Table 4 shows that multiple regression analysis was conducted to predict APAIS using six predictors: Emotional Deprivation, Failure, and Vulnerability to Harm, Subjugation, Self-Sacrifice, and Gender. The model was statistically significant, F (6, 303) = 3.007, p = .007, explaining 5.6% of the variance in APAIS scores (R² = .056). Among the predictors, only sex was statistically significant (B = 1.273, p = .012), indicating that females reported higher levels of preoperative anxiety than males. None of the EMS subscales (ED, Failure, VH, SB, SS) were significant predictors in this model (all p > .05). These results suggest that, while sex plays a significant role in preoperative anxiety, the specific EMS subscales included in this analysis do not independently contribute to predicting anxiety levels. Statistical Analysis Statistical Package for Social Sciences (SPSS) version 29 was used for data analysis. Categorical data are summarized as frequencies and percentages, while continuous variables are presented as mean ± Standard Deviation (SD).Pearson’s correlation test was used to examine the relationships between continuous parametric variables. Independent samples t-tests were conducted to compare means between two groups (e.g., gender) for continuous variables, ensuring that assumptions of normality and homogeneity of variance were met. Linear regression analysis was used to predict the value of the dependent variable (e.g., preoperative anxiety) based on the values of the independent variables (e.g., maladaptive schemas and sex). All statistical tests were performed at an alpha level of 0.05 to determine statistical significance. Discussion This study assessed anxiety levels in a broad sample of participants using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). This study found a strong relationship between early maladaptive schemas (EMS), deeply rooted, negative thought patterns formed in childhood, and preoperative anxiety, particularly among young adults and adolescents1. Specifically, schemas in the domains of disconnection/rejection (e.g., mistrust or feelings of defectiveness), Impaired Autonomy/Performance (e.g., dependence or incompetence), and other-directedness (placing others’ needs above one’s own) were significant predictors of heightened anxiety before surgery1. Notably, women are more likely to exhibit schemas related to hypervigilance and excessive concern for others, which makes them especially vulnerable to preoperative anxiety1. Interestingly, the Entitlement/Grandiosity schema, which involves feelings of overconfidence or entitlement, was sometimes associated with lower anxiety levels, possibly due to a protective effect of overconfidence1. These findings highlight the importance of assessing EMS in surgical patients, as identifying and addressing these schemas can help tailor interventions to reduce anxiety, particularly for high-risk groups, such as women or those with dominant maladaptive schemas. To identify the underlying psychological characteristics that lead to anxiety before surgery, this study examined the correlation between preoperative anxiety and various EMS subscales, including Emotional Deprivation, Failure, Vulnerability to Harm, Subjugation, and Self-Sacrifice. Additionally, the significant role of sex in predicting anxiety levels was highlighted, providing insights into the biological, psychological, and social factors that influence preoperative anxiety. This comprehensive examination offers a nuanced understanding of the factors shaping preoperative anxiety and suggests potential strategies for interventions to manage anxiety levels preoperatively (Celik & Edipoglu, 2018 ; Moerman et al., 1996 ; Salzmann et al., 2021 ). First, the level of anxiety among the preoperative patients was moderate. This finding aligns with previous research that highlights the prevalence of moderate anxiety levels in pre-operative patients (Moerman et al., 1996 ). The APAIS subscales, including anxiety about anesthesia and surgery, also showed moderate levels of anxiety. These results are consistent with the notion that both anesthesia and surgical procedures are significant sources of anxiety among patients (Vergara-Romero et al., 2017 ). These include increased anesthetic and analgesic requirements, postoperative delirium, and prolonged recovery times (Shebl et al., 2025 ). Numerous studies have shown that women regularly report significantly higher levels of preoperative anxiety than men (Celik & Edipoglu, 2018 ; Moerman et al., 1996 ). Several factors are frequently cited as the causes of this discrepancy. Hormonal changes, such as those involving estrogen and progesterone, have the potential to increase anxiety levels (Celik & Edipoglu, 2018 ). According to Oh et al. (2024), women are more likely to view events as threatening due to their higher trait anxiety and propensity for ruminative thinking. Social conventions encourage women to communicate their feelings and seek support, leading to higher anxiety levels. Women frequently bear the brunt of caregiving tasks (Eberhart et al. 2020). All of these elements work together to explain why women typically feel more anxious before surgery than men do. Higher preoperative anxiety in females has been linked to poorer surgical outcomes, including increased postoperative pain and longer recovery times (Salzmann et al., 2021 ). Therefore, Recognizing that females generally experience higher levels of preoperative anxiety suggests the need for gender-specific interventions. For instance, providing more detailed information about the surgical procedure, offering additional psychological support, and addressing specific fears related to anesthesia and surgery can help mitigate anxiety in female patients (Celik & Edipoglu, 2018 ). Implementing routine screening for preoperative anxiety, particularly among female patients, can help identify those at higher risk. This allows healthcare providers to intervene early and provide appropriate support, potentially improving the surgical outcomes (Shebl et al., 2025 ). In addition, the Early Maladaptive Schema (EMS) subscales demonstrated varying levels of endorsement among participants. The highest mean score was for Unrelenting Standards, suggesting that many participants had high internal standards and strived for perfection. This schema is often associated with high levels of stress and anxiety as individuals may feel constant pressure to meet these standards (Young et al., 2003 ).Conversely, the lowest mean score was obtained for dependence/competence, indicating that fewer participants felt either dependent or incompetent. This lower endorsement reflects the relatively high level of self-efficacy and independence in the sample. This variability suggests that, while some individuals may have multiple maladaptive schemas, others may have fewer schemas, highlighting the diverse psychological profiles within the sample (Schmidt et al., 1995 ). However, evidence suggests that the impact of preoperative anxiety on surgical outcomes may vary depending on individual patient factors and type of surgery, and some studies did not find significant associations between preoperative anxiety and postoperative pain (Ni et al., 2023 ). This variability underscores the need for personalized approaches to preoperative care and for further research to clarify these relationships. Overall, these findings highlight the importance of psychological assessments and interventions in the preoperative setting to enhance patient well-being and surgical outcomes. Research has shown that males often exhibit higher levels of entitlement than females. This can be attributed to social and cultural norms that encourage assertiveness and self-advocacy in males (Jackson et al., 2020 ).Studies have found that males generally report lower levels of self-control than females, which can be linked to higher impulsivity and risk-taking behaviors (Chiesi et al., 2020 ).The expressions of entitlement and self-control can vary significantly depending on the context and the specific population studied. Some studies have suggested that these traits are influenced by situational factors and may not be inherently tied to gender (Jackson et al., 2020 ). The negative correlation between APAIS and Emotional Deprivation indicates that individuals with higher preoperative anxiety tend to report lower levels of emotional deprivation. An Emotional Deprivation schema refers to the perceived lack of emotional support and nurturing. Individuals with this schema often feel that others do not meet their emotions. This negative correlation indicated that those who experience higher preoperative anxiety may not necessarily feel emotionally deprived. This could be because their anxiety was more focused on the immediate stressor of surgery than on long-term emotional needs. This could be because their anxiety is more focused on the immediate stressor of surgery rather than on long-term emotional needs, and preoperative anxiety often centers on the immediate threat of surgery, which can overshadow general feelings of emotional deprivation (Shebl et al., 2025 ). On the other hand, some studies suggest that emotional deprivation can exacerbate anxiety, indicating that the relationship might be more bidirectional than unidirectional (Ni et al., 2023 ), and may also be related to Complex Interactions that The relationship between emotional deprivation and anxiety is complex and may be influenced by other factors, such as personality traits and coping mechanisms (Salzmann et al., 2021 ). The current study revealed that there is a negative correlation between APAIS and the Failure schema, suggesting that individuals with higher preoperative anxiety are less likely to endorse feelings of failure. This might be because anxiety about surgery overshadows other concerns; therefore, anxiety can shift focus away from feelings of failure to immediate concerns about surgery, reducing the endorsement of the failure schema (Shebl et al., 2025 ). However, some studies have suggested that feelings of failure can exacerbate anxiety, indicating that the relationship might be bidirectional (Ni et al., 2023 ).The strongest negative correlation was found between APAIS and Vulnerability to Harm & Illness, This suggests that individuals with higher preoperative anxiety are less likely to feel vulnerable to harm and illness, possibly because their anxiety is focused on the surgery itself., this may be explained by the fact that preoperative anxiety often centers on the immediate threat of surgery, which can overshadow general feelings of vulnerability (Celik & Edipoglu, 2018 ).However, some studies have indicated that individuals who feel vulnerable to harm and illness may also experience higher levels of general anxiety, including preoperative anxiety (Salzmann et al., 2021 ). In addition, the negative correlation between the APAIS and Subjugation suggests that higher preoperative anxiety is associated with fewer feelings of subjugation. This might be because anxiety related to surgery takes precedence over the feelings of being controlled or oppressed. This may be explained by anxiety about surgery, which can dominate an individual's thoughts and reduce the impact of feelings of subjugation (Shebl et al., 2025 ). However, subjugation can contribute to anxiety, particularly in interpersonal contexts, suggesting a complex relationship (Ni et al. 2023 ).The negative correlation between APAIS and Self-Sacrifice indicates that individuals with higher preoperative anxiety are less likely to engage in self-sacrificial behaviors. This could be because their anxiety made them more focused on their well-being. This is supported by the fact that high anxiety levels can lead individuals to prioritize their own needs over self-sacrificial behaviors (Dugas et al., 2016 ).However, in some cultures, self-sacrifice is highly valued and can coexist with high anxiety levels, suggesting that cultural context may influence this relationship (Dugas et al., 2016 ). According to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the current study also found that only sex was a statistically significant predictor of preoperative anxiety, suggesting that women experienced higher levels of preoperative worry than men. The current study found no significant predictors among the Early Maladaptive Schema (EMS) subscales of Emotional Deprivation, Failure, and Vulnerability to Harm, Subjugation, and Self-Sacrifice. These findings imply that although preoperative anxiety is significantly influenced by sex, the EMS subscales used in this investigation do not independently predict anxiety levels. The finding that sex is a strong predictor of preoperative anxiety is one of these crucial relationships, which is consistent with a large body of research showing that women often report higher feelings of worry than men. According to recent research, emotional deprivation, failure, vulnerability to injury, subjection, and self-sacrifice schemas are not significantly correlated with preoperative anxiety. This indicates that anxiety levels before surgery are not independently predicted by feelings of emotional deprivation, vulnerability, failure, control, or excessive self-sacrifice. These broader emotional patterns tend to be overshadowed by immediate fear of surgery, which is likelythe cause of preoperative worry (Shebl et al., 2025 ; Dugas et al., 2016 ). Overall, the acute stress of surgery seems to be the main factor determining anxiety levels before an operation, although some research indicates that thoughts of failure might occasionally worsen anxiety, suggesting a potential two-way interaction (Ni et al., 2023 ). In conclusion, this study highlights the critical role of psychological factors, particularly preoperative anxiety and maladaptive schemas, in influencing the surgical outcomes. These findings underscore the need for tailored interventions and routine screening to address the unique anxiety-related needs of female patients who report significantly higher levels of preoperative anxiety. By implementing gender-specific strategies and enhancing communication, healthcare providers can improve patient well-being and surgical experience. Further research is essential to deepen our understanding of these psychological factors and develop effective interventions, ultimately leading to better patient care and outcomes. Declarations Data access statement: research data supporting this publication are available from the corresponding author. Conflict of interest declaration: the author declare that they have no affiliation with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript. Author Contributions: Mira NAGUIB Abdel-Razek Research main idea Methodology development. Data collection and management Primary manuscript writing Heba Mahmoud Mahmoud Mohamed Critical review of intellectual content Final manuscript approval Ahmed Hashem El-Monshed Statistical analysis Data interpretation Table representation of results Omima mohammed Manuscript formatting Reference management Laila Saad Mahmoud Technical support. Manuscript editing. Conceptualization of research design. Clinical trial number : not applicable Recommendations : Pre-Screening Administer tools, such as the Young Schema Questionnaire (YSQ), to identify high-risk patients with dominant EMS domains. Targeted Interventions Address Disconnection/Rejection schemas using cognitive restructuring to challenge mistrust or defective beliefs. Combined exposure and response prevention (ERP) with schema therapy for patients with entrenched EMS. Gender-Sensitive Approaches: Tailor interventions for females, reducing hypervigilance and other-directed behaviors. Monitor patients with high EMS scores for prolonged anxiety or relapse, offering booster sessions, if needed. Ethical acceptance& participation informed consent. Our work followed the rules and procedures specified by Helsinki (DoH-Oct2008) declarative formation. The study received ethical approval and permission from the Research Ethics Committee (Institutional Review Board=110-j) of the Damanhur University Faculty of Nursing in Egypt. Prior to participation, all study participants were provided with detailed information about the study's objectives and were assured of their anonymity and confidentiality. Written informed consent was obtained from each participant, emphasizing the right to withdraw from the study at any point. Data Availability All data generated or analyzed during this study are included in this published article [and its supplementary information files]. Funding No specific funding for this study was received from the public, commercial, or not-for-profit sectors. Acknowledgments We sincerely thank all participants of this study. References Almalki, M. S., Hakami, O. A. O., & Al-Amri, A. M. (2017). Assessment of preoperative anxiety among patients undergoing elective surgery. The Egyptian Journal of Hospital Medicine , 69 (4), 2329-2333. Ang, B. H., Gollapalli, S. D., Du, M., & Ng, S. K. (2025). Unraveling online mental health through the lens of early maladaptive schemes: AI-enabled content analysis of online mental health communities. Journal of Medical Internet Research , 27 , e59524. Barazandeh, H., Kissane, D. W., Saeedi, N., Gordon, M. (2016). Systematic review of the relationship between early maladaptive schemas and borderline personality disorders/traits. Personality and Individual Differences, 94, 130-139. Bartlett, F. C. (1932). Remembering: A Study of Experimental and Social Psychology. Cambridge: Cambridge University Press. Berth, H., Petrowski, K., & Balck, F. (2007). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was the first trial of its German version. Psychosocial Medicine 4, Doc01. Boker, A., Brownell, L., & Donen, N. (2002). The Amsterdam Preoperative Anxiety and Information Scale is a simple and reliable measure of preoperative anxiety. Canadian Journal of Anaesthesia , 49 (8), 792-798. Celik, F., & Edipoglu, I. S. (2018). Evaluation of preoperative anxiety and fear of anesthesia using the APAIS score. European journal of medical research, 23, 1-10. Celik, F., & Edipoglu, I. S. (2018). Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. European Journal of Medical Research, 23 (41). https://doi.org/10.1186/s40001-018-0339-4 Chiesi, F., Bonacchi, A., Lau, C., Tosti, A. E., Marra, F., & Saklofske, D. H. (2020). Measuring self-control across gender, age, language, and clinical status: A validation study of the Italian version of the Brief Self-Control Scale (BSCS). PLOS ONE, 15 (8), e0237729. https://doi.org/10.1371/journal.pone.0237729 Danaei, M., Manshaee, G. R., Hasanbadi, H., & Ali, M. (2018). Psychometric properties of the Young Schema Questionnaire-Short Form (YSQ-S2) in an Iranian sample. Journal of Cognitive and Behavioral Psychotherapies, 18 (2), 83-96. Dhungana, M., Limbu, R., Shrestha, M. (2019). Assessment of preoperative anxiety among patients in selected hospitals in Rupandehi, Nepal. Journal of Psychiatrists' Association of Nepal , 8 (1), 28-32. Dugas, M., & Bélanger, J. J., Moyano, M., Schumpe, B. M., Kruglanski, A. W., Gelfand, M. J., Touchton-Leonard, K., & Nociti, N. (2016). The quest for significance motivates self-sacrifices. Motivation Science, 2 (1), 15–32. https://doi.org/10.1037/mot0000030 Faustino, B., Vasco, A. B., Delgado, J., Farinha‐Fernandes, A., & Guerreiro, J. C. (2022). Early maladaptive schemas and COVID‐19 anxiety: The mediational role of mistrustfulness and vulnerability to harm and illness. Clinical Psychology & Psychotherapy, 29(4), 1297-1308. Friedrich S, Reis S, Meybohm P, Kranke P. Preoperative anxiety. Current Opinion in Anesthesiology , 35 (6), 674-678. doi: 10.1097/ACO.0000000000001186. Epub 2022 Sep 21. PMID: 36131642. Ghimire, R., & Poudel, P. (2019). Preoperative anxiety and its determinants in patients scheduled for major surgery: A hospital-based study. International Journal of Anesthesia and Clinical Medicine , 6 (2), 57-60. Gong, J., Chan, R. C., 2018. Early maladaptive schemas as mediators between childhood maltreatment and later psychological distress in Chinese college students. Psychiatry Research, 259, 493-500. doi: http://dx.doi.org/10.1016/j.psychres.2017.11.019 Goyal, P., Prisha, J. S., Chacko, A., Goyal, S., Gupta, S., & Kathuria, S. (2025). Assessment of perioperative anxiety levels at three time points during the hospital stay in patients undergoing elective surgery. Perioperative Medicine, 14 (27). https://doi.org/10.1186/s13741-025-00504-0 Halvorsen, M. and C. Wang, C. E., Richter, J., Myrland, I., Pedersen, S. K., Eisemann, M., & Waterloo, K. (2009). Early maladaptive schemas, temperament, and character traits in clinically and previously depressed subjects. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice , 16 (5), 394-407. Hernandez, P. J., Fuentes, G. D., Falcon, A. L., Rodriguez, R. A., Garcia, P. C., & Roca, C. M. J. (2015). Visual analogue scale for anxiety and Amsterdam preoperative anxiety scale provide a simple and reliable measurement of preoperative anxiety in patients undergoing cardiac surgery. Jackson, D. L., Frey, M. P., McLellan, C., Rauti, C. M., Lamborn, P. B. and Singleton-Jackson, J. A. (2020). I deserve more A’s: a report on the development of a measure of academic entitlement. PLOS ONE, 15 (9), e0239721. https://doi.org/10.1371/journal.pone.0239721 James, I. A., Southam, L., & Blackburn, I. M. (2004). Schemas revisited. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice , 11 (6), 369-377. Jawaid, M., Mushtaq, A., Mukhtar, S., Khan, Z. (2007). Preoperative anxiety before elective surgery. Neurosciences Journal , 12 (2), 145-148. Jovanovic, K., Kalezic, N., Sipetic Grujicic, S., Zivaljevic, V., Jovanovic, M., Savic, M., ... & Davidovic, L. (2022). Translation and Validation of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in Serbia. Brain and Behavior, 12(1), e2462. Kuzminskaitė, V., Kaklauskaitė, J., & Petkevičiūtė, J. (2019). Incidence and features of preoperative anxiety in patients undergoing elective non-cardiac surgery. Acta Medica Lituanica , 26 (1), 93. Lakhe, G., Shrestha, B. B., Subedi, A. (2022). Preoperative anxiety among patients undergoing elective surgery in a tertiary care center: a descriptive cross-sectional study. JNMA: Journal of the Nepal Medical Association , 60 (252), 681. Le Roy, B., Selvy, M., & Slim, K. (2016). The concept of prehabilitation: what the surgeon needs to know?. Journal of visceral surgery, 153(2), 109-112. Maheshwari, D. and Ismail, S. (2015). Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section. Journal of Anaesthesiology Clinical Pharmacology, 31(2), 196-200. Moerman, N., van Dam, F. S., Muller, M. J., & Oosting, H. (1996). The Amsterdam preoperative anxiety and information scale (APAIS). Anesthesia & Analgesia , 82(3), 445-451. Moerman, N., van Dam, F. S., Muller, M. J., & Oosting, H. (1996). The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesthesia & Analgesia, 82 (3), 445-451. https://doi.org/10.1097/00000539-199603000-00002 Moradian, S. T., Ebadi, A., Saeid, Y., Asiabi, M. (2013). Hospital anxiety and depression in patients with coronary artery disease. Ni, K., Zhu, J., & Ma, Z. (2023). Preoperative anxiety and postoperative adverse events: A narrative overview. Anesthesiology and Perioperative Science, 1 (23). https://doi.org/10.1007/s44254-023-00019-1 Nigussie, S., Belachew, T. and Wolancho, W. (2014). Predictors of preoperative anxiety among surgical patients in Jimma University specialized teaching hospital in South Western Ethiopia. BMC surgery, 14, 1-10. Salzmann, S., Rienmüller, S., Kampmann, S., Euteneuer, F., & Rüsch, D. (2021). Preoperative anxiety and its association with patients’ desire for support: an observational study in adults. BMC Anesthesiology, 21 (149). https://doi.org/10.1186/s12871-021-01361-2 Schmidt, N. B., Joiner, T. E., Young, J. E., & Telch, M. J. (1995). The Schema Questionnaire: Investigation of psychometric properties and hierarchical structure of a measure of maladaptive schemas. Cognitive Therapy and Research, 19 (3), 295-321. https://doi.org/1 Seavey, A., Moore, T. M. (2012). Schema-focused therapy for major depressive and personality disorders: A case study. Clinical Case Studies, 11(6), 457-473. Shahamat, F. (2011). Predicting general health symptoms (somatization, anxiety, and depression) using early maladaptive schemas. Journal of Modern Psychological Researches, 5(20), 103-124. Shebl, M.A., Toraih, E., Shebl, M., Tolba, A. M., Ahmed, P., Banga, H. S., Orz, M., Tammam, M., Saadalla, K., Elsayed, M., Kamal, M., Abdulla, M., Eldessouky, A. I., Moustafa, Y. T., Ahmed, O., & Aiash, M. H. (2025). Preoperative anxiety and its impact on surgical outcomes: a systematic review and meta-analysis. Journal of Clinical and Translational Science, 9 (1), e33. https://doi.org/10.1017/cts.2025.33 Sigdel, S. (2015). Perioperative anxiety. Clin Trials Patent, 1(1), 2. Smith, J. D., Dishion, T. J., Shaw, D. S., Wilson, M. N. (2015). Negative relational schemas predict the trajectory of coercive dynamics in early childhood. Journal of Abnormal Child Psychology, 43 (4), 693703. Spanner, S., & Sayer, L. (2019). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a valid tool for guiding the management of preoperative anxiety in adult patients. A literature review. Journal of Nursing and Practice, 3(1), 95-102. Stamenkovic, D. M., Rancic, N. K., Latas, M. B., Neskovic, V., Rondovic, G. M., Wu, J. D., & Cattano, D. (2018). Preoperative anxiety and implications for postoperative recovery: What can we do to change our history? Minerva anestesiologica , 84 (11), 1307-1317. Stevens, B., & Roediger, E. (2017). Schema Therapy toward the Science of Relationships. Breaking Negative Relationship Patterns: A Schema Therapy Self-help and Support Book.1st ed. Oxford: John Wiley & Sons, Ltd. Available at Breaking Negative Relationship Patterns: A Schema Therapy Self-Help and Support Book | Wiley. Tariq, A., Reid, C., & Chan, S. W. (2021). Meta-analysis of the relationship between early maladaptive schemas and depression in adolescence and young adulthood. Psychological Medicine , 51 (8), 1233-1248. Vergara-Romero, M., Morales-Asencio, J. M., Morales-Fernández, A., Canca-Sanchez, J. C., Rivas-Ruiz, F., & Reinaldo-Lapuerta, J. A. (2017). Validation of the Spanish version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Health and Quality of Life Outcomes , 15(1), 120. Vergara-Romero, M., Morales-Asencio, J. M., Morales-Fernández, A., Canca-Sanchez, J. C., Rivas-Ruiz, F., & Reinaldo-Lapuerta, J. A. (2017). Validation of the Spanish version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Health and Quality of Life Outcomes, 15 (120). https://doi.org/10.1186/s12955-017-0698-3 Wagoner B. (2013). Bartlett's concept of schema in reconstruction. Theory & Psychology, 23 (5), 553-575. Walker, E. M., Bell, M., Cook, T. M., Grocott, M. P., & Moonesinghe, S. R. (2016). Patient-reported outcomes of adult perioperative anesthesia in the United Kingdom: A cross-sectional observational study. BJA: British Journal of Anaesthesia , 117 (6), 758-766. Wang, R., Huang, X., & Wang, Y. (2022). Non-pharmacological approaches to preoperative anxiety: a comprehensive review. Frontiers in Public Health . https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.854673/full Young, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. Professional Resource Press . Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema Therapy: A Practitioner's Guide . Guilford Press. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2006). Schema therapy: A practitioner's guide . guilford press. Young, J. E., Klosko, J. S., Weishaar, M. E., 2003. Schema therapy: Practitioner’s guidance. New York: Guilford Press. Retrieved from: http://www.schematherapy.com/id201.htm Additional Declarations No competing interests reported. Supplementary Files EMSANDANXIETYPREOPERATIVE300.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6941702","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496266607,"identity":"47056118-990b-4e1b-9598-656e1f2f5bc8","order_by":0,"name":"Mira Naguib Abdelraze","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIie2NsUoDQRCG5zjYazak/S00TyCcBI4UeZjd5qpYCeGKJCwEztIH8CUUwTqwcDaLtpaRtBZnl+rImECwyK1XCu5XDP/8zMcQBQJ/kXg/R31OK1ofurSLgjNDQpHqpNBRkWk35fK291FTAfTv3VetCqtNsnwGFfNWJbPJEOQAvF4/QblcG1lNuXnxKIIQlViQ6z1Al2NtMMm4qXxKvI0aYODkZqsbaDP4ZKXxKgKRAVInBd9/f5GsmJlXGakKuHIi45APS5nfcFi1K29V/F7Pxrhw8YaDPb9L7COHRauyR/1cxKGxfuUUv3wJBAKB/8QOpV9Nrc6aVIsAAAAASUVORK5CYII=","orcid":"","institution":"Alexandria University","correspondingAuthor":true,"prefix":"","firstName":"Mira","middleName":"Naguib","lastName":"Abdelraze","suffix":""},{"id":496266608,"identity":"3a800cb0-5ed4-4e88-a9a5-837f1831e633","order_by":1,"name":"Heba Mahmoud Mahmoud Mohamed","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Heba","middleName":"Mahmoud Mahmoud","lastName":"Mohamed","suffix":""},{"id":496266610,"identity":"62827f12-5e45-45e8-8113-789d1e616772","order_by":2,"name":"Ahmed Hashem El Monshed","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"Hashem El","lastName":"Monshed","suffix":""},{"id":496266615,"identity":"57a90018-b689-402c-a009-f13012962473","order_by":3,"name":"Omima mohammed Ibrahim Morsy","email":"","orcid":"","institution":"Damanhour University","correspondingAuthor":false,"prefix":"","firstName":"Omima","middleName":"mohammed Ibrahim","lastName":"Morsy","suffix":""},{"id":496266616,"identity":"58dfd589-20a1-4d5d-9e8b-35e6ea6bed34","order_by":4,"name":"Laila Saad Mahmoud shokhba","email":"","orcid":"","institution":"Alexandria University","correspondingAuthor":false,"prefix":"","firstName":"Laila","middleName":"Saad Mahmoud","lastName":"shokhba","suffix":""}],"badges":[],"createdAt":"2025-06-20 22:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6941702/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6941702/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90784128,"identity":"46982d3f-9ebc-4a11-a44d-2e9e764cd1b5","added_by":"auto","created_at":"2025-09-08 06:32:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1167740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6941702/v1/2e4f1d9e-4f80-4bd5-a570-fd5a077ec535.pdf"},{"id":88569481,"identity":"e9206ba8-824c-40a4-9cd6-0dbf71e8b21c","added_by":"auto","created_at":"2025-08-07 21:40:45","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":125010,"visible":true,"origin":"","legend":"","description":"","filename":"EMSANDANXIETYPREOPERATIVE300.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-6941702/v1/ac145bdcd2eb9418d6dd2e72.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unraveling the Mind's Blueprint Early Maladaptive Schemas as Crystal Balls for Preoperative Anxiety","fulltext":[{"header":"Highlights","content":"\u003cp\u003e. Strong Overall Correlation: A meta-analysis revealed a significant association between EMS and anxiety symptoms (r\u0026thinsp;=\u0026thinsp;0.59), particularly in adolescents and young adults. Critical Schema Domains\u003c/p\u003e\u003cp\u003e. Disconnection/Rejection: Schemas such as Mistrust-Abuse and Defectiveness/Shame are linked to fear of abandonment and social isolation. Impaired Autonomy/Performance: Features Dependence\u003c/p\u003e\u003cp\u003e/ Incompetence and Vulnerability tied to perceived inability to cope with stressors: Other-Directedness: This involves putting other people's needs above one's own, which exacerbates anxiety.\u003c/p\u003e\u003cp\u003eParadoxical Role of Entitlement/ Grandiosity: This schema may reduce anxiety in some cases, potentially due to overconfidence.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eAnxiety is an emotional disorder characterized by worry about potentially dangerous situations, fear, and uneasiness, as well as restlessness, weariness, difficulty concentrating, and muscular tension (Almalki et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Stamenkovic et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Anxiety is a normal human feeling that prepares the mind and body to respond to threats, and is something everyone experiences on occasion. It is important to emphasize that anxiety is a normal element of human life. Anxiety, whether acute or chronic, can affect perioperative anesthetic management and the overall surgical results (Celik \u0026amp; Poudel, 2019; Celik \u0026amp; Edipoglu \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Surgery is a life-threatening procedure that increase tension, anxiety, and fear.\u003c/p\u003e\u003cp\u003eTherefore, preoperative anxiety is a significant mental health problem in many surgical patients. (Nigussie et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Lakhe et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Preoperative anxiety is an uncomfortable sense of fear and worry about surgery, anesthesia, hospitalization, pain, unknown, or sickness. This condition affects many patients. (Jovanovic et al. 2021; Spanner and Sayer \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Preoperative anxiety is frequently cited as the most difficult aspect of treatment process (Walker et al., 2017).\u003c/p\u003e\u003cp\u003eThe perioperative phase is one of the most frightening procedures for most patients undergoing surgery. Most patients experience anxiety during the preoperative phase, which is usually considered a normal patient response (Sigdel, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Boker et al., 2003). Physical symptoms, such like palpitations, dyspnea, sweating, frequent urination, abdominal pain, diarrhea, or disturbed sleep. Are often associated with this condition. (Stamenkovic et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The prevalence of preoperative anxiety varies according to the type of surgery, sex, reasons for surgery, and nation, reaching 97% (Maheshwari \u0026amp; Ismail, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Preoperative anxiety has been reported to affect between 60% and 92% of surgical patients globally. (Dhungana et al, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSurgical complications, length and severity of post-procedure disability, general anesthesia and the resulting loss of control, and the possibility of waking up, pain, and discomfort during or after surgery are among the underlying fears of surgical patients. The degree of preoperative anxiety varies according to the invasiveness and nature of the procedure, which affects patient well-being and makes it difficult to understand patient care (Friedrich et al., 2022; Jawaid et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Le Roy et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Several factors have been found to correlate with elevated preoperative anxiety levels (Hernandez et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOne of the factors that has been suggested as a predictor of anxiety is early maladaptive schemas (EMS), which have been found to be a major underlying contributing factor to the development of anxiety disorders and other mental illnesses. According to research conducted in the field of cognitive development, schemas are mental representations used by humans to understand the world, organize information, and make decisions in various situations (Bartlett \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1932\u003c/span\u003e). Schemas significantly influence thought processes, emotions, and behaviors, and their significance has been recognized since the beginning of scientific studies of mental health. It was found that schemas might be useful guides or blueprints for gaining awareness of oneself and the surrounding world. Individuals often have biases in their perceptions, preferring to accept things that align with their existing knowledge to feel comfortable in their surroundings. (Smith et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Self-perpetuating dysfunctional cognitive frameworks that directly impact a person's thoughts, feelings, emotions, and behaviors are known as EMS (Young et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). EMS are pervasive, unhealthy thinking, emotions, and behavioral patterns that start in infancy or adolescence. When main caregivers fail to meet young people's basic emotional needs, they develop early maladaptive schemas. These needs are not weaned off, as children grow into adults. Individuals are constantly troubled by unrealistic expectations, which can lead to negative behaviors towards themselves and others. Early maladaptive schemas (EMSs) can emerge in children and adolescents struggling to receive emotional support. This can result in the formation of early maladaptive schemas. (Seavey \u0026amp; Moore, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEarly maladaptive schemas can lead to emotional and psychological issues, including anxiety disorders, as they are often associated with various mental health conditions. According to Young's hypothesis, schemas can influence how people perceive risk, manage emotions, and respond to stress, making them particularly important in the context of anxiety. The 18 maladaptive schemas identified Young et al. (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) were divided into five groups: hypervigilance and inhibition, other-directedness, impaired autonomy and performance, and impaired limitations. (Wagoner, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Stevens \u0026amp; Roediger, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Some alter worldviews and are often connected with mental health disorders, including anxiety disorders (Faustino et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Barazandeh et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eStressful environmental situations and poor childhood interactions with significant adults are the causes of EMS. Nonetheless, they are believed to exist and change over the course of a person's life, preventing them from reaching their objectives (Gong \u0026amp; Chan, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).Negative or maladaptive schemas can cause maladaptive behaviors that frequently result in depression or anxiety. (Tariq et al, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Early maladaptive schemas contribute significantly to the development and maintenance of psychological distress such as anxiety symptoms. Some people may develop dysfunctional ideas and negative environmental perspectives of the environment (James et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2004\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThese early maladaptive cognitive habits provide the foundation for the psychological reactions that have evolved throughout our lives. These early maladaptive cognitive schemas are activated by life-threatening events and can result in the development of emotions, such as fear, grief, rage, or shame. According to the Schema Therapy paradigm, numerous psychological disorders are influenced by EMS at both the onset and progression. Anxiety symptoms and EMS were strongly correlated in multiple studies, with schemas of vulnerability, lack of discipline, and mistrust serving as powerful predictors of anxiety. EMS symptoms, including depression, anxiety, and age are also linked to EMS(Halvorsen et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2009\u003c/span\u003e;Shahamat, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Moradyan et al., 2013 ; Ang et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aimed to investigate the role of early maladaptive schemas (EMS) in preoperative anxiety, with the aim of informing healthcare providers about strategies for managing preoperative distress and enhancing surgical experience. In addition, we aimed to evaluate the relationship between early maladaptive schemas (EMS) and preoperative anxiety. Understanding these schemas will help to anticipate potential schemas and inform targeted therapeutic interventions. Identifying schemas and symptoms can enhance therapy effectiveness, and treatment outcomes, and improve quality of life.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003eAim\u003c/p\u003e\u003cp\u003e• To examine the connection between preoperative anxiety and early maladaptive schemas, this study used descriptive correlational methodology.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe participants in this study will be 310 patients scheduled for surgery.\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eInclusion Criteria\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAdults aged 18–65, scheduled for elective surgery, and able to provide informed consent. Patients with severe psychiatric disorders or cognitive impairment.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eStudy setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study was conducted at the Operations Department of the Damanhur Medical National Institute.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTools of the study\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eData from the present study will be collected using the following tools.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTool I: Sociodemographic and clinical data questionnaire\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis was used to gather background and demographic data, such as age, sex, marital status, occupation, education, and medical history.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTool II\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a validated tool designed to measure preoperative anxiety and the need for information in patients scheduled for surgery. It was developed to provide a simple, reliable, and rapid assessment of anxiety levels and information requirements that are crucial for effective preoperative care. The APAIS consists of six items, divided into two main components.\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAnxiety Related to Anesthesia and Surgery\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eAnesthesia-related anxiety\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"I am worried about the anesthetic.\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"The anesthetic is on my mind continually.\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSurgery-related anxiety\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"I am worried about the procedure.\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"The procedure is on my mind continually.\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eInformation Desire:\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"I would like to know as much as possible about the anesthetic.\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"I would like to know as much as possible about the procedure.\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003eA 5-point Likert scale, with 1 denoting \"not at all\" and 5 denoting \"extremely,\" was used to rate each item. A total anxiety score (sum C) was created by adding the scores for anxiety related to anesthesia (sum A) and anxiety related to surgery (sum S).The information desire component is assessed separately. The APAIS has been validated in multiple studies and languages, and has demonstrated good internal consistency and reliability. Moerman et al. (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1996\u003c/span\u003e) found that the APAIS had a Cronbach’s α of 0.86 for the anxiety component and 0.68. (Moermanet al \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1996\u003c/span\u003e; Berth et al \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Vergara et al 2017.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTool III: Young Schema Questionnaire- Short Form, Second Edition (YSQ-S2)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eYoung et al. (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) created the Young Schema Questionnaire (YSQ), which consists of 75 measures to evaluate 18 early maladaptive schemas (EMSs). Five domains are used to classify these schemas: Impaired Autonomy/Performance, which includes dependence/incompetence, susceptibility to injury or illness, entanglement/undeveloped self, and failure; Impaired Limits, which include entitlement/grandiosity and inadequate self-control/self-discipline; other-directedness, which includes subjugation, self-sacrifice, and approval-seeking/recognition seeking; and Disconnection and Rejection, which includes abandonment/instability, mistrust/abuse, emotional deprivation, defectiveness/shame, and social isolation/alienation, as well as over-vigilance and inhibition, which include punitiveness, unyielding standards/hyper-criticalness, emotional inhibition, and negativity/pessimism. Weishaar, Klosko, and Young (2003).It was reported that the Cronbach’s alpha of the YSQ-S-2 and the test-retest correlation coefficients of its domains were 0.83–0.96 and 0.50–80, respectively (Danaei, Manshaee, Hasanbadi\u0026amp; Ali, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cb\u003eSTUDY PROCEDURE.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur work followed the rules and procedures specified by Helsinki (DoH-Oct2008) declarative formation. The study received ethical approval and permission from the Research Ethics Committee (Institutional Review Board = 110-j) of the Damanhur University Faculty of Nursing in Egypt. Written permission to conduct this study was obtained from the responsible authorities. The goal of the study and participants' freedom to decline participation were explained to them. The researchers also stressed that participants' privacy and anonymity would be strictly protected, and that they could leave the study at any moment, even after it had begun. These steps were taken to guarantee the study's ethical conduct and safeguard the participants' rights and welfare.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePilot study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing the necessary official permission from the responsible authorities, a pilot study was conducted on 10 patients who met the inclusion criteria to evaluate the objectivity, transparency, viability, and applicability of the research instruments. The study sample did not include patients in this category. Cronbach alpha “non-parametric statistical test” was used to test tools’ internal consistency. The Cronbach’s alpha reliability for Tool II (\u003cb\u003eMOCA\u003c/b\u003e), Tool III (\u003cb\u003eBDI\u003c/b\u003e), \u003cb\u003eand Tool IV (MSPSS) was\u003c/b\u003e 0.885, \u003cb\u003e0.639 and 0.755 respectively\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile tools II and III were adopted, tool I was created by the researcher after careful analysis of the pertinent literature. Five mental health and psychiatric nursing specialists examined the instruments to ensure that they were culturally appropriate, complete, and had valid content for the Egyptian community. The necessary modifications were made to improve the appropriateness and quality of the instruments in response to their input.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive Statistics of the Study Measures (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;310)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy Measures\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMinimum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaximum\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e19\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e40\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e28.75\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e6.638\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAPAIS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e6\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e30\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e11.06\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e3.803\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Anesthesia-related anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.680\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Surgery-related anxiety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.751\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaladaptive Schemas\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e116.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e375.00\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e239.39\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e54.559\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Emotional Deprivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.316\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Abandonment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Mistrust/Abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.434\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Social Isolation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.037\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Defectiveness/Shame\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.860\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e6.151\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Dependence/Incompetence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.004\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Vulnerability to Harm \u0026amp; Illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.399\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Enmeshment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.693\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Subjugation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.426\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Self-Sacrifice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.327\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Emotional Inhibition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.253\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Unrelenting Standards\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.142\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Entitlement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.934\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Insufficient Self-Control/Self-Discipline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.952\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD\u0026thinsp;=\u0026thinsp;Standard Deviation, APAIS\u0026thinsp;=\u0026thinsp;Amsterdam Preoperative Anxiety and Information Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGender Differences in Study Variables (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;310)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStudy Measures\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale (N\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale (N\u0026thinsp;=\u0026thinsp;236)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPAIS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.03 (3.222)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.39 (3.918)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.708\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.007\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaladaptive Schemas\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e245.65 (51.62)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e237.43 (55.41)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.570\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e.569\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Emotional Deprivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16.95 (6.495)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.47 (6.268)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.617\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Abandonment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.95 (5.139)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.58 (5.576)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.617\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Mistrust/Abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16.01 (5.548)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.02 (5.410)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.992\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Social Isolation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.05 (6.063)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.74 (6.039)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.393\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.694\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Defectiveness/Shame\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.66 (5.604)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.39 (5.948)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.348\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.728\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Failure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.20 (6.325)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.10 (6.109)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.898\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Dependence/Incompetence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.86 (5.540)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.75 (4.806)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.096\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Vulnerability to Harm \u0026amp; Illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16.80 (5.361)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.72 (5.396)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.135\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Enmeshment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.42 (4.812)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.04 (4.662)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.602\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.548\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Subjugation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.01 (5.246)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14.94 (5.492)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.915\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Self-Sacrifice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.18 (4.606)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.39 (5.542)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.768\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Emotional Inhibition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.66 (4.994)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.33 (5.302)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.905\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Unrelenting Standards\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.78 (4.858)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.81 (5.238)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.970\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Entitlement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17.14 (4.875)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.56 (4.903)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.409\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.017\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Insufficient Self-Control/Self-Discipline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16.97 (4.814)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.59 (4.958)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.036\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eSD\u0026thinsp;=\u0026thinsp;Standard Deviation, t\u0026thinsp;=\u0026thinsp;Independent Sample Test, APAIS\u0026thinsp;=\u0026thinsp;Amsterdam Preoperative Anxiety and Information Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCorrelations Analysis Between the Study Measures (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;310)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eStudy Measures\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAPAIS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eAPAIS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.666\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eMaladaptive Schemas\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.125\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.433\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEmotional Deprivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.122\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.353\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.031\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAbandonment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.072\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.101\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.077\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMistrust/Abuse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.037\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.517\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.617\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSocial Isolation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.467\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDefectiveness/Shame\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.090\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.598\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.114\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.120\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.968\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eDependence/Incompetence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.079\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.903\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.165\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVulnerability to Harm \u0026amp; Illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.173\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.252\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.002\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEnmeshment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.073\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.365\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSubjugation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.144\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.959\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSelf-Sacrifice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.126\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEmotional Inhibition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.043\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.149\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.449\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eUnrelenting Standards\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.896\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.930\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eEntitlement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.010\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.866\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.376\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eInsufficient Self-Control/Self-Discipline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003er\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.066\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.784\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.250\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;Pearson correlation, APAIS\u0026thinsp;=\u0026thinsp;Amsterdam Preoperative Anxiety and Information Scale\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e**Correlation is significant at the 0.01 level (2-tailed).\u003c/p\u003e\u003cp\u003e*Correlation is significant at the 0.05 level (2-tailed).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression Analysis Predicting APAIS Scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePredictors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"7\" nameend=\"c8\" namest=\"c2\"\u003e\u003cp\u003eAPAIS\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnstandardized Coefficients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardized Coefficients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e95% CI for difference\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003e\u0026szlig;\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eLower bound\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUpper bound\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eConstant\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e8.883\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e13.697\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmotional Deprivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.488\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.626\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.098\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.059\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFailure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.349\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.727\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVulnerability to Harm \u0026amp; Illness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.097\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-1.332\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.184\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubjugation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.045\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.901\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-Sacrifice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.054\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.162\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.872\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.098\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.143\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.542\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.288\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e2.258\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eEffect (B)\u0026thinsp;=\u0026thinsp;Unstandardized Coefficient; \u003cem\u003e\u0026szlig;\u003c/em\u003e = standardized coefficient beta; SE\u0026thinsp;=\u0026thinsp;Standard Error; \u003cem\u003et\u0026thinsp;=\u003c/em\u003e\u0026thinsp;Student t test for linear regression\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e95% CI for difference\u0026thinsp;=\u0026thinsp;95% Confidence Interval for Difference\u003c/p\u003e\u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.056 (\u003cem\u003eAdj R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.038), \u003cem\u003eF-\u003c/em\u003echange =, F(6, 303)\u0026thinsp;=\u0026thinsp;3.007, P\u0026thinsp;=\u0026thinsp;0.007.\u003c/p\u003e\u003cp\u003eDependent variable: APAIS\u0026thinsp;=\u0026thinsp;Amsterdam Preoperative Anxiety and Information Scale\u003c/p\u003e\u003cp\u003eThe descriptive statistics for the study variables are presented in Table\u0026nbsp;1. The sample consisted of 310 participants, 19 to 40 years (M\u0026thinsp;=\u0026thinsp;28.75, SD\u0026thinsp;=\u0026thinsp;6.64). The Amsterdam Preoperative Anxiety and Information Scale (APAIS) scores ranged from 6 to 30 (M\u0026thinsp;=\u0026thinsp;11.06, SD\u0026thinsp;=\u0026thinsp;3.80), indicating moderate levels of preoperative anxiety. The subscales of the APAIS, including anxiety about anesthesia (M\u0026thinsp;=\u0026thinsp;3.34, SD\u0026thinsp;=\u0026thinsp;1.68) and surgery (M\u0026thinsp;=\u0026thinsp;4.26, SD\u0026thinsp;=\u0026thinsp;1.75), also showed moderate levels of anxiety. The Early Maladaptive Schema (EMS) subscales demonstrated varying levels of endorsement, with the highest mean score for Unrelenting Standards (M\u0026thinsp;=\u0026thinsp;18.80, SD\u0026thinsp;=\u0026thinsp;5.14) and lowest for dependence/incompetence (M\u0026thinsp;=\u0026thinsp;14.02, SD\u0026thinsp;=\u0026thinsp;5.00). The total EMS score ranged from 116 to 375 (M\u0026thinsp;=\u0026thinsp;239.39, SD\u0026thinsp;=\u0026thinsp;54.56), indicating a wide range of schema endorsements among participants.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;2 presents the results of the independent sample t-tests comparing males and females on the study variables, including the APAIS and EMS subscales. Females reported significantly higher levels of APAIS (M\u0026thinsp;=\u0026thinsp;11.39, SD\u0026thinsp;=\u0026thinsp;3.92) than males (M\u0026thinsp;=\u0026thinsp;10.03, SD\u0026thinsp;=\u0026thinsp;3.22), t(308) = -2.708, p\u0026thinsp;=\u0026thinsp;.007. Additionally, males scored significantly higher on entitlement (M\u0026thinsp;=\u0026thinsp;17.14, SD\u0026thinsp;=\u0026thinsp;4.88) than females (M\u0026thinsp;=\u0026thinsp;15.56, SD\u0026thinsp;=\u0026thinsp;4.90), t (308)\u0026thinsp;=\u0026thinsp;2.409, p\u0026thinsp;=\u0026thinsp;.017, and Insufficient Self-Control (M\u0026thinsp;=\u0026thinsp;16.97, SD\u0026thinsp;=\u0026thinsp;4.81) than females (M\u0026thinsp;=\u0026thinsp;15.59, SD\u0026thinsp;=\u0026thinsp;4.96), t(308)\u0026thinsp;=\u0026thinsp;2.103, p\u0026thinsp;=\u0026thinsp;.036. No significant sex differences were found for the remaining EMS subscales or total EMS scores (all p\u0026thinsp;\u0026gt;\u0026thinsp;.05). These findings highlight the role of sex in pre-operative anxiety and specific maladaptive schemas.\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;3, the correlation analysis examined the relationships among age, APAIS, and EMS subscales. Age showed no significant correlation with APAIS or any of the EMS subscales (all p\u0026thinsp;\u0026gt;\u0026thinsp;.05), indicating that age did not influence preoperative anxiety or maladaptive schema endorsement in this sample. However, significant negative correlations were found between the APAIS and several EMS subscales, including Emotional Deprivation (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.122, p\u0026thinsp;=\u0026thinsp;.031), failure (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.120, p\u0026thinsp;=\u0026thinsp;.034), Vulnerability to Harm \u0026amp; Illness (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.173, p\u0026thinsp;=\u0026thinsp;.002), subjugation (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.144, p\u0026thinsp;=\u0026thinsp;.011), and self-sacrifice (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.126, p\u0026thinsp;=\u0026thinsp;.026). These findings suggest that higher levels of preoperative anxiety are associated with a lower endorsement of these specific maladaptive schemas. Notably, Vulnerability to Harm \u0026amp; Illness had the strongest negative correlation with APAIS, highlighting its potential relevance in understanding pre-operative anxiety.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;4 shows that multiple regression analysis was conducted to predict APAIS using six predictors: Emotional Deprivation, Failure, and Vulnerability to Harm, Subjugation, Self-Sacrifice, and Gender. The model was statistically significant, F (6, 303)\u0026thinsp;=\u0026thinsp;3.007, p\u0026thinsp;=\u0026thinsp;.007, explaining 5.6% of the variance in APAIS scores (R\u0026sup2; = .056). Among the predictors, only sex was statistically significant (B\u0026thinsp;=\u0026thinsp;1.273, p\u0026thinsp;=\u0026thinsp;.012), indicating that females reported higher levels of preoperative anxiety than males. None of the EMS subscales (ED, Failure, VH, SB, SS) were significant predictors in this model (all p\u0026thinsp;\u0026gt;\u0026thinsp;.05). These results suggest that, while sex plays a significant role in preoperative anxiety, the specific EMS subscales included in this analysis do not independently contribute to predicting anxiety levels.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical Package for Social Sciences (SPSS) version 29 was used for data analysis. Categorical data are summarized as frequencies and percentages, while continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation (SD).Pearson\u0026rsquo;s correlation test was used to examine the relationships between continuous parametric variables. Independent samples t-tests were conducted to compare means between two groups (e.g., gender) for continuous variables, ensuring that assumptions of normality and homogeneity of variance were met. Linear regression analysis was used to predict the value of the dependent variable (e.g., preoperative anxiety) based on the values of the independent variables (e.g., maladaptive schemas and sex). All statistical tests were performed at an alpha level of 0.05 to determine statistical significance.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed anxiety levels in a broad sample of participants using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). This study found a strong relationship between early maladaptive schemas (EMS), deeply rooted, negative thought patterns formed in childhood, and preoperative anxiety, particularly among young adults and adolescents1. Specifically, schemas in the domains of disconnection/rejection (e.g., mistrust or feelings of defectiveness), Impaired Autonomy/Performance (e.g., dependence or incompetence), and other-directedness (placing others\u0026rsquo; needs above one\u0026rsquo;s own) were significant predictors of heightened anxiety before surgery1. Notably, women are more likely to exhibit schemas related to hypervigilance and excessive concern for others, which makes them especially vulnerable to preoperative anxiety1. Interestingly, the Entitlement/Grandiosity schema, which involves feelings of overconfidence or entitlement, was sometimes associated with lower anxiety levels, possibly due to a protective effect of overconfidence1. These findings highlight the importance of assessing EMS in surgical patients, as identifying and addressing these schemas can help tailor interventions to reduce anxiety, particularly for high-risk groups, such as women or those with dominant maladaptive schemas.\u003c/p\u003e\u003cp\u003eTo identify the underlying psychological characteristics that lead to anxiety before surgery, this study examined the correlation between preoperative anxiety and various EMS subscales, including Emotional Deprivation, Failure, Vulnerability to Harm, Subjugation, and Self-Sacrifice. Additionally, the significant role of sex in predicting anxiety levels was highlighted, providing insights into the biological, psychological, and social factors that influence preoperative anxiety. This comprehensive examination offers a nuanced understanding of the factors shaping preoperative anxiety and suggests potential strategies for interventions to manage anxiety levels preoperatively (Celik \u0026amp; Edipoglu, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Moerman et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1996\u003c/span\u003e; Salzmann et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFirst, the level of anxiety among the preoperative patients was moderate. This finding aligns with previous research that highlights the prevalence of moderate anxiety levels in pre-operative patients (Moerman et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). The APAIS subscales, including anxiety about anesthesia and surgery, also showed moderate levels of anxiety. These results are consistent with the notion that both anesthesia and surgical procedures are significant sources of anxiety among patients (Vergara-Romero et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). These include increased anesthetic and analgesic requirements, postoperative delirium, and prolonged recovery times (Shebl et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eNumerous studies have shown that women regularly report significantly higher levels of preoperative anxiety than men (Celik \u0026amp; Edipoglu, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Moerman et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). Several factors are frequently cited as the causes of this discrepancy. Hormonal changes, such as those involving estrogen and progesterone, have the potential to increase anxiety levels (Celik \u0026amp; Edipoglu, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). According to Oh et al. (2024), women are more likely to view events as threatening due to their higher trait anxiety and propensity for ruminative thinking. Social conventions encourage women to communicate their feelings and seek support, leading to higher anxiety levels. Women frequently bear the brunt of caregiving tasks (Eberhart et al. 2020). All of these elements work together to explain why women typically feel more anxious before surgery than men do. Higher preoperative anxiety in females has been linked to poorer surgical outcomes, including increased postoperative pain and longer recovery times (Salzmann et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Therefore, Recognizing that females generally experience higher levels of preoperative anxiety suggests the need for gender-specific interventions. For instance, providing more detailed information about the surgical procedure, offering additional psychological support, and addressing specific fears related to anesthesia and surgery can help mitigate anxiety in female patients (Celik \u0026amp; Edipoglu, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Implementing routine screening for preoperative anxiety, particularly among female patients, can help identify those at higher risk. This allows healthcare providers to intervene early and provide appropriate support, potentially improving the surgical outcomes (Shebl et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition, the Early Maladaptive Schema (EMS) subscales demonstrated varying levels of endorsement among participants. The highest mean score was for Unrelenting Standards, suggesting that many participants had high internal standards and strived for perfection. This schema is often associated with high levels of stress and anxiety as individuals may feel constant pressure to meet these standards (Young et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).Conversely, the lowest mean score was obtained for dependence/competence, indicating that fewer participants felt either dependent or incompetent. This lower endorsement reflects the relatively high level of self-efficacy and independence in the sample. This variability suggests that, while some individuals may have multiple maladaptive schemas, others may have fewer schemas, highlighting the diverse psychological profiles within the sample (Schmidt et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e1995\u003c/span\u003e). However, evidence suggests that the impact of preoperative anxiety on surgical outcomes may vary depending on individual patient factors and type of surgery, and some studies did not find significant associations between preoperative anxiety and postoperative pain (Ni et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). This variability underscores the need for personalized approaches to preoperative care and for further research to clarify these relationships. Overall, these findings highlight the importance of psychological assessments and interventions in the preoperative setting to enhance patient well-being and surgical outcomes.\u003c/p\u003e\u003cp\u003eResearch has shown that males often exhibit higher levels of entitlement than females. This can be attributed to social and cultural norms that encourage assertiveness and self-advocacy in males (Jackson et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).Studies have found that males generally report lower levels of self-control than females, which can be linked to higher impulsivity and risk-taking behaviors (Chiesi et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).The expressions of entitlement and self-control can vary significantly depending on the context and the specific population studied. Some studies have suggested that these traits are influenced by situational factors and may not be inherently tied to gender (Jackson et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe negative correlation between APAIS and Emotional Deprivation indicates that individuals with higher preoperative anxiety tend to report lower levels of emotional deprivation. An Emotional Deprivation schema refers to the perceived lack of emotional support and nurturing. Individuals with this schema often feel that others do not meet their emotions. This negative correlation indicated that those who experience higher preoperative anxiety may not necessarily feel emotionally deprived. This could be because their anxiety was more focused on the immediate stressor of surgery than on long-term emotional needs. This could be because their anxiety is more focused on the immediate stressor of surgery rather than on long-term emotional needs, and preoperative anxiety often centers on the immediate threat of surgery, which can overshadow general feelings of emotional deprivation (Shebl et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). On the other hand, some studies suggest that emotional deprivation can exacerbate anxiety, indicating that the relationship might be more bidirectional than unidirectional (Ni et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and may also be related to Complex Interactions that The relationship between emotional deprivation and anxiety is complex and may be influenced by other factors, such as personality traits and coping mechanisms (Salzmann et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe current study revealed that there is a negative correlation between APAIS and the Failure schema, suggesting that individuals with higher preoperative anxiety are less likely to endorse feelings of failure. This might be because anxiety about surgery overshadows other concerns; therefore, anxiety can shift focus away from feelings of failure to immediate concerns about surgery, reducing the endorsement of the failure schema (Shebl et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, some studies have suggested that feelings of failure can exacerbate anxiety, indicating that the relationship might be bidirectional (Ni et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).The strongest negative correlation was found between APAIS and Vulnerability to Harm \u0026amp; Illness, This suggests that individuals with higher preoperative anxiety are less likely to feel vulnerable to harm and illness, possibly because their anxiety is focused on the surgery itself., this may be explained by the fact that preoperative anxiety often centers on the immediate threat of surgery, which can overshadow general feelings of vulnerability (Celik \u0026amp; Edipoglu, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).However, some studies have indicated that individuals who feel vulnerable to harm and illness may also experience higher levels of general anxiety, including preoperative anxiety (Salzmann et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition, the negative correlation between the APAIS and Subjugation suggests that higher preoperative anxiety is associated with fewer feelings of subjugation. This might be because anxiety related to surgery takes precedence over the feelings of being controlled or oppressed. This may be explained by anxiety about surgery, which can dominate an individual's thoughts and reduce the impact of feelings of subjugation (Shebl et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, subjugation can contribute to anxiety, particularly in interpersonal contexts, suggesting a complex relationship (Ni et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).The negative correlation between APAIS and Self-Sacrifice indicates that individuals with higher preoperative anxiety are less likely to engage in self-sacrificial behaviors. This could be because their anxiety made them more focused on their well-being. This is supported by the fact that high anxiety levels can lead individuals to prioritize their own needs over self-sacrificial behaviors (Dugas et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).However, in some cultures, self-sacrifice is highly valued and can coexist with high anxiety levels, suggesting that cultural context may influence this relationship (Dugas et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the current study also found that only sex was a statistically significant predictor of preoperative anxiety, suggesting that women experienced higher levels of preoperative worry than men. The current study found no significant predictors among the Early Maladaptive Schema (EMS) subscales of Emotional Deprivation, Failure, and Vulnerability to Harm, Subjugation, and Self-Sacrifice. These findings imply that although preoperative anxiety is significantly influenced by sex, the EMS subscales used in this investigation do not independently predict anxiety levels. The finding that sex is a strong predictor of preoperative anxiety is one of these crucial relationships, which is consistent with a large body of research showing that women often report higher feelings of worry than men.\u003c/p\u003e\u003cp\u003eAccording to recent research, emotional deprivation, failure, vulnerability to injury, subjection, and self-sacrifice schemas are not significantly correlated with preoperative anxiety. This indicates that anxiety levels before surgery are not independently predicted by feelings of emotional deprivation, vulnerability, failure, control, or excessive self-sacrifice. These broader emotional patterns tend to be overshadowed by immediate fear of surgery, which is likelythe cause of preoperative worry (Shebl et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Dugas et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Overall, the acute stress of surgery seems to be the main factor determining anxiety levels before an operation, although some research indicates that thoughts of failure might occasionally worsen anxiety, suggesting a potential two-way interaction (Ni et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn conclusion, this study highlights the critical role of psychological factors, particularly preoperative anxiety and maladaptive schemas, in influencing the surgical outcomes. These findings underscore the need for tailored interventions and routine screening to address the unique anxiety-related needs of female patients who report significantly higher levels of preoperative anxiety. By implementing gender-specific strategies and enhancing communication, healthcare providers can improve patient well-being and surgical experience. Further research is essential to deepen our understanding of these psychological factors and develop effective interventions, ultimately leading to better patient care and outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData access statement:\u003c/strong\u003e research data supporting this publication are available from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e declaration: the author declare that they have no affiliation with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMira NAGUIB Abdel-Razek\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eResearch main idea\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eMethodology development.\u003c/li\u003e\n \u003cli\u003eData collection and management\u003c/li\u003e\n \u003cli\u003ePrimary manuscript writing\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eHeba Mahmoud Mahmoud Mohamed\u0026nbsp;\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eCritical review of intellectual content\u003c/li\u003e\n \u003cli\u003eFinal manuscript approval\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAhmed Hashem El-Monshed\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eStatistical analysis\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eData interpretation\u003c/li\u003e\n \u003cli\u003eTable representation of results\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOmima mohammed\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eManuscript formatting\u003c/li\u003e\n \u003cli\u003eReference management\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eLaila Saad Mahmoud\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eTechnical support.\u003c/li\u003e\n \u003cli\u003eManuscript editing.\u003c/li\u003e\n \u003cli\u003eConceptualization of research design.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e: not applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePre-Screening Administer tools, such as the Young Schema Questionnaire (YSQ), to identify high-risk patients with dominant EMS domains. Targeted Interventions Address\u0026nbsp;Disconnection/Rejection\u0026nbsp;schemas using cognitive restructuring to challenge mistrust or defective beliefs. Combined exposure and response prevention (ERP) with schema therapy for patients with entrenched EMS.\u003c/li\u003e\n \u003cli\u003eGender-Sensitive Approaches: Tailor interventions for females, reducing hypervigilance and other-directed behaviors. Monitor patients with high EMS scores for prolonged anxiety or relapse, offering booster sessions, if needed.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eEthical acceptance\u0026amp; participation informed consent.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur work followed the rules and procedures specified by Helsinki (DoH-Oct2008) declarative formation. The study received ethical approval and permission from the Research Ethics Committee (Institutional Review Board=110-j) of the Damanhur University Faculty of Nursing in Egypt. Prior to participation, all study participants were provided with detailed information about the study\u0026apos;s objectives and were assured of their anonymity and confidentiality. Written informed consent was obtained from each participant, emphasizing the right to withdraw from the study at any point.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article [and its supplementary information files].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;No specific funding for this study was received from the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;We sincerely thank all participants of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAlmalki, M. S., Hakami, O. A. O., \u0026amp; Al-Amri, A. M. (2017). 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Non-pharmacological approaches to preoperative anxiety: a comprehensive review. \u003cem\u003eFrontiers in Public Health\u003c/em\u003e. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.854673/full\u003c/li\u003e\n\u003cli\u003eYoung, J. E. (1990). Cognitive therapy for personality disorders: A schema-focused approach. \u003cem\u003eProfessional Resource Press\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eYoung, J. E., Klosko, J. S., \u0026amp; Weishaar, M. E. (2003). \u003cem\u003eSchema Therapy: A Practitioner\u0026apos;s Guide\u003c/em\u003e. Guilford Press.\u003c/li\u003e\n\u003cli\u003eYoung, J. E., Klosko, J. S., \u0026amp; Weishaar, M. E. (2006). \u003cem\u003eSchema therapy: A practitioner\u0026apos;s guide\u003c/em\u003e. guilford press.\u003c/li\u003e\n\u003cli\u003eYoung, J. E., Klosko, J. S., Weishaar, M. E., 2003. Schema therapy: Practitioner\u0026rsquo;s guidance. New York: Guilford Press. Retrieved from: http://www.schematherapy.com/id201.htm\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Early Maladaptive Schemas, Preoperative Anxiety","lastPublishedDoi":"10.21203/rs.3.rs-6941702/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6941702/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEarly maladaptive schema (EMS), as fundamental cognitive structures, may act as “crystal balls,” revealing how individuals with certain schemas are predisposed to experiencing heightened anxiety before surgery. Exploring how these early life experiences shape an individual's cognitive and emotional responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim of the study\u003c/strong\u003e: To investigate the predictive power of early maladaptive schemas as Crystal Balls for Preoperative Anxiety, and how these schemas may influence how individuals perceive and respond to anxiety related to surgery and hospitalization.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubjects and setting: \u003c/strong\u003eThis study was conducted at the Operations Department of Damanhur Medical National Institute.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection tools\u003c/strong\u003e: Tool I: A Socio-demographic characteristics questionnaire; Tool II:, the Amsterdam preoperative Anxiety and Information Scale; and Tool III:,Young schema questionnaire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly maladaptive schemas (EMS) have demonstrated robust associations with anxiety symptoms, particularly in young adults and teens, with meta-analytical evidence revealing a strong overall correlation (r = 0.59) between EMS and anxiety. Key schema domain disconnection/rejection (e.g., Mistrust-Abuse, Defectiveness/Shame), Impaired Autonomy/Performance (e.g., Dependence/Incompetence), and Other-Directedness emerged as significant predictors of anxiety severity. Gender differences are notable, with females exhibiting heightened vulnerability to schemas involving hypervigilance and excessive focus on others’ needs. Specific schemas such as \u0026nbsp;\u003cem\u003e\u0026nbsp;entitlement/grandiosity \u003c/em\u003emay paradoxically reduce anxiety in some contexts, potentially due to overconfidence. These findings underscore the utility of EMS assessment in clinical settings to tailor interventions, particularly for high-risk populations undergoing stressors such as medical procedures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEMS acts as a cognitive vulnerability that amplifies anxiety responses. For surgical patients, schemas tied to loss of control (e.g., impaired autonomy) or social evaluation (e.g., social isolation) may disproportionately drive preoperative distress. The titlement/grandiosity schema paradoxically reduced anxiety in some cases, possibly by fostering overconfidence.\u003c/p\u003e","manuscriptTitle":"Unraveling the Mind's Blueprint Early Maladaptive Schemas as Crystal Balls for Preoperative Anxiety","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 21:40:41","doi":"10.21203/rs.3.rs-6941702/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"029b3cd7-066e-4240-9a1a-2349fd38ce0a","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T06:24:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 21:40:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6941702","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6941702","identity":"rs-6941702","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}