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.
Abdelraze et al. (2025) studied this question.