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Background: The escalating global prevalence of aging populations presents distinct psychological challenges for elderly women, frequently manifesting as disturbed sleep patterns and diminished psychological well-being. Objectives: This investigation sought to determine the effectiveness of schema therapy in ameliorating sleep quality and fostering psychological coherence among elderly women. Methods: A quasi-experimental study design was employed, featuring baseline, immediate post-intervention, and three-month follow-up assessments for both the experimental and a waiting-list control group. The study's target population included elderly women (mean age 68.7 years, SD = 4.0) residing in community settings in Sabzevar, Iran, during the year 2023. A sample of 30 qualifying women was selected via convenience sampling and subsequently allocated randomly to either the group-based schema therapy intervention group (n = 15) or the control group (n = 15). Participants in the experimental arm engaged in eight weekly, 90-minute group schema therapy sessions. Data were gathered utilizing the Pittsburgh Sleep Quality Index (PSQI) and the Sense of Coherence Questionnaire (SOC-29). Statistical analysis, primarily involving repeated measures ANOVA and subsequent post-hoc tests, was conducted with SPSS software. Results: The findings demonstrated that the schema therapy group exhibited statistically significant enhancements in both sleep quality and psychological coherence from the pre-intervention phase to the post-intervention assessment (P < 0.001, η² = 0.83 for sleep quality; η² = 0.95 for psychological coherence). These improvements, which directly address the study’s objectives, were largely sustained at the three-month follow-up, in contrast to the control group, which showed no significant changes. Conclusions: Schema therapy proves to be a highly effective intervention for fostering improved sleep quality and bolstering psychological coherence in elderly women, offering clinicians a valuable therapeutic approach to enhance well-being in this population, with findings suggesting potential generalizability to similar community-dwelling elderly women in other cultural and geographic contexts, pending further cross-cultural validation.