The Effectiveness of Cognitive-Behavioral Therapy on Difficulties in Emotional Regulation and Cognitive Flexibility in Patients with Obsessive-Compulsive Disorder
Subject Areas : Psychology
Farzin Bagheri Sheykhangafshe
1
*
,
Maryam Saeedi
2
,
Vahid Savabi Niri
3
,
Zahra Nakhostin Asef
4
,
Zeynab Bourbour
5
1 - Faculty of Humanities, Tarbiat Modares University, Tehran, Iran
2 - Islamic Azad University of Tonekabon Branch, Tonekabon, Iran
3 - Islamic Azad University of Ardabil Branch, Ardabil, Iran
4 - Islamic Azad University, Behshahr Branch, Mazandaran, Iran
5 - Islamic Azad University, Garmsar Branch, Semnan, Iran
Keywords: Cognitive-behavioral therapy, difficulties in emotional regulation, cognitive flexibility, obsessive-compulsive disorder,
Abstract :
The aim of this study was to evaluate the effectiveness of cognitive-behavioral therapy on difficulties in emotional regulation and cognitive flexibility in patients with obsessive-compulsive disorder. The research method was quasi-experimental pre-test-post-test with a control group. In this study, 30 patients with obsessive-compulsive disorder syndrome were assigned to psychology clinics in Rasht in 2021 as a research sample in two experimental and control groups. Groups were assessed with questionnaires Padua obsessive-compulsive disorder by Sanavio (1988), Gratz & Roemer (2004) difficulties in emotional regulation, and Dennis & Vander Wal (2010) cognitive flexibility. After 10 sessions of 90 minutes of cognitive-behavioral therapy for the experimental group, participants again answered the research questionnaire. Findings showed that cognitive-behavioral therapy significantly reduces the difficulties in emotion regulation (rejection of emotional responses, difficulty in performing purposeful behavior, difficulty in controlling impulse, lack of emotional awareness, limited strategies, lack of Emotional state) and increased cognitive flexibility (P<0.001). Due to the problems that patients with obsessive-compulsive disorder have in emotional and cognitive dimensions, it is necessary to pay more attention to these cases in the treatment process.
باقری شیخانگفشه، فرزین؛ شریفی پور چوکامی، زینب؛ تاج بخش، خزر؛ حمیده مقدم، عارفه؛ حاجی علیانی، وحید. (1401). رابطه شبکه‌‌های اجتماعی انعطاف پذیری شناختی و حساسیت اضطرابی در پیش بینی کرونا فوبیا دانش‌‌آموزان. دست‌آوردهای روانشناختی، 29(1)، 209-228.
شباهنگ، رضا؛ شجاعی، مهرانه؛ باقری شیخانگفشه، فرزین؛ حسین خانزاده، عباسعلی؛ نیکوگفتار، منصوره. (1398). تحلیل ساختاری ارتباط احتکار با مشکلات بین فردی: نقش میانجی دشواری در تنظیم هیجان. فصل‌نامه پژوهش‌های کاربردی روانشناختی، 10(4)، 49-67.
کریم‌‌پور، مریم؛ فراهانی، محمدنقی؛ خانی‌‌پور، حمید. (1400). رابطه فرآیندهای خودنظم‌بخش (بهوشیاری، خودشناسی‌انسجامی و خودمهارگری) با شدت علائم اختلال شخصیت وسواسی- جبری: نقش واسطه‌ای وجدان‌گرایی. مجله روانشناسی، 99(25)، 411-389.
وکیلی‌‌هریس، شهرام؛ لیوارجانی، شعله؛ محب، نعیمه. (1399). مدل ساختاري اختلال وسواس جبري براساس کمالگرايي ناسازگار و کنترل روانشناختي والدين. مجله روانشناسی، 94(24)، 231-247.
Abramowitz, J. S., & Reuman, L. (2020). Obsessive-compulsive disorder. Encyclopedia of personality and individual differences, 3304-3306.
Abramowitz, J. S., & Jacoby, R. J. (2014). Obsessive‐compulsive disorder in the DSM‐5. Clinical Psychology: Science and Practice, 21(3), 221.
Berman, N. C., Shaw, A. M., & Wilhelm, S. (2018). Emotion regulation in patients with the obsessive-compulsive disorder: Unique effects for those with “taboo thoughts”. Cognitive Therapy and Research, 42(5), 674-685.
Chase, T. E., Chasson, G. S., Hamilton, C. E., Wetterneck, C. T., Smith, A. H., & Hart, J. M. (2019). The mediating role of emotion regulation difficulties in the relationship between self-compassion and OCD severity in a non-referred sample. Journal of Cognitive Psychotherapy, 33(2), 157-168.
Caudek, C., Sica, C., Marchetti, I., Colpizzi, I., & Stendardi, D. (2020). Cognitive inflexibility specificity for individuals with high levels of obsessive-compulsive symptoms. Journal of Behavioral and Cognitive Therapy, 30(2), 103-113.
Dennis, J. P., & Vander Wal, J. S. (2010). The cognitive flexibility inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research, 34(3), 241-253.
Eichholz, A., Schwartz, C., Meule, A., Heese, J., Neumüller, J., & Voderholzer, U. (2020). Self‐compassion and emotion regulation difficulties in obsessive–compulsive disorder. Clinical psychology & psychotherapy, 27(5), 630-639.
Ferreira, S., Couto, B., Sousa, M., Vieira, R., Sousa, N., Picó-Pérez, M., & Morgado, P. (2021). Stress influences the effect of obsessive-compulsive symptoms on emotion regulation. Frontiers in psychiatry, 11, 1622.
Fergus, T. A., & Bardeen, J. R. (2014). Emotion regulation and obsessive–compulsive symptoms: A further examination of associations. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 243-248.
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods, 39(2), 175-191.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26(1), 41-54.
Goldin, P. R., Lee, I., Ziv, M., Jazaieri, H., Heimberg, R. G., & Gross, J. J. (2014). Trajectories of change in emotion regulation and social anxiety during cognitive-behavioral therapy for social anxiety disorder. Behaviour research and therapy, 56, 7-15.
Goodarzi, M. A., & Firoozabadi, A. (2005). Reliability and validity of the Padua Inventory in an Iranian population. Behaviour Research and therapy, 43(1), 43-54.
Görmezoğlu, M., Bouwens van der Vlis, T., Schruers, K., Ackermans, L., Polosan, M., & Leentjens, A. F. (2020). Effectiveness, timing and procedural aspects of cognitive behavioral therapy after deep brain stimulation for therapy-resistant obsessive compulsive disorder: A systematic review. Journal of clinical medicine, 9(8), 2383.
Huang, F. F., Wang, P. C., Yang, X. Y., Luo, J., Yang, X. J., & Li, Z. J. (2023). Predicting responses to cognitive behavioral therapy in obsessive-compulsive disorder based on multilevel indices of rs-fMRI. Journal of Affective Disorders, 323, 345-353.
Hoppen, L. M., Kuck, N., Bürkner, P. C., Karin, E., Wootton, B. M., & Buhlmann, U. (2021). Low intensity technology-delivered cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis. BMC psychiatry, 21(1), 1-17.
Hirschtritt, M. E., Bloch, M. H., & Mathews, C. A. (2017). Obsessive-compulsive disorder: advances in diagnosis and treatment. Jama, 317(13), 1358-1367.
Keeley, M. L., Storch, E. A., Merlo, L. J., & Geffken, G. R. (2008). Clinical predictors of response to cognitive-behavioral therapy for obsessive–compulsive disorder. Clinical psychology review, 28(1), 118-130.
Kim, K. L., Christensen, R. E., Ruggieri, A., Schettini, E., Freeman, J. B., Garcia, A. M., ... & Dickstein, D. P. (2019). Cognitive performance of youth with primary generalized anxiety disorder versus primary obsessive–compulsive disorder. Depression and Anxiety, 36(2), 130-140.
Knowles, K. A., Jessup, S. C., & Olatunji, B. O. (2018). Disgust in anxiety and obsessive-compulsive disorders: recent findings and future directions. Current psychiatry reports, 20(9), 1-10.
Khosravani, V., Samimi Ardestani, S. M., Sharifi Bastan, F., & Malayeri, S. (2020). Difficulties in emotion regulation and symptom dimensions in patients with obsessive-compulsive disorder. Current psychology, 39(5), 1578-1588.
Lackner, J. M., Gudleski, G. D., Radziwon, C. D., Krasner, S. S., Firth, R. S., Naliboff, B. D., ... & Mayer, E. A. (2022). Cognitive flexibility improves in cognitive behavioral therapy for irritable bowel syndrome but not nonspecific education/support. Behaviour Research and Therapy, 154, 104033.
Lewin, A. B., Peris, T. S., Bergman, R. L., McCracken, J. T., & Piacentini, J. (2011). The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder. Behaviour research and therapy, 49(9), 536-543.
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., ... & Veale, D. (2015). Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry research, 225(3), 236-246.
Macdonald, A. M., & de Silva, P. (1999). The assessment of obsessionality using the Padua Inventory: Its validity in a British non-clinical sample. Personality and Individual differences, 27(6), 1027-1046.
Mohammadi, M. R., Ahmadi, N., Hooshyari, Z., Khaleghi, A., Yazdi, F. R., & Mehrparvar, A. H. (2021). Prevalence, comorbidity, and predictors of obsessive-compulsive disorder in Iranian children and adolescents. Journal of Psychiatric Research, 141, 192-198.
Nielsen, S. K. K., Hageman, I., Petersen, A., Daniel, S. I. F., Lau, M., Winding, C., ... & Vangkilde, S. (2019). Do emotion regulation, attentional control, and attachment style predict response to cognitive behavioral therapy for anxiety disorders?–an investigation in clinical settings. Psychotherapy Research, 29(8), 999-1009.
Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of psychiatric research, 47(1), 33-41.
Oguz, G., Celikbas, Z., Batmaz, S., Cagli, S., & Sungur, M. Z. (2019). Comparison between obsessive compulsive disorder and panic disorder on metacognitive beliefs, emotional schemas, and cognitive flexibility. International Journal of Cognitive Therapy, 12(3), 157-178.
Paast, N., Khosravi, Z., Memari, A. H., Shayestehfar, M., & Arbabi, M. (2016). Comparison of cognitive flexibility and planning ability in patients with obsessive compulsive disorder, patients with obsessive compulsive personality disorder, and healthy controls. Shanghai archives of psychiatry, 28(1), 28.
Rosa-Alcázar, A. I., Rosa-Alcázar, Á., Martínez-Esparza, I. C., Storch, E. A., & Olivares-Olivares, P. J. (2021). Response Inhibition, Cognitive Flexibility and Working Memory in Obsessive-Compulsive Disorder, Generalized Anxiety Disorder and Social Anxiety Disorder. International Journal of Environmental Research and Public Health, 18(7), 3642.
Sarokhani, D., Sarokhani, M., Sayehmiri, K., & Azodi, M. Z. (2016). The evaluation of obsessive-compulsive disorder prevalence in iran: a meta-analysis and systematic review. International Journal of Pharmacy & Technology, 8(4), 21482-92.
Suveg, C., Sood, E., Comer, J. S., & Kendall, P. C. (2009). Changes in emotion regulation following cognitive-behavioral therapy for anxious youth. Journal of Clinical Child & Adolescent Psychology, 38(3), 390-401.
Şahin, H., Köşger, F., EşSizoğlu, A., & Aksaray, G. (2018). The relationship between obsessive belief level and cognitive flexibility in patients with obsessive compulsive disorder. Archives of Neuropsychiatry, 55(4), 376.
Sternberger, L. G., & Burns, G. L. (1990). Obsessions and compulsions: Psychometric properties of the Padua Inventory with an American college population. Behaviour Research and therapy, 28(4), 341-345.
Sanavio, E. (1988). Obsessions and compulsions: the Padua Inventory. Behaviour research and therapy, 26(2), 169-177.
Thorsen, A. L., de Wit, S. J., de Vries, F. E., Cath, D. C., Veltman, D. J., van der Werf, Y. D., ... & van den Heuvel, O. A. (2019). Emotion regulation in obsessive-compulsive disorder, unaffected siblings, and unrelated healthy control participants. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4(4), 352-360.
Tomiyama, H., Nakao, T., Murayama, K., Nemoto, K., Ikari, K., Yamada, S., ... & Kanba, S. (2019). Dysfunction between dorsal caudate and salience network associated with impaired cognitive flexibility in obsessive-compulsive disorder: A resting-state fMRI study. NeuroImage: Clinical, 24, 102004.
Villalta, L., Smith, P., Hickin, N., & Stringaris, A. (2018). Emotion regulation difficulties in traumatized youth: a meta-analysis and conceptual review. European child & adolescent psychiatry, 27(4), 527-544.
Van Ameringen, M., Patterson, B., & Simpson, W. (2014). DSM‐5 obsessive‐compulsive and related disorders: Clinical implications of new criteria. Depression and anxiety, 31(6), 487-493.
Whitehead, M. R., & Suveg, C. (2016). Difficulties in emotion regulation differentiate depressive and obsessive–compulsive symptoms and their co-occurrence. Anxiety, Stress, & Coping, 29(5), 507-518.
Wolff, N., Giller, F., Buse, J., Roessner, V., & Beste, C. (2018). When repetitive mental sets increase cognitive flexibility in adolescent obsessive–compulsive disorder. Journal of Child Psychology and Psychiatry, 59(9), 1024-1032.
Wilhelm, S., & Steketee, G. S. (2006). Cognitive therapy for obsessive compulsive disorder: A guide for professionals. New Harbinger Publications.
Weinberg, A.; Klonsky, ED. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment. 21(4), 616-621.
Yap, K., Mogan, C., Moriarty, A., Dowling, N., Blair‐West, S., Gelgec, C., & Moulding, R. (2018). Emotion regulation difficulties in obsessive‐compulsive disorder. Journal of clinical psychology, 74(4), 695-709.