Hamed Kavand1* and Shahrbanoo Ghahari2
Received: February 18, 2020 Published: February 27, 2020
Corresponding author: Hamed Kavand, MA of Clinical Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
Objective: Dysfunctional attitudes are factors leading to many of psychiatric diseases such as obsession. In this regard, this study was conducted to examine the efficacy of Cognitive Therapy (CT) on beliefs in Obsessive Compulsive Disorder (OCD).
Method: Experimental method with two control and experimental groups applied in this study. Statistical population of this study consisted of 120 patients with OCD referring to a specialized clinic for OCD treatment in Tehran; of that, 40 patients who had required criteria were selected through random method and assigned to two 20-member groups including experimental group (cognitive restructuring) and control group. Pretesting two groups, first group participated in 10 sessions for cognitive restructuring while control group were in waiting list. Weissman and Beck’s Dysfunctional Attitude Scale was used as tool in this research and obtained findings were analyzed using descriptive statistics and ANCOVA through SPSS-18 Software.
Results: The results showed that there is a significant difference between two groups in negative beliefs in post intervention (P<0.001).
Discussion and Conclusion: Cognitive therapy could significantly effect on negative beliefs and attitude in patients with OCD.
Keywords: Cognitive therapy; belief; Obsessive-Compulsive Disorder (OCD)
Obsession is the fourth mental disorder  that consists of various symptoms such as disturbing thoughts and compulsion in repeated stereotyped behaviors, etc. . Genetic, mental pressures and cognitive factors can be named as risk factors for OCD [1,3] so that stressful thoughts are one of reasons for OCD based on cognitive perspective . Epidemiological studies in Iran indicate high prevalence of this disease  reporting 2-3 percent among normal population and 10% in patients referring to psychiatric clinics . Various studies show that cognitive factors such as dysfunctional beliefs and attitudes play a vital role in prevalence of psychiatric diseases such as mood and anxiety disorders . Such disorders are arrogant beliefs  that are activating right after life incidents influencing on information processing and leading to negative cognitive disorder. Dysfunctional attitudes are inflexible beliefs with valuable context for individual that are expressed within words such as should, definitely, and necessarily; such beliefs can effect on information processing and play vital role in negative emotions, diseases incidence and intensity [9-13]. Hence, psychological interventions are required to release from such beliefs. Dysfunctional beliefs and attitudes can create OCD in individuals [1,14] these attitudes exposure person to a defected cycle leading to severe stress so that the person has no way out of such dysfunctional beliefs and behaviors Mokmaly et al. . Many studies showed cognitive techniques can improve self-efficacy and beliefs about self  and change behavior problems  and anxiety and conduct problems, 2016). Since majority of studies on psychological treatments for obsession have more focused on effect of Cognitive Behavioral Therapy (CBT) on obsession, depression and anxiety in patients with such disorder [18-21] and since that there has not been any study about change in dysfunctional attitudes in these patients, this study was conducted to examine the efficacy of Cognitive Therapy(CT) on beliefs in Obsessive Compulsive Disorder(OCD).
Semi experimental method with two control and experimental groups used in this research. Statistical population of this study consisted of 120 patients with OCD referring to a specialized clinic for OCD treatment in Tehran; of that, 40 patients who had required criteria were selected through random method and assigned to two 20-member groups including experimental group (under cognitive restructuring intervention) and control group that hold on waiting list. Inclusion criteria were as follows:
a) no background of psychoses and personality disorders,
b) non-consumption of new psychological medicines during study period,
c) non-consumption of alcohol and drugs,
d) obtaining higher scores than cut0-off point in depression and anxiety tests,
e) age of lower than 35,
f) having diploma degree. Signing consent by participants, cognitive restructuring intervention was implemented for experimental group for 10 to 70-minutes sessions. Data analysis was conducted using descriptive statistics (mean and standard deviation) as well as inferential statistics (ANCOVA) through SPSS- 18 Software.
Weissman and Beck’s Dysfunctional Attitude Scale (1978) was used as instrument in this research. The revised version of this scale consists of two parallel 40-item forms and evaluates specific patterns of maladaptive thoughts. Each item is scored at 7-point Likert Scale and each participant can obtain the score between 40 and 280. Higher scores than 180 are related to persons with dysfunctional attitudes. Tehranizadeh  reported reliability of this questionnaire to 0.84-0.92 using Cronbach’s alpha.
This intervention was hold for 10 70-minute sessions. Introducing cognitive method in first session, the relationship between thinking method, behavior and feeling was explained. In second session, the focus was on 3-coulumn table of activating event, thought and emotional consequences. Third session allocated to identification of automatic thoughts and its effect on depression and anxiety. In fourth session, participants learnt to challenge negative automatic thoughts. The focus of fifth session was on dysfunctional attitudes and challenging them. In sixth session, participants learnt to rank their dysfunctional attitudes from 0 to 100 in order to correct. In seventh session, cognitive triangular was introduced. In sessions 8 and 9, the identified cognitive errors were identified and challenged. Tenth session was related to review of previous sessions and posttest. It should be noted some tasks were given to participants at the end of each session to do them until the next session.
Relevant data to demographic features of participants are as follows: They were at age range of 21-38. 29 members (42.5%) were female and 11 members (27.5%) were male. 21 members (52.5%) were employee and 19 members (47.5%) were unemployed. 15 members (37%) of them were at a good socio-economic class, 18 members (46%) were at middle class and 7 members (17%) were at low class. 32 members (80%) had academic education and 8 members (20%) had diploma degree. Mean and standard deviation of pretest and posttest scores of both groups are presented in following Table 1. Scores obtained for dysfunctional attitudes of two experimental and control group are compared in Table 2. As can be seen in this TABLE, ANCOVA results indicate effect of cognitive restructuring therapy on improvement of dysfunctional attitudes among members of experimental group.
Table 1: Mean and standard deviation of posttest and pretest scores of participants considering dysfunctional attitudes.
This research showed that cognitive therapy could effectively correct negative beliefs in patients with OCD. Although there was not any similar study in this field, some similar results can be obtained if consider cognitive restructuring as an agent for CBT. For instance, Olatunji et al.  conducted a meta-analysis and proved that CBT can effectively treat OCD. Study of Abramowitz et al.  found that improvement strategies have long-run consequences in CBT for OCD. Results of studies conducted by [20,21] were similar. The mentioned finding was also in line with following studies: results of study conducted by Park et al.  showing that cognitive therapy can reduce clinical symptoms in patients with OCD, results of study conducted by Rohleman et al.  that found cognitive retraining in improvement of OCPD, results of study conducted by Storch et al. (2007) that showed effect of cognitive methods on obsession treatment, findings by Whittal et al.  that showed CBT methods could effect on treatment of patients with OCD, and results of study conducted by Ghamarigivi et al.  about effect of cognitive therapy methods on OCPD. It seems that CBT in general and cognitive restructuring method, in particular use ABC model to help patients identifying their irrational beliefs that increase stress and obsession in them substitute functional attitudes and beliefs through challenging with negative beliefs .This approach is effective for changing negative beliefs in patients with OCD [26-27].
In conclusion, dysfunctional attitudes are one of risk factors for obsession. Seemingly, correction of these attitudes at the early stage of process can prevent from depression and anxiety that are significant correlates of dysfunctional attitudes and important abnormal disorders in OCD; in this regard, such diseases and disorders can be treated easily.
We appreciate all personnel and patients of Meraj Clinic for Obsession Treatment in Tehran who participated in this study.
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