Comparing the effectiveness of online acceptance and commitment therapy and behavioral activation therapy on repetitive negative thinking in obsessive patients

Document Type : Research Paper

Authors

1 Ph.D. student, Department of General Psychology, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran.

2 Visiting assistant professor, Department of Psychology, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran. Assistant professor of Kheradgarayan Motahar Institute of Higher Education, Iran.

3 Assistant professor of psychology, Payame Noor University, Iran.

Abstract

Introduction: This study aimed to compare the effectiveness of online acceptance and commitment therapy and behavioral activation therapy on repetitive negative thinking in obsessive patients.
 
Materials and Methods: In this study, 45 obsessive-compulsive patients who were referred to psychotherapy clinics in Mashhad city, Iran in 2020 were selected and randomly divided into 3 equal groups (2 experimental groups and one control group). They responded to McEvoy et al. (2010) and the obsessive-compulsive disorder questionnaire of Maudsley (1997). The first experimental group underwent eight sessions of an online Acceptance and Commitment Therapy (ACT) and the second experimental group underwent eight sessions of ninety-minute group behavioral activation therapy. The control group did not receive any intervention. The data analyzed through descriptive statistics, ANOVA, Chi-square tests, Shapiro-Wilk test, repeated measures analysis of variance, and SPSS software version 22.
 
Results: The results showed that the mean of negative thinking in the ACT group and behavioral activation in the post-test was significantly decreased (P< 0.05). In the ACT group, the effect of intervention was persistent in the follow-up.
 
Conclusion: The results showed that both therapies were effective on repetitive negative thinking in obsessive-compulsive individuals, but online ACT intervention was significantly more effective than behavioral activation therapy.

Keywords


  1. Kaplan HI, Sadock BJ. Synopsis of psychiatry: Behavioral sciences clinical psychiatry. Philadelphia: Williams and Wilkins; 1988.
  2. Bouvard M, Fournet N, Denis A, Sixdenier A, Clark D. Intrusive thoughts in patients with obsessive compulsive disorder and non-clinical participants: a comparison using the International Intrusive Thought Interview Schedule. Cogn Behav Ther 2017; 46(4): 287-99.
  3. Derakhtkar A, Najian Tabriz F, Mordadi H, SafiKhani A. [The comparison of the effectiveness of Acceptance and Commitment Therapy and Clomipramine in treating patients with obsessive compulsive disorders in men and women in the city of Shiraz]. Journal of women interdisciplinary researches 2020; 2(1): 23-35. (Persian)
  4. Spinhoven P, Drost J, van Hemert B, Penninx BW. Common rather than unique aspects of repetitive negative thinking are related to depressive and anxiety disorders and symptoms. J Anxiety Disord 2015; 33: 45-52.
  5. Wong QJ, McEvoy PM, Rapee RM. A comparison of repetitive negative thinking and post-event processing in the prediction of maladaptive social-evaluative beliefs: A short-term prospective study. J Psychopathol Behav Assess 2016; 38(2): 230-41.
  6. Tolin DF, Gilliam C, Wootton BM, Bowe W, Bragdon LB, Davis E, et al. Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment 2018; 25(1): 3-13.
  7. Moshier SJ, Otto MW. Behavioral activation treatment for major depression: A randomized trial of the efficacy of augmentation with cognitive control training. J Affect Disord 2017; 210: 265-8.
  8. Chartier IS, Provencher MD. Behavioural activation for depression: Efficacy, effectiveness and dissemination. J Affect Disord 2013; 145(3): 292-9.
  9. Lanzillo R, Chiodi A, Carotenuto A, Magri V, Napolitano A, Liuzzi R, et al. Quality of life and cognitive functions in early onset multiple sclerosis. Eur J Paediatr Neurol 2016; 20(1): 158-63.
  10. Blakey SM, Abramowitz JS, Leonard RC, Riemann BC. Does exposure and response prevention behaviorally activate patients with obsessive-compulsive disorder? A Preliminary Test. Behav Ther 2019; 50(1): 214-24.
  11. Manjula M, Sudhir PM. New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies. Indian J Psychiatry 2019; 61(Suppl 1): S104.
  12. Mosher CE, Secinti E, Hirsh AT, Hanna N, Einhorn LH, Jalal SI, et al. Acceptance and commitment therapy for symptom interference in advanced lung cancer and caregiver distress: a pilot randomized trial. J Pain Symptom Manage 2019; 58(4): 632-44.
  13. Ito M, Muto T. Effectiveness of acceptance and commitment therapy for irritable bowel syndrome non-patients: A pilot randomized waiting list controlled trial. J Context Behav Sci 2020; 15: 85-91.
  14. Mataix-Cols D, De La Cruz LF, Monzani B, Rosenfield D, Andersson E, Pérez-Vigil A, et al. D-cycloserine augmentation of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders: a systematic review and meta-analysis of individual participant data. JAMA Psychiatry 2017; 74(5): 501-10.
  15. Gootzeit JH. ACT process measures: specificity and incremental value. Iowa: The University of Iowa; 2014.
  16. Rajabi F, Hasani F, Keshavarzi Arshadi F, Emamipour S. [Effectiveness of acceptance and commitment therapy on symptoms of obsessive-compulsive disorder and guilt feeling in patients with obsessive-compulsive disorder]. Iranian journal of rehabilitation research 2019; 6(2): 140-7. (Persian)
  17. Khosravi Z, Shahi Sadrabadi F, Rahmatinejad P. [The relationship between obsessive-compulsive disorder and obsessive-compulsive personality disorder: The evaluation of categorical and dimensional approaches in conceptualizing obsessive-compulsive spectrum disorders]. Journal of thought and behavior in clinical psychology 2018; 12: 7-16. (Persian)
  18. Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry 2019; 61(Suppl 1): S85-S92.
  19. Fang A, Siev J, Minichiello WE, Baer L. Association between scrupulosity and personality characteristics in individuals with obsessive-compulsive symptoms. Int J Cogn Ther 2016; 9(3): 245-59.
  20. López FJC, Salas SV. Acceptance and Commitment Therapy (ACT) in the treatment of panic disorder: Some considerations from the research on basic processes. Int J Psychol Psychol Ther 2009; 9(3): 299-315.
  21. Delavar A. [Probability and applied statistics in psychology and educational sciences (with revisions and additions)]. Tehran: Roshd; 2018. (Persian)
  22. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther 2006; 44(1): 1-23.
  23. Gortner ET, Gollan JK, Dobson KS, Jacobson NS. Cognitive-behavioral treatment for depression: Relapse prevention. J Consult Clin Psychol 1998; 66(2): 377.
  24. McEvoy PM, Mahoney AE, Moulds ML. Are worry, rumination, and post-event processing one and the same?: Development of the Repetitive Thinking Questionnaire. J Anxiety Disord 2010; 24(5): 509-19.
  25. Khaleghi S, Liaghat R, Ganjdanesh Y. The repetitive thinking questionnaire: Psychometric properties in Iranian students and relationship with depression, anxiety and social anxiety. Proceeding in the 2nd International Conference on Psychiatry and Psychotherapy-PSYCHO 2011: 23-25.
  26. Rachman SJ. Obsessions and compulsions. Englewood Cliffs, NJ: Prentic-Hall; 1980.
  27. Sajjadian I. [Effectiveness of mindfulness on obsessive-compulsive symptoms]. MA. Dissertation. Isfahan: University of Isfahan, 2006. (Persian)
  28. Abutorabian M. [The effectiveness of group therapy based on acceptance and commitment depressed adolescent's rumination on high school girl in Isfahan city]. Proceeding of the First Congress of the Third Wave of Behavior Therapy. Kashan University of Medical Sciences and Health Services, 2015. (Persian)
  29. Namani E, Abdolahzade H, Pirani H, Jajarmi M. [The effectiveness of group therapy based on acceptance and commitment (ACT) on suppression of negative thoughts and learned helplessness in infertile women]. Journal of Sabzevar University of Medical Sciences 2019; 25(5): 599-607. (Persian)
  30. Amiri S, Ehteshamzadeh P, Hafezi F, Borna MR. [Comparison of the effectiveness behavioral activation therapy and acceptance and commitment therapy on executive functions of learning the rules, inhibiting impulsivity, and flexibility in patients with depression]. Shefaye Khatam 2021; 9(2): 68-78 (Persian)
  31. Ismaili LAF, Abedi MR, Rumi H. [The effectiveness of acceptance and commitment-based therapy with a focus on compassion on adolescent girls' social anxiety]. Journal of clinical psychology studies 2018; 8: 117-38. (Persian)
  32. Zettle RD, Rains JC, Hayes SC. Processes of change in acceptance and commitment therapy and cognitive therapy for depression: A mediation reanalysis of Zettle and Rains. Behav Modif 2011; 35(3): 265-83.
  33. Ebrahimi S, Sajjadian I. [The effect of behavioral activation therapy on rumination and pain-related anxiety in women with breast cancer]. Community health journal 2020; 14(3): 26-36. (Persian)
  34. Rahbaran R, Karami R, Shahmohammadi M. [The effectiveness of behavioral activation therapy on rhubarab and depressive disorder in adolescents]. Journal of thought and behavior in clinical psychology 2019; 14: 17-26. (Persian)
  35. Zemestani MDI, Mehrabizadeh M, Zargar Y. [The effectiveness of group behavioral activation therapy on the symptoms of depression, anxiety and rumination in patients with depression and anxiety]. Journal of clinical psychology 2013; 5: 73-4. (Persian)
  36. Mazzucchelli TG. Behavioural activation interventions for depression and well-being. Curtin University; 2010.