Fundamentals of Mental Health

Fundamentals of Mental Health

Comparing the efficacy of dialectical behavioral therapy and cognitive-behavioral therapy in extreme responsibility and clinical symptoms in obsessive-compulsive disorder patients

Document Type : Research Paper

Authors
Roghayeh Dulab Nia 1
Narges Rasouli 2
Hossein Mahdian 3
1 PhD. student of counseling, Department of Psychology, Bojnord Branch, Islamic Azad University, Bojnord, Iran.
2 Department of Psychology, TeMS.C.,Islamic Azad University, Tehran, Iran.
3 Assistant professor, Department of Psychology, Bojnord Branch, Islamic Azad University, Bojnord, Iran.
10.22038/JFMH.2025.85245.3205
Abstract
Introduction: Obsessive-Compulsive Disorder (OCD) is a debilitating mental health condition. Two therapeutic approaches for treating OCD are Dialectical Behavior Therapy (DBT) and Cognitive-Behavioral Therapy (CBT). The aim of the present study was to compare these therapies on extreme responsibility and clinical symptoms in individuals with obsessive-compulsive disorder.
 
Materials and Methods: The statistical population consisted of those who referred to Arteman Psychological Center in Mashhad, Iran, in 2022, with diagnosis of obsessive-compulsive disorder. The sample included 45 people who were purposefully selected and randomly divided into three equal groups: dialectical behavior therapy, cognitive behavioral therapy, and control group. We used structured clinical interview to diagnose obsessive-compulsive disorder, Maudsley Obsessive Compulsive Inventory (MOCAI), and California accountability questionnaire. The data were analyzed using multivariate analysis of covariance and Bonferroni post hoc tests.
 
Results: The data analysis showed that both dialectical behavior therapy and cognitive behavioral therapy reduced the symptoms of obsessive-compulsive disorder (P< 0.001), and extreme responsibility (P< 0.001). While, cognitive behavioral therapy was more effective than dialectical behavior therapy (P< 0.001).
 
Conclusion: These results indicate the use of cognitive behavioral therapy and dialectical behavior therapy to reduce clinical symptoms of obsessive-compulsive disorder, and both treatments are promising as evidence-based interventions for patients with obsessive-compulsive disorder.
Keywords
Cognitive-behavioral therapy
Dialectical behavior therapy
Obsessive-compulsive disorder
Responsibility
  1. Remmerswaal KC, Batelaan NM, Hoogendoorn AW, van der Wee NJ, van Oppen P, van Balkom AJ. Four-year course of quality of life and obsessive–compulsive disorder. Soc Psychiatr Psychiatr Epidemiol 2020; 55: 989-1000.
  2. Żerdziński M, Burdzik M, Żmuda R, Witkowska-Berek A, Debski P, Flajszok-Macierzyńska N, et al. Sense of happiness and other aspects of quality of life in patients with obsessive-compulsive disorder. Front Psychiatry 2022; 13: 1077337.
  3. Almutairi AM, Aladhadh KM, Alsayed SA, Alhuwairini FF, Alzuwayed AM, Agha S. Prevalence of obsessive-compulsive disorder symptoms among medical students. International journal of medicine in developing countries 2021; 5(5): 1183-7.
  4. Mohammadi MR, Ahmadi N, Hooshyari Z, Khaleghi A, Yazdi FR, Mehrparvar AH. Prevalence, comorbidity, and predictors of obsessive-compulsive disorder in Iranian children and adolescents. J Psychiatr Res 2021; 141: 192-8.
  5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, D.C.: American Psychiatric Association; 2022.
  6. Jensen S, Hybel KA, Højgaard DR, Nissen JB, Weidle B, Ivarsson T, et al. Quality of life in pediatric patients with obsessive-compulsive disorder during and 3 years after stepped-care treatment. Eur Child Adolesc Psychiatry 2022; 31(9): 1377-89.
  7. Mathieu SL, Conlon EG, Waters AM, McKenzie ML, Farrell LJ. Inflated responsibility beliefs in paediatric OCD: Exploring the role of parental rearing and child age. Child Psychiatry Hum Dev 2020; 51: 552-62.
  8. Sharma E, Tripathi A, Grover S, Avasthi A, Dan A, Sharma M, et al. Association of insight, avoidance behavior, indecisiveness, and inflated responsibility with other clinical characteristics in children and adolescents with obsessive-compulsive disorder. Braz J Psychiatry 2020; 43(2): 160-7.
  9. Cludius B, Mannsfeld AK, Schmidt AF, Jelinek L. Anger and aggressiveness in obsessive-compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability. Eur Arch Psychiatry Clin Neurosci 2021; 271(6): 1179-91.
  10. Jassi A, Shahriyarmolki K, Taylor T, Peile L, Challacombe F, Clark B, et al. OCD and COVID-19: A new frontier. Cogn Behav Therap 2020; 13: e27.
  11. Spencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatr Clin North Am 2023; 46(1): 167-80.
  12. Spencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-behavioral therapy for obsessive-compulsive disorder. Psychiatr Clin North Am 2022; 46(1): 167.
  13. Kathmann N, Jacobi T, Elsner B, Reuter B. Effectiveness of individual cognitive-behavioral therapy and predictors of outcome in adult patients with obsessive-compulsive disorder. Psychother Psychosom 2022; 91(2): 123-35.
  14. Amani M, Abolghasemi A. [The effectiveness of group training of dialectical behavior therapy concepts on improvement of emotional recognition strategies and decrease of obsessive-compulsive disorder (OCD)]. Clinical psychology and personality 2020; 14(2): 125-34. (Persian)
  15. Stein MB, Nyer M. Dialectical behavior therapy and cognitive behavioral therapy techniques on a general psychiatric inpatient unit. The Massachusetts general hospital handbook of cognitive behavioral therapy. New York: Springer; 2023: 437-53.
  16. Sotsky J, Brodsky BS. Dialectical behavioral therapy. In: Tasman’s psychiatry. Cham: Springer International Publishing; 2024: 3693-716.
  17. First MB, Williams JBW, Karg RS, Spitzer RL. User's guide for the SCID-5-CV Structured Clinical Interview for DSM-5® disorders: Clinical version. Arlington, VA: American Psychiatric Association Publishing; 2016.
  18. Sharifi V, Asadi SM, Mohammadi MR, Amini H, Kaviani H, Semnani Y, et al. [Reliability and feasibility of the Persian version of the Structured Diagnostic Interview for DSM-IV (SCID)]. Advances in cognitive sciences 2004; 6(1): 10-22. (Persian)
  19. Lefebvre A, Cohen A, Maruani A, Amsellem F, Beggiato A, Amestoy A, et al. Discriminant value of repetitive behaviors in families with autism spectrum disorder and obsessional compulsive disorder probands. Autism Res 2021; 14(11): 2373-82.
  20. SoleimanvandiAzar N, Amirkafi A, Shalbafan M, Ahmadi SA, Asadzandi S, Shakeri S, et al. Prevalence of obsessive-compulsive disorders (OCD) symptoms among health care workers in COVID-19 pandemic: A systematic review and meta-analysis. BMC Psychiatry 2023; 23(1): 862.
  21. Ahovan M, Jajarmi M, Bakhshipoor A. [Comparing the effectiveness of Schema Therapy (ST) and Emotional Schema Therapy (EST) on clinical syndromes of individuals with Obsessive-Compulsive Symptoms (OCS)]. Avicenna journal of nursing and midwifery care 2020; 28(3): 239-50. (Persian)
  22. Linehan MM. Skills training manual for treating borderline personality disorder. New York: Guilford; 1993.
  23. Nordgren LB, Ludvigsson M, Silfvernagel K, Törnhage L, Sävås L, Söderqvist S, et al. Tailored internet-delivered cognitive behavior therapy for depression in older adults: A randomized controlled trial. BMC Geriatr 2024; 24(1): 1-2.
  24. Ahovan M, Balali S, Shargh NA, Doostian Y. Efficacy of dialectical behavior therapy on clinical signs and emotion regulation in patients with obsessive-compulsive disorder. Mediterranean journal of social sciences 2016; 7(4): 412.
  25. Taghavi Garamaleki M, Moheb N. [The effectiveness of cognitive behavioral therapy on rumination, worry and anxiety sensitivity in people with anxiety disorders]. Journal of instruction and evaluation 2021; 14: 13-29. (Persian)
  26. Borjali A, Bagiyan MJ, Yazdanpanah MA, Rajabi M. [The effectiveness of group mindfulness-based cognitive therapy on obsessive-compulsive disorder, metacognition beliefs and rumination]. Clinical psychology studies 2015; 6: 133-61. (Persian)
  27. Clark DA. Cognitive-behavioral therapy for OCD. New York: Guilford; 2006.
Fundamentals of Mental Health
Volume 27, Issue 5
September and October 2025
Pages 287-293