Fundamentals of Mental Health

Fundamentals of Mental Health

Effectiveness of family-based interventions on symptoms of patients with obsessive-compulsive disorder and adjustment and resilience of family members: A clinical randomized trial

Document Type : Research Paper

Authors
Neda Alibeigi 1
Seyed Ali Hoseini Sogh 2
Robabeh Mazinani 3
Alireza Zibaei 4
Mojtaba Rostamzadeh 5
1 Assistant professor of clinical psychology, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
2 Psychiatrist, Psychiatry Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
3 Psychiatrist, Associate professor, Psychiatry Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
4 Psychiatry resident. Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
5 Psychiatry resident. Razi Educationl and therapeutic Psychiatric Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
10.22038/jfmh.2025.89671.3265
Abstract
Introduction: Obsessive-Compulsive Disorder (OCD) significantly impacts family members, leading to poor adjustment and low resilience. Family-based interventions are increasingly used, but their simultaneous effect on patient symptoms and family-member-specific psychological outcomes is not fully established. This study aimed to investigate the effect of a family-based intervention on OCD symptoms in patients and psychological adjustment and resilience in their family members.

Materials and Methods: This randomized clinical trial included 40 families of patients with OCD, recruited from three psychiatric centers in Tehran, Iran. Participants were randomly assigned to an intervention group (n= 20) or a control group (n= 20). The intervention group received 12 weekly sessions of a family-based psychoeducational program in addition to standard medication. The control group received medication only. Patients were assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Family members were assessed using the Bell's Adjustment Inventory (BAI) and the Connor-Davidson Resilience Scale (CD-RISC) at pre-test, post-test (12 weeks), and 3-month follow-up. Data were analyzed using repeated-measures ANOVA.

Results: The repeated-measures ANOVA revealed a significant times × group interaction effect. The intervention group showed a significant reduction in patient OCD symptoms on the Y-BOCS (F(1,38)= 246.49, P< 0.001) and a significant improvement in family member adjustment on the BAI and resilience on the CD-RISC (P< 0.05) at post-test and follow-up, compared to the control group.

Conclusion: Family-based psychoeducational interventions, when added to pharmacotherapy, are an effective strategy for not only reducing patient symptomatology but also for improving the psychological well-being of the family unit.
Keywords
Adjustment
Family-based intervention
Obsessive-compulsive disorder
Resilience
1.                    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed., text rev. Washington, D.C.: American Psychiatric Association; 2022.
2.                   Sahu A, Sagar R, Sarkar S, Singh A. Caregiver burden in obsessive-compulsive disorder: A systematic review. J Family Med Prim Care 2021; 10(5): 1812-19.
3.                   Li Y, Liu D, Wu J, Wang H, Wang Y. Correlation between caregiving burden, anxiety, and psychological resilience in caregivers of adolescents with mental and behavioral disorders. BMC Psychiatry 2024; 24(1): 1623.
4.                   Rossi D, Alberici S, Signorini G, Pozza A. Pooled-frequency meta-analysis of family accommodation (FA) in obsessive-compulsive disorder (OCD): A pervasive phenomenon. J Obsessive Compuls Relat Disord 2025; 44: 100898.
5.                   Storch EA, Geffken GR, Merlo LJ, Jacob ML, Murphy TK, Goodman WK, et al. Family accommodation in pediatric obsessive-compulsive disorder. J Clin Child Adolesc Psychol 2007; 36(2): 207-16. 
6.                   Wu MS, Grisham JR, Norberg MM, Abbott MJ. Family-integrated cognitive-behavioral therapy (CBT) for adult obsessive-compulsive disorder (OCD): A meta-analysis. J Affect Disord 2020; 276: 1159-68.
7.                   Stewart SE, Rucklidge J, Surrounded-by-Close-Relatives C, Malcom K, Stoddard J, Rnic K, et al. Family-integrated cognitive-behavioral therapy for adults with obsessive-compulsive disorder: A 2021 update. Focus 2021; 19(2): 161-8.
8.                   International OCD Foundation. SPACE - Supportive Parenting for Anxious Childhood Emotions. Boston (MA): IOCDF; 2025 [cited 2025 Oct 28]. Available from: https://iocdf.org/ocd-treatment-guide/space/
9.                   Veeger JDK, van der Heiden C, van Woudenberg C, de Haan E, van den Heuvel O, Theunissen J. Efficacy of a parent-based treatment for children and adolescents with obsessive-compulsive disorder: Protocol of a multiple baseline, single-case experimental design study. Contemp Clin Trials Commun 2025; 41: 101456.
10.                Lebowitz ER, Marin C, Martino A, Shimshoni Y, Silverman WK. Parent-based treatment as efficacious as cognitive-behavioral therapy for childhood anxiety: A randomized noninferiority study of supportive parenting for anxious childhood emotions. J Am Acad Child Adolesc Psychiatry 2020; 59(3): 362-72.
11.                Asadi M, Shafiabady A, Ehteshamzadeh P. Validity and reliability of the Persian version of the Machiavellian personality scale and its association with social adjustment and risky behaviors in Iranian college students. BMC Psychiatry 2023; 23(1): 694.
12.                Shen J, Zhou S, Du M, Jiang Y. Cluster analysis of family resilience in adolescents with emotional disorders: A cross-sectional study. BMC Psychiatry 2025; 25(1): 1237.
13.                Freeman JB, Garcia AM. Family based treatment for young children with OCD: Therapist guide. New York: Oxford University; 2008.
14.                Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46(11): 1006-11.
15.                Rajezi Esfahani S, Motaghipour Y, Kamkari K, Zahiredin A, Janbozorgi M. [Reliability and validity of the Persian version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)]. Iranian journal of psychiatry and clinical psychology 2012; 17(4): 297-303. (Persian)
16.                Connor KM, Davidson JR. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003; 18(2): 76-82.
17.                Besharat MA, Ramesh S. [Prediction of severity of cardiovascular disease based on resilience, spiritual well-being, and social support]. Medicine and spiritual cultivation 2019; 27: 34-45. (Persian)
18.                Keyhani M, Taghvaei D, Rajabi A, Amirpour B. [Internal consistency and confirmatory factor an analysis of the Connor-Davidson Resilience Scale (CD-RISC) among nursing female students]. Iranian journal of medical education 2015; 14(10): 851-9. (Persian)
19.                Bell HJ. The Bell Adjustment Inventory. Palo Alto, CA: Consulting Psychologists Press; 1961.
20.                Amani R, Etemadi O, Fatehizadeh M, Bahrami F. [The relationship between attachment styles and social adjustment]. Clinical psychology and personality 2012; 2(6): 15-26. (Persian)
21.                Pagsberg AK, Lønfeldt NN, Thoustrup CL, Korsbjerg NLJ, Uhre CF, Christensen SH, et al. Family-based cognitive behavioral therapy versus family-based psychoeducation and relaxation training for obsessive-compulsive disorder in children and adolescents: A randomized clinical trial (TECTO). Eur Child Adolesc Psychiatry 2025; 34(12): 3955-71. 
22.                Kobayashi Y, Kanie A, Nakagawa A, Takebayashi Y, Shinmei I, Nakayama N, et al. An evaluation of family-based treatment for OCD in Japan: A pilot randomized controlled trial. Front Psychiatry 2020; 10: 932.
23.                Thompson-Hollands J, Abramovitch A, Tompson MC, Barlow DH. A randomized clinical trial of a brief family intervention to reduce accommodation in obsessive-compulsive disorder: a preliminary study. Behav Ther 2015; 46(2): 218-29.
24.                Peris TS, Rozenman M, Sugar CA, McCracken JT, Piacentini J. Ethnicity moderates outcome in family focused treatment for pediatric obsessive compulsive disorder. J Anxiety Disord 2020; 73: 102229.
25.                Jassi A, Kiff J, McPhedran S, St-Jean O, Krebs G. The supportive parenting for anxious childhood emotions (SPACE) programme for obsessive-compulsive disorder (OCD) in children and young people: An acceptability and feasibility study. J Clin Psychol 2024; 80(2): 413-29.
26.                Garcia AM, Sapyta JJ, Moore PS, Freeman JB, Franklin ME, March JS, et al. Predictors and moderators of treatment outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I). J Am Acad Child Adolesc Psychiatry 2010; 49(10): 1024-33. 
27.                Heidari T, Azimi Lolaty H. Psychological interventions affecting obsessive-compulsive disorder patients' family members' accommodative behaviors: A narrative review. J Nurs Midwifery Sci 2020; 7(3): e141428.
28.                Knopp J, Knowles S, Bee P, Lovell K, Bower P. A systematic review of predictors and moderators of response to psychological therapies in OCD: do we have enough empirical evidence to target treatment? Clin Psychol Rev 2023; 33(8): 1067-81.
 
Fundamentals of Mental Health
Volume 28, Issue 2
March and April 2026
Pages 103-108