Evaluation of the efficacy of the integrated protocol of the Acceptance and Commitment Therapy (ACT) for OCD and couple therapy in patients with Relationship Obsessive-Compulsive Disorder (ROCD)
The purpose of the current study was to evaluate the efficacy of the integrated protocol of the Acceptance and Commitment Therapy (ACT) for OCD and couple therapy in patients with Relationship Obsessive-Compulsive Disorder (ROCD)
Design
Clinical trial in format of single case study with multiple baseline; three interventions of couple therapy of ACT, ACT for OCD and integrated treatment of ACT for OCD and couple therapy; random selection of two individuals with ROCD in each intervention; parallel interventions; one blind
Settings and conduct
In the current study, the studied sample were 6 couples with ROCD from universities of Tehran, Shahid Beheshti, Shahed, Tarbiat Modarres, Allameh Tabatabai, Kharazmi, Amir Kabir and Sharif and in each of the three mentioned treatments, 2 couples were selected randomly.Couples were unaware of the types of treatments in this study (a blind head).
Participants/Inclusion and exclusion criteria
Inclusion criteria: Being married (male or female); Diagnosis of OCD; Diagnosis of ROCD (score above one standard deviation of the ROCI and PROCSI); To lapse at least 6 months from marriage; consent to participate in the research and to sign a written consent.
Exclusion criteria: Being treated for the past 6 months; History of substance abuse (due to interference with treatment sessions); Diagnosis of psychiatric disorders other than obsessive spectrum disorders, based on SCID-5-RV interview; Absence of the treatment in three consecutive sessions.
Intervention groups
Group 1- Integrated intervention of the Acceptance and Commitment Therapy (ACT) for OCD and couple therapy
Group 2- Couple therapy of ACT
Group 3- ACT for OCD
Evaluation of the efficacy of the integrated protocol of the Acceptance and Commitment Therapy (ACT) for OCD and couple therapy in patients with Relationship Obsessive-Compulsive Disorder (ROCD)
Public title
Evaluation of the protocol of ACT in patients with obssesion
Purpose
Treatment
Inclusion/Exclusion criteria
Inclusion criteria:
Being married (male or female)
Diagnosis of OCD
Diagnosis of ROCD (score above one standard deviation of the ROCI and PROCSI)
To lapse at least 6 months from marriage; consent to participate in the research and to sign a written consent
Exclusion criteria:
Being treated for the past 6 months
History of substance abuse (due to interference with treatment sessions)
Diagnosis of psychiatric disorders other than obsessive spectrum disorders based on SCID-5-RV interview
Absence of the treatment in three consecutive sessions
Age
No age limit
Gender
Both
Phase
N/A
Groups that have been masked
Participant
Sample size
Target sample size:
15
Actual sample size reached:
6
Randomization (investigator's opinion)
Randomized
Randomization description
Simple random method with the help of lottery
Blinding (investigator's opinion)
Single blinded
Blinding description
Participants were not aware of the types of interventions in this study.
Placebo
Not used
Assignment
Parallel
Other design features
Design of integrated protocol of the Acceptance and Commitment Therapy (ACT) for OCD and couple therapy
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Ethics committee of Shahed University
Street address
Shahed University, In front of Shrine, Persian Gulf Freeway, Tehran, Iran
City
Tehran
Province
Tehran
Postal code
3319118651
Approval date
2018-12-03, 1397/09/12
Ethics committee reference number
IR.SHAHED.REC.1397.078
Health conditions studied
1
Description of health condition studied
Relationship Obsessive Compulsive Disorder
ICD-10 code
F42.2
ICD-10 code description
Compulsion mixed with obsessional thoughts
Primary outcomes
1
Description
Psychological Flexibility
Timepoint
Twice at baseline; three times during treatment; twice at follow-up (two weeks and four weeks after treatment)
Method of measurement
Acceptance and Action Questionnaire II (AAQ-II)
Secondary outcomes
1
Description
Relationship Obsessive and Compulsive Disorder
Timepoint
Twice at baseline; three times during treatment; twice at follow-up (two weeks and four weeks after treatment)
Method of measurement
Relationship Obsessive Compulsive Inventpry; Partner Related Obsessive Compulsive Symptom Inventory
2
Description
Marital Satisfaction
Timepoint
Twice at baseline; three times during treatment; twice at follow-up (two weeks and four weeks after treatment)
Method of measurement
Enrich Scale
Intervention groups
1
Description
Intervention group: Integrated intervention of the Acceptance and Commitment Therapy (ACT) for OCD and couple therapy: This intervention consists of 20 sessions that summarize the sessions of this intervention as follows: Sessions 1-4: Two sessions of OCD therapy (assessment of obssesion and introduction of treatment structure, creative frustration) and two sessions of couples therapy (assessment of couples and introduction of couple therapy orientation of ACT). Sessions 5 and 6: One OCD therapy (keep up the creative frustration) and one couple therapy (constructive frustration); Sessions 7-9: Two OCD therapy (realizing control and acceptance, mindfulness) and one couple therapy (acceptance and mindfulness training); Sessions 10-13: Two sessions of OCD therapy (introducing self as context and defusion) and two sessions of couple therapy (defusion and observation of thoughts); sessions 14-20: Three sessions of OCD therapy (focus on value and examine the barriers to value, committed action) and four sessions of couple therapy (focus on value and examine the barriers to value, committed action and self as context).
Category
Behavior
2
Description
Intervention group: Couple therapy of ACT:The number of sessions of this intervention is 10. Summary of Acceptance and Commitment Therapy (ACT) sessions are as follows: Session 1: Getting to know couples and presenting orientation of ACT; Session 2: Individual assessment; Session 3: Creative frustration, reviewing options and what issues are controllable and uncontrollable; Session 4: Mindfulness and Acceptance Training; Session 5: Cognitive defusion, Examining the barriers to paying thoughts, tagging thoughts and moving away from thoughts; Session 6: Observing thoughts; Session 7: Choosing valuable orientations; Session 8: Exploring the barriers to a worthy life; Session 9: Describing yourself as a texture in communication; Session 10: Committed action, end of treatment and prevention of recurrence.
Category
Behavior
3
Description
Intervention group: ACT for OCD: This intervention contains 10 sessions of Acceptance and Commitment Therapy (ACT) for OCD. At each meeting, the client's reactions to the previous meeting are first reviewed, a new issue raised, a new assignment determined, and a behavioral commitment agreed. At first, the type of therapeutic relationship is specified by metaphor of the "two mountains". Then, the treatment begins by gathering information about the obsessive thoughts and actions. The difference between obsessive thoughts and actions arises and shows how one happens without the other, but in the lives of their clients, they usually happen together. Then ask the clients what has been done so far to reduce obsessive thinking, what has been effective and what has not been effective. This shows that the only way to get rid of obsessive thinking is to do obsessive action, but it only works for a short period of time. The metaphor of "Obsessive Well" and "Monster Draw" was used to illustrate the ineffectiveness of one's attempts to control obsessive thinking. The function of these metaphors was to reduce the focus of the client on the decline of obsessive-compulsive thinking and to become aware of the difficulty of controlling it, which is called the Creative frustration in ACT. Sessions 3, 4, and 5 deal with how trying to control obsessive thinking rather than being the solution is the problem. The purpose of these sessions was to emphasize the limitations of control when internal events occure. Sessions 6, 7, and 8 focused on changing the psychological function of obsessive thinking from what is threatening to merely another verbal event. These sessions include training of defusion, communication with the present or mindfulness exercises and working on the self as a background. The last session (9 and 10) included discussions about the values of the client and increased behavioral commitments to pursue those values.
Category
Behavior
Recruitment centers
1
Recruitment center
Name of recruitment center
Tehran University
Full name of responsible person
Soheila Ghomian
Street address
Tehran university; Enghelab St; Enghelab Square; Tehran