Effectiveness of Acceptance and Commitment Therapy on Improving Symptoms and Increasing Quality of Life in Patients with Obsessive-compulsive Disorder in Interacting with OCD Family History

Document Type : Research Article


1 Assistant Professor, Psychology Department, Rahman Institute of Higher Education, Ramsar, Iran

2 Professor, Psychology Department, University of Mohaghegh Ardabili, Ardabil, Iran

3 Professor, Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran

4 Professsor, Psychology Department, University of Guilan, Rasht, Iran


The present study aimed to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) on improving symptoms and increasing quality of life among the patients with obsessive-compulsive disorder (OCD) in interacting with OCD Family History: This is a quasi-experimental and pretest-posttest study with control and follow-up groups. The study population entirely consisted of over-18-years of age OCD patients referred to private consultation centers, and rural and urban healthcare centers in Rasht city during2014. The sample selected through purposive sampling consisted of 60 OCD patients who were randomly included in two experimental(ACT with and without OCD Family History) and two control (control with and without OCD Family History) groups. The experimental groups received eight ACT 45-minute sessions of Yale-Brown Obsessive Compulsive Scale was used to determine the severity of OCD. In addition, the brief version of WHO Quality of Life Scale was used to measure life quality and the clinical interview was used to investigate OCD family history. Multivariate analysis of variance test with repeated measures was used to examine the differences in pretest-posttest and follow-up scores. The results show that ACT caused a significant decrease in OCD symptoms and a significant increase in patients' quality of life while OCD family history had no impact on the effectiveness of ACT. Therefore, all patients can benefit from this therapy regardless of their OCD Family History.


Main Subjects

Abramowitz J.S. (1996). Variants of exposure and response prevention in the treatment of obsessive-compulsive disorder: A meta-analysis. Behavior Therapy; 27, 583-600. http://www.ocdtherapist.com/PDFs/1996metaanalysis.pdf
Abramowitz J.S. (1997). Effectiveness of psychological and pharmacological treatments of obsessive-compulsive disorder: A quantitative review. Journal of Consulting and Clinical Psychology, 65(1): 44-52: https://10.1037//0022-006x.65.1.44
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, 4th ed., Text Revision Washington, DC: Author.
Borghei, S., Roshan, R., Bahrami, H. (2020). Treatment Based on Acceptance and Commitment and Spirituality of Religious Therapy in a Group Method Improvement of the Severity of Obsessive-Compulsive Symptoms and Obsessive Beliefs and Quality of Life in People with Obsessive-Compulsive Disorder. Middle Eastern Journal of Disability Studies, 10, 6-6. http://jdisabilstud.org/article-1-1238-fa.html
Dadfar, M. (1998). Investigation of comorbidity of personality disorders among obsessive-compulsive patients and comparison with normal people. M. Sc. Thesis on clinical psychology, Tehran Psychiatric Institute.
Dadfar, M., Bolhari, J., Dadfar, K., Bayanzadeh, S. A. (2001). Prevalence of the obsessive-compulsive disorder symptoms. Iranian Journal of Psychiatry and Clinical Psychology. 7 (1 and 2):27-33. http://ijpcp.iums.ac.ir/article-1-1963-fa.html
Fisher PL, Wells A (2008). Metacognitive therapy for obsessive-compulsive disorder: a case series. Journal of Behavior Therapy and Experimental Psychiatry; 39(2):117-132. [DOI: 10.1016/j.jbtep.2006.12.001]
Flaxman, P. E., Blackledge, J. T., Bond, F., W. (2011). Acceptance and Commitment Therapy: Distinctive Features. (Translated by Mosleh Mirzaie and Saman Nonahal). Tehran: Arjmand publication, Original work published 2013.
Foa, E. B., Franklin, M. E., & Kozak, M. J. (1998). Psychosocial treatments for obsessive–compulsive disorder: Literature review. In R. P. Swinson, M. M. Antony, S. Rachman, & M. A. Richter (Eds.), Obsessive-compulsive disorder: Theory, research, and treatment (pp. 258–276). The Guilford Press. https://psycnet.apa.org/record/1998-07751-011 
Foster, K., Meltzer, H., Gill, B., Hinds, K. (1996). Adults with a psychotic disorder living in the community OPCS Survey of Psychiatric Morbidity Report 8. London, HMSO.
Goodman, W. K., Prince, L. H, Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale Brown Obsessive-Compulsive Scale: Development, Use, and Reliability. Archives of General Psychiatry. 46(11):1006-1011.
Grados, M. A., Walkup, J., Walford, S. (2003). Genetics of obsessive-compulsive disorder: New findings and challenges. Brain Development, 25(suppl. 1): 55-61. https://pubmed.ncbi.nlm.nih.gov/14980374/
Halgin, R., & Whitbourne, S. K. (2014). Abnormal psychology: Clinical perspective on psychological disorders (7th  ed.). DSM-5 update (Translated by Yahya Sied Mohammadi), Ravan Press. (Original work published 2013)
Hanna, G. L., Himle, J. A., Curtis, G. C., Gillespie, B. W. (2005). A family study of obsessive-compulsive disorder with pediatric probands. American Journal of Medical Genetic, 134: 9-13. [DOI: 10.1002/ajmg.b.30138]
Hayes, S. C., Strosahl, K. D. (2010). A practical guide to acceptance and commitment therapy. New York: Springer Press.
Hayes, S. C., Barnes-Holmes, D., & Roche, B. (2001). Relational Frame Theory: A Post-Skinnerian Account of Human Language and Cognition. Hingham, M. A., Kluwer Academic Publisher.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. NewYork. Guilford Press.
Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A, & Lillis, J. (2006). Acceptance and Commitment Therapy: Model, Processes and Outcomes. Behavior Research and Therapy, 44 (1), 1-25. [DOI: 10.1016/j.brat.2005.06.006]
Hayes, S.C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L.F (2004). DBT, FAP, ACT: How Empirically Oriented are the New Behavior Therapy technologies? Behavior Therapy, 35 (1), 35-54. [DOI/10.1016/S0005-7894(04)80003-0]
Heninger, G. R., Charney, D. S. (1989). The Yale-Brown Obsessive-Compulsive Scale: Development, Use, and Reliability. Archive of General Psychiatry, 46(11):1006-1011. [DOI: 10.1001/archpsyc.1989.01810110048007]
Izadi, R., Abedi, M, (2013). Decrease of obsessive symptoms in obsessive-compulsive patients through acceptance and commitment therapy. Feyz Journal of Kashan University of Medical Sciences. 17 (3), 275-286. http://feyz.kaums.ac.ir/article-1-1963-fa.html
Mokhtari Davoudli, M., (2014). Effectiveness of group therapy based on acceptance and commitment method on the decrease of obsessive-compulsive disorder, thought suppression and increase of women's quality of life with obsessive cleaning disorder, M. Sc. Thesis, Ferdowsi University of Mashhad.
Mokmeli, Z., Moulavi, H., Abedi, M.R. (2006). The effect of group and individual exposure and response prevention treatment on reduction of obsessive – compulsive symptoms in out –patients, Journal of psychology, 2 (38), 169-180. https://www.sid.ir/en/journal/ViewPaper.aspx?id=58426
Narimani, M., Maleki-Pirbazari, M., Mikael, N., Abolghasemi, .A. (2016). Appraisal of Effectiveness and Comparison of Exposure and Response Prevention Therapy and Acceptance and Commitment Therapy (ACT)-Based Training on Improving Obsessive and Compulsive Disorder Patients' Components of Life Quality. Journal of Clinical Psychology, 8(1), 25-36. [DOI: 10.22075/JCP.2017.2224]
Nejat, S, Montazeri, A., Holakouie Naieni, K., Mohammad, K., Majdzadeh, S. (2006). The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of School .of Public Health and Institute of Public Health Research, 4 (4), 1-12. http://sjsph.tums.ac.ir/article-1-187-en.html
Safari, S., Esfahani, M., Sepanta, M., Amiri, S. (2013). Effectiveness of acceptance and commitment therapy on obsessive-compulsive mothers and their children's behavioral problems, 6th International Congress of Child and Adolescent Psychiatry, Iran, Tabriz University of medical sciences and health services.
Salkovskis, PM, Westbrook, D. (1989). Behavior therapy and obsessional ruminations: Can failure be turned into success? Behavior Research and Therapy, 27(2): 149-60. [DOI: 10.1016/0005-7967(89)90073-9]
Srivastava, S., Bhatia, M.S. (2008). Quality of Life in Obsessive-Compulsive Disorder- A Brief Review. Delhi Psychiatry Journal, 11(2): 197-202.
Steketee, G, Pigott, T. G., (2020). Obsessive- compulsive disorder: the latest assessment and treatment strategies (4rd ed). (Translated by Habibollah Ghassemzadeh). Tehran: Arjmand. (Original work published 2006)
Tolin, D. F., (2009). Alphabet Soup: ERP, CT, and ACT for OCD. Cognitive and Behavioral Practice, 16(1), 40–48. [DOI: 10.1016/j.cbpra.2008.07.001]
Twohig M P, Hayes S C, Plumb J C, Pruitt L D, Collins A B, Hazlett-Stevens H and Woidneck M R (2010). A randomized clinical trial of Acceptance and Commitment Therapy versus. Progressive Relaxation Training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5): 705–716. [DOI: 10.1037/a0020508]
Twohig, M. P. (2009). The application of acceptance and commitment therapy to obsessive-compulsive disorder. Cognitive and Behavioral Practice, 16, 18–28. [DOI: 10.1016/j.cbpra.2008.02.008]
Twohig, M. P. (2007). A randomized clinical trial of acceptance and commitment therapy versus progressive muscle relaxation in the treatment of obsessive-compulsive disorder. Dissertation Abstracts International: Section B: The Sciences and Engineering, 68(7), 48-50.
Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and Commitment Therapy as a treatment for Obsessive-Compulsive Disorder. Behavior Therapy, 37(1), 3–13. [DOI: 10.1016/j.beth.2005.02.001]
Twohig MP (2004). Acceptance and Commitment Therapy for Obsessive and Compulsive Disorder: Treatment Manual. Reno, NV.
World Health Organization. Division of Mental Health. (‎1996)‎. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996. World Health Organization. http://apps.who.int/iris/bitstream/handle/10665/63529/WHOQOL-BREF.pdf?sequence=1