The Effectiveness of Cognitive-Behavioral Therapy on Repetitive Thoughts and Negative Emotional Dimensions in Women with Obsessive-Compulsive Disorder

Document Type : Original Article


1 Master of clinical Psychology,Department of Psychological Sciences, Faculty of Humanities, Neyshabur Branch, Islamic Azad University, Neyshabour, Iran.

2 Associate Professor of Psychology, Department of Psychological Sciences, Faculty of Humanities, Neyshabur Branch, Islamic Azad University, Neyshabour, Iran.


Introduction: The aim of this study was to investigate the effectiveness of cognitive-behavioral therapy on repetitive thoughts and negative meta-exciting dimensions in women with obsessive-compulsive disorder.
Method: The present study was a semi-experimental study of the pre-test-test design with the control group. The statistical population of the study consisted of all women with obsessive-compulsive disorder referred to psychiatric services medical centers in Mashhad, of whom 24 were selected by available sampling and then were replaced in experimental and control groups (each group of 12). Data were collected using  Repeated NegativeAfter that, the therapeutic intervention was performed based on Leahy's pattern cognitive-behavioral approach for the experimental group during 8 sessions of 90 minutes, but the control group was placed on the waiting list. After the end of the treatment period, a post-test was performed in both groups.
Results: The results of covariance analysis showed that there was a significant difference in recurring thoughts and negative meta-exciting dimensions. The experimental group showed a significant decrease compared to the control group.
Conclusion: Identifying, challenging, and correcting negative repetitive thoughts, and dysfunctional schemas and identifying hopeless thoughts and emotions and challenging them is the main goal of cognitive-behavioral therapists.


  1. منابع

    1. Joormann, J., & Gotlib, I. Emotion Regulation in Depression: relation to cognitive inhibition. Cognition and Emotio. (2013), 24(2), 281-298.
    2. Scarff, J. R. The potential application of obsessions to reduce compulsions in individuals with obsessive–compulsive disorder. Medical Hypotheses, 2010, 74, 216-218.
    3. Fiest, K. M., Walker, J. R., Bernstein, C. N., Graff, L. A., Zarychanski, R., Abou-Setta, A. M., Patten, S. B., Sareen, J., Bolton, J. M., Marriott, J. J., Fisk, J. D., Singer, A., & Marrie, R. A. Systematic review and meta-analysis of in terventions for depression and anxiety in persons with multiple sclerosis. Review mult scler relate disord, national center for biotechnology information. (2016).
    4. Kaplan, H., & Zadok, B. Summary of Clinical Psychiatry. Translation: Seyed Yahya Seyed Mohammadi. (2013). [In Persian].
    5. Herbert, J. D., Gaudiano, B. A., Rheingold, A. A., Myers, V. H., Dalrymple, K., & Nolan, E. M. Social skills training augments the effectiveness of cognitive behavioral group therapy for social anxiety disorder. Behavior Therapy, (2004). 36(2), 125-138.
    6. Smeat, J., & Alovey, p. The positive psychology of Emotional Intelligence. (2009).
    7. Andrada, D., Neacsiu, A., Jeremy, W., Eberle, R., Kramer, R., Wiesmann, T., & & Linehan, M. Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial.. Behav Res Ther, (2015). 59(12), 40-51.
    8. Butler, E., Matcham, F., & Chalder, T. A systematic review of anxiety amongst people with Multiple Sclerosis. Multiple Sclerosis and Related Disorders, (2016). 10, 145-168.
    9. Rector, N. A., Bartha, C., Kitchen, K., Katzman, M., & Richter, M. Obsessive-Compulsive Disorder: An Information Guide. (2011).
    10. Chiu, A., Langer, D., Mcleod, B., Kim, I. I., Drahota, A., Galla, B., Jacobs, J., Lfekwunigwe, M., & Wood, J. Effectiveness of Modular CBT for Child Anxiety in Elementary Schools. Sch Psychol, (2013). 28 (2), 141-153.
    11. Foa, E. B. (2010). Cognitive behavioral therapy of obsessive-compulsive disorder.. Journal Dialoguesin clinical neuroscience.
    12. Pachi, A., bratis, d., moussas, g. e., & tselebis, A. Psychiatric morbidity and other factors affecting treatment adherence in pulmonary tuberculosis patients. Tuberculosis research and treatment, (2013). 1-37.
    13. Armstrong, T., Zald, H., & Olatunji, O. Attentional control in OCD and GAD: Specificity and associations with corecognitive symptoms.. Behaviour Research and Therapy, (2011). 49(11), 756-762.
    14. Duggan, D. S., Crane, C., & Fennell, M. J. Mindfulness-based cognitive therapy for prevention of recurrence of suicidal behavior. Journal of Clin Psychol, 62 (2), 201-210.
    15. McNally, R. J. (2004). Psychological approaches to panic disorder: A review. Psychological bulletin, (2013). 3, 403-419.
    16. Salkovskis, P. M. Cognitive-behavioral factors and the persistence of intrusive thoughts in obsessional problems. Behavior Research and Therapy, (2009). 27, 677-682.
    17. Perczel-Forintos, D., & Kresznerits, S. Social anxiety and self-esteem: Hungarian validation of the Brief Fear of Negative Evaluation Scale - Straightforward Items. ORV Hetil, (2017).843-850.
    18. Schutz, P. A., Distefano, C., Benson, J., & Davis, H. A. The emotional regulation during test-taking scale. Journal of anxiety, stress & coping, (2004). 17(3), 253-269.
    19. Razurel, C., Kaiser, B., Antonietti, J. P., Epiney, M., & Sellenet, C. Relationship between perceived perinatal stress and depressive symptoms, anxiety, and parental self-efficacy in primiparous mothers and the role of social support. Women Health, (2017). 154-172.
    20. Dalrymple, K. L., Galione, J., Hrabosky, J., Chelminski, I., Young, D., O'brien, E., & Zimmerman. Diagnosing social anxiety disorder in the Pres ence Of Obesity: Impli cations for a Proposed Change in DSM 5.. Depression and Anxiety, (2011). 28(5), 377-382.
    21. Ebner, N. C., & Fisher, H. Meta-Emotion and aging: eveidence from brain and behavior., Journal of Frontiers in Psychology. Department of Psychology University of Florida. (2019).
    22. Gottman, J. M., Katz, L. Q., & Hooven, C.Meta emotion: How qamilies communicate emotionally. (1999).
    23. Katz, L. F., Maliken, A. C., & Stettler, N. M. Parental meta-emotion philosophy: A review of research and theoretical framework. Child Development Perspectives, (2012). 6, 417-422.
    24. Barloo DH. Clinical handbook of psychological disorders: A step-by-step treatment manual. Guilford Publications. 2014.
    25. Van Kassel, k., Moss-Morris, R., & Willoughby, E. A randomized controlled trial of cognitive behavior therapy for multiple sclerosis fatigue. Psychosom Med, (2017). 70 (2), 205-2013.
    26. Kocak, C., & Onen, A. The Analysis On Interpersonal Relationship Dimension of Secondary School Students.According to their Ruminative Thinking Skills. Social and Behavioral Sciencess, (2014). 143, 783-787.
    27. Lopez, M. Social anxiety and autism spectrum traits among adult FMR1 premutation carriers. Clin Genet, (2017). 111-114.
    28. Yoo, Y., Lee, D. J., Lee, I. S., Shin, N., & Park, J. Y. The Effects of Mind Subtraction Meditation on Depression, Social Anxiety, Aggression, and Salivary Cortisol Levels of Elementary School Children in South Korea. Pediatr Nurs, (2016). 185-197.
    29. Ehring, T., & Watkins, E. R. Repetitive negative thinking as a transdiagnostic process. International Journal of cognitive Therapy, (2011). 1 (3), 192-205.
    30. Fancourt, D., Perkins, R., Ascenso, S., Carvalho, L., & Williamon, A. Effects of Group Drumming Interventions on Anxiety, Depression, Social Resilience and Inflammatory Immune Response among Mental Health Service Users. PLoS One. (2016). e0151136.
    31. McEvoy, H. Test anxiety and academic delay gratification. College Student Journal, (2013). 43(1), 10-12.
    32. Macedo, A., Marqes, M., & Pereira, A. Perfectionism and psychological distress:A review of the cognitive factors. International Journal of and Clinical Neurosciences Mental Health. (2014). 45, 213.
    33. Arco, L. A case study in treating chronic comorbid obsessive-compulsive disorder and depression with behavioral activation and pharmacotherapy. Psychotherapy. (Chic). 2015). 278-286.
    34. O’Connor, D. B., O’Connor, R. C., & R., M. Perfectionism and psychological distress: Evidence of mediating effects of rumination. European Journal of personality, (2007). 21, 429-452. Moroz, M., & Dunkley. Self-critical perfectionism and depressive symptoms:Low self-esteem and experiential avoidance as media. Personality and Individual differences. (2015).
    35. Bernstein, A. A longitudinal study of Emotional distress Intolerance and psychopathology following Exposure to a potentially Traumatic Event in acommunity sample. cognitive therapy and research (2013).
    36. Bernstein, A., Zvolensky, M. J., Vujanovic, A. A., & Moos, R. Integrating anxiety sensitivity, distress tolerance, and discomfort intolerance: A hierarchical model of affect sensitivity and tolerance. Behavior Therapy, (2009). 40(3), 291-301.
    37. Vanderkaap-deeder, s., Soenens, b., Boone, l., Beatrise vandenkerc, k., Stemgee, e., & Van steenkiste, m. Evaluative concerns perfectionism and coping with failure: effects on rumination, avoidance, and acceptance. Personality and Individual differences, (2016). 101, 114-119.
    38. Gross, J. J., & Thompson, R. A. Emotion regulation: Conceptual foundations. In: Gross, J.J. (2007).
    39. McEvoy, P. M., Mahoney, A. E., & Moulds, M. L.Are worry, rumination, and post-event processing one and the same?: Development of the Repetitive Thinking Questionnaire. Journal of anxiety disorders, (2010). 24(5), 509-519.
    40. McEwoy, D. Identity style and coping strategies. Journal of personality, (2013). 60(4), 771-788.
    41. Bernstein, A. Mind fullness and distress Tolerance: Relations in a mindfulness preventive intervention International Journal of cognitive Therapy. (2013).
    42. Davison, D., Neal, J., kring, A., & Johnson, S. Abnormal Psychology. (2007).
    43. Gottz, M., & Gottman, J. Emotional Intelligence, Introduction taken from the book raisingan Emotionally Intelligent Child.. Journalism Quarterly, (2016). 60, 615-621.
    44. Leahy, R., Holland, S., & Mcginn. Treatment plans and interventions for depression and anxiety disorders. (2012).
    45. Clark, D. A., & Beck, A. T. Cognitive theory and therapy of anxiety and depression: convergence with neurobiological findings. Journal of Trends Cogn Sci. (2010). 14, 418-424.
    46. Sheikhmoonesi F, Hajheidari Z, Masoudzadeh A, Ali Mohammadpour R, & M., M. Prevalence and Severity of Obsessive-Compulsive Disorder and their Relationships with Dermatological Diseases.. Acta Med Iran, (2014). 52(7), 511-514.
    47. Taylor, S., Abramowiz, j. S., & MeKay, D. Cognitive-Behaviaral Models of Obsessive Compulsive Disorder. In M.M. Antony., C, Purdon. & L.J. Summerfeldt. (Eds).. Psycological treatment of obsessive-compulsive disorder: Fundamentals and beyond, (2007). 9-29.
    48. Martin, E. F., Jonathan, S., Abromowitz, J. S., Donald, A., Bux, J., Lori, A., Zoellner, & Norah, C. F. Cognitive-behavioral Therapy with and withoutmedication in the treatment of obsessive-compulsivw disorder. Professional Psychology. Research and Practice (2002). 33(2), 162-168.
    49. Parhon F, Moradi T, Hatami A. Evaluating Effectiveness of cognitive-behavioral therapy in group therapy on depression rate. Journal of Shahid Sadoughi University of Medical Sciences Yazd. 2010; 18(4): 299-308.
    50. Alipour A, Afrooz Gh, Vali'I J. Effect of Cognitive-Behavioral Therapy on Depression. General Health and Adaptation of Depressed Deaf Married Women. Master's thesis. 2009; Tehran: Payame Noor University. [Persian].
    51. Leigh, E., & Clark, D. Understanding social anxiety Disorder in Adolescents and Improving Treatment outcomes:Applying the cognitive model of clark and wells Clinical child and family psychology Review. (2018).
    52. Zessin, U., Dickhauser, O., & Garbade, S. The Relationship Between self-compassion and well-Being:A meta Analysis. The Journal of AnalyTical psychology. (2015).
    53. Grant, B. L., Hofmann, W. A., Hiller, S. J., & Berking, J. E. Emotion regulation and impulsivity in young adults. Journal of Psychiatric Research, (2014). 46, 651-658.
    54. Marzban E. Ahmadi A. Khasha M. Moradkhah V. The study of the Relationship between Psychological well-being and Alexithymia with Resilience and Suicidal Thoughts in DrugDependent Persons in Shiraz. 8th International Conference on Psychology and Social Sciences. Tehran. Iran. 2017. [In Persian].
    55. Ghazali S, Moradibaglooei M, Sarichloo ME, Alipour M. The effect of Logo Therapy Group on the Resilience of Spouses of male substance Abusers. Iranian journal of psychiatric nursing. 2018; 6(3): 54-59. [In Persian].
    56. Salimzade, O., R. Pourhosein, and M. Lavasani, Investigating the effectteaching mindfulness-based stress reduction in reducing psychological symptoms in adolescent boys in dorms. International Journal of Behavioral Social and Movement Sciences, 2014. 3(4): p. 44-9.), (2014).. [In Persian].
    57. Rachman S & Hodgson R. Obsessive compulsive complains. Behavior Research and Therapy. 1977; 15: 389-95.
    58. Dadfar, M., Bolhari, J., Malakouti, K., & Bayanzade, A. Study of Obsessive-compulsive disorder symptoms. Journal of Experimental Social Psychology, 2011. 31(4): p. 70-22.), (2011). [In Persian].
    59. Mahoney AE, McEvoy PM, Moulds ML. Psychometric properties of the Repetitive Thinking Questionnaire in a clinical sample. Journal of anxiety disorders. 2012; 26(2): 359-67.
    60. McEvoy PM, Mahoney AE, Moulds ML. Are worry, rumination, and post-event processing one and the same: Development of the Repetitive Thinking Questionnaire. Journal of anxiety disorders. 2010; 24(5): 509-19.
    61. Mitmansgruber, H., Beck, T. N., Hö fer, S., & Schüßler, G. When you don’t like what you feel: Experiential avoidance, mindfulness and meta-emotion in emotion regulation. Pers Individ Diff. (2009). 46(4), 448-453.