Development and Evaluation of an Acceptance and Commitment Therapy based on Religious Content to Control Obsessive-Compulsive Disorder, Dysfunctional Beliefs, Feeling Guilty, Scrupulosity, and Thought Control among Muslims in Iran

Abstract

Background Religious or moral obsessions, also known as scrupulosity has not been adequately investigated in studies of acceptance and commitment therapy (ACT). The present study aimed to develop an integrated protocol by combining religious content and ACT and evaluate its effectiveness in controlling obsessive-compulsive disorder (OCD), dysfunctional beliefs, feeling guilty, scrupulosity, and thought control among Muslims in Iran. Methods An exploratory mixed-method research design was applied in this study. In the qualitative stage, the document analysis method was used to extract components related to ACT with religious content. Also, the content and face validity of the intervention were confirmed by experts. Subsequently, a semi-experimental, pretest-posttest, control-group design was performed to evaluate the effectiveness of the adapted protocol with a three-month follow-up. In the quantitative stage, a total of 35 participants were randomly assigned into two groups using the convenience sampling method based on the inclusion criteria. The experimental and control groups participated in 25 individual treatment sessions based on the adapted protocol and eight conventional ACT sessions, respectively. The research instrument included the Yale-Brown Obsessive-Compulsive Scale, the Guilt Inventory, the Penn Inventory of Scrupulosity, the Questionnaire of Religious Beliefs about Purification Rituals, and the Thought Control Questionnaire. Results The present findings indicated the interactive effects of time and group on the severity of purity/impurity obsessions (F = 9.455, P < .001) and dysfunctional religious beliefs (F = 7.963, P = .001) in patients with OCD. The Bonferroni correction results showed no significant difference between the intervention and control groups in the severity of obsession (P = .448), dysfunctional religious beliefs (P = .176), feeling guilty (P = .787), scrupulosity (P = .891), and thought control (P = .554) in the follow-up. According to the results, the effectiveness of the religion-adapted ACT intervention on the severity of obsession and dysfunctional religious beliefs was higher in patients with OCD compared to the control group in the posttest. Although the intervention influenced scrupulosity, the difference was not significant with the control group. Besides, the findings showed that group and time failed to significantly affect feeling guilty and thought control. Conclusion The present study showed that adding religious components to the ACT protocol can increase its effectiveness in reducing the severity of purity/impurity obsessions compared to the conventional ACT in the Muslim Iranian population.