Exposure and Response Prevention therapy on Inflated Sense of Responsibility, and Intolerance of Uncertainty, in Patients with Obsessive Compulsive Disorder

Obsessive-compulsive disorder is a heterogeneous disorder and has different therapeutic approaches. Over the past few decades, we have witnessed tremendous advances in the role of cognitive systems in the formation, continuity, and treatment of the obsessive-compulsive disorder (OCD). Certain beliefs have been identified as a significant contributor to the creation and continuation of this disorder, Cognitive models of OCD also indicating that responsibility assessment is involved in the etiology and preservation of OCD symptoms. According to Salkovskis (1985), the Inflated Sense of responsibility in OCD has a central role. Intolerance of uncertainty (IU), which means the tendency to avoid ambiguous situations and the inability to deal with uncertainty, is considered significant damage to OCD. ERP as a standard golden treatment, including the gradual inclusion of anxiety due to obsessive-compulsive disorder, and the prevention or limitation of obsessive-compulsive procedures and reduction of anxiety. Aim of this study was the efficacy of Exposure and Response Prevention Therapy (ERP) in Inflated Sensory Responsibility and Intolerance of Uncertainty in Patients with OCD.

The research design was a semi-experimental study with pretest, post-test, and follow-up. The statistical population consisted of all the people of Mahallat city, which is located in Markazi province in Iran in 2018. Sixteen patients with OCD were selected through the available sampling method and randomly within two groups: ERP and control group. (8 patients in each group). Each person in the treatment group received 12 treatment sessions by the Salkovskis exposure and Response prevention therapy method for OCD. Subjects were measured both before and at the end of interventions as well as three months later in the follow-up phase by the Yale-Brown Obsessive-Compulsive Scale (Yale-BOCS; Goodman, 1989), the Salkovskis Responsibility Attitude Scale; (RAS; Salkovskis, Wroe, Morrison, Richards, Reynolds & Thorpe, 2000) and The Intolerance of Uncertainty Scale; (IUS; Freeston et al, 1994) . The Yale-Brown Obsessive-Compulsive Scale is a reliable instrument; with internal stability of 0.89 by Goodman and in Iran with internal stability for the sign index (SC) and severity scale (SS) were 0.97 and 0. 95 for the Persian version by Rajazi Esfahani et al. Responsibility Attitude Scale is a 26-item scale, consistency (α=0.91), excellent test-retest reliability over a five-week period (r=0.78), and Intolerance of Uncertainty Scalexcellent internal consistency (α=0.89), and satisfactory test-retest reliability (r=0.74). Post-extraction research data analyzed by repeated measurements analysis using SPSS-23 software.

To test the hypothesis of the research, about the existence of the pre-test variables and the possibility of the primary difference between the two intervention and control groups, as well as reducing the initial difference and comparing the groups, the multivariate analysis of variance, and used repeated measure design. In the semi-experimental design, before analyzing the hypothesis of the research, Levin's findings showed that the homogeneous assumption of covariance of data and regression slope established. The results of Mocheli's test also showed that there is no spheroidal assumption (p<0.050). The findings showed that there is a significant difference between the mean variables of the inflated sense of responsibility and uncertainty of intolerance in the experimental group with the control group. Therefore, the effectiveness of treatment on the reduction of the inflated sense of responsibility and uncertainty of intolerance can be verified (p<0.001), and this effect was lasting after three months (p<0.001).

The results of this study have shown the effectiveness of exposure and Response prevention therapy in improving an inflated sense of responsibility and uncertainty of intolerance in patients with OCD.