Determining the Effectiveness of Schema Therapy on the Distress and Ambiguity Tolerance in People with Obsessive-Compulsive Disorder

Obsessive–compulsive disorder (OCD) is a common psychological disorder causing a severe disturbance in an individual's life. One of the areas in OCD that has drawn so much attention in recent years is the concept of ambiguity tolerance, a psychological trait characterized by a person's tendency to perceive ambiguous situations as threatening or distressing. Another concept is distress tolerance, which refers to tolerating and managing distressing feelings, thoughts, and problems without resorting to harmful or ineffective behaviors. Due to the limitations of drug therapy, much attention has been paid to the treatment of OCD in the psychological field, and various therapies have been suggested to effectively deal with the symptoms and emotions related to obsession, including schema therapy. So, this research aimed to determine the effectiveness of schema therapy on distress tolerance and ambiguity tolerance in people with OCD.

The current research was quasi–experimental with a pretest–posttest design with one control group and one experimental group. The statistical population included people with OCD referred to counseling and psychology clinics in Mashhad City, Iran, in 2022. Since the number of subjects in groups in quasi–experimental studies is considered to be at least 15 people, 30 qualified volunteers were recruited using the available sampling and were randomly assigned to the experimental and control groups (each group included 15 people). The inclusion criteria comprised patients who obtained a higher–than–average score on the Yale–Brown Obsessive–Compulsive Scale (Y–BOCS), had at least a diploma level of education, and did not simultaneously participate in other therapeutic interventions. The exclusion criteria comprised the absence of more than three sessions from the intervention program and disobeying the rules of group therapy. Both groups completed the Ambiguity Tolerance Questionnaire (Mclain, 1993) and Distress Tolerance Scale (Simons & Gaher, 2005) in the pretest and posttest. The experimental group received schema therapy in 13 ninety–minute sessions, one session per week. No treatment program was provided for the control group. Data analysis was carried out in two parts: descriptive statistics and inferential statistics. At the level of descriptive statistics, frequency, percentage, mean, and standard deviation were used. At the level of inferential statistics, multivariate covariance analysis and univariate covariance analysis were used. Data analysis was done in SPSS version 24. The significance level of the tests was considered 0.05.

The schema therapy has significant effects on increasing the ambiguity tolerance variable (p<0.001) and increasing the subscales of the distress tolerance variable, including tolerance of emotional distress (p<0.001), absorption by negative emotions (p<0.001), mental estimation of distress (p<0.001) and regulation of efforts to relieve distress (p<0.001) in the experimental group with OCD.

According to the results, schema therapy improves distress tolerance and ambiguity tolerance in people with OCD by correcting dysfunctional thoughts, improves the distress tolerance and ambiguity tolerance in people with obsessive-compulsive disorder.