A Comparison of the Effectiveness of Virtual Reality Exposure Therapy with Cognitive-Behavioral Therapy on Ambiguity Tolerance in Individuals with Obsessive-Compulsive Disorder

Document Type : Research Paper

Authors

1 Department of psychology, Faculty of Educational Sciences and Psychology, Isfahan Branch (Khorasgan), Islamic Azad University, Isfahan, Iran.

2 Department of psychology, Faculty of Educational Sciences and Psychology, Isfahan Branch (Khorasgan), Islamic Azad University Isfahan, Iran.

Abstract

The objective of this investigation was to evaluate the efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder symptoms in individuals with the disorder in comparison to virtual reality exposure therapy. A quasi-experimental method was implemented, followed by a pretest-posttest and a two-month follow-up. The population consisted of all individuals who were referred to Nik Mehr Counseling and Psychological Services in Tehran during 2020 and 2021. Among them, 45 were selected through convenience sampling method, randomly assigned to experimental and control groups and administered Madzli's Obsessive-Compulsive Questionnaire (1980). Subsequently, the subjects were subjected to cognitive-behavioral therapy for 12 sessions (2 forty-five-minute sessions per week for 6 weeks) and virtual reality exposure for 12 sessions (2 eight-minute sessions per week for 6 weeks). No intervention was administered to the control group. The data was analyzed in SPSS.23 software using a Bonferroni post hoc test and mixed analysis of variance. The results indicated that both therapies were efficacious (F=192; Eta=0.67; P<0001) in reducing obsession syndromes in individuals with the disorder. Additionally, the follow-up test demonstrated that there is no statistically significant difference in the efficacy of these two therapies on individuals with obsessive-compulsive disorder (P<0.05). According to the results, since there is no difference in the effectiveness of virtual reality exposure therapy and cognitive-behavioral therapy, both can be applied to reduce obsession syndromes amongst people with the disorder.

Keywords


اصل علوی پایدار، س.، خدابخش، ر.، و مهری‌نژاد، س. ا. (1397). مقایسۀ اثربخشی درمان شناختی-رفتاری و فراشناختی بر درهم‌آمیختگی فکر بیماران مبتلا به وسواس فکری-عملی. روان‌شناسی بالینی و شخصیت. 16(2)، 51-41. https://doi.org/10.22070/cpap.2020.2856
اصلی آزاد، م.، منشئی، غ.، و قمرانی، ا. (1398الف). اثربخشی درمان مبتنی بر پذیرش و تعهد بر تنظیم شناختی هیجان و تحمل ابهام دانش‌آموزان مبتلا به اختلال وسواس فکری-عملی. روان‌شناسی افراد استثنایی. 9(36)، 53-33. https://doi.org/10.22054/jpe.2019.44480.2027
اصلی آزاد، م.، منشئی، غ.، و قمرانی، ا. (1398ب). اثربخشی درمانگری مبتنی بر پذیرش و تعهد بر نشانگان وسواس-ناخودداری و درآمیختگی فکر و عمل در دانش‌آموزان مبتلا به اختلال وسواس-ناخودداری. مجلۀ علوم روان‌شناختی. 18(73)، 76-67. http://psychologicalscience.ir/article-1-135-fa.html
افشاریان، ن.، و ابراهیمی قوام، ص. (1395). بررسی اثربخشی درمان مبتنی بر مواجهه از طریق واقعیت مجازی در کاهش هراس از رانندگی: بررسی تک‌آزمودنی. مطالعات روان‌شناختی. 12(1)، 124-111. https://doi.org/10.22051/psy.2016.2261
بخشی‌پور رودسری، ع.، هاشمی نصرت‌آباد، ت.، و نکونام، م. ص. (1394). مقایسۀ عدم تحمل ابهام و کمال‌گرایی در بین بیماران مبتلا به اختلال وسواسی-جبری و افراد عادی. مجلۀ روان‌شناسی بالینی. 7(1)، 50-41. https://doi.org/10.22075/jcp.2017.2189
پورمحسنی کلوری، ف.، شجاعی‌مقدم، آ.، جعفری، ع.، و مولایی، م. (1399). مقایسۀ نیمرخ شخصیتی، تحمل ابهام و مقابلۀ مذهبی در افراد مبتلا به سرطان خون و افراد سالم. روان‌شناسی سلامت. 9(1)، 60-45. https://doi.org/10.30473/hpj.2020.44151.4260
تبریزی، م.، منشئی، غ.، قمرانی، ا.، و راستی، ج. (1399). مقایسۀ اثربخشی درمان واقعیت مجازی با نوروفیدبک بر کمبود توجه دانش‌آموزان مقطع ابتدایی مبتلا به اختلال نقص‌توجه/ بیش‌فعالی. دانش و پژوهش در روان‌شناسی کاربردی. 21(1)، 128-115. https://doi.org/10.30486/jsrp.2019.1872455.1910
سلمانی، ب.، و حسنی، ج. (1395). نقش عدم تحمّل ابهام و باورهای فراشناختی مثبت در اختلال‌های وسواس فکری عملی و افسردگی اساسی. مجلۀ علوم پزشکی رازی. 23(142)، 72-64. http://rjms.iums.ac.ir/article-1-3491-fa.html
فرنوش، ف.، و خدادادی، م.، و نوحی، ش. (1398). مقایسۀ اثربخشی درمان مبتنی بر فناوری واقعیت مجازی و ذهن‌آگاهی-پذیرش بر خودکارآمدی اجتماعی و نشانه‌های اختلال اضطراب اجتماعی. روان‌شناسی بالینی. 11(1)، 26-13. https://doi.org/10.22075/jcp.2019.17390.1642
قمری گیوی، ح.، محمودی، ه‍.، و نریمانی، م. (1394). اثربخشی روش‌های درمان شناختی و انزجاری بر علائم اختلال وسواس فکری-عملی. تحقیقات علوم رفتاری. 13(3)، ۴۵۱-۴۴۱. http://rbs.mui.ac.ir/article-1-418-fa.html
کیانی، م.، منشئی، غ.، قمرانی، ا.، و راستی، ج. (1399). مقایسۀ اثربخشی دارودرمانی و واقعیت مجازی بر اضطراب درد و شدت درد بیماران سوختگی. روان‌پرستاری. 8(2)، ۵۶-۴۵. http://ijpn.ir/article-1-1477-fa.html
گال، ج.، بورگ.، و گال، م. (1393). روش‌های تحقیق کمی و کیفی در علوم تربیتی و روان‌شناسی. ترجمۀمنیجه شهنی‌ییلاق و همکاران. تهران: دانشگاه شهید بهشتی و سمت.
لیهی، ر.، هولند، پ.، استفان، ج.، و مک‌گین، ل. (1395). مداخلات و طرح‌های درمانی برای افسردگی و اختلال‌های اضطرابی. ترجمۀ مهدی اکبری و مسعود چینی‌فروشان. تهران: ارجمند.
مرتضائی‌فر، س.، حمدیه، م.، باغداساریانس، آ.، و ترقی‌جاه، ص. (1399). مقایسۀ اثربخشی درمان شناختی-رفتاری و روان‌درمانی معنوی-مذهبی با تأکید بر آموزه‌های اسلامی بر شدت نشانگان وسواس فکری-عملی زنان مبتلا به وسواس شستشو. مطالعات روان‌شناختی. 16(4)، 40-25. https://doi.org/10.22051/psy.2021.29617.2118
منشئی، غ. (1400). مبانی درمان واقعیت مجازی در روان‌شناسی. اصفهان: نشر علمی و دانشگاهی دانشگاه آزاد اسلامی اصفهان.
اسلامی، پ.، منشئی، غ.، و حاج‌ابراهیمی، ز. (1397). اثربخشی شیوۀ درمان مواجهه‌ای واقعیت مجازی بر کاهش اضطراب در افراد مبتلا به هراس از پرواز. روان‌شناسی بالینی و شخصیت. 16(2)، 199-191. https://jcps.atu.ac.ir/article_543.html
References
Afsharian, N., & Eebrahimighavam, S. (2016). The Study of Effectiveness of Virtual Reality Exposure Therapy in Reducing the Driving Phobia: A Case Study. Journal of Psychological Studies12(1), 65-84. https://doi.org/10.22051/psy.2016.2261
Akkan, H., Seyyar, G. K., Aslan, B., & Karabulut, E. (2022). The effect of virtual reality-based therapy on fear of falling in multiple sclerosis: A systematic review and meta-analysis. Multiple Sclerosis and Related Disorders, 63(12), 1037-1040. https://doi.org/10.1016/j.msard.2022.103791
Asl Alavi Paidar, S. S., Khodabakhsh, R., & Mehrinejad, S. A. (2020). Comparison of the effectiveness of behavioral-cognitive & metcognitive approaches on thought fusion in patient with Obsessive Compulsive Disorder with one month follow up. Clinical Psychology and Personality16(2), 41-51. https://doi.org/10.22070/cpap.2020.2856 (In Persian)
Asli Azad, M., Manshaee, G. R., & Ghamarani, A. (2020.). Effectiveness of acceptance and commitment therapy on cognitive emotion regulation and intolerance of uncertainty of the students with obsessive-compulsive disorder. Psychology of Exceptional Individuals9(36), 33-53. https://doi.org/10.22054/jpe.2019.44480.2027 (In Persian)
Asli azad, M., Manshaei, G. R, & Ghamarani, A. (2019). Effectiveness of acceptance and commitment therapy on the signs of obsessive-compulsive disorder and thought-action fusion in the students with obsessive-compulsive disorder. Journal of Psychological Science, 18(73), 67-76. http://psychologicalscience.ir/article-1-135-en.html (In Persian)
Bakhshipour, A., Hashemi-Nosratabad, T., & Nekunam, M. (2015). Comparison of intolerance of ambiguity and perfectionism among patients with obsessive-compulsive disorder and ordinary people. Journal of Clinical Psychology7(1), 41-50. https://doi.org/10.22075/jcp.2017.2189 (In Persian)
Belloch, A., Cabedo, E., Carrió, C., Lozano-Quilis, J. A., Gil-Gómez, J. A., & Gil-Gómez, H. (2014). Virtual reality exposure for OCD: is it feasible? Revista de Psicopatología y Psicología Clínica19(1), 37-44. https://doi.org/10.5944/RPPC.VOL.19.NUM.1.2014.12981
Boger, S., Ehring, T., Schwarzkopf, W., & Werner, G. G. (2020). Potential mediators of the association between childhood maltreatment and obsessive-compulsive disorder in adulthood. Journal of Obsessive-Compulsive and Related Disorders, 27(54), 1005-1009. https://doi.org/10.1016/j.jocrd.2020.100587
Brinkman, W. P., Van Der Mast, C., Sandino, G., Gunawan, L. T., & Emmelkamp, P. M. G. (2010). The therapist user interface of a virtual reality exposure therapy system in the treatment of fear of flying. Interacting with Computers, 114(3), 299–310. https://doi.org/10.1016/j.intcom.2010.03.005
Cullen, A. J., Dowling, N. L., Segrave, R., Carter, A., & Yücel, M. (2021). Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder. Journal of Anxiety Disorder, 80(16), 102404. https://doi.org/10.1016/j.janxdis.2021.102404
Eslami, P., Manshaee, G., & Hajebrahimi, Z. (2013). Effectiveness of Virtual Reality on Alleviating Fear of Flying in People with Aviophobia. Clinical Psychology Studies4(13), 43-62. https://jcps.atu.ac.ir/article_543.html (In Persian)
Farnoush, F., Khodadadi, M., & Nouhi, S. (2019). Comparison of the effectiveness of virtual reality therapy and mindfulness-acceptance therapy on social self-efficacy and social anxiety disorder symptoms. Journal of Clinical Psychology11(1), 13-26. https://doi.org/10.22075/jcp.2019.17390.1642 (In Persian)
Francova, A., Darmová, B., & Fajnerová, I. (2019). Virtual Reality Exposure Therapy in Patients with Obsessive-Compulsive Disorder. 2019 International Conference on Virtual Rehabilitation (ICVR), Tel Aviv. http://dx.doi.org/10.1109/ICVR46560.2019.8994404
Gall, M. D., Borg, W. R., & Gall, J. P. (1996). Educational research: An introduction (6th ed.). Translated by: A. R. Nasr et al. Tehran: University of Shahid Beheshti and SAMT. (In Persian)
Ghamari Givi, H., Mahmoodi, H., & Narimani, M. (2015). Efficacy of the cognitive and Aversion therapy methods in the treatment Symptoms of obsessive-compulsive disorder. Journal of Reaearch Behavioral Sciences, 13(3), 441-451. http://rbs.mui.ac.ir/article-1-418-en.html (In Persian)
Gillett, S. B., Bilek, E. L., Hanna, G. L., & Fitzgerald, K. D. (2018). Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment. Clinical Psychology Review, 60(74), 100-108. https://doi.org/10.1016/j.cpr.2018.01.007
Hezel, D. M., Stewart, S. E., Riemann, B. C., & McNally, R. J. (2019). Standard of proof and intolerance of uncertainty in obsessive-compulsive disorder and social anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 64(19), 36-44. https://doi.org/10.1016/j.jbtep.2019.02.002
Hodson, R. J., & Rachman, S. (1977). Obsessionalcompulsive complaints. Journal of Behavior Research Therapy, 15(3), 389-395. https://doi.org/10.1016/0005-7967(77)90042-0
Kiani, M., Manshaee, G., Ghamarani, A., & Rasti, J. (2020). Comparing the effectiveness of drug therapy and virtual reality on pain anxiety and pain severity of burn patients in Imam Musa Kazem Center in Isfahan. Iranian Journal Psychiatric Nursing, 8(2), 45-56. http://ijpn.ir/article-1-1477-en.html (In Persian)
Leahy, R. L., Holland, S. J., & McGinn, L. K. (2011). Treatment plans and interventions for depression and anxiety disorders. Translated by: M. Akbari & M. Chiniforoushan. Tehran: Arjamand. (In Persian)
Manshaee, Gh. (2021). The basics of virtual reality therapy in psychology. Islamic Azad Isfahan: Isfahan Islamic Azad University Scientific and Academic Publication. (In Persain)
Matsumoto, K., Hamatani, S., Makino, T., Takahashi, J., Suzuki, F., Ida, T., ... & Shimizu, E. (2022). Guided internet-based cognitive behavioral therapy for obsessive-compulsive disorder: A multicenter randomized controlled trial in Japan. Internet Interventions, 28(20), 1005-1009. https://doi.org/10.1016/j.invent.2022.100515
McKay, D. (2021). Introduction to the Special Issue: Mechanisms of Action in Cognitive-Behavior Therapy. Behavior Therapy, 50(6), 1013-1015. https://doi.org/10.1016/j.beth.2019.07.006
McLain, D. L. (1993). The MSTAT-I: A new measure of an individual’s tolerance for ambiguity, Educational and Psychological Measurement, 53(2), 183-189. https://doi.org/10.1177/0013164493053001020
Mohyadini, H., Bakhtiarpoor, S., Pasha, R., & Ehteshamzadeh, P. (2021). Comparison the effectiveness of cognitive behavioral group therapy” and drug therapy (fluoxetine) on symptoms of obsessive-compulsive disorder. Journal of Health Promotion Management, 10(1), 23-33. http://jhpm.ir/article-1-1019-en.html
Mortezaeifar, S., Hamdieh, M., Baghdasaryans, A., & Targhi Jah, S. (2021). Comparison of cognitive behavior therapy and Islamic based spiritual religion psychotherapy on the intensity of the symptoms of obsessive-compulsive of women with washing Compulsive. Journal of Psychological Studies16(4), 25-40. https://doi.org/10.22051/psy.2021.29617.2118 (In Persian)
Pascual-Vera, B., Belloch, A., Ghisi, M., Sica, C., & Bottesi, G. (2021). To achieve a sense of rightness: The joint role of not just right experiences and intolerance of uncertainty in obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 29(112), 1006-1009. https://doi.org/10.1016/j.jocrd.2021.100627
Pinciotti, C. M., Riemann, B. C., & Abramowitz, J. S. (2021). Intolerance of uncertainty and obsessive-compulsive disorder dimensions. Journal of Anxiety Disorders, 81(11), 1024-1029. https://doi.org/10.1016/j.janxdis.2021.102417
Pourmohseni Koluri, F., Shojaee, A., Jafari, I., & Mowlaie, M. (2020). Comparison of personality profiles, tolerance for ambiguity and religious coping in leukemia patients and healthy people. Health Psychology, 9(33), 45-60. https://doi.org/10.30473/hpj.2020.44151.4260 (In Persian)
Pozza, A., Dèttore, D., Marazziti, D., Doron, D., Barcaccia, B., & Pallini, S. (2021). Facets of adult attachment style in patients with obsessive-compulsive disorder. Journal of Psychiatric Research, 144(144), 14-25. https://doi.org/10.1016/j.jpsychires.2021.09.045
Reid, J. R., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Naomi, A. (2021). Fineberg cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Compr Psychiatry, 106(19), 152223. https://doi.org/10.1016/j.jpsychires.2021.09.045
Remmerswaal, K. C. P., Lans, L., Seldenrijk, A., Hoogendoorn, A. W., & Van Balkom, A. J. L. M., Batelaan, N. M. (2021). Effectiveness and feasibility of intensive versus regular cognitive behaviour therapy in patients with anxiety and obsessive-compulsive disorders: A meta-analysis. Journal of Affective Disorders Reports, 6(2), 1002-1008. https://doi.org/10.1016/j.jadr.2021.100267
Riquelme-Marín, A., Rosa-Alcázar, A. I., & Ortigosa-Quiles, J. M. (2022). Mindfulness-based psychotherapy in patients with obsessive-compulsive disorder: A meta-analytical Study. International Journal of Clinical and Health Psychology, 22(3), 1003-1006. https://doi.org/10.1016/j.ijchp.2022.100321
Salmani, B., & Hasani, J. (2016). The role of intolerance of uncertainty and positive metacognitive beliefs in obsessive compulsive disorder and depression. RJMS, 23(142), 64-72. http://rjms.iums.ac.ir/article-1-3491-fa.html (In Persian)
Sharifpour, S. H, Manshaee G. R, & Sajjadian I. (2021). Effects of virtual reality therapy on perceived pain intensity, anxiety, catastrophising and self-efficacy among adolescents with cancer. Counselling and Psychotherapy Research, 21(1), 218-226. https://doi.org/10.1002/capr.12311
Stang, F., Palutturi, S., Amiruddin, R., & Syafar. M. (2020). Development of cognitive behavior therapy apps application on depression management in patients of diabetes mellitus type II. Enfermería Clínica, 30(5), 21-27. https://doi.org/10.1016/j.enfcli.2019.11.017
Tabrizi, M., Manshaee, Gh., Ghamarani, A., & Rasti, J. (2020). Comparison of the effectiveness of virtual reality therapy with neurofeedback on attention deficit of ADHD elementary students. Knowledge & Research in Applied Psychology, 21(1), 8-19. https://doi.org/10.30486/jsrp.2019.1872455.1910 (In Persian)
Toffolo, M. B. J., Hout, M. A., Engelhard, I. M., Hooge, I. T. C., Cath, D. C. (2014). Uncertainty, checking, and intolerance of uncertainty in subclinical obsessive-compulsive disorder: An extended replication. Journal of Obsessive-Compulsive and Related Disorders, 3(4), 338-344. https://doi.org/10.1016/j.jocrd.2014.08.004
Wickberg, F., Lenhard, F., Aspvall, K., Serlachius, E., Andrén, P., Johansson, F., ... & Mataix-Cols, D. (2022). Feasibility of internet-delivered cognitive-behavior therapy for obsessive-compulsive disorder in youth with autism spectrum disorder: A clinical benchmark study. Internet Interventions, 28(84), 1005-1008. https://doi.org/10.1016/j.invent.2022.100520
 
Volume 15, Issue 3
November 2024
Pages 331-347
  • Receive Date: 12 August 2022
  • Revise Date: 01 October 2022
  • Accept Date: 11 October 2022
  • First Publish Date: 19 August 2024
  • Publish Date: 22 October 2024