A New Scrupulosity Scale for the Dimensional Obsessive-Compulsive Scale (DOCS): Validation With Clinical and Nonclinical Samples

Evaluation of an acceptance and commitment therapy with religious content to control obsessive-compulsive disorder, dysfunctional beliefs, feeling guilty, scrupulosity, and thought control among Muslims in Iran

BACKGROUND

The present study aimed to develop an integrated protocol by combining religious content and acceptance and commitment therapy (ACT) and evaluate its effectiveness in controlling obsessive-compulsive disorder (OCD), dysfunctional beliefs, feeling guilt, scrupulosity, and thought control among Muslims in Tehran, Iran.

MATERIALS AND 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 3-month follow-up. In the quantitative stage, the inclusion criteria were meeting the diagnostic criteria for OCD based on the diagnostic interview of a psychiatrist, having religious purity/impurity obsessions, not receiving minimum psychological treatment for at least one month before entering the study, religious commitment; minimum age of 18 years and maximum age of 50 years; and having at least a high school diploma. The exclusion criteria from the research were as follows: age over 50 years; educational level of less than a high school diploma; having a personality disorder; receiving other treatments, inability to participate in sessions; and being introduced by a family member. The experimental and control groups participated in 25 individual treatment sessions based on the adapted protocol and 8 conventional ACT sessions.

RESULTS

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.

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.

Rethinking Unacceptable Thoughts: Validation of an Expanded Version of the Dimensional Obsessive-Compulsive Scale

The Dimensional Obsessive-Compulsive Scale (DOCS) is widely used to measure obsessive-compulsive disorder (OCD) severity across four broad symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, symmetry). Despite its proven utility, there is reason to suspect that the unacceptable thoughts subscale conflates different types of unacceptable thoughts that are meaningfully distinct from one another. In the current study, we first evaluated the psychometric properties of a newly developed DOCS violent and/or aggressive thoughts subscale. We then examined the factor structure, psychometric properties, and diagnostic sensitivity of a seven-factor version of the DOCS that includes the four original DOCS subscales and three more-specific versions of the unacceptable thoughts scale (i.e., sexually intrusive thoughts, violent and/or aggressive thoughts, and scrupulous or religious thoughts). The sample included 329 residential and intensive outpatients, the majority of which had a diagnosis of OCD (75.2%). The new unacceptable thoughts subscales demonstrated convergent and discriminant validity with unique associations between the subscales and depression, suicide, and perceived threat from emotions that were not present in the broader unacceptable thoughts subscale. The seven-factor version of the DOCS demonstrated slightly lower levels of diagnostic sensitivity than the original DOCS. Thus, the four-factor version of the DOCS is recommended for screening purposes. A score of 40 or higher on the seven-factor version of the DOCS best predicted a diagnosis of OCD. Overall, the three additional unacceptable thoughts subscales appear to be distinct factors that have potential value in research and clinical settings.

Clinical Considerations for an Evidence-Based Assessment for Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is an impairing mental health disease, generally beginning in childhood, affecting up to ∼3% of the population. Using evidence-based assessments (EBAs) is the starting point for the accurate diagnosis and treatment of OCD. EBAs consist of structured and semistructured clinician-administered interviews, parent-report and child-report, and self-report for adults. This article details the practical application, psychometric properties, and limitations of available assessments to determine the presence of OCD and evaluate OCD symptom severity. The following reviews measurement of constructs relevant to OCD (ie, insight, family accommodation, impairment) and details considerations for best clinical interview practices.

Best practices for CBT treatment of taboo and unacceptable thoughts in OCD

Although general cognitive behavioural therapy (CBT) can help alleviate distress associated with obsessive-compulsive disorder (OCD), strategies tailored to targeting specific cognitions, feelings, and behaviours associated with OCD such as exposure and ritual prevention (Ex/RP) and cognitive therapy (CT) have been shown to be a significantly more effective form of treatment. Treatment of individuals with unacceptable/taboo obsessions requires its own specific guidelines due to the stigmatizing and often misunderstood nature of accompanying thoughts and behaviours. In this article, OCD expert practitioners describe best practices surrounding two of the longest standing evidence-based treatment paradigms for OCD, CT and Ex/RP, tailored specifically to unacceptable and taboo obsessions, so that clients may experience the best possible outcomes that are sustained once treatment ends. In addition, CT specifically targets obsessions while Ex/RP addresses compulsions, allowing the two to be highly effective when combined together. A wide range of clinical recommendations on clinical competencies is offered, including essential knowledge, psychoeducation, designing fear hierarchies and exposures, instructing the client through behavioural experiments, and relapse prevention skills.

Key learning aims

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