Clinical Psychology: Research and Practice Innovations

Clinical Psychology: Research and Practice Innovations"

Presenting a causal model of obsessive-compulsive disorder in adolescents based on psychological flexibility and metacognitive with the mediating role of mindfulness

Document Type : Original Article

Authors
Sina Safari 1
Mojtaba Nadri 1
Behnaz Koolivand 2
Masoud Sadeghi 3
1 PhD student in General Psychology, Lorestan University, Khorramabad, Iran
2 Master of General Psychology, Lorestan University, Khorramabad, Iran
3 Associate Professor, Department of Psychology, Lorestan University, Khorramabad, Iran
10.22075/jcp.2021.20817.1912
Abstract
introduction: Obsessive-compulsive disorder is one of the most common psychological disorders in adolescents with a relatively high prevalence. This disorder causes a lot of social and economic costs for the affected people and society and affects their social, educational and occupational functions. The aim of this study was to explain the symptoms of obsessive-compulsive disorder based on psychological flexibility and metacognitive beliefs with the mediating role of mindfulness.
Method: The present study was cross-sectional and correlational. 225 male and female high school students in Aleshtar city in the academic year 1397-98 were selected using multi-stage cluster sampling. Data collection tools were metacognition questionnaire, obsessive-compulsive disorder questionnaire, acceptance and practice questionnaire and mindfulness questionnaire. Pearson correlation coefficient and structural equations were used to analyze the findings.
Results: The evaluation of the model showed the acceptable fit of the hypothetical model.The results of model analysis showed that the predictor variables of psychological flexibility and metacognitive beliefs were directly and indirectly mediated by the awareness of mindfulness on the symptoms of obsessive-compulsive disorder had a significant effect (p <0.01). Also, the variable of mindfulness had a direct and significant effect on obsessive-compulsive disorder (p <0.01).
Conclusion: The results indicate that psychological flexibility and adjustment of dysfunctional metacognitive beliefs can reduce the symptoms of obsession, and Meanwhile, mindfulness as a mediating variable is part of the process of reducing obsessive-compulsive symptoms.
Keywords
Obsessive-compulsive disorder
psychological flexibility
Meta-cognitive
Mindfulness

  1.  

    1. World Health Organization: Adolescents: health risks and solutions. 2017. http://www.who.int/mediacentre/factsheets/fs345/en/
    2. Chowdhury HR, Mullick MS, Arafat Y. Clinical Profile and Comorbidity of Obsessive- Compulsive Disorder among Children and Adolescents: A Cross-Sectional Observation in Bangladesh. Psychiatry Journal. 2008; 7(3).
    3. Ganji M, Ganji H. Psychological Pathology Based on DSM-5. Third edition. Volume 1. Tehran. publication of Savalan. 2016.
    4. Shams G, Foroughi E, Esmaili Y, Amini A, Ebrahimkhan N. Prevalence Rates of Obsessive-Compulsive Symptoms and Psychiatric Comorbidity Among Adolescents in Iran. Acta Medica Iranica. 2010; 49(10): 680-687. [in persion]
    5. van Oudheusden L, Eikelenboom, M, van Megen H, Visser, H, Schruers K, Hendriks G van der Wee N, Hoogendoorn A, van Oppen P, van Balkom, A. Chronic obsessive–compulsive disorder: Prognostic factors. Psychological Medicine. 2018; 48, 1–10.
    6. Vaidya N, Adhikari K. The Role of Rumination in the Relationship between Attention Deficits and Obsessive Compulsive Symptoms among Non Clinical Sample. Nternational. Journal Of Public Mental Health And Neurosciences. 2014; 1(1); 34-39.
    7. Malakar P, Basu J, Chaudhuri A. The Effect of Obsession Thoughts on Intelligences Achievement Relationship of Late Adolescents. Journal of the Indian Academy of Applied Psychology. 2009; 35(2):277-282.
    8. Vivan A, Rodrigues L, Wendt L, Giaretton Bicca M Cordioli A. Quality of life in adolescents with obsessive-compulsive disorder. Revista Brasileira de Psiquiatria. 2013; 35: 369–374.
    9. Badri Gargari R, Kazemi F, Abdollahi F. The relationship between perfectionism, obsessive compulsive behavior and personality traits with procrastination of martyred students. Journal of Psychological Studie. 2015; 11(2): 26-46. [in persion]
    10. Leeuwerik T, Cavanagh K, Strauss C. The Association of Trait Mindfulness and Self‑compassion with Obsessive ‑ Compulsive Disorder Symptoms: Results from a Large Survey with Treatment‑Seeking Adults. Cognitive Therapy and Research. 2020; 44: 120–135.
    11. Neff KD, Germer C, Siege R.The science of self-compassion. New York: Guilford Press: Compassion and Wisdom in Psychotherapy. 2012; pp. 79-92.
    12. Bryan C, Ray-Sannerud B, Heron E. Psychological flexibility as a dimension of resilience for posttraumatic stress, depression, and risk for suicidal ideation among Air Force personnel. Journal of Contextual Behavioral Science. 2015; 12(5).
    13. Kabat-Zinn, J. Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice. 2003; 10: 144–156.
    14. Pourmohamadi S, Bagheri F. Effectiveness of Mindfulness Training on Automatic Cognitive Processing. Psychological Studies. 2015; 11(3): 142-160. [in persion]
    15. Crowe K, McKay D. Mindfulness, Obsessive–Compulsive Symptoms, and Executive Dysfunction. Cogn Ther Res. 2016; 6: 1-18.
    16. Külz A, Landmann S, Cludius B, Hottenrott B, Rose N. Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial. BMC Psychiatry. 2014; 14:314, 1-9.
    17. Esfand Zad AH, Shams G, Meysami AP, Erfan A. The Role of Mindfulness, Emotion Regulation, Distress Toler-ance and Interpersonal Effectiveness in Predicting Obsessive-Compulsive Symptoms. Iranian Journal of Psychiatry & Clinical Psychology. 2015; 22(4): 270-283. [in persion]
    18. Oguz G, Celikbas Z, Batmaz S, Cagli S, Zihni Sungu M. Comparison Between Obsessive Compulsive Disorder and Panic Disorder on Metacognitive Beliefs, Emotional Schemas, and Cognitive Flexibility. International Journal of Cognitive Therapy. 2019; 12(10).
    19. Gutierrez R, Hirani T, Curtis L, Ludlow, A. Metacognitive beliefs mediate the relationship between anxiety sensitivity and traits of obsessive-compulsive symptoms. Psychology. 2020; 40(8): 1-7.
    20. Irak M, Tosun A. Exploring the role of metacognition in obsessive–compulsive and anxiety symptoms. Journal of Anxiety Disorders. 2008; 22: 1316–1325.
    21. Wells A. Metacognitive therapy for anxiety and depression. London: the Guilford Press. 2009.
    22. Hansmeier J, Exner CW. A test of the metacognitive model of obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders. 2016; 10: 42–48.
    23. Heiden C, Rossen K, Dekker A, Damstra M. Metacognitive therapy for obsessive–compulsive disorder: A pilot study. Journal of Obsessive-Compulsive and Related Disorders. 2016; 9: 24–29.
    24. Purdon C, Clark DA. Meta cognition and Obsessions. Clinical Psychotherapy. 1999; 6: 102 -110.
    25. Cejudo JR, Salguero M. Negative metacognitive beliefs moderate the influence of perceived stress and anxiety in long-term anxiety. Psychiatry Research. 2017; 10(16): 12-28.
    26. Gonzáleza PO, Álvarezb MP, Montesc JM, Garcelánd S, Fernándeze OV. The mediating role of metacognitive variables in the relationship between Thought-Action Fusion and obsessive-compulsive symptomatology. Suma Psicológica. 2017; 23 (2): 80–89.
    27. Myers S, Grøtte T, Haseth S, Guzey IC, Hansen B, Vogel PA. The role of metacognitive beliefs about thoughts and rituals: a test of the metacognitive model of obsessive-compulsive disorder in a clinical sample. Journal of Obsessive-Compulsive and Related Disorders. 2017; 13: 1-27.
    28. Hassanzadeh A, Sharifi P, Sohrabi F. Comparison of meta-cognitive beliefs in adolescents with and without obsessive-compulsive disorder. Journal of Psychological Studies. 2013; 9(1):92-107. [in persion] 29. Samani B, Mohammadi N, Rahimi, Ch. Investigating Psychological Flexibility and Emotional Schemas in OCD Rehabilitation. American Journal of Psychology and Cognitive Science. 2018; 4(3): 46-50.
    29. Hayes SC, Strosahl K, Wilson KG. Acceptance and Commitment Therapy The Process and Practice of Mindful Change. Second Edition. The Guilford Press: 2012; p. 64-66.
    30. Hayes SC, Pistorello J, Levin ME. Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist. 2012; 40(7). 976-1002.
    31. Twohig M, Vilardaga JP, Levin ME, Hayes SC. Changes in psychological flexibility during acceptance and commitment therapy for obsessive compulsive disorder. Journal of Contextual Behavioral Science. 2015; 4: 196–202.
    32. Izadi R, Asgari K, Neshatdust H, Abedi M. The effect of acceptance and commitment therapy on the frequency and severity of symptoms of obsessive compulsive disorder. Zahedan J Res Med Sci (ZJRMS). 2012; 14(10): 107-112. [in persion]
    33. Armstrong AB. Acceptance and Commitment The rapy for Adolescent Obsessive-Compulsive Disorder. Logan: UTAH STATE UNIVERSITY. 2011; P.120-125.
    34. DeBerry L. The Relation Between Cognitive Inflexibility and Obsessive-Compulsive Personality Traits in Adults: Depression and Anxiety as Potential Mediators. Honors Theses. 2012; P. 55-60.
    35. Hussain D. Meta-Cognition in Mindfulness: A Conceptual Analysis. Psychological Thought. 2015; 8(2): 132–141. [in persion]
    36. Jankowski T, Holas P. Metacognitive model of mindfulness. Consciousness and Cognition. 2014; 28: 64–80.
    37. Fleming S, Dolan R. The neural basis of metacognitive ability. 2011; 367: 1338–1349.
    38. Farb NAS, Segal ZV, Mayberg H, et al. Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference. Social Cognitive and Affective Neuroscience. 2007; 2(4):313–22.
    39. Martínez Ruiz, Xicoténcatl. The alignment argument: at the crossroads between mindfulness and metacognition. Learning: Research and Practice. 2019. 4:1, 1-9.
    40. Foa EB, Coles ME, Huppert, JD, Pasupuleti R, Franklin ME, March JS. Development and validation of a child version of the Obsessive Compulsive Inventory. Behavior Therapy. 2010; 41: 121-132.
    41. Khoramdel K, Sajadian P, Bahrami F, Zangene S. Validation of the adolescent meta-cognition questionnaire version. Zahedan J Res Med Sci (ZJRMS). 2012; 14(1): 29-40. [in persion]
    42. Imani M. examine the factor structure of the Acceptance and Action Questionnaire-II in Students. Journal of Teaching and Learning. 2016; 8(1): 162-181. [in persion]
    43. Ghasemi Jowneh R, Arabzadeh M, Jalili Niko S, Mohammad Ali C. The validity and reliability of the Persian version of the Freiburg Mind Awareness Questionnaire. Journal of Rafsanjan University of Medical Sciences. 2014; 14 (2): 137-150. [in persion]
    44. Buchheld N, Walach H, Buttenmuller V, Kleinknecht N, Schmidt S. Measuring mindfulness - The Freiburg mindfulness inventory (FMI). Pers Individ Dif. 2006; 40: 1543-1555.
    45. Karimi J, Homayouni F, Homayouni Najaf Abadi S. Validation of the Persian version of the Obsessive-Compulsory Child Questionnaire. J Res Behav Sc. 2015; 13(3): 388-399. [in persion]
    46. Sharifi H, Farzad V, Reza Khani S, Hassan Abadi H. Multivariate Applied Research (Design and Interpretation). 2015; Third edition. Growth Publishing House«. Tehran. [in persion]
    47. Hertenstein E, Rose N, Voderholzer U, Heidenreich TH, Nissen Ch & et.al. Mindfulness-based cognitive therapy in obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders. 2012; 9: 24–29.
    48. Fairfax H. The Use of Mindfulness in Obsessive Compulsive Disorder: Suggestions for Its Application and Integration in Existing Treatment. Clinical Psychology and Psychotherapy. 2008; 15: 53–59.

  • Receive Date 07 July 2020
  • Revise Date 12 September 2021
  • Accept Date 12 December 2021
  • First Publish Date 21 March 2022
  • Publish Date 21 March 2022