Volume 24, Issue 4 (Winter 2019)                   IJPCP 2019, 24(4): 356-369 | Back to browse issues page

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Shameli L, Mehrabizadeh Honarmand M, Naa'mi A, Davodi I. The Effectiveness of Emotion-Focused Therapy on Emotion Regulation Styles and Severity of Obsessive-Compulsive Symptoms in Women With Obsessive-Compulsive Disorder. IJPCP. 2019; 24 (4) :356-369
URL: http://ijpcp.iums.ac.ir/article-1-2828-en.html
1- PhD. in Psychology, Assistant Professor, Department of General Psychology, Faculty of Literature and Humanities, Salman Farsi University of Kazeroon, Kazeroun, Iran. , Lshameli29@yahoo.com
2- PhD. in Psychology, Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahwaz, Iran.
3- PhD. in Psychology, Associate Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahwaz, Iran.
4- PhD. in Psychology, Assistant Professor, Department of Psychology, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahwaz, Iran.
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Extended Abstract
1. Introduction

ymptoms of Obsessive-Compulsive Disorder (OCD) are not pleasing obsessive thoughts and compulsive actions. The results of the studies on patients with anxiety and mood disorders indicate that in comparison with the control group, these individuals present a range of emotional problems such as severe reactions to emotional experience and disturbance in the correction of negative emotions. Emotional responses should be regulated, because emotion setting has different consequences in one’s life, especially in social and compromising issues. 
During research on various patients, including those with OCD, defects in emotional regulation styles have been reported as one of their major problems. Applying a therapeutic approach that helps patients with their abnormal emotional experiences will be beneficial. This kind of therapy that directly deals with emotions and tries to overcome emotional problems is an Emotion-Focused Therapy (EFT). It helps patients to enrich their emotional knowledge, work (not confront with excitement), change and improve them. Research indicates lack of such approaches for patients with OCD. The present research seeks to answer the question of whether EFT affects the emotional regulation styles and the severity of obsessive-compulsive symptoms in patients with OCD at the post-test and follow-up stage.

2. Method
The statistical population of this study was all women with OCD referring to clinics and counseling centers of Ahwaz City, Iran. To select the eligible samples, the suitable candidates were recruited by referring to the psychiatric centers and clinics in Ahvaz and enrolling the patients with the diagnosis of OCD and other criteria (at least third grade middle school, aged between 18 and 35 years, no drug intake since one month before beginning treatment). For definitive diagnosis, the researcher conducted a clinical interview with them and implemented the Yale-Brown scale. After meeting the criteria and obtaining at least 16 score of Yale-Brown scale, 30 women were selected by available sampling method and randomly assigned into two groups (experimental and control groups). 
Six individuals in the sample group were excluded from the eight 90-minute treatment sessions (that were performed twice a week) because they did not completely participate in sessions. Finally, a sample of 24 women with OCD in experimental group (12 subjects) and control group (12 subjects) were evaluated with Affective Styles Questionnaire (ASS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and EFT protocol in three stages (pre-test, post-test and follow-up) and then the results were compared using covariance test. 

3. Results
 The results indicate a significant difference between the women in the experimental group and control group in terms of concealing style from emotional regulation styles in the post-test and follow-up stages. Also, there was a difference between two groups in terms of severity of obsessive-compulsive symptoms. Considering the mean score of concealing style in the experimental group compared to control group and also the mean score of severity of obsessive-compulsive symptoms in the experimental group compared to the control group, EFT increased concealing style and reduced the severity of obsessive-compulsive symptoms in women suffering from OCD in the experimental group.

4. Discussion
The purpose of this study was to investigate the effectiveness of EFT on emotion regulation styles and severity of obsessive-compulsive symptoms in women with OCD. The results of multivariate covariance analysis indicate that EFT among the three emotion regulation styles has a significant effect only on the concealing style in post-test and follow-up stages. The effectiveness of the treatment was to enhance the style of concealing and reduced severity of obsessive-compulsive symptoms in the experimental group compared to the control group. 
The process of EFT protocol is to lead the patient toward internal control (instead of external control). Hence, we did not expect that the concealing style of emotion regulation exaggerated because of treatment. In addition, it can be pointed out that patients were required at the end of the therapeutic process to use practical solutions, rather than to use obsessive-compulsive strategies. Consequently, over time, obsessive-compulsive patients consider the use of concealing style as a practical way of controlling their emotions, in order to increase their level of awareness and responsibility by reflecting on their own inner ties. 
To explain the reduction in the severity of obsessive-compulsive symptoms, it can be noted that EFT has principles that help patients overcome their feelings of guilt and maladaptive shame. Researchers have identified these feelings as important factors in the continuation of OCD. So that if obsessive patients can reduce their high levels of self-criticism and feelings of shame during the course of treatment, the likelihood of the continuation of symptoms of this disorder diminishes.
In sum, EFT helps patients become aware of their emotions, and rebuild abnormal cognitive-emotional schemas, which are often the basis of anxiety symptoms. These findings potentially provide important implications for practitioners and therapists to treat obsessive-compulsive patients. One of the implications of this study is to provide a clear prospect for clinicians who in their treatment sessions with obsessive-compulsive patients do not pay attention to the primary and secondary excitement of patients, and do not inform them of abnormal emotions that occur during obsessions and compulsion behavior. Other benefit of this treatment is its low cost due to the short-term and group-based nature of the protocol, as Ellis believes that the best treatment is to teach patients how to deal with life’s problems in a limited time.

Ethical Considerations
Compliance with ethical guidelines

In this research, the form of ethical considerations was filled by the patients and was followed by the researchers.

This article is from the PhD. dissertation of Leila Shameli in Department of Psychology, Shahid Chamran University of Ahvaz.

Authors contributions
The authors contributions is as follows: Conceptualization: all authors; Methodology: Leila Shameli; Validation: all authors; Analysis: all authors; Research: Leila Shameli; Sources: Leila Shameli; Writing draft: Leila Shameli; Editing and finalizing: Leila Shameli; and Project management: all authors.

Conflict of interest
The authors declare no conflict of interest.

In the end, we appreciate the director of Taravat Counseling Center, who provided the consultation center space.
Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2018/03/27

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