Rethinking Cognitive Psycho-education -4T Model- in the Psychotherapy of Religious Obsessive-Compulsive Disorder: Report of Three Resistant Cases

Year 2024, Volume: 9 Issue: 1, 75 - 105, 01.02.2024

Taha Burak Toprak

https://doi.org/10.37898/spiritualpc.1319545

Cited By: 1

Abstract

Obsessive Compulsive Disorder is one of the most resistant disorders in the field of psychopathology. As this disorder challenges clinicians in pharmacological treatments; In psychotherapies, it brings together resistance in the areas of therapeutic alliance and healing. ERP, which is the gold standard, also fails when a full consensus cannot be achieved in the cognitive process. The Vesvese Treatise, was written for people with religious obsessions. The 4T Model (the first letters of the four cognitive levels in Turkish), adapted from the content of this work, was integrated into the classical treatment rationale of patients with CBT, and by using it in the fields of "formation and source of obsession", "normalization" and "cognitive restructuring", the stage of individualization of the CBT model for the patient was provided on the 4T model. The results obtained in 4 OCD Resistant Cases treated with this method showed that the model made a significant difference especially in the field of "thought-action fusion", and that it was convincing and practical in the "cognitive restructuring" process with the hierarchy of thought it presented.

Keywords

Obsessive Compulsive Disorder, Cognitive Behavioral Therapy, 4T Model

References

• Abramowitz, J. S. (1997). Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative Review. Journal of Consulting and Clinical Psychology, 65(1), 44–52. https://doi.org/10.1037/0022006X.65.1.44
• Abramowitz, J. S. (2001). Treatment of scrupulous obsessions and compulsions using exposure and response prevention: A case report. Cognitive and Behavioral Practice, 8(1), 79–85. https://doi. org/10.1016/S1077-7229(01)80046-8
• Abramowitz, J. S. (2006). The psychological treatment of obsessive—compulsive disorder. The Canadian Journal of Psychiatry, 51(7), 407-416. https://doi.org/10.1177/070674370605100702
• Abramowitz, J. S., & Hellberg, S. N. (2020). Scrupulosity. In Advanced casebook of obsessive- compulsive and related disorders (pp. 71-87). Academic Press.
• Abramowitz, J. S., & Jacoby, R. J. (2014). Scrupulosity: A cognitive-behavioral analysis and ı̇ mplications for treatment. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 140- 149. https://doi.org/10.1016/j.jocrd.2013.12.007
• Abramowitz, J. S., Deacon, B. J., Woods, C. M., & Tolin, D. F. (2004). Association between Protestant religiosity and obsessive-compulsive symptoms and cognitions. Depression and Anxiety, 20, 70-76. https://psycnet.apa.org/doi/10.1002/da.20021
• Abramowitz, J. S., Franklin, M. E., Schwartz, S. A., & Furr, J. M. (2003). Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 71(6), 1049–1057. https://doi.org/10.1037/0022- 006X.71.6.1049
• Abramowitz, J. S., Huppert, J. D., Cohen, A. B., Tolin, D. F., & Cahill, S. P. (2002). Religious obsessions and compulsions in a non-clinical sample: The Penn inventory of scrupulosity (PIOS). Behaviour Research and Therapy, 40(7), 825-838. https://doi:10.1016/s0005-7967(01)00070-5
• Abramowitz, J. S., Taylor, S., & McKay, D. (2005). Potentials and limitations of cognitive treatments for obsessive-compulsive disorder. Cognitive Behaviour Therapy, 34(3), 140–147. https://doi.org/10.1080/16506070510041202
• Abramowitz, J. S., Whiteside, S., Kalsy, S. A., & Tolin, D. F. (2003). Thought control strategies in obsessive-compulsive disorder: A replication and extension. Behaviour Research and Therapy, 41(5), 529–540. https://doi.org/10.1016/s00057967(02)00026-8
• Akuchekian, S. H., Almasi, A., Meracy, M. R., & Jamshidian, Z. (2011). Effect of religious cognitive behavior therapy on religious content obsessive compulsive disorder. Procedia-Social and Behavioral Sciences, 30, 1647-1651. https://doi.org/10.1016/j.sbspro.2011.10.319
• Akuchekian, S., Nabi, L. N., Emranifard, V., Najafi, M., & Almasi, A. (2015). The affect of religious cognitive-behavior therapy on quality of life obsessive–compulsive disorder. Advanced Biomedical Research, 3(1), 71-74. https://doi.org/10.19070/2332-3000-1500013
• Alimadadi, S., Najafi, M., Mohammadi, M., Rahimian Bogar, I., & Salmanian, M. (2020). Assessment the effect of spiritual psychotherapy protocol in groups on symptoms, cognitive factors and religious obsession in adult patients with obsessive compulsive disorder. Islamic Life Journal, 4(3), 18-25.
• Alonso, P., Menchon, J. M., Pifarre, J., Mataix-Cols, D., Torres, L., Salgado, P., & Vallejo, J. (2001). Long-term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy. Journal of Clinical Psychiatry, 62(7), 535-544. https://doi.org/10.4088/jcp.v62n07a06
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, (DSM-5). APA.
• American Psychological Association. (n.d.). Psyche. In APA dictionary of psychology. APA.
• Amir, N., Freshman, M., Ramsey, B., Neary, E., & Brigidi, B. (2001). Thought-action fusion in individuals with OCD symptoms. Behaviour Research and Therapy, 39(7), 765–776.
• Andersson, E., Steneby, S., Karlsson, K., Ljótsson, B., Hedman, E., Enander, J., Kaldo, V., Andersson, G., Lindefors, N., & Rück, C. (2014). Long-term efficacy of internet-based cognitive behavior therapy for obsessive-compulsive disorder with or without booster: A randomized controlled trial. Psychological Medicine, 44(13), 2877–2887. https://doi.org/10.1017/S0033291714000543
• Anholt, G. E., Aderka, I. M., van Balkom, A. J., Smit, J. H., Hermesh, H., de Haan, E., & van Oppen, P. (2011). The impact of depression on the treatment of obsessive–compulsive disorder: Results from a 5-year follow-up. Journal of Affective Disorders, 135(1–3), 201–207. https://doi. org/10.1016/j.jad.2011.07.018
• Aouchekian, S., Karimi, R., Najafi, M., Shafiee, K., Maracy, M., & Almasi, A. (2017). Effect of religious cognitive behavioral therapy on religious obsessive compulsive disorder (3 and 6 months follow-up). Advanced Biomedical Research, 6, 1-5. https://doi.org/10.4103/abr. abr_115_16
• Arip, A., Sharip, S., & Nabil, M. R. (2018). Islamic integrated exposure response therapy for mental pollution subtype of contamination obsessive-compulsive disorder: A case report and literature review. Mental Health, Religion & Culture, 21, 210–218. https://doi.org/10.1080/13674676.20 18.1436047
• Arshad, M. (2019). The history of psychology in Islam. American Journal of Humanities and Social Sciences Research (AJHSSR), 3, 187-193.
• Badri, M. (2017). Müslüman psikologların çıkmazı [The dilemma of muslim psychologist], Trans. İ. N. Kaya. Mahya.
• Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893– 897. https://doi.org/10.1037/0022-006X.56.6.893
• Beck, A. T., Ward, C., Mendelson, M., Mock, J., & Erbaugh, J. (1961). Beck Depression Inventory (BDI). Arch Gen Psychiatry, 4(6), 561-571. https://doi.org/10.1001/ archpsyc.1961.01710120031004
• Belhi (2012). Beden ve ruh sağlığı [Sustenance for the body and soul], Trans. M. Uysal. Endülüs.
• Besiroglu, L., Agargun, M.Y., Boysan, M., Eryonucu, B., Gulec, M., & Selvi, Y. (2005). Obsesif- kompulsif belirtilerin değerlendirilmesi: Padua Envanteri’nin Türk toplumunda geçerlik ve güvenilirliği [The assessment of obsessive-compulsive symptoms: the reliability and validity of the padua ınventory in a turkish population]. Türk Psikiyatri Dergisi, 16(3), 179-189.
• Besiroglu, L., Karaca, S., & Keskin, I. (2014). Scrupulosity and obsessive-compulsive disorder: The cognitive perspective in Islamic sources. Journal of Religion and Health, 53(1), 3–12. https://doi.org/10.1007/s10943-012-9588-7
• Beydavi (2011). Envarut tenzil ve esraruttevil [The lights of revelation and the secrets of interpretation], Trans. A. Öztürk. Kahraman.
• Bouchard, C., Rhéaume, J., & Ladouceur, R. (1999). Responsibility and perfectionism in OCD: An experimental study. Behaviour Research and Therapy, 37(3), 239–248.
• Bozkurt, A. (Ed.). (2021). Kaplan & Sadock’s comprehensive textbook of Psychiatry. Anxiety Disorders (pp.1718- 88). Günes Medical Bookstore.
• Çiftçi, Ş., & Kuru, T. (2013). Thought action fusion in obsessive compulsive disorder. Journal of Cognitive Behavioral Psychotherapy and Research, 2, 138-146.
• Clark, D. A. (2005). Focus on “cognition” in cognitive behavior therapy for OCD: Is it really necessary? Cognitive Behaviour Therapy, 34(3), 131–139.
• Clark, D. A. (1999). Cognitive behavioral treatment of obsessive-compulsive disorders: A commentary. Cognitive and Behavioral Practice, 6, 408-415. https://doi.org/10.1016/S1077- 7229(99)80059-5
• Clark, D. A. (2019). Cognitive-behavioral therapy for OCD and its subtypes. Guilford.
• Collins, L. M., & Coles, M. E. (2018). A preliminary investigation of pathways to inflated responsibility beliefs in children with obsessive compulsive disorder. Behavioral and Cognitive Psychotherapy, 46(3), 374–379. https://doi.org/10.1017/S1352465817000844
• Duarte, D. (2021). Cognitive behavioral therapy in obsessive-compulsive disorder: A review. European Psychiatry, 64(1), 418-S418. https://doi.org/10.1192/j.eurpsy.2021.1117
• Eric .A. S., Lewin, A.B., (Eds.). (2017). Treatment of scrupulosity in childhood obsessive compulsive disorder. Springer.
• Er-Razi (2019). Et-tıbbu’r-rûhânî [Spiritual medicine], Trans. H. Karaman. İz.
• Ferrão, Y. A., Shavitt, R. G., Bedin, N. R., de Mathis, M. E., Carlos Lopes, A., Fontenelle, L. F., Torres, A. R., & Miguel, E. C. (2006). Clinical features associated to refractory obsessive- compulsive disorder. Journal of Affective Disorders, 94(1-3), 199–209. https://doi.org/10.1016/j. jad.2006.04.019
• Fisher, P. L. (2009). Obsessive compulsive disorder: A comparison of CBT and the metacognitive approach. International Journal of Cognitive Therapy, 2(2), 107–122.
• Garcia, H. A. (2008). Targeting Catholic rituals as symptoms of obsessive-compulsive disorder: A cognitive-behavioral and psychodynamic, assimilative integrationist approach. Pragmatic Case Studies in Psychotherapy, 4, 1-38. https://doi.org/10.14713/pcsp.v4i2.931
• Gazali (1998). İhya’u ulum’id-din [The revival of the religious sciences], Trans. S. Gülle. Huzur.
• Giasuddin, N. A., & Hossain, M. J. (2020). Understanding obsessive compulsive disorder and management options. Faridpur Medical College Journal, 15(1), 38- 42.
• Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006–1011.
• Goz, I. (Ed.). (2021). Psikolojide araştırma yöntemleri [Research Methods in Psychology]. Nobel.
• Håland, Å. T., Vogel, P. A., Lie, B., Launes, G., Pripp, A. H., & Himle, J. A. (2010). Behavioural group therapy for obsessive–compulsive disorder in Norway. An open community-based trial. Behaviour Research and Therapy, 48(6), 547-554. https://doi.org/10.1016/j. brat.2010.03.005
• Healy, H. A., Barnes-Holmes, Y., Barnes-Holmes, D., Keogh, C., Luciano, C., & Wilson, K. (2008). An experimental test of a cognitive defusion exercise: Coping with negative and positive self- statements. The Psychological Record, 58, 623–640. https://doi.org/10.1007/BF03395641
• Hisli, N. (1989). Validity and reliability of Beck Depression Inventory for university students. Journal of Psychology, 7(23), 3-13.
• Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69(4), 621. https://doi.org/10.4088/jcp.v69n0415
• Huppert, J. D., & Siev, J. (2010). Treating scrupulosity in religious individuals using cognitive- behavioral therapy. Cognitive and Behavioral Practice, 17(4), 382–392. https://doi.org/10.1016/j. cbpra.2009.07.003
• Huppert, J. D., Siev, J., & Kushner, E. S. (2007). When religion and obsessive-compulsive disorder collide: Treating scrupulosity in ultra-orthodox Jews. Journal of Clinical Psychology, 63, 925- 941. https://doi.org/10.1002/jclp.20404
• Ibn-i Hazm (2012). Ahlak ve davranış tarzları [Morals and behaviours], Trans. M. Çağrıcı. Türkiye Diyanet Vakfı.
• Isgandarova, N. (2019). Muraqaba as a mindfulness-based therapy in Islamic psychotherapy. Journal of Religion and Health, 58(4), 1146-1160. https://doi.org/10.1007/s10943-018-0695-y
• Isik H. R., & Toprak, T.B. (2023, October 4-7). Am I religiously responsible about my sexual intrusive thoughts? The use of the 4t model to distinguish cognition hierarchy in the context of religious responsibility after sexual abuse: A case report [Conference presentation]. European Association for Cognitive Behavioral Psychotherapies (EABCT), Antalya, Turkey.
• Karakan, B., & Toprak, T. B. (2023, October 4-7) Using religiously extended psycho-educational 4t model for psychotherapy of scrupulosity: A case report [Conference presentation] European Association for Cognitive Behavioral Psychotherapies (EABCT), Antalya, Turkey.
• Kearns, C., Tone, Y., Rush, G., & Lucey, J. V. (2010). Effectiveness of group-based cognitive– behavioural therapy in patients with obsessive–compulsive disorder. The Psychiatrist, 34(1), 6-9 https://doi.org/10.1192/pb.bp.106.011510
• Kocoglu, F., & Bahtiyar, B. (2021). Yale-Brown Obsession Compulsion Scale-Turkish self report form: A study of reliability and validity. Journal of Clinical Psychology, 5(3), 229-243.
• Koran, L. M., Hanna, G. L., Hollander, E., Nestadt, G., Simpson, H. B., & American Psychiatric Association (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. The American Journal of Psychiatry, 164(7), 5–53.
• Mantz, S. C., & Abbott, M. J. (2017). Obsessive-compulsive disorder in paediatric and adult samples: Nature, treatment and cognitive processes. A review of the theoretical and empirical literature. Behaviour Change, 34(1), 1-34. https://psycnet.apa.org/doi/10.1017/bec.2017.6
• Mataix-Cols, D., Marks, I. M., Greist, J. H., Kobak, K. A., & Baer, L. (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: Results from a controlled trial. Psychotherapy and Psychosomatics, 71(5), 255-262. https://doi. org/10.1159/000064812
• Mathes, B. M., Van Kirk, N., & Elias, J. A. (2015). Review of psychotherapeutic approaches for OCD and related disorders. Current Treatment Options in Psychiatry, 2, 284-296.
• Md Rosli, A. N., Sharip, S., & Thomas, N. S. (2019). Scrupulosity and Islam: A perspective. Journal of Spirituality in Mental Health, 1-23. https://doi.org/10.1080/19349637.2019.1700476
• Md Rosli, A. N., Sharip, S., & Wan Ismail, W. S. (2017). Religious-integrated therapy for religious obsessive-compulsive disorder in an adolescent: A case report and literature review. Mental Health, Religion & Culture, 21(2), 204-209.
• Mohamad Arip, A. A., Sharip, S., & Md Rosli, A. N. (2018). Islamic integrated exposure response therapy for mental pollution subtype of contamination obsessive-compulsive disorder: A case report and literature review. Mental Health, Religion & Culture, 21(2), 210–218. https://doi.org /10.1080/13674676.2018.1436047
• Murray, C.J.L., & Lopez, A.D. (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Global Burden of Disease and Injury Series, 1.
• Nursi, S. (2008). Sözler, [The words], Trans. Ş. Vahide. Sözler.
• Nursi, S. (2010). Sözler, [The words], Trans. H. Akarsu. The Light.
• Nursi, S. (2012). İşaratül İcaz, [Signs of Miraculousness], Trans. V. Şükran. Sözler.
• Olatunji, B. O., Davis, M. L., Powers, M. B., & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: A meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47(1), 33-41. https://doi.org/10.1016/j.jpsychires.2012.08.020
• Omranifard, V., Akuchakian, S., Almasi, A., & Maraci, M. R. (2011). Effect of religious cognitive- behavior therapy on religious content obsessive compulsive disorder and marital satisfaction. European Psychiatry, 26(2), 1742-1742. https://doi.org/10.1016/S0924-9338(11)73446-0
• Ost, L. G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156-169. https://doi.org/10.1016/j.cpr.2015.06.003
• Pearce, M. J., Koenig, H. G., Robins, C. J., Nelson, B., Shaw, S. F., Cohen, H. J., & King, M. B. (2015). Religiously integrated cognitive behavioral therapy: A new method of treatment for major depression in patients with chronic medical illness. Psychotherapy (Chicago, Ill.), 52(1), 56–66. https://doi.org/10.1037/a0036448
• Ponniah, K., Magiati, I., & Hollon, S. D. (2013). An update on the efficacy of psychological therapies in the treatment of obsessive-compulsive disorder in adults. Journal of Obsessive- Compulsive and Related Disorders, 2(2), 207–218. https://doi.org/10.1016/j.jocrd.2013.02.005
• Prasko, J., Raszka, M., Adamcova, K., Grambal, A., Koprivova, J., Kudrnovská, H., Latalova, K., & Vyskocilová, J. (2009). Predicting the therapeutic response to cognitive behavioural therapy in patients with pharmacoresistant obsessive-compulsive disorder. Neuro Endocrinology Letters, 30(5), 615–623.
• Rachman S. (1998). A cognitive theory of obsessions: Elaborations. Behaviour Research and Therapy, 36(4), 385–401. https://doi.org/10.1016/s0005-7967(97)10041-9
• Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16(4), 233–248. https://doi.org/10.1016/0005-7967(78)90022-0
• Rosa-Alcázar, A.L., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008). Psychological treatment of obsessive-compulsive disorder: A meta-analysis. Clinical Psychology Review, 28(8), 1310-1325. https://doi.org/10.1016/j.cpr.2008.07.001
• Rothman, A., & Coyle, A. (2018). Toward a framework for Islamic psychology and psychotherapy: An Islamic model of the soul. Journal of Religion and Health, 57, 1731-1744. https://doi. org/10.1007/s10943-018-0651-x
• Rufer, M., Grothusen, A., Maß, R., Peter, H., & Hand, I. (2005). Temporal stability of symptom dimensions in adult patients with obsessive–compulsive disorder. Journal of Affective Disorders, 88(1), 99-102. https://doi.org/10.1016/j.jad.2005.06.003
• Safak, Y., Karadere, M. E., Ozdel, K., Ozcan, T., Turkcapar, M. H., & Kuru, E. (2014). Obsesif kompulsif bozuklukta bilişsel davranışçı grup psikoterapisinin etkinliğinin değerlendirilmesi [The effectiveness of cognitive behavioral group psychotherapy for obsessive-compulsive disorder]. Turkish Journal of Psychiatry, 25(4), 225-233.
• Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583. https://doi.org/10.1016/0005-7967(85)90105- 6
• Sanavio, E. (1988). Obsessions and compulsions: The Padua Inventory. Behaviour Research and Therapy, 26(2), 169–177. https://doi.org/10.1016/0005-7967(88)90116-7
• Siev, J., & Cohen, A. B. (2007). Is thought–action fusion related to religiosity? Differences between Christians and Jews. Behaviour Research and Therapy, 45, 829–837. https://doi.org/10.1016/j. brat.2006.05.001
• Simpson, H. B., Huppert, J. D., Petkova, E., Foa, E. B., & Liebowitz, M. R. (2006). Response versus remission in obsessive-compulsive disorder. The Journal of Clinical Psychiatry, 67(2), 269–276. https://doi.org/10.4088/jcp.v67n0214
• Stanley, M. A., & Turner, S. M. (1995). Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behavior Therapy, 26(1), 163–186.
• Starcevic, V., & Brakoulias, V. (2008). Symptom subtypes of obsessive-compulsive disorder: Are they relevant for treatment? The Australian and New Zealand Journal of Psychiatry, 42(8), 651–661. https://doi.org/10.1080/00048670802203442
• Toprak, T. B. (2018). Dini obsesyon ve kompulsiyonların psikoterapisinde kuramlar, ı̇mkanlar, sınırlılıklar [The treatment of scrupulosity: between theories, opportunities and limits]. Turkey Journal of Holistic Psychotherapy, 1(1), 123-141.
• Toprak, T. B. (2022). Dini içerikli psiko-eğitim eklenmiş bilişsel davranışçı grup psikoterapisinin dini içerikli obsesyon ve kompulsiyonları olan hastalardaki etkililiği [Effectiveness of religious psycho-education integrated cognitive behavioral group therapy in the treatment of the patients with religious obsessions and compulsions](Publication No. 719272) [Master’s thesis, Hasan Kalyoncu University].
• Toprak, T. B. & Emül, H. M (2016, July 27-31). A contrubition attempt to contemporary OCD theories: “Meratib-i ilim of dimağ” framework within Islamic tradition [Conference presentation]. Annual OCD Congress, Chicago, United States.
• Toprak, T.B. (2018, June 7-9) An attempt for alternative approach for the structure of human and its applications: Ilm’u nafs [Conference presentation]. World Congress of Pyshcotherapy, Amsterdam, Netherlands.
• Toprak, T.B. (Ed.). (2021). İslam ve psikoterapi: Bir model ve uygulama örneği [Islam and psychotherapy: An example of a model and application]. (pp.166-167). Muhit Book.
• Torres, A. R., Prince, M. J., Bebbington, P. E., Bhugra, D., Brugha, T. S., Farrell, M., Jenkins, R., Lewis, G., Meltzer, H., & Singleton, N. (2006). Obsessive-compulsive disorder: Prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. The American Journal of Psychiatry, 163(11), 1978–1985.
• Tukel, R., Polat, A., Ozdemir, O., Aksut, D., & Turksoy, N. (2002). Comorbid conditions in obsessive-compulsive disorder. Comprehensive Psychiatry, 43(3), 204–209. https://doi. org/10.1053/comp.2002.32355.
• Turkcapar, H. (2005). Yale Brown Obsession Compulsion Scale Self-Assessment Form (YBOCS- Self-Report). https://www.bilisseldavranisci.org/images/stories/olcekler/yobcshakan.pdf
• Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Reuman, L., & Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-Compulsive and Related Disorders, 6, 167–173. https://doi.org/10.1016/j.jocrd.2014.12.007
• Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Bluett, E. J., Reuman, L., Blakey, S. M., & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 108, 1–9.
• Ulusoy, M., Sahin, N.H., & Erkmen, H. (1998). Turkish Version of the Beck Anxiety Inventory. Journal of Cognitive Psychotherapy, 12, 163-172.
• van Oppen, P., van Balkom, A. J., de Haan, E., & van Dyck, R. (2005). Cognitive therapy and exposure in vivo alone and in combination with fluvoxamine in obsessive-compulsive disorder: A 5-year follow-up. The Journal of Clinical Psychiatry, 66(11), 1415–1422. https://doi. org/10.4088/jcp.v66n1111
• Van Oudheusden, L., van de Schoot, R., Hoogendoorn, A., van Oppen, P., Kaarsemaker, M., Meynen, G., & van Balkom, A. (2020). Classification of comorbidity in obsessive-compulsive disorder: A latent class analysis. Brain and Behavior, 10(7), e01641. https://doi.org/10.1002/ brb3.1641
• Vyskocilova, J., Prasko, J., & Sipek, J. (2016). Cognitive behavioral therapy in pharmacoresistant obsessive–compulsive disorder. Neuropsychiatric Disease and Treatment, 12, 625-639.
• Whittal, M. L., Robichaud, M., Thordarson, D. S., & McLean, P. D. (2008). Group and individual treatment of obsessive-compulsive disorder using cognitive therapy and exposure plus response prevention: A 2-year follow-up of two randomized trials. Journal of Consulting and Clinical Psychology, 76(6), 1003–1014. https://doi.org/10.1037/a0013076
• Williams, A. D., Lau, G. & Grisham, J. R. (2013). Thought-action fusion as a mediator of religiosity and obsessive-compulsive symptoms. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 207–212. https://doi.org/10.1016/j.jbtep.2012.09.004
• Wilson, K. A., & Chambless, D. L. (1999). Inflated perceptions of responsibility and obsessive- compulsive symptoms. Behaviour Research and Therapy, 37(4), 325–335.
• Witzig,T. (2017, July 7-9). Developing effective treatment plans for religious scrupulosity with emphasis on adult clients [Conference presentation]. Annual OCD Congress, San Francisco, United States.
• World Health Organization. (2001). Mental Health: A call for action. Geneva: by World Health Minister. https://www.mhinnovation.net/sites/default/files/downloads/resource/Mental%20 Health%20A%20Call%20for%20Action%20by%20World%20Health%20Ministers.pdf
• Zandberg, L. J., Zang, Y., McLean, C. P., Yeh, R., Simpson, H. B., & Foa, E. B. (2015). Change in obsessive-compulsive symptoms mediates subsequent change in depressive symptoms during exposure and response prevention. Behaviour Research and Therapy, 68, 76–81. https://doi. org/10.1016/j.brat.2015.03.005