كليدواژه :
برنامهٔ زماني پارادوكسي , نگراني , نشخوار فكري , درهم آميختگي فكر و عمل , وسواس فكري عملي , اختلال وسواسي - جبري , OCD
چكيده لاتين :
Background & Objectives: Obsessive–Compulsive Disorder (OCD) is a prevalent mental disorder that causes severe disruption in personal life. Extensive experimental evidence suggests behavioral therapy as the first–line treatment for OCD. Some researchers believe that behavioral
therapy requires alternative or complementary approaches. One of the newest of these integrated approaches is the Paradoxical Time Table Therapy (PTTT). An approach that incorporates systemic, behavioral, and analytical aspects into treatment could be an appropriate method for
managing all disorders, including anxiety disorders and OCD. The present study aimed to explore the effects of PTTT on worry, rumination,
thought–action fusion, and symptoms in patients with OCD.
Methods: In this research, a single–case experimental method was used. Among the single–subject approaches, multiple baselines method was
applied in this study. The study population consisted of individuals with OCD who referred with an active case to the Aramesh Novin Clinic in
Tehran City, Iran, in the spring of 2019. Among them, 3 patients received PTTT. The study participants were selected by purposive sampling
approach. Patients who were diagnosed with OCD by a psychiatrist were referred to the therapist. The study inclusion criteria included receiving
OCD diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM–5) criteria for OCD by a psychiatrist;
not receiving any psychological treatment before entering the study; having a minimum age of 20 years, and a maximum of 40 years; having at
least high–school diploma, and providing consent to participate in the research. The PTTT consists of 6 therapeutic sessions, including two basic
paradoxical techniques and a time table. To collect the required data, the Yale–Brown Obsessive–Compulsive Scale (1989), Thought Action
Fusion Scale–Revised (Shafran et al., 1996), Penn State Worry Questionnaire (Zingbarg & Barlow, 1990), and Ruminative Response Scale
(Nolen–Hoeksema et al., 1993) were employed. Besides, chart analysis, reliable change index, clinical significance, and the improvement
percentage of paradoxical time table were used for data analysis.
Results: The paradoxical treatment group participants aged between 25 and 34 years with a mean±SD age of 30.33±4.72 years. The obtained
data suggested that in the paradoxical schedule treatment, the reliability index values for worry in the first, second, and third subjects were –
4.19, –3.44, and –5.27, respectively. For rumination, the same value in the three subjects were –3.76, –2.42, and –4.46, respectively. The thought–
action fusion values were –4.41, –4.32, and –4.73, respectively. Symptoms scores were also –4.42, –3.78, and –5.18, respectively. Furthermore,
in the paradoxical time table group, the reliability index values were higher than the criterion value of 1.96; thus, the results were not caused by
the measurement error and unreliability of the test, and they were due to the therapeutic intervention. The current study findings demonstrated
that PTTT has remarkably reduced worry, thought rumination, the intertwining of thought and action (thought–action fusion), and OCD
symptoms (p≥0.05). Notably, a significant level of symptoms remained declined after the intervention, indicating that the PTTT maintained its
consistency in reducing the symptoms in all three study subjects at the follow–up phase.
Conclusion: In general, PTTT is an appropriate and effective method for reducing OCD symptoms. Accordingly, it can be used as a proposed
treatment in this area. PTTT could present a greater impact, because it increases the power of ego, and disrupts communication between cue and
anxiety, and it changes their meaning. However, this is a novel treatment approach. Moreover, studies that have previously addressed the use of
contradictory intention elements only considered one intervention of the paradoxical schedule treatment. It is recommended to use this treatment for other patients, including those with anxiety and mood disorders.
