1. ISSN: 2277-5536 (Print); 2277-5641 (Online)
DAV International Journal of Science Volume-4, Issue-2 June 2015
Page | 339
The effectiveness of cognitive behavioral family therapy on
improving obsessive –compulsive disorder in female student
Hassan Aminpoor
Department of psychology, Payame Noor University (PNU), PO BOX19395-3697 Tehran,
I.R. of IRAN
Email: h_aminpoor@pnu.ac.ir
Mohammad Hafeznia
Department of Psychology, Urmia Branch, Islamic Azad University, Urmia, Iran
Shafie Azari (Corresponding author)
M.A in clinical psychology, Department of Psychology, Payame Noor University, PO
BOX19395-3697 Tehran, I.R. of IRAN
Email: psychology1389@gmail.com
Mansour Agashteh
M.A in clinical psychology ,Department of Psychology, Payame Noor University, PO
BOX19395-3697 Tehran, I.R. of IRAN
Abstract
Background and Purpose: obsessive compulsive disorder (OCD) is an anxiety disorder which
can disable girls functioning at home and schools, so this study was aimed at examining the
effectiveness of cognitive behavioral family therapy on improving obsessive –compulsive
disorder in female students.
Material and methods: the sampling method was accessible sampling. So, the high school
students of Urmia city that had higher scores in Maudsley Obsessive questionnaire and
according to clinical psychologist interview were selected. Their parents were invited to
voluntarily participate in this study. The students were randomly assigned into two
experimental (12 couples) and control group (12 couples) of parents. Experimental group
received 8 sessions of family therapy and control group received no intervention. The Tool of
this study was Maudsley Questionnaire. The data were statistical analyzed using of covariance
analyses. All analysis was performed using spss16 software.
Results: Statistical analysis of covariance showed that cognitive-behavioral family therapy was
effective in improving obsessive-compulsive in female students (p<0/001).
Conclusion: This study showed that the cognitive-behavioral family therapy is effective in
reducing the severity of obsessive-compulsive. Therefore, careful planning for early
intervention for these patients is recommended by mental health authorities.
Keywords: Cognitive-behavioral family therapy, obsessive-compulsive disorder, female
students
Introduction
The human life span from birth to death has special importance. As many of psychologists
suggest that childhood and adolescence are more important stages of our life and called
“becoming” period which means that the personality is made and this “becoming” and
qualitative development will accomplish through other periods (1). In this regard one of the
pervasive psychiatric disorders which influence personality and development of children and
adolescents is obsessive-compulsive disorder (OCD). The OCD is an anxiety disorder includes
consistent and repetitive rituals or thoughts which make individual feel forced to respond to in
ordering to reduce internal anxiety. The prevalence of OCD has been reported between 2-3%
in population (2). The obsessive compulsive disorder is one of the most important anxiety
disorders which cause dysfunction in home and school daily works of children and
adolescents(3). According to WHO report (4) the obsessive compulsive disorder is one of the
20 prominent psychiatric disorders that is high prevalence. In his study, Masoudzadeh (5)

2. reported 31% prevalence rate for OCD in girls. The prevalence of this disorder is reported 33%
in Jaisooray study and 1.8% in 18 years old people in the sudy of Muhammadi and colleague
(7) which the highest prevalence was in women. Rezayi and colleague (8) studied high school
students and reported 34.1% prevalence. The study of Heyman and colleague (9) suggested
that although there is rare level of OCD in children but there is increased development in OCD
in children which explain high prevalence of OCD in this age. The cognitive-behavior therapy
and drug therapy are always best choice in treating this disorder. One of the new methods is
family cognitive-behavior therapy. In is undoubted that affective reactions, perception,
attitudes, and values of child and family are important determinants of obvious behavior of
child. Self-concept and self-worthy of child is shaped by family members attitudes toward him.
So the influence of family is so dominant in child’s development. Family atmosphere includes
the parent-child, child-child and partners (parents) relationships which can be helpful or
inhibitive in child adaptation (10). The family cognitive-behavior therapy emphasize on
members thoughts and their behaviors. One of the most common types of this method is
behavior educating to parents (11). Educating and rearing parents refer to methods which one
or both of parents receive communication skill training for communicating with child. The
parent management training is designed for changing parent-child communication patterns.
According to this method, instead of authoritative, socialized behavior should be reinforce and
support within family. This issue needs scheduling different behaviors like assigning rules for
child, give positive reinforce for right behaviors, punishment for negative behaviors and
negotiation (11). Many researches have confirmed the effectiveness of cognitive behavioral
family therapy in improving OCD among child and adolescents. Ollary and colleague (12)
suggested that cognitive behavioral family therapy is an effective method for improving OCD
among child and adolescents. Jeniffer and colleague (13) claimed that family engaging-based
cognitive behavioral family therapy is effective in OCD treatment. In another study (14)
Bouschler and colleague reported effectiveness of cognitive behavioral family therapy in
improving OCD among child and adolescents. Freeman (15) Barti and colleague (16), and
March and colleague (17) suggested the importance of cognitive behavioral family therapy in
improving OCD. So, current study is aimed at examining the effectiveness of cognitive
behavioral family therapy on improving obsessive –compulsive disorder in female high school
students.
Tools and materials
This study is semi-experimental which examines the effectiveness of independent variable
(cognitive behavioral family therapy) on dependent variable (OCD). So, two groups
(experimental and control) were selected as sample in accessible sampling method and
randomly replaced in two groups. Experimental group received therapy (independent variable)
and control group received no treatment. At the end of last session, post-test has been taken
from control and experimental groups.
The population of this study was all students which diagnosed with OCD according to clinical
interview and Maudsely questionnaire. After that, 24 female students of one of Salmas city high
schools were selected and their parent replaced into the two groups. 12 couples place in
experimental group and 12 couples in control group.Experimental group received 8 sessions 60
minutes of cognitive behavioral family therapy and control group received no intervention. The
mean of age of subjects were 38 ± 12 years. Co-variance analysis has been used and data were
analyzed by SPSS 16 software.
Sessions of cognitive behavioral family therapy:
Session 1: presenting and introducing behavior problems in children and assigning method and
goals of sessions
Session 2: training positive reinforce, conditioned contract, behavior distinction
Session 3: training behavior shaping, and like-like behavior
Session 4: relaxation training and mental imagery
Session 5: systematic desensitization
Session 6: communication skills training
Session 7: problem-solving training
Session 8: recognition cognitive distortion and attitude

3. Tool of research:
Maudsely Obsessive-Compulsive Inquiry (MOCI):
This tool is prepared by Rachman and Hadgson (1980) regarding to examine type and area of
obsession. This tool assess obsessive-compulsive symptoms in the areas of contamination fears
and washing behaviors, checking, slowness, and doubting using 30 dichotomously scored
(true/false) items, with each pathological response receiving a score of 1 or 0. The higher than
15 scores are indicators of OCD. Sanayo and colleague (18) reported .77 Cronbach's alpha for
total score. Pakravan, GHale bandi, Alavi and Ebrahimi (18) assigned cut-point of this tool for
score 9 and reported sensitivity and features of this tool 7.45 and 93.9 respectively.
Results:
Table 1: scores of pre-test, post-test and follow-up features
Experimental
group
Control
group
Mean Std.deviation Mean Std.deviation
OCD Pre-test 12.40 4.60 12.56 3.79
Post-test 5.6 3.71 12.39 3.40
Follow-up 5.92 4.54 11.28 2.89
As showed in table 1, there is scores of pre-test features. The mean and standard deviation of
experimental group are 12.40 and 4.60 respectively. The mean and standard deviation of control
group are 12.65 and 3.79 respectively. The Results shows no difference in pre-test between two
groups. The mean and standard deviation of experimental group and control group are 5.60,
3.71 and 12.39, 3.40 in post-test. There is significant difference between two groups in post-
test scores. The mean and standard deviation of experimental group and control group are 5.92,
4.54 and 11.28, 2.89 in follow-up. There is significant difference between two groups in follow-
up scores. For examining test of normality, we used Levin’s test and results showed that there
is no difference in normality of two groups (Levin’s Test: F=.33 and F=.13).
Table 2: Results of covariance analysis on pre- and post-test scores
Table 2 showed that the effect of pre-test on post-test scores are meaningful [F=41.452,
P<0.001]. Membership of group is meaningful on post-test scores [F= 6.141, P<0.001]. The
results show that cognitive behavioral family therapy is effective in reducing OCD. Then first
hypothesis is approved.
Table 3: Co-variance test results for evaluating the effect of education level on effectiveness of cognitive
behavioral family therapy in improving OCD in girls
As table 3 shows, there is no significant difference between patients with different levels of
education in the effectiveness of treatment on OCD (F= .85). in fact, parent’s level of education
had no effect on the effectiveness of cognitive behavioral family therapy in improving OCD in
girls.
Table 4: Co-variance test results for evaluating the effect of gender on the effectiveness of cognitive behavioral
family therapy in improving OCD in girls
Sum of Squares df Mean Square F Sig. eta
OCD Pre-test 185.271 1 185.271 41.452 0.000 .54
Group 31.467 1 31.467 6.141 0.000 .17
error 156.519 45 4.279
Sum of Squares df Mean Square F Sig. eta
OCD Education level 621.381 3 208.674 .85 N.S .44
Error 730.875 3 241.524
Sum of Squares df Mean Square F Sig. eta
OCD Gender 514.261 2 311.531 .72 N.S .44
Error 268.710 2 620.431

4. As table 4 shows, there is no significant difference between patients with different gender in
the effectiveness of treatment on OCD (F= .72). In fact, parent’s gender had no effect on the
effectiveness of cognitive behavioral family therapy in improving OCD in girls.
Table 5- Results of covariance analysis on 2 month follow-up scores
Table 5 showed that the mean of pre-test and post-test scores between experimental and control
group are meaningful [F=38.560, P<0.001] and the score of experimental group is [F=8.150,
P<0.001] and Eta=.19 more than control group. So it can be said that cognitive behavioral
family therapy is effective in reducing OCD at follow-up stage.
Conclusion
This study was aimed at examining the effectiveness of cognitive behavioral family therapy on
improving OCD among girl students. The results showed that the cognitive behavioral family
therapy is effective in reducing OCD. Since family is the first origin of child behavior and
education then the issue of parent-child relationship has been received remarkably attention of
theorists. Family is the first base for developing child-environment relationship. The child
learns primary concepts about world within family, physically grows, learn speech, receive
norms and shape his attitudes, morals and mood which means being socialized (18). The family
system has important role in preventing and treatment of behavior disorders. Child and
adolescent are seen as a part of whole. Researches show that parents of children with behavior
disorders have lack of parenting skills (19). Parent educating programs increase parenting skills
and have effective role in changing behaviors of child and adolescent. (20). Hence, the cognitive
behavioral family therapy is a new treatment approach which can reduce level of behavior
disorders in child and adolescents. The attempts for applying cognitive behavior therapies
among family and couples have been started since 1970s (20). Clinicians suggest cognitive
behavior therapy for receiving long-term outcomes (21). Drug therapies can reduce OCD
symptoms but cannot improve negative sense of patient about himself. Applying psychological
interventions emphasize on cognitive reconstruction, challenging unreasonable thoughts,
coping strategies training like cognitive behavioral family therapy based strategies. It can
reduce not only negative outcomes but also increase commitment to therapy. So we can say
that cognitive behavioral family therapy led patients to change their reactions or recognize
reducing ways of reactions. Strouch and colleague (21) claimed that combining drug and
cognitive behavioral family therapy is effective in reducing OCD. In their study, Waters and
colleague (22) emphasized on combining drug and cognitive behavioral family therapy in
reducing OCD. The results of current study is consistent with Ollary and colleague (12) Jeniffer
and colleague (13), Boschler and colleague (14), Freeman and colleague (15), Barti and
colleague (16), March and colleague (17), Strouch and colleague (21) and Waters and colleague
(22). The results also showed that parent’s level of education had no effect in reducing OCD.
Two month follow-up showed that results remains. We can conclude that children mental health
is dependent to parent’s mental health. Authors suggest that more researches be conduct in
metal health of family. The research about metal health of family is rear in Iran so the current
study was aimed at examining the effectiveness of cognitive behavioral family therapy on
improving obsessive –compulsive disorder in female student. In sum, applying this approach is
effective and low-consuming. So it anticipate future researches have greater sample, long
period of treatment, in-treatment assessment and long-term follow-up. This reseach has some
limitation. It conducted in Salma city and we suggest that future researches conduct it in other
cities and with other samples. Also, this research conducted on girls and we hope other
researches conduct on boy students.
Acknowledgments
The authors thank all parent and students which participated in this research.
Sum of Squares df Mean Square F Sig. eta
OCD Pre-test 190.168 1 190.168 38.560 0.000 .59
Group 28.480 1 28.480 8.150 0.000 .19
error 128.716 45 5.179

5. References
1.Movasagi H. play Psychology , Publication Azad University of karaj 2000 . (persian)
2. Mohammadi M.R , Ghasemzadeh A. Rahgozar M. prevalence of OCD in IRAN. BMC
Psychiatry, 2004,147- 244/4-2.
3. Piacetini J. Bergman R.L, Jacobs C. Open Trail of cognitive behaviorol therapy For
Childhood obsessive-compulsive disorder. Journal of anxiety disorder 2002, (16): 207-219.
4. World health organization. Revised globate burden of disease (GBD) 2002 estimate,
retrieved Agust 7,2007, from the who websit:
http:/ /www.who.int.healthin. Fo/bod E bd 2002 revised/ in dex. htmI.
5. Masoudzadeh A. Theresearch epidemiology of obsessive- compulsive disorder in student
of high school in sari City in 1385, medical science of mazandaran 2007(6):95-101 (persian).
6. Jaisooray T.S, Redd Y Y. Srinath S.C. IS Juvenile OCD a developmental subtype of
disorder. Europian Child and adolescent psychiatry 2003, 290-297.
7. Rezai F. The research epidemiology OCD in high school of neka City.2001
{disertation}(persian).
8. Heyman I, Fombonne E, Simmons H. prevalence of OCD in brititsh nation wide
survey of child mental health. Int Rev psychiatry 2003, 15(1-2):178-84.
9.Ahadi B, Hejazi A, Behpojoh A. Significantly marieg and problem affect- behavior in
Children. Journal of psychology 2005,(1): 52-54
10. Glading S. Family therapy,Translated by bahari F and et al. Tehran, Tazkye publi
cation 2003(persian).
11.OL eavy E , Barrett P, Krister W. Cognitive – behavioral Family therapy for
adolecsent obsessive-compulsive disorder:A 7- year Follow – up study. Journal of anxiety
disorder 2009 (23): 973-978.
12. Jennifer B, Ferman L, Phoebe S,Moore S ,Jeffrey J. Cognitive- behavior family
Treatment for young dougther with obsessive- compulsive disorder. Journal of Blol
psychiatry 2006(61): 337-343.
13.Boulter N, Dadds M, Farreli L. Cognitive-behavioral Family treatment of children
obsessive- compulsive disorder: long- term Follow up and predictors of outcome. Journal of
the American academy of child and adolescent psychiatry,2008(44):1005_1014.
14.Freeman J,B. Gareia A.M, Coyne L, Prezeworski A. Prelminary Finding form a
family_bused cognitive_ behavioral approch. journal of the A Calemy of child and adolescent
psychiatry,2008(5):593_602.
15.March J.S,Healy_Farrell L, Barrett P. Cognitive behavioral Family treatment oF
odolescent obsessive- compulsive disorder: a controlled trail. Journal of the American
accademy of child and adolescent psychiatry 2004(43):46-62.
16.Barrett p, farrell L, Pina A.A, Peris T.S .Evidence- based psycho social treatment for
adolescentpsycholgy 2008(37):131-155.
17.Saram Z, Amir SH, Neshat doust H, Molovi H. Maternal obsessive - compulsive
disorder and anxiety in children. Journal of psychology univerrsity of Isfahan 2009(6):1-10
(persian)
18. Hosseini nasab D. The relationship between mental health and Self- efficacy and
perinting style onstudent. Journal of psychology university of mashhad 2002.(parsian).
19.Comijani M. Conduct disorder in adolescents. journal of estesnay 2007(45):7-
14(persian).
20.Tavakolizadeh J. obsessive- compulsive disorder in adolescents. Journal of talim o
tarbiate stesnaya 2008 (84,85): 92-111.
21. Storch L.A, Geffken G.R, Mann G, Munsun M .family based cognitive- behavior
therapy For pedatric obsessive compulsive Disorder Journal of child and adolescent
psychiatry 2007(46):469-478.
22. Estrouch B, Ferman L, Phoebe S,Moore S ,Jeffrey J. Cognitive- behavior family
Treatment for young dougther with obsessive- compulsive disorder. Journal of Blol
psychiatry 2009(61): 337-343.