1. Introduction

bsessive-Compulsive personality disorder (OCPD) is a one of personality disorders. The main feature of this disorder is the pervasive pattern of preoccupation with perfectionism [1]. People with this disorder, due to perfectionism, often show stubbornness and rigidity, and less intimate behavior with others [2]. This lack of flexibility and intimacy has led to difficulties in the psychotherapeutic process, and there is still no treatment that is valid and standardized for this disorder. However, psychotherapy is recommended as the treatment of choice [3].

Various studies have shown the effectiveness of Cognitive-Behavioral Therapy (CBT) as a leading second-wave therapy for OCPD and its various symptoms [4-14]. Compared to CBT, there is less research on the effectiveness of Acceptance and Commitment Therapy (ACT); however, these limited studies have shown that this method of treatment has an acceptable effect on this personality disorder [5, 15]. Quantitative studies have compared the effects of these two therapies on different variables; most of them have examined these variables in the form of comorbid and non-comorbid disorders where some have indicated the superiority of treatment based on ACT [14, 16-18] and others have indicated the superiority of CBT [19, 20]. In the present study, we aimed to compare the effects of CBT and ACT on the perfectionism of patients with OCPD.

2. Materials and Methods

This is a quasi-experimental study with pre-test, post-test, and follow-up design using a control group. The study population consisted of 73 patients with OCPD referred to the Ehya counseling center in Rasht, Iran in 2017. Of these, 45 were selected using a purposive sampling method and randomly assigned into two intervention groups and one control group (each with 15 samples). Their OCPD was diagnosed using 175-item Millon Clinical Multiaxial Inventory-III (MCMI-III). The psychometric properties on of its Persian version have already examined by Chegini et al. [21]. The reliability using Cronbach’s alpha coefficient was in a range of 0.64-0.89 for all subscales; the test-retest reliability ranged 0.795 to 0.972, and the total detection power was in a range of 0.77-0.97 [21]. The perfectionism of participants was measured by the 59-item perfectionism inventory designed by Hill, et al [2]. The psychometric properties on of its Persian version have already examined by Hooman and Samaei [22]. They reported its internal consistency as 0.926, and for its test-retest reliability, it was 0.726. Its convergence validity was measured by calculating its correlation with the Frost Multidimensional Perfectionism Scale, which was r=0.741.

3. Results

The results showed that the effect of CBT on the perfectionism of patients was statistically significant (P=0.001) and its effect size was 39.7%, which was considerable. This effect size reached 44.4% in the 1-month follow-up phase, which indicates the improvement of their perfectionism. The effect of ACT on the perfectionism was also statistically significant (P=0.000) and its effect size was 63.1% which reached 61.8% in the follow-up stage (Table 1).

Pairwise comparison of groups using Bonferroni test indicated that ACT had more significant effect on perfectionism (P<0.05) in comparison with CBT (Table 2).

4. Discussion

Our results are consistent with the findings of other similar studies. For example, Lioyd et al. [23] in a systematic review and meta-analysis, concluded that psychological interventions could reduce perfectionism and related disorders, such as anxiety, depression, eating disorders, and obsessive-compulsive symptoms. In our study, both CBT ad ACT as psychological interventions could significantly affect the perfectionism, however, they did not perform a comparison between psychological interventions. In a similar study conducted in Iran (in terms of study design, method, and using follow-up), Izadi et al. [14] compared the effects of CBT and ACT on the symptoms of OCPD patients. They found that both treatments were effective in reducing the symptoms of the disease, but in overall, ACT was more effective than CBT.

In another study conducted in Iran, Malleki Pirbazari et al. [24] compared the effectiveness of Exposure and Response Prevention (ERP) treatment and ACT (in interaction with hereditary factor) in improving the quality of life and reducing the symptoms of patients with OCPD. They concluded that both treatments significantly reduced the severity of OCPD symptoms and increased the quality of life, where the effect of Act was higher, and the results were independent of the hereditary factor. Since the ERP method is one of CBT techniques, it can be said that their results are consistent with our findings. Based on the results, both CBT and ACT can be effective in treatment of OCPD. Psychotherapists are recommended to use the combined form of methods to treat the various symptoms of this disorder based on the comparison results reported in the present study. This study had some disadvantages and limitations. For example, the researcher and the therapist were the same person. The use of non-random sampling method was another limitation due to the purposeful selection of subjects based on their higher scores in the study variable.

5. Conclusion

Despite the significant effects of both CBT and ACT approaches on the perfectionism of OCPD patients, ACT was more effective. Given the clinical significance of this disorder, further studies in this area are recommended.

Ethical Considerations

Compliance with ethical guidelines

This study has ethical approval obtained from the Research Ethics Committee of Islamic Azad University of Rasht Branch (Code: IR.IAU.RASHT.REC.1397.024).

Funding

This study received no financial support from any organization. It was extracted from the PhD thesis of first author approved by Islamic Azad University of Rasht Branch (Code: 117207059611033) in collaboration with Ehya counseling center.

Authors' contributions

All authors contributed in preparing this article.

Conflicts of interest

The authors declared no conflict of interest.

Acknowledgements

The authors would like to thank the faculty members of Islamic Azad University of Rasht Branch, the Ehya counseling center staff, and all participants for their support and cooperation.


 

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