The Effectiveness of Cognitive-Behavioral Therapy on Cognitive Avoidance and Thought-Action Fusion in Infertile Women with Obsessive-Compulsive Disorder
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Objective: To evaluate the effectiveness of cognitive-behavioral therapy (CBT) in reducing cognitive avoidance and thought–action fusion among infertile women with obsessive–compulsive disorder.
Methods and Materials: In a randomized controlled clinical trial with pretest, posttest, and follow-up phases, 30 infertile women with OCD were recruited from counseling centers in Tehran in 2025. After diagnostic screening and eligibility assessment, participants were randomly assigned to CBT (n= 15) or wait-list control (n= 15), matched on age, marital status, education, and illness duration. The Cognitive Avoidance Questionnaire (CAQ) and the Thought–Action Fusion Questionnaire (TAF-Q) served as primary outcomes. The intervention comprised eight 90-minute CBT sessions based on cognitive restructuring, exposure to intrusive thoughts, stress management, and skills practice. Data were analyzed using multivariate analysis of covariance (MANCOVA) and univariate ANCOVA.
Findings: Groups were comparable at baseline. MANCOVA indicated a significant overall treatment effect (Wilks’ Lambda = 0.050, F(3, 23) = 146.056, p < .001, η² = .950). Adjusted posttest comparisons showed significantly lower cognitive avoidance in the CBT group compared with controls (F= 40.716, p< .001, partial η² = .601) and significantly lower TAF (F= 110.980, p< .001, partial η²= .804). Error variances were homogeneous for both outcomes, supporting ANCOVA assumptions. Results suggest that CBT reduced dysfunctional obsessive beliefs and enhanced cognitive–emotional flexibility in this population.
Conclusion: CBT produced large and clinically meaningful reductions in cognitive avoidance and TAF among infertile women with OCD. Findings support incorporating structured CBT modules targeting cognitive avoidance and TAF into routine care.
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