Abstract
Background & Objectives: Obsessive–Compulsive Disorder (OCD) is characterized by intrusive, irrational, and distressing thoughts (obsessions) and repetitive physical or mental acts (compulsions), often leading to reduced quality of life, increased suicide risk, and significant interference with daily activities. A key aspect of OCD is its negative impact on cognitive functions, including attention, memory, executive functions, and response inhibition. Acceptance and Commitment Therapy (ACT) emphasizes altering individuals' psychological relationship with their thoughts and emotions through acceptance, mindfulness, and value–based action. Conversely, binaural beats, a non–invasive brain stimulation method, involve presenting two different frequencies to each ear, processing the frequency difference as a new frequency, leading to brainwave synchronization (eg, alpha or gamma waves). Given OCD's detrimental effects on cognitive functions and the scarcity of comparative studies in Iran, this study aimed to compare the effectiveness of ACT and binaural beats in improving cognitive functions (inhibition, working memory, and processing speed) in women with OCD. This research not only identifies more effective approaches but also provides clinicians with diverse therapeutic options to enhance patients' quality of life.
Methods: This quasi–experimental study used a pretest–posttest with a 1–month follow–up design and a control group. The statistical population comprised all women with OCD referred to counseling centers in Zanjan City, Iran, in 2024. Forty–five eligible women were selected via convenience sampling and randomly assigned to three groups: ACT (15 participants), binaural beats (15 participants), and control (15 participants). The inclusion criteria for the subjects in the study were as follows: female gender, having at least a bachelor's degree, being between the ages of 25 and 40, not participating in workshops and psychotherapy sessions at the same time as the current study, not taking psychiatric medications specific to obsessive–compulsive disorder, lacking substance abuse, and scoring more than 30 on the Yale–Brown Obsessive–Compulsive Disorder Scale. The exclusion criteria for the subjects from the study included not cooperating in completing the research instruments, missing more than two sessions in therapy sessions, not completing therapy assignments, being consistently late for more than 30 minutes during three sessions, and the occurrence of unexpected events such as severe illness or death of a loved one during the study. Written consent forms were obtained from all participants, and they were informed of their right to withdraw from the study at any time. Participant information was recorded with specific codes to maintain confidentiality. Data collection tools included the Yale–Brown Obsessive–Compulsive Scale (YBOCS) (Goodman et al., 1989), the N–Back Test (Kirchner, 1958) for working memory, the Go/No–Go Test (Hoffman, 1984) for inhibition, and the Symbol Digit Modalities Test (SDMT; Smith, 1973) for processing speed. The ACT intervention, based on Hayes and Strosahl's (2004) protocol (CVR=0.69), consisted of eight 90–minute weekly sessions covering rapport–building, creative hopelessness, acceptance, cognitive defusion, self–as–context, value identification, and committed action. The binaural beats intervention (420 and 460 Hz frequencies, 30 minutes, three times weekly for 15 days; CVR=0.73) was delivered via headphones. The control group received no intervention. For data analysis in the descriptive section, descriptive statistics, including frequency, percentage, mean, and standard deviation, were used. In the inferential analysis section, the research objective was examined using a repeated–measures ANOVA and a Bonferroni post hoc test. All analyses were performed in SPSS statistical software version 25. The significance level of statistical tests was set at 0.05.
Results: Time, group, and their interaction effects on cognitive functions (inhibition, working memory, and processing speed) in women with OCD were significant (p<0.05). The two interventions based on acceptance and commitment and binaural beats had a significant effect on cognitive functions (p<0.05). Also, there was no significant difference between the two intervention methods in their effects on the variables (p>0.05).
Conclusion: This study demonstrated that both ACT and binaural beats significantly improve cognitive functions (inhibition, working memory, and processing speed) in women with OCD, with no significant difference between the two interventions. These findings suggest that clinicians can utilize both methods to enhance cognitive flexibility and reduce symptoms.
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