The Effectiveness of Emotion-Focused Therapy on Anxiety Sensitivity and Intolerance of Uncertainty in Students with Obsessive-Compulsive Disorder

Authors
hava Mahmoudzadeh Kenari
afsaneh Khajound Khoshli
javanshir asadi
Abstract


The present study aimed to examine the effectiveness of emotion-focused therapy in reducing anxiety sensitivity and intolerance of uncertainty in students with obsessive-compulsive disorder (OCD). This semi-experimental study employed a pretest-posttest design with a control group. The statistical population consisted of female high school students diagnosed with OCD during the 2024–2025 academic year in Babolsar. Thirty participants were purposefully selected and randomly assigned to experimental and control groups (15 in each). The experimental group received eight 90-minute sessions of emotion-focused therapy, while the control group received no intervention. Data were collected using the Anxiety Sensitivity Index (ASI) and the Intolerance of Uncertainty Scale (IUS) at pretest and posttest stages. Data were analyzed using analysis of covariance (ANCOVA) and the least significant difference test. Results indicated that emotion-focused therapy significantly reduced anxiety sensitivity and intolerance of uncertainty in the experimental group compared to the control group (p < 0.01). These findings suggest that emotion-focused therapy can be an effective approach to reduce cognitive-emotional components related to OCD in adolescents.
Keywords
Emotion-focused therapy
Obsessive-compulsive disorder
Anxiety Sensitivity
intolerance of uncertainty
Students
Asadpour, E., Sharei, A., & Salmani, A. (2025). Premarital intervention based on attachment and differentiation improves communication and conflict management in Iranian couples. Scientific reports, 15(1), 29151.
Aymerich, C., Pacho, M., Catalan, A., Yousaf, N., Pérez-Rodríguez, V., Hollocks, M. J., ... & Salazar de Pablo, G. (2024). Prevalence and correlates of the concurrence of autism spectrum disorder and obsessive compulsive disorder in children and adolescents: A systematic review and meta-analysis. Brain sciences, 14(4), 379.
Bahraminia, M., Khaleghipour, S., & Soltani, F. (2025). The effectiveness of emotion-focused‎ therapy on distress tolerance, fear of‎ positive experience, and‎ psychosomatic symptoms in‎ individuals experiencing grief due to‎ COVID-19‎. EBNESINA, 27(1), 23-35.
Connolly-Zubot, A., Timulak, L., Hession, N., & Coleman, N. (2020). Emotion-focused therapy for anxiety and depression in women with breast cancer. Journal of Contemporary Psychotherapy, 50(2), 113-122.
Foroughi, A. A., Mohammadpour, M., Khanjani, S., Pouyanfard, S., Dorouie, N., & Parvizi Fard, A. A. (2019). Psychometric properties of the Iranian version of the Anxiety Sensitivity Index-3 (ASI-3). Trends in psychiatry and psychotherapy, 41(3), 254-261.
Franklin, M. E., & Foa, E. B. (2002). Cognitive behavioral treatments for obsessive compulsive disorder. A guide to treatments that work, 2, 367-386.
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry?. Personality and individual differences, 17(6), 791-802.
Grenier, S., Barrette, A. M., & Ladouceur, R. (2005). Intolerance of uncertainty and intolerance of ambiguity: Similarities and differences. Personality and individual differences, 39(3), 593-600.
Hashem, S. E., Mehrabizadeh Honarmand, M., Zargar, Y., & Naaimi, A. (2023). effectiveness of emotion focused therapy on anxiety sensitivity and pain catastrophizing in Patients with chronic pain and alexithymia. Iranian Journal of Psychiatric Nursing, 11(3), 46-56.
Hodgson, R. J., & Rachman, S. (1977). Obsessional-compulsive complaints. Behaviour research and therapy, 15(5), 389-395.
Khayeri, B., Mirmahdi, R., Akouchekian, S., Heydari, H., & Aleyasin, S. A. (2019). The effectiveness of emotion-focused therapy and dialectical behavior therapy on reducing obsessive-compulsive symptoms in women with obsessive-compulsive disorder. Journal of Isfahan Medical School, 37(517), 145-153.
Khosravani, V., Bastan, F. S., Ardestani, S. M. S., & Amirinezhad, A. (2020). Psychometric evaluation of the Vancouver Obsessional-Compulsive Inventory (VOCI) and its adaptation based on the DSM-5 in Iranian patients with obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 25, 100536.
Knowles, K. A., & Olatunji, B. O. (2023). Intolerance of uncertainty as a cognitive vulnerability for obsessive-compulsive disorder: A qualitative review. Clinical Psychology: Science and Practice, 30(3), 317.
Masjedi, M. A., Khalatbari, J., Abolghasemi, S., & Khah, J. K. (2020). Comparison of the effectiveness of acceptance and commitment therapy and emotion-focused therapy on anxiety sensitivity in cardiac patients. International Journal of Applied Behavioral Sciences, 7(3), 13-24.
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., ... & Veale, D. (2015). Efficacy of cognitive-behavioral therapy for obsessive–compulsive disorder. Psychiatry research, 225(3), 236-246.
Nagata, J. M., Chu, J., Zamora, G., Ganson, K. T., Testa, A., Jackson, D. B., ... & Baker, F. C. (2023). Screen time and obsessive-compulsive disorder among children 9–10 years old: A prospective cohort study. Journal of Adolescent Health, 72(3), 390-396.
Ojalehto, H. J., Abramowitz, J. S., Hellberg, S. N., Butcher, M. W., & Buchholz, J. L. (2021). Predicting COVID-19-related anxiety: The role of obsessive-compulsive symptom dimensions, anxiety sensitivity, and body vigilance. Journal of Anxiety Disorders, 83, 102460.
Pinciotti, C. M., Riemann, B. C., & Abramowitz, J. S. (2021). Intolerance of uncertainty and obsessive-compulsive disorder dimensions. Journal of Anxiety Disorders, 81, 102417.
Rad, N. Y., Toozandehjani, H., & Golmakani, Z. B. (2020). Comparing the effectiveness of schema therapy and compassion-focused therapy on forgiveness and ambiguity tolerance in divorce-seeking women. Journal of Fundamentals of Mental Health, 22(6).
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour research and therapy, 24(1), 1-8.
Samantaray, N. N., Mishra, A., Singh, A. R., Sudhir, P. M., & Singh, P. (2023). Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting. Journal of affective disorders, 324, 92-101.
Sanavio, E., & Vidotto, G. (1985). The components of the Maudsley obsessional-compulsive questionnaire. Behaviour Research and Therapy, 23(6), 659-662.
Schadegg, M. J., Clark, H. L., & Dixon, L. J. (2021). Evaluating anxiety sensitivity as a moderator of misophonia and dimensions of aggression. Journal of Obsessive-Compulsive and Related Disorders, 30, 100657.
Shahar, B. (2020). New developments in emotion-focused therapy for social anxiety disorder. Journal of clinical medicine, 9(9), 2918.
Shaw, A. M., Halliday, E. R., & Ehrenreich-May, J. (2020). The effect of transdiagnostic emotion-focused treatment on obsessive-compulsive symptoms in children and adolescents. Journal of Obsessive-Compulsive and Related Disorders, 26, 100552.
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., ... & Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological assessment, 19(2), 176.
Wheaton, M. G., Messner, G. R., & Marks, J. B. (2021). Intolerance of uncertainty as a factor linking obsessive-compulsive symptoms, health anxiety and concerns about the spread of the novel coronavirus (COVID-19) in the United States. Journal of obsessive-compulsive and related disorders, 28, 100605.
Wichers, R. H., van der Wouw, L. C., Brouwer, M. E., Lok, A., & Bockting, C. L. (2023). Psychotherapy for co-occurring symptoms of depression, anxiety and obsessive-compulsive disorder in children and adults with autism spectrum disorder: a systematic review and meta-analysis. Psychological Medicine, 53(1), 17-33.
Yadollahi, A. S., & Shakib, N. (2021). The effectiveness of emotion-focused cognitive therapy on cognitive flexibility and rumination of adolescents with practical obsessive compulsive disorder.
Zaccari, V., D'Arienzo, M. C., Caiazzo, T., Magno, A., Amico, G., & Mancini, F. (2021). Narrative review of COVID-19 impact on obsessive-compulsive disorder in child, adolescent and adult clinical populations. Frontiers in psychiatry, 12, 673161.
Zemestani, M., Didehban, R., Comer, J. S., & Kendall, P. C. (2022). Psychometric evaluation of the intolerance of uncertainty scale for children (IUSC): Findings from clinical and community samples in Iran. Assessment, 29(5), 993-1004.