Comparing the Effectiveness of Mindfulness Based Stress Reduction (MBSR) and Intensive Short Term Dynamic Psychotherapy (ISTDP) on Reducing Obsessive Compulsive Symptoms and Improving Treatment Adherence in Patients with Non Alcoholic Fatty Liver Disease

Authors
Abstract
The aim of the present study was to compare the effectiveness of Mindfulness‑Based Stress Reduction (MBSR) and Intensive Short‑Term Dynamic Psychotherapy (ISTDP) on reducing obsessive‑compulsive symptoms and improving treatment adherence in patients with non‑alcoholic fatty liver disease (NAFLD). This study employed a quasi‑experimental design with a pretest‑posttest and one‑month follow‑up, including two experimental groups and one control group. The statistical population comprised all patients with non-alcoholic fatty liver disease (NAFLD) who attended treatment centers in Tehran during autumn 2025. From this population, 72 individuals were initially selected using purposive sampling; after attrition, the final sample consisted of 45 participants who were randomly assigned to three groups (15 participants per group). MBSR and ISTDP were each delivered individually over eight 90‑minute sessions to the experimental groups, while the control group was placed on a waiting list. Data were collected using the Maudsley Obsessive‑Compulsive Inventory (MOCI) and the Morisky Medication Adherence Scale (MMAS). Results of repeated‑measures analysis of variance (ANOVA) indicated that both MBSR and ISTDP significantly reduced obsessive‑compulsive symptoms and improved treatment adherence, and these effects remained stable for at least one month post‑intervention. Furthermore, Bonferroni post‑hoc tests showed that MBSR was significantly more effective than ISTDP in reducing obsessive‑compulsive symptoms and improving treatment adherence (p < 0.05). This superiority may be attributed to MBSR’s capacity to enhance emotion regulation, reduce stress, and increase body awareness—factors that play a decisive role in managing chronic diseases and health‑oriented behaviors. Therefore, incorporating mindfulness‑based interventions as an effective approach alongside other psychological treatments may help improve treatment outcomes and quality of life in patients with NAFLD.
Keywords

Abbass, A., & Town, J. (2021). Alliance rupture repair processes in intensive short term dynamic psychotherapy: Working with resistance. Journal of Clinical Psychology, 77(2), 373–385. https://doi.org/10.1002/jclp.23115
Sheykholeslami, A., Seyedesmaili Ghomi, N., Salmani, A., & Sharei, A. (2025). The effectiveness of psychological empowerment on academic self-concept of students with low academic performance. Journal of Research in Educational Systems, 19(68), 21-35.
Aghajani, S., Salmani, A., & Sharei, A. (2024). The effectiveness of education based on resilience on the attitude of responsibility and academic self-regulation of students who are children of divorce. Journal of School Psychology, 13(2), 1-16.
Abrams, Z. (2026, April 1). CE Corner: Diagnosing and treating obsessive-compulsive disorder. Monitor on Psychology, 57(3). https://www.apa.org/monitor/2026/04-05/obsessive-compulsive-disorder-diagnosis-treatment[reference:0]
Basu, S. (2026). Medication adherence and its predictors in patients with type 2 diabetes mellitus in India: A systematic review and meta-analysis of current evidence. Health Science Reports, *9*(2), e71845.
Dadfar M, Bolhari J, Malakuti K, Malakuti K, Bayanzade A.(2002). The study of the epidemiology of symptoms of Obsessive Compulsive Disorder. Iran J Psychiatry Clin Psychol.1(2):27-32.
Hodgson, R. J., & Rachman, S. (1977). Obsessional-compulsive complaints. Behaviour Research and Therapy, 15(5), 389–395.
Laghousi, D., Rezaie, F., Alizadeh, M., & Jafarabadi, M. A. (2021). The eight-item Morisky Medication Adherence Scale: validation of its Persian version in diabetic adults. Caspian journal of internal medicine, 12(1), 77-83.
Lilliengren, P., Ljungdahl, M., Rööst, M., Falkenström, F., Town, J. M., & Maroti, D. (2026). Online intensive short-term dynamic psychotherapy for treatment-resistant somatic symptom disorder: An interrupted time-series study. Psychotherapy and Psychosomatics. Advance online publication. https://doi.org/10.1159/000550629
Liu, C., Zhou, R., & Shi, J. (2024). How to enhance adherence in patients with nonalcoholic fatty liver disease: A thought-provoking issue. Journal of Medical Internet Research, *26*, e59208. https://doi.org/10.2196/59208
Moaty, M. I. A., El Shebini, S. M., Mohamed, R. A., El Sherity, S. Y., & Ahmed, N. H. (2026). Prevalence and dietary factors associated with nonalcoholic fatty liver disease in a sample of obese middle-aged Egyptian women. Scientific Reports, *16*, Article 10413. https://doi.org/10.1038/s41598-026-42141-7
Morisky, D. E., Ang, A., Krousel‐Wood, M., & Ward, H. J. (2008). Retracted: predictive validity of a medication adherence measure in an outpatient setting. The journal of clinical hypertension, 10(5), 348-354.
Wang, S., Gao, H., Lin, P., Qian, T., & Xu, L. (2024). Causal relationships between neuropsychiatric disorders and nonalcoholic fatty liver disease: A bidirectional Mendelian randomization study. BMC Gastroenterology, *24*(1), 299 (1-15). https://doi.org/10.1186/s12876-024-03386-6