Brief Culturally Adapted CBT for OCD

Brief Culturally Adapted Cognitive Behaviour Therapy (CaCBT) for Obsessive-Compulsive Disorder: A Randomised Controlled Trial From Pakistan

The purpose aims to assess the efficacy of Brief Culturally Adapted Cognitive Behaviour Therapy (Ca-CBT) for the treatment of Obsessive Compulsive Disorder (OCD).

Study Overview

• Status: Recruiting
• Conditions: Obsessive-Compulsive Disorder; Cognitive Behavioral Therapy
• Intervention / Treatment: Other: Brief culturally adapted cognitive behaviour therapy (CaCBT)

Detailed Description

The presence of obsessions and compulsions characterises obsessive-compulsive disorder (OCD). Obsessions are intrusive, unwanted thoughts, images, or impulses that are distressing and difficult to control. These obsessive thoughts cause significant emotional discomfort. Conversely, compulsions are repetitive behaviours or mental acts performed in response to an obsession or according to rigid rules. These actions are intended to reduce anxiety or prevent a feared event, even though they may not logically connect to the feared outcome. The individual often experiences temporary relief from distress through these ritualistic responses despite their lack of practical relevance to the obsessive fears.

Cognitive Behaviour Therapy (CBT) is widely recognised as a treatment option in both the US and UK National Treatment Guidelines (National Institute for Health and Care Excellence, 2009; American Psychiatric Association, 1993). There is strong evidence supporting CBT's effectiveness in treating, preventing relapse, and managing depression and anxiety (Embling, 2002; Fava et al., 1998; Paykel et al., 1999; Thase, 1997).

However, despite this evidence, there has been limited progress in assessing CBT's effectiveness in low and middle-income countries. CBT may require adaptation in non-Western cultures, as it involves exploring and modifying automatic thoughts and core beliefs (Padesky and Greenberger, 1995).

Preliminary research suggests that treatment manuals based on fundamental CBT principles are effective (Husain et al., 2013; Rahman et al., 2008; Sumathipala et al., 2008; Araya et al., 2003). In Pakistan, an adapted version of CBT for depression was conducted, demonstrating its effectiveness in primary care settings (Naeem et al., 2011). Similarly, a pilot study was conducted on brief culturally adapted cognitive behaviour therapy for obsessive-compulsive disorder (Aslam et al. 2015).

This study aims to conduct a randomised controlled trial using brief culturally adapted cognitive behaviour therapy for obsessive-compulsive disorder in Pakistan, as limited research is available on this aspect. Conducting this trial can provide valuable data on the effectiveness of culturally adapted CBT in the Pakistani cultural setting, informing both local and international practices.

• Study Type: Interventional
• Enrollment (Estimated): 166
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Muhammad Aslam; Phone Number: +92 301 7170139; Email: Muhammadaslam139@gmail.com

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54000
      • Recruiting
      • Professional Association of Cognitive Therapy
      • Principal Investigator: Farooq Naeem
      • Contact: Muhammad Aslam, MSCP; Phone Number: +92 301 7170139; Email: Muhammadaslam139@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Participants aged 18 years or above
• Participants with at least an elementary level of reading and writing
• Clinical diagnosis of Obsessive Compulsive Disorder, either alone or comorbid with depression or anxiety

Exclusion Criteria:

• Participants with excessive use of alcohol or drugs (using ICD-10 RDC for alcohol or drug abuse or dependence)
• Those with significant cognitive impairment (for example, intellectual disability or dementia)
• Or those with OCD comorbid active psychosis

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Brief culturally adapted CBT (CaCBT) group; Participants in this group will receive the Culturally Adapted CBT (CaCBT) manual along with treatment as usual (which typically involves medication prescriptions and regular hospital visits). The manual will focus on psychoeducation, symptom management, Exposure and Response prevention (ERP), thought distraction techniques, relaxation exercises, detection of mood and thoughts, cognitive errors, changing negative thinking, behavioural activation, problem solving, improving relationships and communication skills, Thought diaries and progress diary.	Other: Brief culturally adapted cognitive behaviour therapy (CaCBT); The intervention will focus on psychoeducation, symptom management, Exposure and Response prevention (ERP), thought distraction techniques, relaxation exercises, detection of mood and thoughts, cognitive errors, changing negative thinking, behavioural activation, problem solving, improving relationships and communication skills, Thought diaries and progress diary.
No Intervention: Treatment as usual group; Participants in this group will receive only treatment as usual (TAU), which typically involves medication prescriptions and regular hospital visits. Research psychologists delivering the intervention will not be involved with participants allocated to TAU.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy of brief culturally adapted cognitive behaviour therapy (CaCBT) for OCD	By comparing pre- and post-treatment OCD scores measured through the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).	6 weeks
Acceptability of the brief culturally adapted cognitive behaviour therapy (CaCBT) for OCD	Feedback will be taken from both patients and their family members, who will be trained as co-therapists, to evaluate their satisfaction with the therapy.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reduction in depression and anxiety associated with OCD	By comparing pre- and post-treatment depression and anxiety scores measured through the Hospital Anxiety and Depression Scale (HADS).	6 weeks
Reduction in functioning decline associated with OCD	By comparing pre- and post-treatment scores on the Brief Disability Questionnaire (BDQ).	6 weeks

Collaborators and Investigators

• Sponsor: Pakistan Association of Cognitive Therapists
• Investigators: Principal Investigator: Farooq Naeem, Professional Association of Cognitive Therapy; Principal Investigator: Muhammad Aslam, Professional Association of Cognitive Therapy

Study record dates

Study Major Dates

• Study Start (Actual): October 20, 2024
• Primary Completion (Estimated): December 10, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: October 16, 2024
• First Submitted That Met QC Criteria: November 15, 2025
• First Posted (Actual): November 18, 2025

Study Record Updates

• Last Update Posted (Actual): November 18, 2025
• Last Update Submitted That Met QC Criteria: November 15, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: OCD; CBT; CaCBT
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders; Obsessive-Compulsive Disorder
• Other Study ID Numbers: CaCBTOCD24

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No