Rethinking Cognitive Psycho-education -4T Model- in the Psychotherapy of Religious Obsessive-Compulsive Disorder: Report of Three Resistant Cases

Author/s: Taha Burak Toprak


Year: 2024 Vol: 9 Number: 1


In religious obsessive-compulsive disorder (OCD), the current cognitive model does not seem to be convincing enough for patients to understand the source of their obsessions and to distinguish between their obsessions and their religious beliefs (iman) and values, which affects secure relationships in therapy. Therefore, there is a need for both religious sensitivity and model proposals to solve the problem of lack of persuasiveness of cognitive psycho- education. From this perspective, the present case study uses the 4T model (tahayyul (imagination), tasawwur (conceptualization/detailed imagination), taakkul (reasoning/reflecting), tasdiq (confirmation)), which is a hierarchical cognitive model and adapted with the inspirations from the texts of Muslim scholars (specifically from Nursi’s text of Treatise on Scrupulosity) on cognitive processes. A case report of three individuals with religious OCD is presented to demonstrate the effectiveness of this treatment method. Symptoms were measured in therapy using the Yale-Brown Obsessive Compulsive Scale, Beck Depression Inventory, Beck Anxiety Inventory, and Padua Inventory scales. Feedback was obtained for post-intervention assessment. The participants received 30 individual face-to-face therapy sessions, one per week, with an average duration of 50 minutes per session, and follow-up sessions were also conducted after the completion of treatment. The results from the three cases of individuals with religiously resistant OCD symptoms, which resulted in improvement on all scale scores, demonstrate that the model is substantially effective, particularly in addressing thought-action fusion (TAF). Furthermore, the thought hierarchy offered by the model is practical and compelling in the process of cognitive restructuring.

Religious OCD (Scrupulosity), Cognitive Behavioral Therapy, 4T Model, Case Study