A randomized mixed-methods pilot feasibility trial of CBT group therapy with 4T-Integrated religious psychoeducation for religious obsessions and compulsions

Abstract

Objective: To evaluate the feasibility, acceptability, and religious congruence of integrating the 4T religiouspsychoeducation model into CBT group therapy for religious OCD, with exploratory analyses of clinical change.Method: Twenty-three adults with religious OCD were randomly assigned to standard CBGT or a 4T-integrated group.Assessments were conducted at pre-test, post-test, and 1-, 3-, and 12-month follow-ups using the Y-BOCS, OBQ-44,TAFS, PIOS, BDI, and BAI. Linear mixed-effects and nonparametric analyses explored within-group change. Feasibilityindicators included recruitment, retention, adherence, and participant feedback. Semi-structured interviews werethematically analyzed to examine acceptability and cultural fit.Results: Both interventions were feasible and well-tolerated, with adequate recruitment and retention. Participants in bothgroups showed within-group improvements across symptom and cognitive measures. Exploratory trends suggested greaterreductions in thought–action fusion (likelihood) and additional late-phase cognitive shifts in the 4T group. Qualitativefindings highlighted positive perceptions of the 4T model’s religious congruence, clearer understanding of intrusivethoughts, and enhanced motivation.Conclusion: This randomized pilot feasibility trial supports the practicality and acceptability of integrating religiouslygrounded psychoeducation into CBGT for religious OCD. Preliminary trends suggest the need for a larger definitivetrial, and qualitative data highlight the contextual relevance of religiously integrated psychoeducation for treatmentengagement.