The study has two main objectives: (1) to evaluate the acceptability and feasibility of a specialized Mindfulness-Based Cognitive Therapy (MBCT) program for Obsessive-Compulsive Disorder (OCD), delivered via videoconference in a synchronous group format; and (2) to explore the associations between selected clinical and biological markers, OCD severity, and treatment response. This is an interventional study involving outpatients with a diagnosis of OCD recruited at two participating centers in Italy: IRCCS Fatebenefratelli in Brescia (Center 1) and Centro Terapia Cognitiva e Mindfulness per il DOC in Vicenza (Center 2). Participants will take part in group-based treatment based on the MBCT program for OCD. Participants recruited at Center 1 will undergo blood and saliva sampling for the molecular analyses planned as part of the study. A healthy control group, matched for age and sex, will also be recruited for comparison in the analyses related to the second objective.
Obsessive-Compulsive Disorder (OCD) is a common and potentially disabling psychiatric condition, characterized by intrusive and distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). Cognitive behavioral therapy, particularly exposure and response prevention, is considered a first-line treatment for OCD. However, a proportion of patients continue to experience clinically significant symptoms after treatment, highlighting the need for complementary therapeutic approaches. Mindfulness-based interventions may help patients develop a less reactive and more accepting relationship with intrusive thoughts, emotions, and bodily sensations, potentially reducing the use of maladaptive strategies such as suppression, neutralization, and compulsions. Preliminary evidence suggests that mindfulness-based approaches may reduce OCD symptoms and may improve the acceptability of exposure-based treatment. However, evidence regarding synchronous, therapist-led online group interventions specifically adapted for OCD remains limited. This study aims to evaluate the feasibility and acceptability of a specialized Mindfulness-Based Cognitive Therapy (MBCT) program for OCD, delivered online through synchronous videoconferencing. The manualized intervention (Didonna, 2022) integrates mindfulness practices with cognitive behavioral therapy, exposure and response prevention, acceptance, decentering, and self-compassion techniques. The primary objective is to assess the feasibility and acceptability of the synchronous online intervention. Exploratory objectives are to evaluate changes in OCD symptoms and other clinical variables and to investigate associations between clinical characteristics, treatment response, and selected biological markers. At least 42 adults aged 18-45 years with a diagnosis of OCD will be recruited at two participating centers in Italy. Participants will attend 11 weekly online group sessions conducted by trained therapists. The intervention may be provided alongside ongoing stable pharmacological treatment and other standard clinical care. Clinical assessments: patients will undergo diagnostic and clinical assessment using the Structured Clinical Interview for DSM-5 (SCID-5-CV), including the personality disorders section (SCID-PD), and a medical and clinical history. Clinical assessments will be performed at baseline, immediately after treatment, and at 3-month follow-up. Clinician-administered assessment will include the Yale-Brown Obsessive Compulsive Scale-2nd version (Y-BOCS-II) to assess OCD symptom severity. Self-report measures will assess depressive and anxiety symptoms, mindfulness, interoceptive awareness, dysfunctional obsessive beliefs, self-compassion, mind wandering, and general psychopathology. Treatment acceptability and feasibility will be assessed through recruitment and dropout rates, treatment adherence, attendance, completion rates of assessment questionnaires, reasons for treatment discontinuation, treatment satisfaction, and home mindfulness practice. Participants will complete an ad hoc treatment satisfaction questionnaire at the end of treatment. Home practice time will be monitored during treatment and follow-up, and practice quality will be assessed using the Practice-Quality-Mindfulness (PQ-M) at predefined time points. Biological assessments: patients recruited at Center 1 will provide blood and saliva samples before and after the intervention. Blood will be collected for RNA, DNA, plasma, and serum analyses; while saliva samples will be collected during the day to measure cortisol levels.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
42
The intervention is a manualized Mindfulness-Based Cognitive Therapy (MBCT) program for OCD that integrates cognitive-behavioral therapy, exposure techniques, mindfulness, decentering, acceptance, and self-compassion practices (Didonna, 2022). The program aims to improve participants' ability to relate to internal experiences and reduce reactive patterns such as rituals and compulsions. Groups of 8-10 patients will receive the intervention online via synchronous videoconference. The program consists of 11 weekly sessions, including a 1.5-hour session involving family members and/or partners and a 6-hour intensive practice day.
IRCCS Centro San Giovanni di Dio Fatebenefratelli
Brescia, Italy
RECRUITINGChange from baseline in the Yale-Brown Obsessive Compulsive Scale 2nd version (Y-BOCS-II) total score.
The Y-BOCS-II is a clinician-administered semi-structured interview used to assess the presence and severity of obsessive-compulsive disorder (OCD) symptoms. The scale consists of 10 severity items, each rated from 0 (no symptoms) to 5 (extreme symptoms). The total score ranges from 0 to 50, where higher scores indicate greater symptom severity. A decrease in the score reflects clinical improvement.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up
Recruitment rate
Recruitment rate will be calculated as the percentage of eligible participants who enroll in the study among all participants assessed for eligibility.
Time frame: From study initiation to completion of recruitment.
Treatment dropout rate
Treatment dropout rate will be calculated as the percentage of participants who discontinue treatment before completing the intervention.End of Treatment (Week 11).
Time frame: End of Treatment (Week 11).
Treatment attendance rate
Treatment attendance rate will be calculated as the percentage of scheduled treatment sessions attended by each participant.
Time frame: End of Treatment (Week 11).
Assessment questionnaire completion rate
Assessment questionnaire completion rate will be calculated as the percentage of scheduled assessment questionnaires completed by participants.
Time frame: Baseline (Week 0), End of Treatment (Week 11), and Post-Treatment Follow-Up (3 months after treatment completion).
Treatment satisfaction score
Treatment satisfaction will be assessed using an ad hoc treatment satisfaction questionnaire completed by participants at the end of treatment.
Time frame: End of Treatment (Week 11).
Home mindfulness practice time
Home mindfulness practice time will be assessed as the total amount of time spent practicing mindfulness at home during the treatment and follow-up periods.
Time frame: During treatment (Weeks 1-11) and Post-Treatment Follow-Up (3 months after treatment completion).
Quality of home mindfulness practice
The quality of home mindfulness practice will be assessed using the Practice-Quality-Mindfulness (PQ-M) scale at predefined assessment time points. The PQ-M score will be calculated according to the scoring procedure of the instrument.
Time frame: At Weeks 4, 8, 12, 20, and 24 from the start of the intervention.
Change from baseline in the Beck Depression Inventory-II (BDI-II) total score.
The Beck Depression Inventory-II (BDI-II) is a self-report questionnaire designed to assess the severity of depressive symptoms. Each item is rated on a 4-point scale ranging from 0 to 3, reflecting increasing severity of the symptom.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up.
Change from baseline in the Beck Anxiety Inventory (BAI) total score.
The Beck Anxiety Inventory (BAI) is a 21-item self-report questionnaire designed to measure the severity of anxiety symptoms over the past week. Each item is rated on a 4-point scale ranging from 0 (not at all) to 3 (severely). The total score ranges from 0 to 63, with higher scores indicating greater anxiety severity.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up.
Change from baseline in the Five Facet Mindfulness Questionnaire-Short Form (FFMQ-SF) total score.
The Five Facet Mindfulness Questionnaire-Short Form (FFMQ-SF) is a 24-item self-report instrument used to assess five facets of mindfulness: Observing, Describing, Acting with Awareness, Non-judging of Inner Experience, and Non-reactivity to Inner Experience. Each item is scored on a 5-point Likert scale ranging from 1 (never or very rarely true) to 5 (very often or always true). The total score is calculated by summing all items and ranges from 24 to 120, with higher scores indicating higher levels of mindfulness.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up.
Change from baseline in the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2) subscale scores.
The Multidimensional Assessment of Interoceptive Awareness (MAIA-2) is a self-report questionnaire designed to evaluate multiple dimensions of individuals' awareness and perception of internal bodily sensations. The questionnaire assesses different aspects of interoceptive awareness, including noticing bodily sensations, emotional awareness, attention regulation, and the ability to respond to bodily sensations in an adaptive manner. Higher scores indicate greater adaptive interoceptive awareness.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up.
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Change from baseline in Obsessional Beliefs Questionnaire (OBQ-20) score.
The Obsessional Beliefs Questionnaire-20 (OBQ-20) is a 20-item self-report instrument designed to assess dysfunctional cognitive beliefs and attitudes critical to the development and maintenance of OCD. The scale evaluates four main domains: 1) Responsibility, 2) Threat Estimation, 3) Perfectionism, and 4) Importance/Control of Thoughts. Each item is rated on a 7-point Likert scale ranging from 1 (disagree very much) to 7 (agree very much). The total score is obtained by summing all 20 items and ranges from 20 to 140, with higher scores indicating a greater presence or severity of dysfunctional obsessional beliefs.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up.
Change from baseline in the Self-Compassion Scale-Short Form (SCS-SF) total score.
The Self-Compassion Scale-Short Form (SCS-SF) is a 12-item self-report questionnaire designed to assess an individual's level of self-compassion. Each item is rated on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always). Higher scores indicate a greater level of self-compassion.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up
Change from baseline in the Mind-Wandering Questionnaire (MWQ) total score.
The Mind-Wandering Questionnaire (MWQ) is a 5-item self-report instrument designed to measure trait levels of task-unrelated thought (mind-wandering). Each item is rated on a 6-point Likert scale ranging from 1 (almost never) to 6 (almost always). Higher total scores indicate a greater propensity or frequency of mind-wandering.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up.
Change from baseline in the Symptom Checklist-90-Revised (SCL-90-R) Global Severity Index (GSI)
The Global Severity Index (GSI) is the primary summary score of the Symptom Checklist-90-Revised (SCL-90-R), a 90-item self-report questionnaire designed to evaluate a broad range of psychological symptoms and psychopathology. Each of the 90 items is rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). The GSI raw score ranges from 0 to 4, with higher scores indicating a greater overall level of psychological distress and symptom severity.
Time frame: Baseline, post-treatment (11 weeks), and 3-month follow-up.