Efficacy of Distress Tolerance Techniques of Dialectical Behavior Therapy in Persons with Obsessive-Compulsive Disorder: a study protocol for a randomized controlled trial

Background Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental health condition that significantly impairs the quality of life. Although cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is considered the gold standard, many patients remain symptomatic or find these approaches challenging due to emotional and cognitive barriers. Distress Tolerance Techniques (DTT), a component of Dialectical Behavior Therapy (DBT), have demonstrated efficacy in various conditions, including substance dependence, binge eating, and depression, by managing negative emotional states and enhancing coping mechanisms beyond their original focus on borderline personality disorder. However, the application of DTT in the treatment of patients with OCD has not been extensively explored. This study aims to evaluate the efficacy of DTT in reducing OCD severity and improving psychological outcomes. Methods This prospective, single-center, open-label randomized controlled trial will recruit 60 adults (18–40 years) diagnosed with OCD (ICD-10 criteria, Y-BOCS score ≥ 16) from the Department of Psychiatry, All India Institute of Medical Sciences, Bhopal. Participants will be randomized 1:1 using a random number table to either the intervention or active control group. Participants in the intervention group will engage in a 12-week structured DTT program specifically tailored for Obsessive-Compulsive Disorder (OCD), whereas those in the active control group will undergo standard treatment of exposure and response prevention (ERP).The primary outcome will be OCD severity, measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Secondary outcomes included distress tolerance (measured using the Distress Tolerance Scale), depressive symptoms (measured using the Beck Depression Inventory), coping strategies (measured using the Dialectical Behavior Therapy-Ways of Coping Checklist), mindfulness (measured using the Kentucky Inventory of Mindfulness Skills), and acceptance (measured using the Acceptance and Action Questionnaire-II). Outcomes for the treatment groups will be evaluated before randomization (baseline, T1) and 12 weeks (end of treatment, T2). The protocol was approved by the Institute Ethical Committee (approval number) and was performed in strict adherence to the Declaration of Helsinki formulated by the World Medical Association. Discussion This trial will explore the efficacy of Distress Tolerance Techniques in patients with OCD. This study will provide evidence for a therapeutic approach that addresses the limitations of traditional CBT and improves outcomes for patients with OCD. Trial Registration: Central Trial Register of India, CTRI/2024/09/073672, registered on 21 December 2024