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

OBJECTIVE: To evaluate the feasibility, acceptability, and religious congruence of integrating the 4T religious psychoeducation 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. Feasibility indicators included recruitment, retention, adherence, and participant feedback. Semi-structured interviews were thematically analyzed to examine acceptability and cultural fit. RESULTS: Both interventions were feasible and well-tolerated, with adequate recruitment and retention. Participants in both groups showed within-group improvements across symptom and cognitive measures. Exploratory trends suggested greater reductions in thought-action fusion (likelihood) and additional late-phase cognitive shifts in the 4T group. Qualitative findings highlighted positive perceptions of the 4T model's religious congruence, clearer understanding of intrusive thoughts, and enhanced motivation. CONCLUSION: This randomized pilot feasibility trial supports the practicality and acceptability of integrating religiously grounded psychoeducation into CBGT for religious OCD. Preliminary trends suggest the need for a larger definitive trial, and qualitative data highlight the contextual relevance of religiously integrated psychoeducation for treatment engagement.