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Group ACT for OCD

Group ACT for OCD. Giselle Brook Cognitive Behavioural Psychotherapist Joe Curran Principal Cognitive Behavioural Psychotherapist Tom Ricketts Cognitive Behavioural Psychotherapist/Consultant Nurse. Obsessions and Compulsions.

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Group ACT for OCD

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  1. Group ACT for OCD Giselle Brook Cognitive Behavioural Psychotherapist Joe Curran Principal Cognitive Behavioural Psychotherapist Tom Ricketts Cognitive Behavioural Psychotherapist/Consultant Nurse

  2. Obsessions and Compulsions • Obsessions: Thoughts urges or images that are experienced as unwanted, intrusive and out-of-character • Compulsions: Repetitive intentional behaviours or mental acts that are often linked to obsessions and serve to reduce discomfort or anxiety

  3. Exposure & Response Prevention (ERP) for OCD • ERP is an effective psychological treatment for OCD (Abramowitz,1997) • However up to 30% of participants do not benefit from ERP, and a further 15-20% withdraw from treatment (Foa et al 1983) • ‘Recovery’ as defined using the Y-BOCS occurs for perhaps 50-60% of completers in ERP (Foa, 2005)

  4. Rationale for an ACT-informed Group for OCD • Low levels of psychological flexibility is a key aspect of OCD phenomenology • People suffering from OCD often are working very hard to ‘control’ obsessions • Valued aspects of life are often severely disrupted by OCD, put on hold pending symptom relief • Experiential avoidance is evident ( Trowhig, Hayes, Masuda 2006 )

  5. Client Group • Clients with longstanding ‘treatment resistant’ problems with OCD • A majority have received prior CBP, generally ERP

  6. Structure and Group Process • Individual pre-group meetings to discuss group attendance , assessment and completion of measures • 12 x 2 hr groups, new material during each of the first 10 sessions, then negotiated revision • Overall content predetermined, ordering and emphasis varied according to group needs • Strategies to gradually enhance willingness to disclose experiences to each other, make behavioural commitments and feed back

  7. Measurement • Pre, mid, end and 3-month f/up • Yale-Brown Obsessive Compulsive Scale • Life Adjustments Scale (5-item) • Acceptance and Action questionnaire

  8. Phase 1: Creative Hopelessness • Differentiating obsessions and compulsions • What works? • Tug-of-war with a monster • Person-in-a-hole • What is digging for you?

  9. Phase 2: Willingness & De-Fusion • Willingness as an alternative to control • The two scales of anxiety and willingness • Acceptance of thoughts and feelings • Willingness to have obsessions • Word repetition • De-fusing self-evaluation

  10. Phase 3: Values & Barriers to Valued Living • Valued Living questionnaire • Discrepancy between values and actions • Life compass • Barriers to achieving valued living • Values guided behavioural commitments • Passengers on the bus

  11. Phase 4: Personalisation • Selecting the approaches which suit you • Personal plans • Continued application of acceptance and action strategies through follow-up

  12. Case Study 1: Background • 48 yr old divorced woman • 15 year history of obsessions regarding contamination, hand-washing cleaning and avoidance • Reported disruptions of relationships, home life and loss of job associated with OCD

  13. Case Study 2: Intervention • Creative hopelessness associated with reported surprise at the idea that mental events may not be controllable • Values work associated with client reporting increased focus on time for self and time with children • Acceptance of thoughts and feelings associated with reported increased willingness to have obsessions • In-session willingness exercise associated with reduced avoidance and increased behavioural change between session

  14. Our Learning • ACT is congruent with ERP approaches • Different people take different things from the approaches - formulation matters • The group is an excellent vehicle for addressing the ‘unacceptability’ of certain mental events • Experiential approaches are most effective • Abandoning the control agenda is difficult for people suffering from OCD (and us)

  15. Next Steps • Complete three-month follow-up on the current group • Report the results • Maintain the focus on ‘treatment non-responders’ as we deliver further groups • Maintain the tertiary care focus of the service in line with NICE guidelines

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