Fact and Fiction in the understanding and treatment of Obsessive-compulsive problems

1. Fact and Fiction in the understanding and treatment of Obsessive-compulsive problems Paul Salkovskis

2. Lets get the obvious fictions out of the way first Fictions: People with OCD are: Mad Dangerous Weird/bizarre Weak Cowardly Neurotic

3. Fiction: Research is answering all of our questions about OCD

5. Clinical Science: �Empirically Grounded Clinical Interventions�

6. Fact Understanding how OCD works is helpful to sufferers, carers and families Oh, and professionals too.

7. Fact: Understanding is in short supply

8. I wish that ( ) would be violently killed tonight

9. More understanding�..

12. Which emotion when? Emotions are specific to particular meanings Depression: Personal loss Anxiety: Threat or danger to you Anger: Someone broke your personal rules (unfairness) Guilt: You broke your own rules

13. Why do some people experience particularly intense anxiety?

14. What are obsessions and compulsions? Obsession: A recurrent thought, image, impulse or doubt which creates awareness of the potential for danger which the person can cause or prevent Compulsion: An action or reaction that is intended to both to prevent the danger of which the obsession has created awareness and to diminish responsibility for its ocurrence.

15. Cognitive theory of OCD simply put: Unacceptable intrusive thoughts, images, impulses and doubt are a frequent normal occurrence The obsessional patient believes that they might be responsible for harm if they don�t act to prevent it They respond by TRYING TOO HARD (to get rid of the thought, to prevent harm, to be sure�..and so on). As time goes by, THE SOLUTION BECOMES THE PROBLEM.

20. Fact: CBT is a structured approach to treatment Engagement in assessment: helping the patient to feel understood through real understanding Formulation: reaching a shared understanding Discussion of alternative explanations Engagement in treatment: helping the patient to choose to change Helping the patient to actively test the alternative account and explore its implications Generalising changes Relapse prevention

21. Fiction: OCD can not be completely eliminated OCD is a genetic disorder

22. Fiction Getting rid of OCD is just a matter of confronting your fears

23. Facts: Getting rid of OCD requires you to confront your fears Cognitive behaviour therapy is the only psychological treatment which has been found to be effective in the treatment of OCD.

24. Fact Reassurance makes OCD worse

25. Fact It is good to get support from people around you when you are resisting your OCD

26. Fact: there is not enough CBT being offered Only 16% of a sample from our clinic had �adequate CBT�

27. Fact It is really hard to get CBT for OCD in the health service

28. Fiction There are insufficient health service resources to provide effective psychological treatment for anything other than a small fraction of people suffering from OCD

29. Facts: There is no such thing as a �Hopeless case� Some clinicians cover their failure to help by telling their patients to �Learn to live with it�, that they are a hopeless case etc; i.e. they blame the victim

30. Am I a hopeless case? Age? Duration of problem? Severity of problem? My therapist/key worker says I am�

31. Some more fictions: OCD is caused by not enough serotonin OCD is caused by a malfunctioning part of the brain Psychosurgery helps OCD Deep Brain Stimulation is a reversible procedure

32. Fiction: Brain scans show that OCD is a brain disease

33. Fact: The brain is the organ of the mind

34. Fiction It is best for sufferers and public perception to describe OCD as a �brain disease�

35. Fact Describing anxiety as being cased by a �brain disease� increases pessimism about the likely response to treatment.

36. Fact It usually takes seven years from onset to diagnosis in OCD

37. Fact OCDUK is a wonderful way of empowering both yourself and others

38. Fact: That�s the end of the presentation