Beginning Activity • On a piece of paper I need you to answer the following questions:
What do you think Obsessive Compulsive Disorder is? • What do you think is the best way for an Individual to overcome the obsessions? • Can you explain some common obsessions that people struggle with?
OCD… • Is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). • Behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. • http://www.youtube.com/watch?v=jqtrXBZ9Rag
Secretive Disease? • Imagine that you have OCD, why would you feel secretive about having the disease?
Signs and Symptoms • People with OCD are plagued with: • Unwelcomed thoughts or images • Urgent need to engage in rituals • Needing to check things over and over • Example: Washing Hands over and over • http://www.nimh.nih.gov/health/publications/anxiety-disorders/obsessive-compulsive-disorder.shtml
Common Obsessions • Fear of contamination • Fear of own saliva, urine, feces etc. • Fear of things not being done perfectly. • Fear of harming oneself, others. • Hoarding.
What causes OCD? • No clear cause • May be a combination of behavioural and cognitive theories.
Behavioural Theory • The behavioural theory suggests that people with OCD associate certain objects or situations with fear • They learn to avoid the things they fear or to perform rituals that help reduce the fear.
Behavioural Theory cont. • Once a connection between an object and the feeling of fear becomes established, people with OCD avoid the things they fear, rather than confront or tolerate the fear.
Example • Toilet Example
Cognitive Theory • While the behavioural theory focuses on how people with OCD make an association between an object and fear. • The cognitive theory focuses on how people with OCD misinterpret their thoughts.
The Cognitive Theory • Comes as a result of exaggerated thoughts early in life. • Example- Washing hands constantly
The following beliefs may be important in the development and maintenance of obsessions • Exaggerated responsibility • Thoughts are important and should be controlled • Having a thought or an urge to do something will increase the chances that it will come true • Tendency to overestimate the likelihood of danger • Belief that one should always be perfect and that mistakes are unacceptable.
Treatment for OCD:Cognitive Behavioural Theory • Modern treatments for OCD have radically changed how the disorder is viewed. • Hope for those with OCD • Cognitive, Behaviour Therapy and antidepressant medications are currently used to treat the disorder. • Neither B.T. not C.T. provide a “cure” for OCD.
What is Cognitive-Behavioural Therapy? • Cognitive-behavioural therapy refers to two distinct treatments: 1.Exposure and Response Prevention 2.Cognitive Therapy. • Although these treatments are increasingly offered in combination, we will discuss them separately.
Behavioural Therapy • The mostly widely practiced behaviour therapy for OCD is called Exposure and Response Prevention (ERP).
Exposure • The “exposure” part of this treatment involves direct or imagined controlled exposure. • Over time, exposure to obsessional cues leads to less and less anxiety. • Eventually, exposure to the obsessional cue arouses little anxiety at all. • This process of getting “used to” obsessional cues is called “habituation.”
Response • Refers to the actions that people with OCD use to alleviate stress. • In ERP treatment, patients learn to resist the compulsion to perform rituals and are eventually able to stop engaging in these behaviours.
How Does ERP work? • Before starting ERP treatment, patients make a list, or what is termed a “hierarchy”of situations that provoke obsessional fears. • For example, a person with fears of contamination might create a list of obsessional cues that looks like this:
Touching Garbage • Using the Toilet • Shaking Hands
ERP Continued • Treatment moves gradually • The pace of the treatment depends on the patient
Exposure Tasks • Exposure tasks are usually first performed with the therapist assisting. • These sessions generally take between 45 minutes and three hours. • Patients are also asked to practice exposure tasks between sessions for two to three hours per day.
How effective is ERP? • Even patients with longstanding and severe symptoms of OCD can benefit from ERP treatment. • Success depends on a number of factors and requires that the patient be motivated to get well. • Studies documenting the benefits of ERP treatment have found that upwards of 75 per cent of patients experience improvement in their OCD symptoms during treatment. • The majority show long-term improvement two and/or three years after treatment.
Cognitive Therapy • People with OCD become anxious about their thoughts (or obsessions) when they interpret those thoughts as being dangerous.
Cognitive Therapy (CT) • Is done in combination with Exposure and Response Prevention. • Patients create a hierarchy of events that cause them distress.
Cognitive Therapy (CT) • In CT, the focus is on how participants interpret their obsessions: • What they believe or assume to be true about them • What their attitude is toward them • Why they think they have those obsessions.
Thought Record • One tool used in CT to help people identify and eventually correct negative thoughts is called The Thought Record.
Thought Record The first step is for the person to record every thought they experience during an intrusive time. It may look like this: • Where was I when the obsession began? • What image did I have? • What meaning do I apply to having the intrusive thought? • What did I do?
Example of a Thought Record • Situation: Sitting at home watching TV. • Intrusive Thought: “God doesn’t care.” • Appraisal of Intrusive thought: • I am a bad person for having bad thoughts. • God will punish my family and me. • I must be losing my mind if I can’t stop these thoughts from happening. • Ritual: Pray
After people learn to identify their intrusive thoughts the next steps are: • Examine evidence that does not support the obsession. • Identify cognitive distortion in the appraisals of the obsession. • Begin to develop a less threatening response to the thought.