Transcript Obsessive Compulsive Disorder

Obsessive Compulsive
Disorder
Beginning Activity
• On a piece of paper I need you to answer
the following questions:
1. What do you think Obsessive
Compulsive Disorder is?
2. What do you think is the best way for an
Individual to overcome the obsessions?
3. 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/anxietydisorders/obsessive-compulsive-disorder.shtml
Common Obsessions
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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:
1. Touching Garbage
2. Using the Toilet
3. 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:
1. Where was I when the obsession began?
2. What image did I have?
3. What meaning do I apply to having the
intrusive thought?
4. What did I do?
Example of a Thought Record
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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
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After people learn to identify their
intrusive thoughts the next steps are:
1. Examine evidence that does not support
the obsession.
2. Identify cognitive distortion in the
appraisals of the obsession.
3. Begin to develop a less threatening
response to the thought.