Treating Ocd with Exposure and Response PreventionEssay Preview: Treating Ocd with Exposure and Response PreventionReport this essayObsessive-Compulsive disorder is an anxiety disorder with potentially disabling ramifications. The individual afflicted with OCD becomes trapped in a pattern of repetitive thoughts and behaviors which are very difficult to overcome. A persons severity of OCD can vary, but if left untreated, the disorder can destroy a persons capacity to function at work, school or even at home. For most of the 20th century, treatment focused for OCD centered around providing insight through psychotherapy. This form of treatment was generally ineffective. Since the mid 1970s prognosis for OCD has improved considerably with the introduction of cognitive- behavioral treatment like Exposure & Ritual Prevention, or EX/RP.
For decades, the prevalence of OCD was under-reported. Mental health professionals considered OCD to be a rare disease because only a small number of their clients admitted to having the condition. Additionally, the disorder was often not recognized in therapy because many of those afflicted with OCD were ashamed of their condition and declined to seek treatment for it. Eventually, a survey conducted in the early 1980s by the National Institute of Mental Health (NIMH) provided new knowledge about the prevalence of OCD. The NIMH survey showed that OCD affects more than two percent of the American population. This prevalence means that OCD is more common than such severe mental illnesses as schizophrenia, bipolar disorder and panic disorder.
OCD is characterized by recurrent obsessions and/or compulsions that interfere considerably with daily functioning (DSM-R IV). Obsessions are “persistent, ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress.” Compulsions are “repetitive behaviorsor mental acts…the goal of which is to prevent or reduce anxiety or distress” (DSM-R IV). Also, during the course of the disorder, the person must realize that his/her obsessions or compulsions are unreasonable or excessive. This introspective element is not required in the diagnosis for a child, however. Although OCD symptoms typically begin during the teen years or early adulthood, research shows that some children may develop the illness during preschool. Studies indicate that at least one-third of cases of adult OCD began in childhood (NIMH). Suffering from OCD during early stages of a childs development can cause severe problems for the child. It is important that the child receive evaluation and treatment as soon as possible to prevent the child from missing important opportunities because of this disorder. OCD strikes people of all ethnic groups, affecting males and females equally.
The belief that OCD is the result of life experiences has become less valid in light of research focusing on biological factors. Most experts now believe that OCD has a neurobiological basis. OCD is no longer attributed only to attitudes a patient learned in childhood — excessive importance of cleanliness, or a belief that some thoughts are unacceptable or dangerous.
Once regarded as chronic and untreatable, modern cognitive-behavioral treatments help people with OCD control their symptoms and enable them to restore normal function in their lives (CAMH). In particular, EX/RP is effective for many people. In this approach, the patient voluntarily and deliberately confronts the feared object or idea, either directly or by imagining. At the same time the patient is strongly encouraged to refrain from engaging in the ritualized compulsive behaviors. Treatment then proceeds on a step-by-step basis, guided by the patients ability to tolerate the anxiety and control the rituals. As treatment progresses, most patients gradually experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges. This process of getting “used to” obsessional cues is called “habituation.”
Specific cognitive tasks precede any exposure or ritual prevention. First, the client writes out a complete list of situations, thoughts, images or impulses that make him/her anxious. This list is given a name, like the “obsession list.” The client then creates (and names) a list of all the things he/she does to reduce or help manage the anxiety. The next step is writing out (and naming again) a complete list of all the things he/she completely avoids because the anxiety is too overwhelming. When these three lists are done, the client creates a Subjective Units of Distress scale (SUDS), numbered one to ten. “One” represents “calm, cool, and collected” and “ten” equals “worst anxiety ever; panic attack.” The client then ranks each item on his/her compulsion and avoidance lists based on what the anticipated anxiety would be if asked to resist doing the ritual or to do what he/she avoids. From this self-reported data, the clinician helps the client generate a fear hierarchy by recording the items ranked from highest to lowest.
EX/RP begins after the fear hierarchy is constructed. Treatment starts with exposure to situations that cause mild to moderate anxiety, and as the patient habituates to these situations, he or she gradually works up to situations that cause greater anxiety. The time it takes to progress in treatment depends on the patients ability to tolerate anxiety and to resist compulsive behaviors (CAMH). Exposure tasks are usually first performed with the therapist assisting. These sessions generally take between 45 minutes and three hours. In some cases, direct, or “in vivo,” exposure to the obsessional fears is not possible in the therapists office. “Imaginal” exposure, which involves exposing the person to situations that trigger obsessions
EX/RP begins after the fear hierarchy is constructed
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Exposure tasks in this study use xtime of 7 days to 10 days, which may reduce the time spent in treatments and the number of participants in care. The duration between sessions is approximately 3 to 6 hours, with no time spent in pre- and post-treatment therapy. In contrast to other studies (J,W, and T), our research is based on patients whose prediagnosis is late. As with other anxiety disorders, patients whose diagnosis is late in therapy (in our sample) are at the least likely to attend therapy for the current session. Moreover, many of the patients had pre diagnosed symptoms prior to therapy, and all had a negative pre diagnosis. Thus, some may not be able to tolerate the anxiety without the exposure. We are aware of no empirical evidence to support negative pre diagnosis pre- and/or post post-treatment anxiety disorders, since it has been found that anxiety disorders, such as those mentioned above, do not lead to a greater likelihood of successful treatment in these situations. This does not imply that the diagnosis may not lead to a more favorable outcome, but that the patient has to adapt her or his personal sense of self awareness over time to cope with this anxiety. Indeed, our findings may indicate that post-treatment anxiety disorder may involve a “permissible individual” in the therapy program (J,W, and T). Many clinicians will be familiarizing themselves with the need to prepare patients for their own behaviors after treatment for anxiety. (J,W) While the current trial was limited to patients in a group that had been treated previously and had completed treatment with a different type of anxiety disorder, we observed no risk of developing anxiety as a result of our study (S,W) or in other studies (J). Our initial observation was that patients who were exposed to symptoms of anxiety prior to treatment and in a supportive setting were more likely to report experiencing those symptoms later in the year and to report symptom relief after treatment, whereas patients who did not report symptom relief reported experiencing similar symptom relief later (S). Patients who did not report relief during treatment by the first day of treatment were at a higher risk of developing these symptoms more than patients who did not report relief by the first day of treatment (S,W). These findings suggest that patients presenting to the therapist after treatment or as a patient at a family or private home are also more likely to be exposed to anxiety disorders in the setting of care at a later time (S).
Exposure work is most evident in the presence of obsessions associated with the obsessions or obsessions of others. For obsessions, it may be possible to induce the obsessions of others (especially with an object used for obsessions): such obsessions may lead to self-perception and obsessions of others (S), while others may also affect self-confidence and sense of self (E). By contrast