Cognitive behavioral therapy for obsessive compulsive disorder. CBT for OCD (ERP in OCD)
30.7 هزار بار بازدید -
3 سال پیش
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Cognitive behavioral therapy of obsessive
Cognitive behavioral therapy of obsessive compulsive disorder. CBT for OCD (ERP in OCD)
Cognitive Behavioral therapy comprises of a variety of techniques used to modify or replace maladaptive thoughts, emotions and behaviors with more adaptive forms of the same. Obsessions and compulsions seen in OCD are examples of maladaptive behaviors as they cause significant distress and interfere with normal functioning of an individual. Behavior therapy helps to remove obsessions and compulsions and thereby ameliorate the distress.
In treating OCD several CBT techniques are used. Of them, “Exposure and Response Prevention”, is the most effective and widely used technique. It is effective in 60-70% of patients suffering from OCD.
The “Exposure and Response prevention” technique based on the principle of “habituation” of emotions breaks this vicious cycle. What then is habituation? It is based on a simple principle that irrational fears and behavior disappear upon repeated exposure to the sources of fear and anxiety. By repeated and prolonged exposure, the individual gets habituated or used to the anxiety or discomfort to the point where the sources of fear lose their ability to provoke any anxiety, fear or discomfort. However, patients with OCD tend to handle their fear and anxiety by indulging in compulsions and active avoidance of all those situations that could trigger obsessions. On the contrary, in behavior therapy, patient is encouraged to gradually expose oneself to the anxiety-provoking situations and get habituated to the discomfort. And also, the patient is encouraged to not avoid any situations and indulge in compulsions. By preventing oneself from performing compulsions. The anxiety associated with obsession gradually dies on its own. Once the patient get used to anxiety the obsessions and compulsions also gradually disappear.
If patient perform compulsions in response to anxiety related to obsession, than he gets temporary relief. But he has to perform compulsions when ever he gets these obsessions. The only way then to break this vicious cycle is to expose but not to wash hands. By such repeated exposures, the fear of contamination gradually disappears and hence the compulsion of hand-washing also
If a patient doesn’t perform any compulsion in response to obsession, then anxiety comes down slowly on its own which is called habituation. Then he doesn’t require performing compulsions whenever he gets these obsessions.
Analysis of the symptoms and implementation of treatment:
1. The first step is careful and detailed documentation of all the obsessions and compulsions.
2. Having done that, all the objects and situations that provokes obsessions and compulsions. Are identified and arranged in a hierarchy of situations from the least anxiety provoking to the most anxiety provoking ones.
3. The information is also obtained about all the objects and situations that the patient avoids to control rituals. For example, a patient may avoid public toilet to prevent having to extensively wash his or her body or clothes. Like objects and situations, certain thoughts and images can also trigger anxiety, panic or discomfort and lead to ritualistic behaviors. For example, blasphemous thoughts may get triggered in a person upon seeing photographs of gods and goddess and visiting temples. To escape from the anxiety the person may end up avoiding temples and praying.
4. In some patients the obsessions and compulsions occur only in home It is very vital to have this information as the treatment has to be accordingly entirely home based, and with full cooperation of other family members.
5. Finally, in some patients, rituals are reinforced by family members ‘co-operation is sought to implement the treatment.
It is important to understand at the outset, that the treatment causes discomfort and that one should be prepared to go through some discomfort to obtain relief ultimately. The speed of habituation of emotional responses varies from person to person. Some may require lesser time (e.g. 30 min) of exposure while others may require repeated long exposures (1-2 hours) before any diminution of the anxiety occurs. Usually the compulsions and rituals are the first to respond and the obsessions take longer to “wear out”. Most show response between 10-12 hours of exposure and response prevention. For a successful outcome, motivation to get well and withstand the discomfort in initial sessions is vital.
Cognitive Behavioral therapy comprises of a variety of techniques used to modify or replace maladaptive thoughts, emotions and behaviors with more adaptive forms of the same. Obsessions and compulsions seen in OCD are examples of maladaptive behaviors as they cause significant distress and interfere with normal functioning of an individual. Behavior therapy helps to remove obsessions and compulsions and thereby ameliorate the distress.
In treating OCD several CBT techniques are used. Of them, “Exposure and Response Prevention”, is the most effective and widely used technique. It is effective in 60-70% of patients suffering from OCD.
The “Exposure and Response prevention” technique based on the principle of “habituation” of emotions breaks this vicious cycle. What then is habituation? It is based on a simple principle that irrational fears and behavior disappear upon repeated exposure to the sources of fear and anxiety. By repeated and prolonged exposure, the individual gets habituated or used to the anxiety or discomfort to the point where the sources of fear lose their ability to provoke any anxiety, fear or discomfort. However, patients with OCD tend to handle their fear and anxiety by indulging in compulsions and active avoidance of all those situations that could trigger obsessions. On the contrary, in behavior therapy, patient is encouraged to gradually expose oneself to the anxiety-provoking situations and get habituated to the discomfort. And also, the patient is encouraged to not avoid any situations and indulge in compulsions. By preventing oneself from performing compulsions. The anxiety associated with obsession gradually dies on its own. Once the patient get used to anxiety the obsessions and compulsions also gradually disappear.
If patient perform compulsions in response to anxiety related to obsession, than he gets temporary relief. But he has to perform compulsions when ever he gets these obsessions. The only way then to break this vicious cycle is to expose but not to wash hands. By such repeated exposures, the fear of contamination gradually disappears and hence the compulsion of hand-washing also
If a patient doesn’t perform any compulsion in response to obsession, then anxiety comes down slowly on its own which is called habituation. Then he doesn’t require performing compulsions whenever he gets these obsessions.
Analysis of the symptoms and implementation of treatment:
1. The first step is careful and detailed documentation of all the obsessions and compulsions.
2. Having done that, all the objects and situations that provokes obsessions and compulsions. Are identified and arranged in a hierarchy of situations from the least anxiety provoking to the most anxiety provoking ones.
3. The information is also obtained about all the objects and situations that the patient avoids to control rituals. For example, a patient may avoid public toilet to prevent having to extensively wash his or her body or clothes. Like objects and situations, certain thoughts and images can also trigger anxiety, panic or discomfort and lead to ritualistic behaviors. For example, blasphemous thoughts may get triggered in a person upon seeing photographs of gods and goddess and visiting temples. To escape from the anxiety the person may end up avoiding temples and praying.
4. In some patients the obsessions and compulsions occur only in home It is very vital to have this information as the treatment has to be accordingly entirely home based, and with full cooperation of other family members.
5. Finally, in some patients, rituals are reinforced by family members ‘co-operation is sought to implement the treatment.
It is important to understand at the outset, that the treatment causes discomfort and that one should be prepared to go through some discomfort to obtain relief ultimately. The speed of habituation of emotional responses varies from person to person. Some may require lesser time (e.g. 30 min) of exposure while others may require repeated long exposures (1-2 hours) before any diminution of the anxiety occurs. Usually the compulsions and rituals are the first to respond and the obsessions take longer to “wear out”. Most show response between 10-12 hours of exposure and response prevention. For a successful outcome, motivation to get well and withstand the discomfort in initial sessions is vital.
3 سال پیش
در تاریخ 1400/05/08 منتشر شده
است.
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