OCD+Psychotherapies

The goals depend on the extend and severity to which symptoms are causing a problem for the client.
 * __COGNITIVE BEHAVIORAL THERAPY- GOALS__**

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Cognitions are significant part of the process when the thoughts combine with the experience of the external world, also known as ‘thought-action fusion' (Veale, 2007). In those with OCD, there is an over response to taking on responsibility or, at creating harm (Veale, 2007). Those who suffer by avoiding their fear usually have problems connect to their sense of fear of what can be contaminated. There is also safety-seeking behavior (Veale, 2007). ======



**The aim of treatment is to emphasize to that most people will have experience some range of intrusive thoughts, but their response is reduced compared to those with OCD. With OCD, they don’t experience the same degree of distress, or duration of the response. __Therapy works to draw attention to the way the client interprets the event or the intrusive thoughts or urges, and how their current OCD symptoms increase rather than control the amount of intrusive thoughts, distress and urges (Veale., 2007)__.**

**__A Stepped Care Approach to OCD Treatment-Recommendations for N ational I nstitute for H ealth and C linical E xcellence__** __** (NICE) **__**// ( // Heyman __et al,__ 2007). **

**See Figure 2 for the Recommended Therapeutic Strategies for Children and Young People (Heyman __et a__l, 2007):**
 * 1) they Suggest a Stepped Approach to care with OCD Clients (including children if not managed adequately with CBT and self-help)
 * 2) Begins with early cases of functional impairment: the suggestion is to consider guided help in terms of management
 * 3) For moderate to Severe Cases, treatment should involve CBT with ERP (Exposure and Response Prevention)
 * 4) With children and adolescents, treatment should only be cognitive behavioral UNLESS this option is ineffective OR refused
 * 5) They suggest a multidisciplinary evaluation prior to considering an SSRI
 * 6) If required, SSRI is secondary in the treatment options, and needs careful monitoring w. kids
 * 7) For the combined approach to therapy, ages 8 to 11 are to be evaluated as a consideration for pharmacotherapy, and at 12 to 18 years to be offered care.

[|**http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1553525/figure/fig2/**]

**See Figure 3 for the Recommended Therapeutic Strategies for Adults (Heyman __et a__l, 2007):** [|**http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1553525/figure/fig3/**]

**__Overview of OCD Treatment Management__**

Presently there is no identifiable cure yet know for OCD, but symptoms are controllable with cognitive-behavioral therapy, and pharmacotherapy when combined. The particular form of counseling required for OCD is CBT; many who suffer from OCD will also benefit from support **from counseling** as well as specialized OCD therapies (CAMH, 2010).

**__Exposure and Response Prevention Therapy (ERP)__**

Can be direct or imagined trigger (which can be a thing or a situation) that causes obsessive thoughts or anxiety. Over time, there is a desensitization process occurs. The person is exposed to stimuli that usually cause an escape or compulsive response, but they are helped not to react this way. By repeating their exposure, with time, there is eventually extinction of the response **There is strong evidence based research to support ERP (Veale __et al__., 2007).**

Mild OCD can be self-managed with self-correcting ERP therapy (Heyman __et al__, 2007).

__Prognosis__ There is a 25% attrition rate. For those who complete the therapy, **75% show improvement** in management of their OCD symptoms (Veale, 2007). Much of this relates to people who are afraid to confront their fears.However, the **prognosis is poorer** for those who also suffer from depression and schizotypal disorders (Veale, 2007).

**__Combining Cognitive with Exposure and Response Prevention__**

Leading researchers consider Cognitive-behavioral therapy to be superior therapy to Exposure and Response Prevention on its own (Veale __et al__, 2007). The difference is that cognitive therapies emphasize recognizing a broader range of cognitive processes (such as being aware of having an exaggerated responsibility and ‘thought action fusion’) that are responsible for perpetuating the symptoms. Cognitive therapies still primarily focus on thinking about behavioral changes (Veale __et al__, 2007).

**__Additional Therapies__** Occasionally, and typically with more severe cases of OCD, treatment options can include more intensive therapies. These therapies may include: psychiatric hospitalization, a residential program, ECT, and different forms of brain stimulation (Mayo Clinic, 2010).