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Breaking The Chains Psychological Treatment for

OCD Dr. Siobhan Kelly

PsychologistPsychology ServicesKK Women’s & Children’s Hospital

25th May 2013

Contents• Treatment guidelines for OCD.

• Evidence and rationale for CBT.

• How does CBT help?

• Treatment of OCD in Children & Adolescents.

• Barriers in Seeking Treatment.

• Getting treatment.

Treatment Guidelines for OCD

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• Guidelines for the treatment of OCD recommend;

1. Cognitive Behavioural Therapy (CBT), which

includes Exposure Response Prevention (ERP)

for treating OCD.

2. Use of medication in combination with CBT.

3. Inclusion of psychoeducation and involvement of

family members.

Divider Title 1

Cognitive Behavioural Therpy

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What’s Involved in Treatment?

1. Assessment

2. Making Sense of OCD.

Rationale For CBT

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TriggerTouching a door handle

Intrusive Thoughts/ Obsession“The door handle has germs”

Appraisal of the thought“I am going to get sick, it’s going to be my fault if other people get

sick too”

Anxiety

CompulsionsWashing hands multiple times

Avoidance/ Safety Behaviours

Asking people to open doors

Rationale of CBT

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What’s Involved in Treatment?

3. Cognitive Therapy

• Interpretation of the intrusive thought

contributes to anxiety.

• CT helps distance and manage anxiety by

challenging these thoughts.

• What are the chances that if I touch the door handle I will get

sick?

• How many people have touched the door before & not gotten

sick?

• If people could get sick from touching the door handle, then

why are more people not afraid of touching the door handle?

What’s Involved in Treatment? 3. Exposure and Response Prevention

• Exposure- confronting the images, objects & situations that make someone anxious.

• Response Prevention- resisting urge to do the compulsive behaviour.

What’s Involved in Treatment? • Initial increase in anxiety will be expected.

• Usually ERP will be done in a graded/gradual manner.

Family Involvement• OCD can affect the entire family & often cause stress to

relationships.

• Families often unintentionally help OCD behaviours

through:

• Participation in rituals and reassurance.

• Assisting in avoidance.

• Accommodating the OCD behaviours.

OCD in Adolescent & Children

• Evidence suggests that CBT is also effective in treating children &

adolescents with OCD (Abramowitz, Whiteside & Deacon, 2005).

• Treatment needs to be adjusted to be developmentally appropriate.

• Family involvement is more critical.

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Taken from OCD-UK

Common Barriers to Seeking Treatment

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• Lack of understanding/public awareness of OCD.

• Embarrassment.

• Fear of treatment.

• Difficulties in assessing appropriate services.

Where Can I Seek Help? Adult

•Local hospitals

•Private hospitals

•Private Clinical Psychologists

Where Can I Seek Help? Children

•Child Guidance Clinic (CGC)

•KKH – if child is already on regular follow-up with a Medical doctor.

•REACH- referral made by school counsellor.

•Private hospital

•Private Clinical Psychologist.

Questions I Should Ask

• What techniques do you use to treat OCD?

• Do you use ERP to treat OCD?

• What are your training and background in treating OCD?

• What are your thoughts on medication?

Online Resources

• International OCD foundation• http://www.ocfoundation.org

• OCD UK • http://ocduk.org/