Psychopathology:Psychopathology:

Psychological therapies for Psychological therapies for OCDOCD

Behavioural therapy – Behavioural therapy – 1) Exposure and Response Prevention 1) Exposure and Response Prevention

(ERP) therapy(ERP) therapy Both obsessions and Both obsessions and

compulsions have been compulsions have been acquired through acquired through conditioning.conditioning.

In order to recover, In order to recover, patients must ‘unlearn’ patients must ‘unlearn’ this behaviour.this behaviour.

Obsessions are maintained Obsessions are maintained through negative through negative reinforcement.reinforcement.

Compulsive rituals have Compulsive rituals have become assosiated with become assosiated with anxiety reduction.anxiety reduction.

ERP is about reconditioning.ERP is about reconditioning.

It consists of two components:It consists of two components:

Exposure – forcing the patient Exposure – forcing the patient to experience the stimulus to experience the stimulus and learn, through and learn, through association with relaxation, association with relaxation, that it no longer produces that it no longer produces anxiety.anxiety.

Response prevention – at the Response prevention – at the same time the patient is also same time the patient is also prevented from engaging in prevented from engaging in their usual compulsive rituals. their usual compulsive rituals. The patient must learn that The patient must learn that anxiety can be reduced anxiety can be reduced without the compulsive ritual.without the compulsive ritual.

Behavioural therapy – Exposure and Behavioural therapy – Exposure and Response Prevention (ERP) therapyResponse Prevention (ERP) therapy

Mode of action:Mode of action:

Psychiatrist Psychiatrist identifies list of identifies list of target symptoms target symptoms using Y-BOCSusing Y-BOCS

List of items ranked List of items ranked by patient from least by patient from least to most anxiety to most anxiety provoking.provoking.

13-20 weekly 13-20 weekly sessions (average)sessions (average)

Sometimes monthly Sometimes monthly booster sessions set booster sessions set up to prevent up to prevent relapse.relapse.

http://http://www.youtube.com/www.youtube.com/watch?watch?v=wvodgCQ5F-0v=wvodgCQ5F-0

2) Cognitive-behavioural therapy2) Cognitive-behavioural therapy

Cognitive therapies focus Cognitive therapies focus on changing thoughts, in on changing thoughts, in contrast to behavioural contrast to behavioural therapies which focus on therapies which focus on changing behaviour.changing behaviour.

Aims to identify, challenge Aims to identify, challenge and modify dysfunctional and modify dysfunctional beliefs and the behaviours beliefs and the behaviours that these will result in.that these will result in.

Cognitive therapists believe Cognitive therapists believe that the behaviourists that the behaviourists overlook and ignore the overlook and ignore the influences of a person’s influences of a person’s thinking on psychological thinking on psychological disorders.disorders.

Our behaviour is the Our behaviour is the product of our thoughts, product of our thoughts, therefore we should first of therefore we should first of all address the thoughts.all address the thoughts.

E.g. ‘I must switch this light E.g. ‘I must switch this light on and off 23 times or on and off 23 times or something terrible will something terrible will happen to me or my family.’happen to me or my family.’

This irrational thought will This irrational thought will be challenged and a patient be challenged and a patient will be required to practise will be required to practise certain optimistic certain optimistic statements which challenge statements which challenge their cognitions.their cognitions.

Cognitive-behavioural therapyCognitive-behavioural therapy

Typical dysfunctional Typical dysfunctional beliefsbeliefs

1) Unrealistic 1) Unrealistic responsibility appraisals – responsibility appraisals – see themselves as solely see themselves as solely responsible for prevention of responsible for prevention of negative outcomes to negative outcomes to themselves or those they love.themselves or those they love.

Over-importance of Over-importance of thoughts – thoughts – sufferer may feel sufferer may feel that having a thought (e.g. that having a thought (e.g. someone dying) will mean it someone dying) will mean it will happen.will happen.

Exaggerated perception Exaggerated perception of threat – of threat – irrational belief in irrational belief in harmful outcomes.harmful outcomes.

You will now be given You will now be given an activity which will an activity which will enable you to:enable you to:

1) understand more 1) understand more about these two about these two therapiestherapies

2) 2) evaluate themevaluate them..

http://http://www.youtube.com/www.youtube.com/watch?watch?v=wvodgCQ5F-0v=wvodgCQ5F-0

Task:Task:

Make a leaflet to be given to patients Make a leaflet to be given to patients explaining to them one of the explaining to them one of the following two therapies for OCD:following two therapies for OCD:

Behavioural (ERP)Behavioural (ERP) CognitiveCognitive

Task continued….Task continued….

Make sure you explain to the client Make sure you explain to the client exactly what will happen to them exactly what will happen to them during the therapy. Perhaps include during the therapy. Perhaps include pictures. pictures.

Explain the likely strengths of this Explain the likely strengths of this therapy.therapy.

Explain any possible problems with Explain any possible problems with this therapy.this therapy.

You have one lesson to get this ready.You have one lesson to get this ready.