Obsessional Compulsive Disorder A Cognitive Behavioural Model

OCD Persistent intrusive thoughts Thoughts are unwanted Thoughts are ego-dystonic

Reactions/strategies – These thoughts are dangerous – I must do something about the thoughts – If I don’t, something terrible will happen – It is possible to do something about the thoughts – I am responsible for the thoughts – These thoughts mean something about me – A thought is a fact – A thought might be an urge

STRATEGIES Thought suppression Neutralising behaviours Concealment Avoidance Reassurance-seeking(internal/external) They “work”

Meanings/Interpretations Something about me Predictions “I am going mad” “I am losing control” “I will eventually carry out the thought” “I must stay vigilant” If there is the slightest possibility that the catastrophe could happen……..”

Meanings/Interpretations “If it happens, I will be responsible” Magical thinking Prevention of Disconfirmation “Bad scientist” “I need to figure this out/make sense of it” Intolerance of Uncertainty Intolerance of Emotional Distress

Problems The strategies become the problem Reassurance-givers grow weary The strategies are compulsive( “I can’t stop”) The catastrophe is a long-term prediction Size of the catastrophe v my resources “Strategies don’t work, but I do more of them” Being safe v Feeling safe

CBT for OCD “The therapist and patient work together to develop and agree a comprehensive cognitive- behavioural account of the problem. Reaching this shared understanding involves the identification og key responsibility assumptions and appraisals, and the collaborative construction of a non-threatening alternative account of their experience. The aim is to allow the patient to explicitly check out the alternatives ( viz; I am harmful vs I am worried that I am harmful) Salkovskis

Assessment and Treatment Socratic Questioning/Guided Discovery Synthesising Questions Psycho-education Behavioural experiments Exposure with Response Prevention(ERP) Collusion of others Process v Content Subtle/covert avoidance Subtle/covert re-assurance-seeking Memory mistrust

Assessment and Treatment Personal Significance Scale Beck Attitude Scale Intolerance of Uncertainty Scale Responsibility Attitude Scale Normal Intrusive Thoughts Cognitive and Behavioural Methods for OCD( Whittal M. L. and O’Neill M.L.) Metacognitive Therapy Cognitive restructuring

EXERCICE In pairs,share your personal experiences of intrusive thoughts, using the “Normal Intrusive Thoughts” list.

EXERCICE One person in each threesome make a statement. One person Socratically question that person. One person act as Supervisor to assess the person being Socrates