ocd: non-bio treatment - behaviourist therapy (ERP)

Question 1

what is cbt?

Answer 1

• usually first treatment used for ocd and is recommended by NICE (National Institute for Health and Care Excellence) for most UK cases with moderate severity
• goal orientated and short term (about 3 months)

Question 2

what are the two components to cbt?

Answer 2

• cognitive component: focuses on changing thoughts processes
• behavioural component: focuses on changing actions/behaviours

Question 3

what is the aim of cbt?

Answer 3

• people with ocd, those thoughts cause beliefs that activate negative emotion of anxiety
• aim of therapy is to not remove intrusive thoughts, but to change beliefs that they trigger

Question 4

how does cbt work?

Answer 4

• starts gradually, starting with thoughts that are least anxiety provoking
• client is encouraged to test beliefs that thoughts activate until they no longer generate anxiety
• aims to prevent common cognitive distortion of catastrophising
• in catastrophising, person firstly predicts negative outcome, and secondly, jumps to conclusion that if the negative outcome did in fact happen, it would be a catastrophe

Question 5

how does cbt work?

Answer 5

• starts gradually, starting with thoughts that are least anxiety provoking
• client is encouraged to test beliefs that thoughts activate until they no longer generate anxiety
• aims to prevent common cognitive distortion of catastrophising
• in catastrophising, person firstly predicts negative outcome, and secondly, jumps to conclusion that if the negative outcome did in fact happen, it would be a catastrophe

Question 6

what is an additional technique used in cbt?

Answer 6

• habituation training (Franklin et al 2000)
• client is asked to think repeatedly about their obsessive thoughts
• idea is that by deliberately thinking about obsessions, they will become less anxiety provoking, with consequence that compulsive behaviour is not required to reduce high levels of anxiety

Question 7

what is the pink bunny effect?

Answer 7

• if you are told not to think about a ‘pink fluffy rabbit’ for a certain amount of time, you will still end up thinking about it at the end, making it less avoidable
• in cbt, we might bring on the thought to show that having thoughts doesn’t actually matter or mean anything, with the ultimate aim of proving ocd to be a liar

Question 8

what is the most common behavioural therapy used as part of cbt for ocd?

Answer 8

• Exposure and Response Prevention Therapy (ERPT)

Question 9

what does ERPT do?

Answer 9

• focuses only on the compulsions found in ocd, so it complements use of cognitive therapy which targets obsessions
• ERP deliberately exposes clients to objects or situations that cause anxiety and requires client to resist performing compulsive behaviour.
• role of therapist is to **help person develop ways in which they can resist performing compulsive behaviours

Question 10

what steps are included in ERPT?

Answer 10

1) informing the client about exposure and response prevention, and what therapy will involve
2) using what is called exposure hierarchy, which starts with mildly anxiety-raising situations and goes through highest level of anxiety (similar to systematic desensitisation)
3) repeated exposure to situations that cause high anxiety, until level of anxiety reduces. process is repeated several times a week until client can engage with the trigger without anxiety
4) getting client to resist and refrain from performing compulsive behaviour. client is trained to monitor their anxiety levels in order to record how they feel accurately and to notice differences as they change

Question 11

how was ERP been used?

Answer 11

• one-to-one and group therapy sessions

Question 12

what are clients asked to do outside therapy sessions? (ERPT)

Answer 12

• to practise exposing themselves to feared situations and refraining from the compulsive behaviour
• research has shown that between 55% and 75% show improvement and that the improvement lasts for 5 to 6 years (Franklin et al 2005)

Question 13

online versions of erp

Question 14

Strengths and limitations of online erp

Question 15

strengths of cbt:

Answer 15

• supported by evidence which shows that it is effective in reducing the symptoms of ocd e.g. it is endorsed by NICE and is promoted as their first choice of treatment
• doesn’t have any side effects (unlike drug treatment) and has lower relapse rates than medication when it is discontinued
• has been shown to be effective in reducing symptoms, can be applied flexibly, e.g. online or group therapy, with therapist monitoring completion for worksheets and an activity plan. it is cost-effective and time-limited showing improvement in more than 50% of cases. its effectiveness is increased when combines with drugs
• cbt is often said to be an ethical form of treatment, since patients are empowered as they are taught techniques which they can then use on their own

Question 16

weaknesses of cbt

Answer 16

• POTS study found that cbt is an effective therapy for ocd when compared to a placebo group, but they also found that sertraline was effective. most effective was a combination of cbt and sertraline. suggests that although cbt is effective, it’s a limited treatment which should ideally be used in combination with other forms of therapy
• difficult to disentangle which of the benefits from cbt are due to the cognitive component and which are due to the behavioural component. Masellis et al 2003 found that substantial proportion of clients (up to 44%) **only suffer from obsession. they also found that up to 75% of ocd clients also suffer with comorbid depression, which lessens effectiveness of ERPT. having persistent depressive symptoms at the end of therapy was found to be a strong predictor of relapse and suggested that combined cognitive therapy with drug treatment would be more beneficial
• although about 70% of people respond well to cbt, they are still many for whom it is ineffective. individual differences mean that therapy needs to be tailored for need of particular person

Question 17

what does the success of the therapy rely on?