|
 |
|
|
|
|
|
|
|
|
|
|
|
 |
|
|
|
|
|
|
|
Lisa Tischler, Ph.D.
141 East 55th Street
Suite 2F
New York, NY 10022
1-917-653-7424
|
|
|
|
|
|
|
OCD Treatment
GAIN CONTROL OF YOUR OBSESSIONS AND
COMPULSIONS WITH TECHNIQUES SHOWN
TO BE EFFECTIVE.
Though it may be difficult to imagine a life without the daily anguish
of OCD, it is an ideal worth pursuing. Powerful treatment is
available those who are willing to put in the time and energy
necessary. Psychotherapy sessions 1 –2 times weekly with a
cognitive-behavioral psychologist will provide you with an
understanding of the condition, and the tools to control it.
Treatment Outline:
 | | Step 1: Assessment
|
| | Step 2: Psychoeducation
|
| | Step 3: Hierarchy
|
| | Step 4: Planned and Unplanned Exposures
|
| | Step 5: Coaching, Encouraging, and Collaboration |
| | |
THE COGNITIVE BEHAVIORAL TREATMENT –
WHAT’S INVOLVED?
Assessment of obsessions and compulsions is conducted with
the help of the therapist. Patients keep track of their occurrence
outside of sessions. Things to be looking for:
Various triggers (Antecedents) for obsessive thoughts and
compulsions/rituals. Be aware of the situations, settings,
people, etc. that lead you to obsess and to become anxious.
Evaluate how much of your day is spent monitoring the
environment or thinking about your concerns. The OCD
brain is on guard against its fears. How much of your day is
that taking up?
Behavior/Thoughts (Reaction): Thoughts and feelings
when confronting OCD challenges. There are various types
of rituals/compulsions that need to be identified. What are
the risks associated with NOT following through with the
ritual? What is your ability to postpone the ritual or delay
solving the problem in your head? What is the level of
distress associated with not engaging in a
ritual/compulsion (not “undoing” or neutralizing the
obsession)?
Psychoeducation: Teaching patients about the relationship
between obsessions and compulsions – short term relief, long
term problems. Pushing thoughts away, trying to solve the
problems presented by an obsessive thought, and/or engaging in
behavioral or mental compulsions make the problem worse!!
Understanding the paradox of OCD will assist in taking the
necessary steps to recovery.
Hierarchy: The hierarchy is a list of threatening situations, in
order of the challenge that would be experienced in following
through with the behavior. Patients will be able to pace themselves
to progressively climb the hierarchy to the point where they are able
to confront the most feared scenario. The hierarchy enables patient
to see progress and can be applied to any type of OCD (e.g.,
hierarchy of behavioral challenges, bothersome thoughts, etc.).
Planned and unplanned exposure: Exposure exercises
take place both during and in between psychotherapy sessions.
This is probably the most important component in the treatment of
OCD. Learning how to approach what was previously avoided or
simply changing the response to a feared situation will allow
patients to gain control of OCD and the anxiety that goes with it.
Coaching, Encouraging, and Collaboration: Treatment
is a team effort. Assignments are agreed upon ahead of time and
the pace is set by each patient. While there may be a frank
discussion about the progress of therapy, some pushing or
encouragement during difficult times or during actual exposure
sessions, as well as coaching during and in-between sessions, a
patient will never feel that they are “made” to do something.
Other considerations:
Adjustment To Treatment Plan: While it is important that
treatment be structured and that efforts are made to plan
ahead, there is no way to predict how people will respond to
treatment. The therapy will always adjust to the individual
needs of each patient.
Getting Others Involved: Family members and friends can
be both helpful and harmful to the progression of the
disorder. Therapy often involves teaching the significant
people in your life how to assist and how not to interfere
with the progress of treatment.
Never Give Up Completely: Progress may at times be
slower than desired and symptoms may initial increase, but
the situation will never be hopeless.
Ongoing Stressors: Real life stressors can trigger an OCD
flare up and can make recovery more difficult. Issues that
arise will need to be discussed, but the emphasis will
always return to the treatment of the OCD. When your
anxiety is under better control, you will be able to manage
life’s ups and downs more easily.
Medication: Though cognitive behavioral treatment for OCD
is often enough for considerable progress, some people
are unable to participate in the therapy without the
assistance of medication. When this becomes apparent,
collaboration with a psychiatrist is recommended.
