Areas of Specialization - Adults
Exposure and Response Prevention for Obsessive Compulsive Disorder Treatment What is exposure and response prevention for obsessive compulsive disorder?
A specific behavior therapy called "exposure and response prevention" has been researched and scientifically demonstrated to be effective for obsessive compulsive disorder. "Exposure" breaks the connection between the obsessive thought and the resultant anxiety and "Response Prevention" breaks the association between the performance of a ritual and the reduction in anxiety that follows. In exposure component of treatment, the individual intentionally and voluntarily confronts the feared object or idea, either in reality or in imagination. Exposure is based on the fact that anxiety typically decreases after long enough contact with something feared. This is due to a process called habituation, the same process that makes a cold swimming pool feel warmer after having been in it for awhile. In the similar manner, touching a contaminated object may result in tremendous anxiety, but this anxiety will eventually lessen on its own, even if we do not wash. Furthermore, the more often we expose ourselves to the things we fear, the more the fear will decrease. In response prevention, compulsive rituals that function to decrease the distress brought on by obsessive thoughts are delayed or prevented entirely. In other words, the client learns that when one takes the risk of confronting our fears and not using compulsive behaviors to immediately provide relief, we learn that our fears were unfounded. Thus, the client learns that certain objects are not dangerous, that the door knob is not contaminated, and that we do not need to avoid certain objects to prevent harm. Throughout treatment, the client is provided support and structure to resist performing any compulsive behaviors or rituals and the client is never asked to engage in any dangerous behaviors. Treatment progresses in a gradual manner as the client becomes increasingly able to tolerate their anxiety and control their compulsions. The advantages of exposure and response prevention is that the client typically experiences results relatively quickly and the skills they are taught enable them to practice independently with a plan toward coping with future symptoms.
What is cognitive therapy for obsessive compulsive disorder?
Cognitive therapy incorporated into the exposure and response prevention sessions can be a helpful adjunct to treatment. The focus of cognitive therapy is to identify, challenge and modify common irrational beliefs associated with obsessive compulsive disorder. People with obsessive compulsive disorder often believe that they should be able to control their thoughts, feel highly responsible for events that they might be able to influence, have faulty appraisals regarding threat and danger, have extreme difficulty tolerating uncertainty and ambiguity, and have perfectionistic beliefs. Cognitive therapy may be particularly helpful when a client's depression or anxiety interferes with their ability to engage in exposure and response prevention treatment. Cognitive restructuring regarding the meaning the client assigns to having obsessive compulsive disorder can also be advantageous. Specifically the client is taught to recognize that the intrusive thoughts and urges are the result of obsessive compulsive disorder. Clients are encouraged to not attribute blame to themselves as they are educated about the role of a biochemical imbalance in the brain causing their obsessions and compulsions. Clients are additionally supported to refocus their attention on something other than their obsessions, even for a few minutes, as a means of delaying or refraining from completing any compulsive behaviors. In addition, education about obsessive compulsive disorder is important for the family as it does not only affect the client. Families frequently have a difficult time understanding that the person with obsessive compulsive disorder cannot stop the distressing, repetitive behaviors. Family members can learn specific ways to manage any anger and resentment and avoid assisting in rituals and providing reassurance that maintains the obsessions and compulsions. In other words, a team approach to combating obsessive compulsive disorder is the optimal form of treatment for the client.
Specialized Intensive Exposure and Response Prevention Treatment Program
This program is designed to help people with severe obsessive compulsive disorder. These individuals are required to attend five sessions of 90 to 120 minutes duration per week. This schedule may be reduced subsequent to completing the initial three weeks in accord with the client's progress. During this treatment, exposure and response prevention is performed in a range of settings that may include public places, the client's home, and other settings specific to the obsessive compulsive symptoms. Throughout the program, homework and outside assignments are essential as a means of generalizing treatment gains to everyday life. This program requires a high degree of commitment and motivation as it emphasizes rehabilitation in order to increase the level of functioning to return to work or school, to be able to live more independently, and improve overall quality of life.
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