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Obsessive Compulsive Disorder

Cognitive Biobehavioral Management

STEP 1:

Goal:

Develop a MINDFUL awareness of the "thoughts" or "urges" as obsessions or compulsions.

STEP 2:

Goal:

Develop and increase one's understanding that a neurobiological imbalance is causing the symptoms.

1. One develops more ability to not take the thoughts or urges at face value.
2. One develops more distance from the thoughts or urges.
   Example: "It's not me, it's my OCD."

STEP 3:

Goal:

Develop a program of self-directed response prevention.

1. REFOCUS: Actively do another reasonable task or activity.

   Goal:

   Prevent a response to OCD symptoms.

   Method:

   Pre-select the activity or task.

   Select it as a homework activity.

2. RECORD: Write down the work in a diary.

   Goal:

   Boost confidence.

   Increase number of ways to refocus (tactical repertoire.

3. 15 MINUTE RULE: Wait 15 minutes before giving in.

   Goal:

   Improve ability to go without giving in to thoughts or urges and applying:

   1. Mindful awareness.
   2. Relabeling.
   3. Reattribution as a pathological process.

4. Interim Goals
   Consider setting interim goals

   Modifications:

   Impose a shorter time delay is used before a compulsion.

   Use refocusing every time with obsessive thoughts.

   Objectives:

   Demonstrate it is not necessary to entirely eliminate thoughts in order to perform other activities.

   Demonstrate the value of repeated tries at refocusing.

STEP 4:

Goal:

Place a lower valuation on the obsessions or compulsions during the later stage of treatment.

1. Accentuation of the relabeling and reattribution.

   Goal:

   Increase habituation.

   1. The thoughts or urges decrease in intensity.
   2. The thoughts or urges become less bothersome.
2. Reduction of effort to dismiss thoughts or urges.

   Goal:

   Positive and assertive revaluation statements intensify the refocusing process.

3. Partial habituation indicates progress with the problem. It's a cue for making more effort at Steps 1 - 3.

The above methods of clinical treatment are adapted from the treatment methods described in the following reference: Schwartz, J.M., Martin, K.M., Baxter, L.R., Neuroimaging and cognitive-biobehavioral self-treatment for obsessive compulsive disorder: practical and philosophical considerations. In: Hand, I., Goodman, W.K., Evers, U., ed. (1992) Obsessive-Compulsive Disorders: New Research Results. New York: Springer-Verlag, p. 82-101.