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Obsessive Compulsive Disorder

OCD Index Behavior Therapy
Medication Therapy Cognitive Biobehavioral Therapy
Treatment Response

Cognitive Biobehavioral Management


STEP 1:

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

STEP 2:

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

Refocus and Record
Goal:
Develop a program of self-directed response prevention.
Actions:
  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:

Revalue
Goal:
Place a lower valuation on the obsessions or compulsions during the later stage of treatment.
Actions:
  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.


Treatment Planning: Behavior therapy strategies | Cognitive-biobehavioral management | Medication strategies | Treatment Response |

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