The cognitive behavioural therapy involves 4sequential steps.1. Identifying how the patient is thinking and thebeliefs about self, world and the future thatunderlie those thoughts.
2. Evaluate the accuracy of those cognitionsthrough examination of their logic, probability andpast evidence.
3. Generating alternatives, more accurateinterpretations, predictions, and ways of believing.
4. Using these perspectives (whenever anxietyand worry are detected), to support them.
Two additional methods to givethe therapy are as follows…1. Tell the patient to make a ‘worryoutcome diary’ and any time they noticethemselves in worrying, writing downthe worry and what they are afraid ofmight happen. At the end of each day they can reviewthe prior entries and identify whether theoutcome relevant to the particular worryhas actually occurred or not.
With this technique the patient can self identifythat the worry outcome was turned out well,and they cope up better then they expectedwith the small number of bad things.
2. Patient are learning to spend more time inpresent rather then in their minds and the future.They are encouraged to give more positive valuesto their present moments.
Patient can overcome their anxietyand worry by some of thefollowing ways… Do different kinds ofrelaxation exerciseslike meditation Avoid alcohol andcaffeine Listen to slow musicand, Make yourself calm.
It is the best and one of the proven stressmanagement technique and it was developedby Swedish Physician L.G. Ost.Guidelines for Practice:- Allow yourself sufficient time in a quite space topractice. Don’t rush yourself. Each new stage will help you relax more quicklyand more deeply.These stages includes …
1. Progressive muscle relaxation It will help you to recognize the differencebetween tension and relaxation in each of themajor muscle group. It helps you to drain the tension from yourmuscles.
2. Release only relaxation It cuts off the tensing step in progressive musclerelaxation. This means you can cut the time byhalf. Give yourself 1 - 2 weeks to practice. Your goal should be relax your entire body inless than 10 minutes.
3. Que-control relaxation It will further reduces the time you need torelax. In this stage you will focus on your breathing. Give yourself 1 – 2 weeks time to practice. Your goal should be to relax your entire body inabout 7 minutes.
4. Rapid relaxation It will reduce the time to relax, less than 1minute. Give yourself 1 – 2 weeks time to practice. Your goal should be to relax your entire body inabout 3 minutes.
5. Applied relaxation The final stage of applied relaxation training involvesrelaxing quickly in the face of anxiety provokingsituations. If your breath speeds up, muscles tense up, or if youfeel your heart rate is increasing, begin these 3steps…1. Take 2 or 3 deep, even breaths2. Think these calming words to yourself as youcontinue to breath deeplyBREATH IN…….RELAXBREATH IN…….RELAX3. Scan your body for tension and concentrate onrelaxing the muscle
Patient can be asked that howhe/she feels before and afterrelaxing for better treatmentwith the help of a simpleexercise…
Exposure and responsePrevention It is one of the most popular and effective formof behaviour therapy for OCD. ERP involves exposing you to anxiety that isprovoked by your obscession and preventingthe patient to use the rituals, to reduce anxiety.
Eg - Exposure Response Prevention Therapyexposes a patient to their drug or alcoholtriggers but prevents them from getting high. ERP makes patient to confront their worst fear:accidental exposure to substance abusetriggers.
Example of Obscession Repetitive thoughts (e.g., feelingcontaminated after touching anobject, doubting whether the stove wasturned off) Repetitive images (e.g., recurrent sexuallyexplicit pictures)
Screening questions Do you have repetitive thoughts that make youanxious and that you cannot get rid of? Do you check things excessively? Do you feel the need to wash your handsfrequently? Do you keep things exceptionally clean?
Relaxation, CravingRating, and Pulse A typical ERP session starts with about 5 minutes ofrelaxation exercises. After relaxing, the patient is asked to rate theircraving level before being exposed to theirtriggering stimuli. They use a 10 point scale to do thiswhere 10 represents a desire to use immediately. The patient’s pulse is also measured (pulse rategenerally increases as a patient’s craving level rises).
Once a patient has completed the first level ofstimulus exposure he proceeds to the next leveland repeats all of the steps. An ERP therapy session continues until thepatient has completed all of the stimulusexposure levels, or the session has to bestopped because of over stimulation. The typical user requires at least 30 ERP sessionsto complete the entire stimulus hierarchywithout experiencing any significant levels ofcraving.