Understanding of Obsessive Compulsive Disorder and its possible Treatment options

1. HIBA REHMAN

2. COMMON FEATURES OF
ANXIETY AND OCD
 Feeling of distress.
 Behavioral or Cognitive action to relieve
distress
 Internal or External trigger factor
 Discomfort from the situation
 Reassurance seeking
 Fear of disaster
 Avoidance behavior

3. DIAGNOSIS OF OCD
- Obsessions
- Compulsions

4. OBSESSIONS
 Repetitive, distressing thought, image,
or impulse.
 May involve multiple obsessions.
 Content of obsessional thoughts is
highly individualistic and is shaped by
personal experiences, sociocultural
influences and critical life incidents.

5. CORE FEATURES OF
OBSESSIONS
 Intrusive quality
 Unacceptability
 Subjective Resistance
 Uncontrollability
 Ego-Dystonicity

6. TYPES OF OBSESSIONS
 Religious
 Health
 Hoarding
 Sex
 Contamination

7. COMPULSIONS
 Repetitive intentional acts to reduce
anxiety.
 Urge and force to perform.
 Diminished sense of control.
 Goal of reducing discomfort.

8. COMPONENTS OF
COMPULSIONS
 Neutralization. (covert, pleasant image,
undo effects of obsession)
 Reassurance seeking
 Avoidance
 Compulsive urges

9. BEHAVIORAL
HYPOTHESIS
 Anxiety reduction hypothesis.
 O.H Mowrer’s 2 stage theory of fear and
avoidance:
Step 1: stimuli is conditioned negatively
Step 2: behavior is learned which reduces
anxiety.
When negative stimulus not avoided,
reassurance seeking.

10. CONTRIBUTING FACTORS IN
DEVELOPING OBSESSIONS
 High sensitivity to stress
 Personality traits (introversion, rigidity,
high emotionality or neuroticism).
 Low mood state
 External trauma

11. NEUROPSYCHOLOGICAL
PERSPECTIVE
 Deficit in frontal striatal area.
 Poor executive functioning.
 Work not executed properly, repetitive
checking.
 Memory impairment leading to repetitive
checking. Or no believe in memory.

12. INFORMATION PROCESS
BIAS
 Particular class of stimuli are attended to,
interpreted, and remembered more than
others because certain underlying
schemas are activated that allocate
processing priority to this type of
information.
 In anxiety disorders the danger detection
processes become hyper-vigilent, so that
the number and severity of threatening or
dangerous events in the environment
becomes exaggerated.

13. PSYCHODYNAMIC VIEW
 The battle between id and ego defense
mechanism operates in the conscious.
 Id impulses: Obsessions
 Ego mechanisms: compulsions
 Defense Mechanisms : Isolation,
Undoing, Reaction Formation.
 Anal stage fixation: determined to
express impulses while trying to
restraint.

14. Cognitive Perspective
 Thought Supression

15.  Carr’s theory: obsessional states are
characterized by an abnormally high subjective
estimate of the probability that unfavorable
outcomes will occur. Results in acting to relieve
stress.
 Another theory emerged: primary and secondary
appraisal. Emergence of high threat detection
and underestimation of coping ability.

16.  It is necessary to be perfect,
 Mistakes should be punished
 One has the power to prevent terrible outcomes
by magical rituals or ruminative thinking,
 Certain thoughts are very unacceptable because
they can cause some catastrophe
 It is easier and more effective to engage in
neutralizing activity than to confront one’s
feelings.
 Feelings of uncertainty and loss of control are
intolerable.
All this leads to distress and reduced believe in
one’s capability and eventually towards compulsion

17. Contemporary Cognitive Theory
Triggering stimulus Unwanted mental thought
Faulty appraisal and belief neutralization and
Compulsion decreased anxiety.

18. TREATMENT PLAN
 Behavioral interventions
 Cognitive interventions

19. BEHAVIORAL
INTERVENTIONS
Exposure and response prevention
 Create hierarchy of least and most
distressing obsessions.
 List of all situations.
 High anxiety should be induced during
exposure.
 Provide support.
 Models before the patient the exposure
and response stage.

20. Thought Stopping
 Make the patient verbalize and then shout
stop.
 If this is not working, rubber band
technique or loud banging technique.
 Client eventually learns to do himself.

21. COGNITIVE RESTRUCTURING
 Done after identifying negative thoughts
associated with obsessions.
 Help the client interpret the emerging
thought and ways of reacting towards it.
 Perspective change is done. From what will
happen to what could happen.
 Make the client realize the difference in his
responding to high and low threatening
stimuli.

22. Challenging Overestimated threat
 Make the client aware of his over
estimation of what will happen.
 DOWNWARD ARROW technique.
 Client starts with his obsessions, therapist
probes and asks repetitively “ what it
means for you.
 Next, therapist summarizes the
overestimated threat for the client.
 Confronts the client “ So you feel, your
obsessions will lead you to….”.
 Further, when client convinced ERP used.

23. Thought Action Fusion
 Clients feel their thoughts will actually lead
the event to happen.
 Develop belief scale. How strongly client
feels an event will happen.
 “How many people do you think are killed
each year by someone else’s thoughts.”

24. Behavioral intervention analysis
 Overestimated threat: ask the client of the
outcome after exposure is given.
 Thought action bias: think of any person
and event and keep record of if actually
that event occurs.
 Incorporate the above exercise from low to
high threatening stimuli.

25. Homework
 Thought log
 Stressful times
 Keep account of whether the stimulus
actually resulted in the feared
consequence.