Presentation Ocd

5,745 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
5,745
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
69
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Presentation Ocd

  1. 1. <ul><li>Obsessive-compulsive disorder (OCD) </li></ul><ul><li>It is a psychiatric disorder most commonly characterized by a subject's obsessive, distressing , intrusive thoughts and related compulsions (tasks or &quot; rituals &quot;) which attempt to neutralize the obsessions. Thus it is an anxiety disorder . It is listed by the World Health Organization as one of the top ten most disabling illnesses in terms of lost income and diminished quality of life </li></ul>
  2. 2. <ul><li>A person suffering from OCD feels obsessions, which cause extreme anxiety, and is then driven to perform compulsions, which momentarily relieve the anxiety </li></ul>
  3. 3. <ul><li>MOST COMMON OBSESSIONS </li></ul><ul><li>Fear of contamination </li></ul><ul><li>Fear of causing harm to another </li></ul><ul><li>Fear of making a mistake </li></ul><ul><li>Fear of behaving in a socially unacceptable manner </li></ul><ul><li>Need for symmetry or exactness </li></ul><ul><li>Excessive doubt </li></ul><ul><li>Religious and sexual concerns </li></ul><ul><li>MOST COMMON COMPULSIONS </li></ul><ul><li>Cleaning/Washing </li></ul><ul><li>Checking </li></ul><ul><li>Arranging/Organizing </li></ul><ul><li>Collecting/Hoarding </li></ul><ul><li>Counting/Repeating </li></ul><ul><li>Touching or tapping </li></ul>
  4. 4. <ul><li>Research </li></ul><ul><li>Telephone administered cognitive behavior therapy for treatment of obsessive compulsive disorder </li></ul>
  5. 5. <ul><li>Objectives </li></ul><ul><li>To compare the effectiveness of cognitive behavior therapy delivered by telephone with the same therapy given face to face in the treatment of obsessive compulsive disorder. </li></ul>
  6. 6. <ul><li>Conclusion </li></ul><ul><li>The clinical outcome of cognitive behavior </li></ul><ul><li>therapy delivered by telephone was equivalent to treatment delivered face to face and similar levels of satisfaction were reported. </li></ul>
  7. 7. COMPARITIVE STUDY BETWEEN COGNITIVE-BEHAVIORAL THERAPY AND CLOMIPRAMINE TREATMENT FOR OCD <ul><li>Many randomized controlled trials have shown the effectiveness of exposure and response prevention (ERP) techniques. One trial included 22 children aged 8-18 years who were randomly assigned to ERP or clomipramine for 12 weeks. Those on ERP showed an average improvement of almost 60%, compared with a 33% improvement for those in the medication arm. </li></ul>
  8. 8. CBT Cognitive Behavioral Therapy (CBT) is based on the idea that how we think ( cognition ), how we feel ( emotion ) and how we act ( behavior ) all interact together. Specifically, our thoughts determine our feelings and our behavior. Therefore, negative - and unrealistic - thoughts can cause us distress and result in problems.
  9. 9. <ul><li>MALADAPTIVE THOUGHTS </li></ul><ul><li>The cognitive model says that a person's core beliefs (often formed in childhood) contribute to 'automatic thoughts' that pop up in every day life in response to situations. </li></ul><ul><li>The therapy is to identify irrational or maladaptive thoughts that lead to negative emotion. An effort is done to reject the distorted thoughts and replace them with more realistic alternative thoughts, in a process sometimes referred to as cognitive-shifting . </li></ul>
  10. 10. <ul><li>Decision-making and behavioral biases </li></ul><ul><li>Many of these biases are studied for how they affect belief formation and business decisions and scientific research. </li></ul><ul><li>Bandwagon effect — the tendency to do (or believe) things because many other people do (or believe) the same. Related to groupthink , herd behaviour , and manias . </li></ul><ul><li>Bias blind spot — the tendency not to compensate for one's own cognitive biases. </li></ul><ul><li>Choice-supportive bias — the tendency to remember one's choices as better than they actually were. </li></ul><ul><li>Confirmation bias — the tendency to search for or interpret information in a way that confirms one's preconceptions. </li></ul><ul><li>Congruence bias — the tendency to test hypotheses exclusively through direct testing. </li></ul><ul><li>Contrast effect — the enhancement or diminishment of a weight or other measurement when compared with recently observed contrasting object. </li></ul>
  11. 11. <ul><li>Déformation professionnelle — the tendency to look at things according to the conventions of one's own profession, forgetting any broader point of view. </li></ul><ul><li>Endowment effect — the tendency for people to value something more as soon as they own it. </li></ul><ul><li>Focusing effect — prediction bias occurring when people place too much importance on one aspect of an event; causes error in accurately predicting the utility of a future outcome. </li></ul><ul><li>Hyperbolic discounting — the tendency for people to have a stronger preference for more immediate payoffs relative to later payoffs, the closer to the present both payoffs are. </li></ul>
  12. 12. <ul><li>Illusion of control — the tendency for human beings to believe they can control or at least influence outcomes which they clearly cannot. </li></ul><ul><li>Impact bias — the tendency for people to overestimate the length or the intensity of the impact of future feeling states. </li></ul><ul><li>Information bias — the tendency to seek information even when it cannot affect action. </li></ul><ul><li>Loss aversion — the tendency for people strongly to prefer avoiding losses over acquiring gains (see also sunk cost effects ) </li></ul><ul><li>Neglect of probability — the tendency to completely disregard probability when making a decision under uncertainty. </li></ul><ul><li>Mere exposure effect — the tendency for people to express undue liking for things merely because they are familiar with them. </li></ul><ul><li>Omission bias — The tendency to judge harmful actions as worse, or less moral, than equally harmful omissions (inactions). </li></ul>
  13. 13. <ul><li>Outcome bias — the tendency to judge a decision by its eventual outcome instead of based on the quality of the decision at the time it was made. </li></ul><ul><li>Planning fallacy — the tendency to underestimate task-completion times. </li></ul><ul><li>Post-purchase rationalization — the tendency to persuade oneself through rational argument that a purchase was a good value. </li></ul><ul><li>Pseudocertainty effect — the tendency to make risk-averse choices if the expected outcome is positive, but make risk-seeking choices to avoid negative outcomes. </li></ul><ul><li>Selective perception — the tendency for expectations to affect perception. </li></ul><ul><li>Status quo bias — the tendency for people to like things to stay relatively the same. </li></ul><ul><li>Von Restorff effect — the tendency for an item that &quot;stands out like a sore thumb&quot; to be more likely to be remembered than other items. </li></ul><ul><li>Zero-risk bias — preference for reducing a small risk to zero over a greater reduction in a larger risk. </li></ul>
  14. 14. <ul><li>BIASES IN PROBABILITY AND BELIEF </li></ul><ul><li>Many of these biases are often studied for how they affect business and economic decisions and how they affect experimental research. </li></ul><ul><li>Ambiguity effect — the avoidance of options for which missing information makes the probability seem &quot;unknown&quot;. </li></ul><ul><li>Anchoring — the tendency to rely too heavily, or &quot;anchor,&quot; on one trait or piece of information when making decisions. </li></ul><ul><li>Anthropic bias — the tendency for one's evidence to be biased by observation selection effects. </li></ul><ul><li>Attentional bias — neglect of relevant data when making judgments of a correlation or association. </li></ul>
  15. 15. <ul><li>Availability heuristic — a biased prediction, due to the tendency to focus on the most salient and emotionally-charged outcome. </li></ul><ul><li>Clustering illusion — the tendency to see patterns where actually none exist. </li></ul><ul><li>Conjunction fallacy — the tendency to assume that specific conditions are more probable than general ones. </li></ul><ul><li>Gambler's fallacy — the tendency to assume that individual random events are influenced by previous random events — &quot;the coin has a memory&quot;. </li></ul><ul><li>Hindsight bias — sometimes called the &quot;I-knew-it-all-along&quot; effect, the inclination to see past events as being predictable. </li></ul><ul><li>Illusory correlation — beliefs that inaccurately suppose a relationship between a certain type of action and an effect. </li></ul>
  16. 16. <ul><li>Ludic fallacy — the analysis of chance related problems with the narrow frame of games. Ignoring the complexity of reality, and the non- gaussian distribution of many things. </li></ul><ul><li>Neglect of prior base rates effect — the tendency to fail to incorporate prior known probabilities which are pertinent to the decision at hand. </li></ul><ul><li>Observer-expectancy effect — when a researcher expects a given result and therefore unconsciously manipulates an experiment or misinterprets data in order to find it (see also subject-expectancy effect ). </li></ul><ul><li>Optimism bias — the systematic tendency to be over-optimistic about the outcome of planned actions. </li></ul><ul><li>Overconfidence effect — the tendency to overestimate one's own abilities. </li></ul><ul><li>Positive outcome bias — a tendency in prediction to overestimate the probability of good things happening to them (see also wishful thinking , optimism bias and valence effect ). </li></ul>
  17. 17. <ul><li>Recency effect — the tendency to weigh recent events more than earlier events (see also peak-end rule ). </li></ul><ul><li>Reminiscence bump — the effect that people tend to recall more personal events from adolescence and early adulthood than from other lifetime periods. </li></ul><ul><li>Rosy retrospection — the tendency to rate past events more positively than they had actually rated them when the event occurred. </li></ul><ul><li>Primacy effect — the tendency to weigh initial events more than subsequent events. </li></ul><ul><li>Subadditivity effect — the tendency to judge probability of the whole to be less than the probabilities of the parts. </li></ul><ul><li>Telescoping effect — the effect that recent events appear to have occurred more remotely and remote events appear to have occurred more recently. </li></ul><ul><li>Texas sharpshooter fallacy — the fallacy of selecting or adjusting a hypothesis after the data is collected, making it impossible to test the hypothesis fairly. </li></ul>
  18. 18. <ul><li>SOCIAL BIASES </li></ul><ul><li>Most of these biases are labeled as attributional biases . </li></ul><ul><li>Actor-observer bias — the tendency for explanations for other individual's behaviors to overemphasize the influence of their personality and underemphasize the influence of their situation. This is coupled with the opposite tendency for the self in that one's explanations for their own behaviors overemphasize my situation and underemphasize the influence of my personality. ( see also fundamental attribution error ). </li></ul><ul><li>Egocentric bias — occurs when people claim more responsibility for themselves for the results of a joint action than an outside observer would. </li></ul><ul><li>Forer effect (aka Barnum Effect) — the tendency to give high accuracy ratings to descriptions of their personality that supposedly are tailored specifically for them, but are in fact vague and general enough to apply to a wide range of people. For example, horoscopes . </li></ul>
  19. 19. <ul><li>False consensus effect — the tendency for people to overestimate the degree to which others agree with them. </li></ul><ul><li>Fundamental attribution error — the tendency for people to over-emphasize personality-based explanations for behaviors observed in others while under-emphasizing the role and power of situational influences on the same behavior ( see also actor-observer bias , group attribution error , positivity effect , and negativity effect ). </li></ul><ul><li>Halo effect — the tendency for a person's positive or negative traits to &quot;spill over&quot; from one area of their personality to another in others' perceptions of them ( see also physical attractiveness stereotype ). </li></ul><ul><li>Illusion of asymmetric insight — people perceive their knowledge of their peers to surpass their peers' knowledge of them. </li></ul>
  20. 20. <ul><li>Illusion of transparency — people overestimate others' ability to know them, and they also overestimate their ability to know others. </li></ul><ul><li>Ingroup bias — preferential treatment people give to whom they perceive to be members of their own groups. </li></ul><ul><li>Just-world phenomenon — the tendency for people to believe that the world is &quot;just&quot; and therefore people &quot;get what they deserve.&quot; </li></ul><ul><li>Lake Wobegon effect — the human tendency to report flattering beliefs about oneself and believe that one is above average ( see also worse-than-average effect , and overconfidence effect ). </li></ul><ul><li>Notational bias — a form of cultural bias in which a notation induces the appearance of a nonexistent natural law . </li></ul><ul><li>Outgroup homogeneity bias — individuals see members of their own group as being relatively more varied than members of other groups. </li></ul>
  21. 21. <ul><li>Projection bias — the tendency to unconsciously assume that others share the same or similar thoughts, beliefs, values, or positions. </li></ul><ul><li>Self-serving bias — the tendency to claim more responsibility for successes than failures. It may also manifest itself as a tendency for people to evaluate ambiguous information in a way beneficial to their interests ( see also group-serving bias ). </li></ul><ul><li>Self-fulfilling prophecy — the tendency to engage in behaviors that elicit results which will (consciously or subconsciously) confirm our beliefs. </li></ul><ul><li>System justification — the tendency to defend and bolster the status quo, i.e. existing social, economic, and political arrangements tend to be preferred, and alternatives disparaged sometimes even at the expense of individual and collective self-interest. </li></ul><ul><li>Trait ascription bias — the tendency for people to view themselves as relatively variable in terms of personality, behavior and mood while viewing others as much more predictable </li></ul>
  22. 22. <ul><li>The goal of CBT is two-fold: to change thoughts and behaviors. The cognitive portion involves the identification and analysis of irrational thoughts, which are then challenged. In the behavioral portion, the therapist and client work together to change the compulsive behaviors. </li></ul>
  23. 23. <ul><li>HISTORY </li></ul><ul><li>Therapy was developed by Albert Ellis in the early 1950s . Ellis eventually called his approach Rational Emotive Behavioral Therapy, or REBT . Aaron T. Beck independently developed another CBT approach, called Cognitive Therapy , in the 1960s. Cognitive Therapy rapidly became a favorite intervention to study in psychotherapy research in academic settings. In initial studies, it was often contrasted with behavioral treatments to see which was most effective. However, in recent years, cognitive and behavioral techniques have often been combined into cognitive behavioral treatment . </li></ul>
  24. 24. <ul><li>EVIDENCE BASE </li></ul><ul><li>CBT has a good evidence base in terms of its effectiveness in reducing symptoms and preventing relapse. It has been clinically demonstrated in over 400 studies to be effective for many psychiatric disorders and medical problems for both children and adolescents. It has been recommended in the UK by the National Institute for Health and Clinical Excellence as a treatment of choice for a number of mental health difficulties, including post-traumatic stress disorder , OCD , bulimia nervosa and clinical depression . </li></ul>
  25. 25. <ul><li>ERP </li></ul><ul><li>A sub-field of Cognitive Behavior Therapy used to treat Obsessive Compulsive Disorder makes use of classical conditioning through extinction (a type of conditioning) and habituation . (The specific technique, Exposure with Response Prevention (ERP) has been demonstrated to be more effective than the use of medication alone.) </li></ul>
  26. 26. <ul><li>This technique includes </li></ul><ul><li>Flooding (where a person repeatedly exposes themselves to their fears), Systematic Desensitization (where a person faces their obsessions in a systematic order. </li></ul>
  27. 27. <ul><li>Exposure and response prevention is successful 75 to 80 percent of the time in reducing symptoms, making it the most effective treatment for OCD </li></ul>
  28. 28. <ul><li>BASIC STEPS IN ERP </li></ul>
  29. 29. <ul><li>Cognitive restructuring is an important component of the treatment. &quot;OCD arises from inaccurate beliefs about stimuli. The aim is to teach the patient to identify and correct anxiety-provoking thoughts that motivate compulsive behaviors--to help them identify the thought and then appraise it accurately. Common cognitive errors are doubt (&quot;I can't remember if I locked my door&quot;); fusion of thought and action (&quot;If I think about something, it must mean I want to do it&quot;); catastrophic thinking (&quot;I'll get sick and die if I go near sick people without washing up&quot;); and responsibility (&quot;If my mom gets cancer, it will be my fault&quot;). </li></ul>
  30. 30. <ul><li>Patients should be asked to keep a thought record. The document consists of recording the action, the thought that came with it, the accompanying anxiety or fear level, and the resulting ritual. </li></ul>
  31. 31. <ul><li>Then the patients should be asked to &quot;talk back to the OCD&quot; by writing logical thoughts that could counteract the illogical assumptions </li></ul>
  32. 32. <ul><li>RANKING the fears in hierarchical order </li></ul><ul><li>from least distressing to most distressing </li></ul><ul><li>Exposure </li></ul><ul><li>Starting the exposure to least distressing fear for a shorter time and then increasing the time gradually. </li></ul><ul><li>Trying to remain relaxed by facing and challenging the fearful thoughts which appear on exposure and recognizing that physical symptoms are not life threatening. </li></ul><ul><li>DEVELOPING CONTROL over preventing the ritual </li></ul><ul><li>Delaying and then preventing the ritual or compulsive act linked to the obsession. </li></ul><ul><li>Gaining satisfactory confidence and control over the fear, moving toward the next higher ranked fear. </li></ul>
  33. 33. <ul><li>Although actually refraining from the ritual is most effective, patients can also practice refraining in their imaginations. &quot;Duration and frequency are important. If you can expose them for long periods frequently, you will have better results.&quot; </li></ul>
  34. 34. <ul><li>The therapist assigns homework to the patient but not more than he can handle and take periodic ratings of symptoms to be sure that the patient is improving. Although It is a difficult process, but very effective and rewarding. </li></ul>
  35. 35. <ul><li>A CASE HISTORY </li></ul><ul><li>A patient from Mandi Bahauddin suffering from OCD for the last 15 years, attempted by many psychiatrists and psychologists. </li></ul><ul><li>Taking full doses of Tab.Fluvoxamine and Tab.Xanax .5 mg for the last many years. </li></ul><ul><li>Referred by a colleague doctor. </li></ul><ul><li>Almost home bound and socially withdrawn, hands keeping up and in front of body to avoid touching anything. </li></ul><ul><li>Completely disappointed from treatment attempts. </li></ul>
  36. 36. <ul><li>OBSESSIONS </li></ul><ul><li>FEAR OF CATCHING THE DISEASE WHICH CAUSED DEATH OF SOME PERSON. </li></ul><ul><li>FEAR THAT THE MAULVI WHO GIVES BATH TO DEAD BODIES MAY CONTRACT THE DISEASE FROM DEAD ONE AND MAY COMMUNICATE TO OTHERS. </li></ul><ul><li>ANY BODY WHO SHAKES HANDS WITH MAULVI CATCHES THE DISEASE. </li></ul><ul><li>ANYBODY WHO HAS BEEN AN ATTENDANT OF THE DECEASED MAY HAVE CAUGHT THE DISEASE. </li></ul><ul><li>THE MAULVI BUYS THINGS FROM THAT SHOP, SO PERHAPS THAT SHOPKEEPER MAY HAVE CAUGHT THE DISEASE AND SPREADING IT. </li></ul><ul><li>THE WIFE OF MAULVI COMES TO MY HOME AND SAT ON SOFA, PERHAPS SHE MIGHT HAVE USED THE SAME SEAT WHERE I SIT. </li></ul><ul><li>MY WIFE HAVE MET HER. </li></ul><ul><li>SHE MIGHT HAVE TOUCHED THE DOOR HANDLES. </li></ul><ul><li>OBCESSION THAT ANYTHING MIGHT HAVE BEEN TOUCHED BY SOMEONE WHO MAY HAVE TOUCHED SOME DEADBODY. </li></ul>
  37. 37. <ul><li>COMPULSIONS </li></ul><ul><li>WASHING HANDS AFTER TOUCHING ANYTHING. </li></ul><ul><li>CHANGING CLOTHS IF SOMEONE TOUCHED HIS CLOTHS OR BY CHANCE IF THE CLOTHS TOUCHED SOME SUSPICIOUS OBJECT. </li></ul><ul><li>TO TAKE BATH IMMEDIATELY IF CAME TO KNOW THAT SOMEONE RELATED TO A DEADONE HAS EMBRACED HIM. </li></ul>
  38. 38. <ul><li>IN 1998 I BOUGHT A CAR HAVING A FIGURE Z IN IT, THEN I DEVELOPED IBS WHICH DISTURBED ME OVER A COUPLE OF YEARS. </li></ul><ul><li>OBCESSION THAT ANY THING WHOSE NAME CONTAINS Z MAY INDUCE IBS AGAIN. </li></ul><ul><li>COMPULSION </li></ul><ul><li>AVOIDANCE </li></ul><ul><li>AVOID EVERYTHING RELATED TO Z </li></ul><ul><li>AVOID EVERYWAY THOUGH WHICH MAULVI MAY COME. </li></ul><ul><li>AVOID EMBRACING WITH ANYONE. </li></ul><ul><li>AVOID HAND SHAKING. </li></ul><ul><li>AVOID GOING TO MOARNING CEREMONIES. </li></ul><ul><li>AVOID GOING OUT OF HOME. </li></ul><ul><li>AVOID DRAWING ROOM OF OWN HOUSE. </li></ul><ul><li>NOT ALLOWING THE KIDS TO COME CLOSER. </li></ul><ul><li>TYPICAL POSTURE BOTH HANDS IN AIR UP. </li></ul><ul><li>HOME BOUND MISEABLE LIFE COMPLETELY WITHDRAWN SOCIALLY. </li></ul>
  39. 39. <ul><li>AVOIDANCES </li></ul><ul><li>AVOID EVERYTHING RELATED TO Z </li></ul><ul><li>AVOID EVERYWAY THROUGH WHICH MAULVI MAY COME. </li></ul><ul><li>AVOID EMBRACING ANYONE. </li></ul><ul><li>AVOID HAND SHAKING. </li></ul><ul><li>AVOID GOING TO MOARNING CEREMONIES. </li></ul><ul><li>AVOID GOING OUT OF HOME. </li></ul><ul><li>AVOID DRAWING ROOM OF OWN HOUSE. </li></ul><ul><li>NOT ALLOWING THE KIDS TO COME CLOSER. </li></ul><ul><li>BOTH HANDS IN FIXED UPRIGHT POSITION. </li></ul><ul><li>HOME BOUND MISEABLE LIFE COMPLETELY WITHDRAWN SOCIALLY. </li></ul>
  40. 40. <ul><li>TREATMENT STRATEGY </li></ul><ul><li>COGNITIVE COMPONENT </li></ul><ul><li>COGNITIVE SHIFTING correcting misconceptions, overgeneralization, and in case of Z attributional error. </li></ul><ul><li>Teaching relaxing practice( making and feeling the muscles more relaxed with each expiration . </li></ul><ul><li>SYSTEMATIC EXPOSURE to least distressing situation first in imaginations and then in practical situations. </li></ul><ul><li>CONTROL THE APPEARING ANXIETY WITH RELAXING PRACTICE. Using the deep respiration as a relaxing tool. </li></ul><ul><li>Telephonic reassurance support available in emergency. </li></ul>
  41. 41. <ul><li>EXPOSURE & RITUAL PREVENION </li></ul><ul><li>TO PASS BY THE SHOP FROM WHERE MAULVI MAKES THE SHOPPING ONCE A DAY WITHOUT LOOKING TO THE SHOP. </li></ul><ul><li>TO PASS BY THE SHOP LOOKING TO THE SHOP ONCE A DAY . </li></ul><ul><li>YOU WILL STAY NEAR THE SHOP AND SEE PEOPLE PURCHASING THE THINGS FROM THE SHOPKEEPER. </li></ul><ul><li>YOU WILL SEND SOMEONE TO GET CIGARETTES FROM THAT SHOP WHILE REMAINING AT HOME. </li></ul><ul><li>YOU WILL SEND SOMEONE TO GET CIGARETTES FROM THAT SHOP WHILE STANDING NEAR THE SHOP. </li></ul><ul><li>YOU WILL GET CHANGE OF MONEY FROM THAT SHOP NOW. </li></ul><ul><li>YOU WILL PURCHASE SOMETHING FROM THAT SHOP. </li></ul>
  42. 42. <ul><li>YOU WILL GET SOMETHING FROM THE SHOP AND WASH HANDS WHEN COME BACK TO HOME. </li></ul><ul><li>YOU WILL GET SOMETHING FROM THE SHOP AND WILL WASH YOUR HANDS AFTER ONE HOUR. </li></ul><ul><li>YOU WILL PURCHASE SOMETHING FROM THE SHOP AND WILL WASH YOUR HANDS BEORE MEALS. </li></ul><ul><li>YOU WILL SHAKE HANDS WITH A CHILD IN YOUR HOME AND THEN WASH HANDS WITHOUT SOAP. </li></ul><ul><li>YOU WILL SIT ON THE DRAWING ROOM SOFA AND CHANGE YOUR CLOTHS AFTERWARDS. </li></ul><ul><li>YOU WILL CHANGE YOUR CLOTHS DAILY ONLY ONCE. </li></ul><ul><li>YOU WILL SHAKE HANDS WITH CHILDREN AND DELAY WASHING THE HANDS. </li></ul><ul><li>YOU WILL SHAKE HANDS WITH ADULTS AND WASH HANDS ONLY BEFORE GOING TO BED. </li></ul><ul><li>SEE THE MAULVI AND SHAKE HANDS WITH HIM AND NOT WASHING THE HANDS TILL MAIN MEALS. </li></ul>
  43. 43. <ul><li>Outcome </li></ul><ul><li>Gradually habituation developed about the new behaviors. </li></ul><ul><li>The patient learnt to neutralize the appearing anxiety by analyzing the rationality of fears. </li></ul><ul><li>The patient got rid of most of his compulsions. </li></ul><ul><li>The patient has joined his social activities. </li></ul><ul><li>He shakes hands with strangers, drives vehicle, attends social gatherings and passing a nearly normal life. </li></ul><ul><li>He has himself reduced the dose of anxiolytic and SSRI, which he has taking for the last many years in full doses. </li></ul>

×