1

Running Head: OCD




                    Obsessive-Compulsive Disorders
2




Background

       Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by obsessions

and compu...
3

and negative parental experience due to anxiety on the condition of their child and fear of

uncertainties in the futur...
4

to Geller, Biederman, Jones, Shapiro, Schwartz, & Park (1998), an estimate of 2% to 4% of

individuals are likely to de...
5

   3) There may be some point that the person suffering from it will recognize that the

       obsessions or compulsio...
6

2001). There is also some confusion regarding the line that separates superstition or habit from

obsession or compulsi...
7

aggressive manner (Osgood-Hynes, n.d.). These sexual and aggressive thoughts cause severe

distress and guilt in those ...
8

individual conditions of the patients (Ravindran, da Silva, Ravindran, & Richter, & Rector,

2009). Although such metho...
9

       Response prevention on the other hand, deals with avoiding known rituals that are either

discernible or mental ...
10

process of exposure is usually done with the assistance of a therapist and a session would

normally run from 45 minut...
11

However, patients that do not show overt compulsions are those that benefit less from the

exposure and response preve...
12

patient is also expected to continue recording the information on the thought record during the

sessions (CAMH, n.d.)...
13

controlling the attention and changing the focus of attention away from the negative implications

of UITs have been s...
14

other psychological problems (i.e. mood and anxiety disorders) wherein it was proven that

acceptance has positive cor...
15

people, wrong efforts of neutralization, or suppression of the unwanted thoughts which will

likely sustain the obsess...
16

         The most vital part in treating OCD is educating the child and family as to what is going

on within the brai...
17

       If there is fear in being near to a pair of scissors because he or she might stab his or her

parents, the kid ...
18



                                               References


Abramowitz, J. (1996). Variants of exposure and response...
19

Freeman, J.B., Garcia, A.M., Fucci, C., Karitani, M., Miller, L., & Leonard, H.L. (2003).

   Family-based treatment o...
20

March, J. A. & Leonard H. (1996). Obsessive-compulsive disorder in children and adolescents:

   A review of the past ...
21

Schwartz, J. A. (1996). Brain lock: free yourself from obsessive-compulsive behavior. Regan

   Books.


Siqueland, L....
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Ocd Obsessive Compulsive Disorders

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Ocd Obsessive Compulsive Disorders

  1. 1. 1 Running Head: OCD Obsessive-Compulsive Disorders
  2. 2. 2 Background Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by obsessions and compulsions. OCD is considered as the fourth most common mental disorder (Hollander and Stein,1997). Obsession, a major element of OCD, is characterized as persistent and repetitive thoughts, images and impulses that are improper, unwelcome, intrusive and bringing anxiety or distress to the individual suffering from it (APA, 1994). The thoughts are usually accompanied by compulsions to reduce the anxiety felt. These obsessions and compulsions are severe in that they can adversely affect the daily life of the patient, especially because these are time consuming and make the individual suffer considerable distress. Moreover, obsessions and compulsions can cause the person functional impairment (Wright and McLaughlin, 2001; APA, 1994). People suffering from OCD are aware that their thoughts and behaviors are unreasonable but continue to engage in them as they feel they have no choice but to do so to relieve themselves of anxiety. According to the DSM-IV-TR (1994), obsessions are characterized by intrusive and inappropriate persistent ideas, thoughts, impulses, or images, which cause distress or anxiety to the patient. While compulsions are characterized by repetition of behaviors or mental acts that are geared towards the reduction of anxiety or distress, rather than to obtain gratification or pleasure. The majority of individuals diagnosed with OCD suffer from both obsessions and compulsion, which are often associated to each other (Wright and McLaughlin, 2001). OCD affects both the child and his or her parents (Freeman, Garcia, Fucci, Karitani, Miller, & Leonard, 2003). The parents of the children suffering from OCD likewise suffer from distress
  3. 3. 3 and negative parental experience due to anxiety on the condition of their child and fear of uncertainties in the future of their children. Having a loved one suffering from OCD is indeed a distressing experience (Storch, Lehmkuhl, Pence, Geffken, Ricketts, Storch, & Murphy, 2009). Children suffering from OCD worry about many things. For instance, they may have the feeling that bad things might happen to them someone they love, or they may have a feeling that they constantly need to get things right and will frequently need to check to make sure. These obsessive worries keep ringing in their head and prevent them from focusing on other things. The large challenge to interventionists is the accompanying anxiety component (Piacentini, Bergman, Keller, & McCracken, 2003). Children having bad thoughts suffer greatly because they are not aware of their source, which leads to confusion as to what they are going to do with those thoughts or images. Many are unable to confide in their parents due to the violent nature of these thoughts, especially if they involve hurting their parents. This leads to the child being irritable, withdrawn, having difficulties in focusing in his or her academics and school activities and having a propensity toward avoiding people, things and going to certain places. (Piacentini et al, 2003). If an individual has OCD, he or she has an increased risk to develop other psychiatric disorders (Geller, 2006). There is no concrete incident rate of OCD because there are still many children or people who refuse to divulge that they are suffering from such disorder or it is also a possibility that they do not know yet that they are suffering from it. Hence, they fail to subject themselves to treatments or interventions (Wright and McLaughlin, 2001). Various estimations of incidence rate have been identified and given by different institutions and researchers. According to Zohar (1999), OCD affects 1% to 3% of the general population before reaching adulthood. According
  4. 4. 4 to Geller, Biederman, Jones, Shapiro, Schwartz, & Park (1998), an estimate of 2% to 4% of individuals are likely to develop OCD before they reach the age of 18 years. March and Leonard (1996) report that 1 in 200 children and adolescents are suffering from OCD. Symptoms The following are the symptoms of the Obsessive Compulsive Disorder according to DSM-IV-TR (1994): 1) Obsessions – Obsessions have the following definition (a) pervasive and repetitive thoughts, images or impulses that are intrusive and improper and cause marked distress and anxiety; (b) such thoughts, images or impulses are not mere extreme worries about real-life conditions; (c) the sufferer exerts efforts to suppress or ignore these unwanted thoughts, impulses or images of even just to neutralize them through some action or thought; and (d) such person knows that the unwanted thoughts, images or impulses are from his or her own mind and not just inserted into his or her mind. 2) Compulsions – Compulsions are defined as (a) repetitive behaviors such as washing of hands, ordering and checking or mental acts like counting, praying or uttering words silently in a repetitive manner. The person suffering from it feels that he or she is obliged to do them as response to an obsession or because of the rules that should be religiously performed; and (b) the behaviors or mental acts are meant to prevent or reduce the distress felt or prevent some avoided situation or condition. However, such behaviors or mental acts are not in accordance with what they should be neutralizing or are evidently extreme or excessive.
  5. 5. 5 3) There may be some point that the person suffering from it will recognize that the obsessions or compulsions are already unreasonable or excessive. However, this is not the case for children. 4) The obsessions or compulsions bring marked distress or consume excess amount of time (e.g more than 1 hour in day), or considerably obstruct the normal activity and routing of a person, his or her occupation or education or even relationships. 5) The presence of another disorder from the Axis I increases the risk of symptoms not limited to obsessions or compulsions. 6) The disorder is not due directly from the psychological effects of a substance like drugs or medication nor it is a general medical condition (American Psychiatric Association 2000) Because of the OCD, individuals may suffer from repetitive rituals like hoarding, hand washing, counting, tapping of the foot, checking doors and locks and may have an unreasonable fear of being contaminated or causing harm to others (March & Leonard, 1996). OCD is difficult to recognize because patients do not share the same exact symptoms. A patient may show changes in symptoms as time passes by which are not caused necessarily by changes in their environments. There a too few children who are likely to show only one type of obsession or compulsion because most children suffering from OCD show different symptoms for both types (March and Leonard, 1996). The symptoms of OCD may be overlooked when a patient is also suffering from other persistent psychotic symptoms because obsessions and compulsions can also be seen from other psychotic disorders. Thus, the symptoms of OCD must be purposely looked into for patients suffering from psychosis (Ganesan, Kumar, & Khanna,
  6. 6. 6 2001). There is also some confusion regarding the line that separates superstition or habit from obsession or compulsion. It is said that it is normal and healthy for children to develop some degree of superstitions, rituals and anxiety. Normally, a distinction can be made when these superstitions or habits are developed when they have no actual purpose for it or if it obstructs the normal functioning of a person (Wright and McLaughlin, 2001). According to Rachman (2003), there are three types of classical obsessions, such as: (a) aggression or thoughts of harming people; (b) sexual obsessions; and (c) blasphemous obsessions or fears of sacrilegious actions against the church. Common obsessions also comprise of fear of being contaminated, forbidden thoughts, urges for symmetry and a necessity to tell or confide matters (March and Leonard, 1996). A person suffering from obsessions in harming people may have thoughts of harming an innocent child, jumping from a high place such as a bridge, mountain or from a tall building, leaping in the face of a train or a vehicle or may have the urge to push another person in front of a moving vehicle or train. A person suffering from sexual obsessions may have intrusive thoughts or images of sexual themes such as kissing, fondling, touching, oral sex, anal sex, rape and intercourse with their friends, co-workers, strangers, parents, children, family members or even as extreme as with animals or religious figures. These may involve heterosexual or homosexual content with individuals regardless of age (Osgood- Hynes, n.d.). Unlike asymptomatic people having unusual sexual images that are meaningless, individuals suffering from OCD have unwanted sexual images and these have significant meanings. This will make the patient feel uncertainty on whether he or she can avoid entertaining bad thoughts which will lead to self-criticism or loathing. The patient may feel negatively critical about himself or herself. The patient may also feel the necessity to confess as often as possible to a religious counselor; otherwise, he or she may act out the strong sexual thoughts in an
  7. 7. 7 aggressive manner (Osgood-Hynes, n.d.). These sexual and aggressive thoughts cause severe distress and guilt in those that experience them. They feel that their bad thoughts are equivalent to actually acting them out. For example, just thinking about hurting someone leads to the same level of distress as actually hurting that person. In the case of sexual and aggressive obsessions, the person will likely engage in avoidance behavior at first. But avoiding such obsessions will make the urge even stronger and increase the obsession and distress. Thus, to be able to lessen the distress, the person will give in to the obsession and engage in a developed ritual. However, this method of lessening distress only takes effect for the short term (Osgood-Hynes, n.d.). Common compulsions are comprised of repetitive washing, checking, touching, counting, ordering or arranging, hoarding and praying (March and Leonard, 1996) The said unwanted intrusive thoughts (UITs) are not only suffered by persons with OCD but are also experienced by sufferers of different disorders like those who are experiencing depression (Clark, 2005) and schizotypal obsessions (Sobin, Blundell, Weiller, Gavigan, Haiman, & Karayiorgou, 2000). Interventions Aimed at Alleviating Intrusive Thoughts Obsessive-compulsive disorder has previously been thought to be a disorder that is untreatable or incurable(Antony, Downey, & Swinson, 1998). Currently, however, it is widely believed that OCD is treatable primarily due to the availability of effective diagnostic assessment techniques of OCD and modern treatments developed as a result. The most widely known methods of treating OCD are medications (e.g. anti-depressant and Serotonin reuptake inhibitors) and cognitive and behavior therapy (e.g. exposure, response and prevention) or can be the combination of both (Health, n.d.). However, the treatment response can vary depending on the
  8. 8. 8 individual conditions of the patients (Ravindran, da Silva, Ravindran, & Richter, & Rector, 2009). Although such methods do not promise to cure OCD, they can control the symptoms and will allow people to function again in a normal way (Center for Addiction and Mental Health, n.d.). For twenty years, cognitive behavior therapy (CBT) is the leading technique for treating children and adults with OCD. The two key elements of cognitive behavior therapy are exposure and response prevention (Wright and McLaughlin, 2001). The determination of the specific symptoms of the person suffering from OCD and the factors that cause the most anxiety are the main keys in using the CBT method. After which the specific therapies based on the identified specific symptoms and factors can be developed that will help the patient to progressively have strength to be in contact with the feared stimulus. Moreover, the patient can be instructed of the different techniques that will help him or her to prevent from engaging in his or her mental rituals (Wright and McLaughlin, 2001). Exposure therapy includes different types. Through exposure therapy, the patient must be able to make contact with the stimulus that produces anxiety and continue to have contact with it until the anxiety weakens. The most common type of exposure therapy is in vivo exposure or direct exposure wherein the patient needs to be in direct contact with the feared stimulus. The other type of exposure therapy is the imagined exposure wherein a child needs to imagine being in contact with the feared stimulus (Wright and McLaughlin, 2001) or the patient is instructed to imagine controlled exposure to objects or situations that activate the obsessions that stir up anxiety. In the process of getting used to the obsessional cue, the exposure will gradually lessen the anxiety. This is what is called habituation (CAMH, n.d.).
  9. 9. 9 Response prevention on the other hand, deals with avoiding known rituals that are either discernible or mental in nature (Wright and McLaughlin, 2001). The stimuli here are the rituals that people with OCD do in order to reduce the anxiety felt (CAMH, n.d.). In this technique, the patient needs to avoid engaging in the ritual when he or she faces the situation that would normally make him or her engage in the ritual. The patient learns to resist the compulsion to do his or her rituals and in the process will learn eventually to stop engaging in such unwanted behaviors (CAMH, n.d.). The members of the family will be used to help the patient from preventing to engage in the ritual in his or her everyday life and to give support to the patient. (Wright and McLaughlin, 2001) According to Abramowitz (1996), the combination of the exposure and response prevention will enable CBT to be more effective. It has been found by Foa, Steketee, & Milby, (1980), that the exposure method is effective in diminishing the obsessions and anxiety felt while response prevention can aid in getting rid of the rituals. As previously noted, determining the specific symptoms is important and CBT should focus on such symptoms. In doing so, it is necessary to understand in detail the individual condition and situation of the patient and records should be compiled for the future implementation of treatment programs (Wright and McLaughlin, 2001). The Center for Addiction and Mental Health (n.d.) relates how exposure and response prevention work. The patient enumerates a list of situations or cues that stir up their obsessional fears at the start of the process. Afterwards, the patient is exposed to the situations that cause mild to moderate anxiety. The patient then habituates to the situations and eventually will work against the situations that causes greater anxiety. The duration of the treatment hinges on the ability of the patient to bear the anxiety and to oppose compulsive behaviors (CAMH, n.d.). The
  10. 10. 10 process of exposure is usually done with the assistance of a therapist and a session would normally run from 45 minutes up to three hours per day (CAMH, n.d.). Direct exposure technique (in vivo) may not be possible in some cases when done in the office of the therapist. In such a case, the therapist would need to employ the imaginal exposure technique which is done through exposing the patient to situations that activate obsession through imagining a variety of scenes (CAMH, n.d.). The objective of the exposure therapy is to have the patient stay in contact with the situations that trigger the obsessional behaviors without performing the rituals. If the person keeps on responding to the feared stimulus by engaging to the ritual behaviors, the person will be asked to be exposed more in such situations until such time that the patient will be able to resist and abstain from engaging to ritual behaviors. For homework or therapy while at home, the patients are likewise trained to become experts in rating their own levels of anxiety to assess their progress while undergoing the task of exposure. The patient will then be encouraged to continue undergoing exposure and response prevention treatment once the patient shows progress and will then be subjected to new situations as the therapy may deem fit. The treatment usually runs between 14 and 16 weeks (Health, n.d.). And according to the Center for Addiction and Mental Health, even patients who have been suffering from OCD for a long period can take advantage from the exposure and response prevention treatment and the success will hinge on different factors and the motivation of the patient (CAMH, n.d.). The Center for Addiction and Mental Health has documented studies showing the efficiency of the said therapy that as high as 75 per cent of the patients suffering from the symptoms of OCD experienced improvements in their conditions upon undergoing therapy. Likewise, majority of the patients that undergone treatment for two to three years have experienced long-term improvement (Health, n.d.).
  11. 11. 11 However, patients that do not show overt compulsions are those that benefit less from the exposure and response prevention (CAMH, n.d.).. Cognitive therapy (CT) is also combined with the exposure and response prevention treatment in treating a patient with OCD. A hierarchy of situations that trigger distress is created when a person is suffering from OCD. And when the person undergoes exposure tasks, he or she is required to pay attention specifically to thoughts and feelings related thereto (CAMH, n.d.). The focus of CT is on how the patient takes their obsessions such as what they think about these obsessions, his attitude toward such obsessions and why he is having such obsessions. The understanding of this fear can be changed and challenged or re-interpreted so that the situation will no longer be seen as a high risk activity. This may require a lot of time before the results can be seen but the outcome may be desirable (CAMH, n.d.). CT also aids patients in identifying and reassessing their beliefs regarding the implications of engaging or not engaging in their compulsive behaviors and to do actions to change or extinguish such unwanted behaviors. Challenging and confronting the situations will help control the behavior. One effective tool that is used in CT is the thought record. It can identify, challenge and correct wrong interpretations of the intrusive thoughts. The patients record their obsessions and the associated interpretations they have with the obsessions in the thought record (CAMH, n.d.). When the patients are able to learn to identify their intrusive thoughts and the interpretations they have for them, the evidence that probably support and do not support the obsession will then be examined. Next is the identification of the cognitive distortions in the obsessions and the development of a less threatening and alternative response for the unwanted intrusive thoughts. The patterns will be identified during the session with the therapist and during the direct exposure activity and the
  12. 12. 12 patient is also expected to continue recording the information on the thought record during the sessions (CAMH, n.d.). Suppression is also a common but lesser popular technique used for countering unwanted thoughts (Najmia, Riemann, & Wegner, 2009). This may be due to the fact that the normal tendency of individuals with OCD are attempting to suppress their unwanted intrusive thoughts (UITs) as shown by a survey conducted by Freeston and Ladoucer (1997). Thus, the method of suppression is methodically developed. However, a drawback of this method is that a person who supresses a thought may likely have a recurrence of his or her intrusive thoughts (Wegner, 1994). This is called the rebound effect. As stressed further by Najmia and colleagues (2009), the repeated efforts of suppressing UIT will only worsen the existing state of obsession. Suppression will only increase the occurrence of unwanted thoughts and the consequent distress after suppression or the so-called rebound effect. And even if the suppression will not lead to the rebound effect, the distress will only be worsened and will not help to ease the anxiety (Najmia, Riemann, & Wegner, 2009). It has been found by Wegner, Schneider, Carter, & White (1987) in their experiments that focused distraction can be effective in getting rid of unwanted intrusive thoughts. This is against the technique of suppression wherein Wegner et al. (1987) averred that successful suppression can be attained by increasing the access to the distracter thoughts. This is complimented by Salkovskis and Campbell (1994) where they asserted that distraction is more efficient in lessening the occurrence of UITs than suppression and found to be even better in reducing distress than neutralization (Salkovskis, Thorpe, Wahl, & Wroe, & Forrester, 2003). Focusing distraction away from the unwanted intrusive thoughts is much the sme with focusing the attention to something else that is not the UIT. The use of the technique of strategically
  13. 13. 13 controlling the attention and changing the focus of attention away from the negative implications of UITs have been seen to be effective by several examinations (Najmia, Riemann, & Wegner, 2009; Wegner et al., 1987). Suppression is not as effective as employing focused distraction as suppression will only be effective if done by focusing on a specific source of distraction (Najmia, Riemann, & Wegner, 2009). However, unlike the positive feedbacks given to the cognitive behavior therapy, focused distraction is found to be for temporary relief from distress and intrusions only (Najmia, Riemann, & Wegner, 2009). There are four steps suggested by the book Brain Lock: Free Yourself from Obsessive- Compulsive Behavior written by the psychiatrist Jeffrey Schwartz (1996) in dealing with the OCD. The following steps are: 1) Relabel – Be familiar with the intrusive obsessive thoughts and the that are outcomes of OCD; 2) Reattribute – understand that the intensity and intrusiveness of the thought is by reason of the OCD and it could be caused by a biochemical imbalance in the brain; 3) Refocus – focus attention on something else even for some minutes and do another behavior; and 4) Revalue – do not look at OCD by its mere face value. There are recent studies showing the effectiveness of acceptance and commitment therapy (ACT) in treating OCD. Acceptance enables the patient to notice UITs and discourages the patient to struggle with it (Twohig, Hayes, & Masuda, 2006). Through acceptance, the patient is encouraged to be exposed to the UIT and is discouraged from suppressing UIT (Najmia, Riemannb, & Wegner, 2009). This is in line with the findings in other studies regarding
  14. 14. 14 other psychological problems (i.e. mood and anxiety disorders) wherein it was proven that acceptance has positive correlation with lesser distress as compared to expressive suppression (Campbell-Sills, Barlow, Brown, & Hofmann, 2006). Another research from the University of British Columbia’s Anxiety Disorder Clinic shows that patients suffering from obsessive-compulsive disorder (OCD) reveal considerable improvement upon undergoing therapy that points to their primary obsession (Haley, 2004). In the beginning, there will be a detailed analysis of the obsession, its evolution and the necessary techniques to effectively manage it. The process will be a targeted therapy intended directly at the primary obsession concerned. The therapy involves combination of different therapy. There will be an appraisal of the obsessions after which the necessary techniques shall be determined to manage and minimize the impact of obsession. In short, there will be a determination of the source of obsession and the means of managing it (Haley, 2004). Thus, there will be two stages in the process of treatment. The first stage is the psychoeducational. This is the stage where the patients are provided with the information on the high frequency of unwanted intrusive thoughts within the population. The patients are likewise educated about the similarities of the content and form of clinical and nonclinical unwanted intrusive thoughts. This is also the stage where the patients are informed of the importance of the undergoing treatment (Haley, 2004). The second stage refers to the cognitive behavioral treatment. The principal goal of this stage is to eradicate the negative and wrong interpretations of the meaning and relevance of the obsessional cognitions and to change these with reasonable alternative interpretations. Also, the second stage aims to change the associated abnormal safety behaviors such as avoidance or escaping the situations that bring about obsessions, covering up of the obsessions from other
  15. 15. 15 people, wrong efforts of neutralization, or suppression of the unwanted thoughts which will likely sustain the obsessions (Rachman, 2003). Lynne Siqueland, (2009) reminded the parents of the children suffering from OCD (especially those suffering from bad thoughts) that such disorder is very treatable despite. There are already numerous techniques that surfaced that can be used for every form of OCD. That is why it is very important to have a careful assement done by a competent professional who has a vast experience in treating OCD especially that the symptoms of OCD can be confused with other psychological disorders. 1) Assessment stage At the start of the treatment, kids may feel stress and could be upset in filling their heads about the unwanted thoughts and could even feel suicidal at the moment. According to Siqueland, it is important to determine the distinction between kids who have OCD and do not have OCD. The bad or violent thoughts of kids with OCD have them as commands as outside voice and not from their heads. Kids may enjoy or like having such thoughts. On the other hand, kids with OCD feel very distress in having bad thoughts and would exert effort to avoid them. Normally, a child having abnormal thoughts may be said to be suffering from OCD if the thoughts are contrary to the personality of the child. The child in this case will show great amount of distress about having intrusive thoughts and would try to avoid them. And in response to these intrusive thoughts, a child may develop doing rituals such as praying, confessing, or uttering special or unusual words (Siqueland, 2009). 2) Education stage
  16. 16. 16 The most vital part in treating OCD is educating the child and family as to what is going on within the brain of a child: that kids are having nonsense messages within their heads that appear to be very scary. It is likewise important to make the child understand that it is his reaction or response to the intrusive though that is igniting the problem. And the most important thing to do is to have the disorder renamed as OCD or anything else. It is also crucial to let the kids understand that they are no longer engaging to do what their thoughts demand no matter how much it bothers them; that it will neither help if they just try to suppress the thoughts as they will just occur more often (Siqueland, 2009). Kids with OCD need to be taught to let the thoughts pass their heads like any other thoughts; that it is not necessary to stop them and force them out; that just having the thoughts does not mean that they want to do them (Siqueland, 2009). 3) Working on the rituals After educating the child and the family, the next step is to work on the rituals. This is usually done by confiding or telling all the thoughts. This process is the most painful and disappointing part for the parents. Parents need to be composed and strong to send positive lights to their children. Upon hearing or knowing all the thoughts of the child, the parent should avoid reacting negatively about their kids especially if the thoughts are too abnormal or violent. In this process, the therapists shall work closely with the kids and parents to reduce the rituals gradually. This can be done by using coupons to let kids write and confess their thoughts on it. The asking of questions by the therapist should be done in a very careful manner (Siqueland, 2009).
  17. 17. 17 If there is fear in being near to a pair of scissors because he or she might stab his or her parents, the kid needs to work on holding a pair of scissors while he is near his parents. The practice will be done step by step until the kids will reach the most feared situations initially in the office of the therapist then eventually at home. The kids should be informed in the process that they are not exposed to the situations to cause them danger, but it is important for them to get used to the feared situations as they will eventually occur in their daily life and are not indeed dangerous to them (Siqueland, 2009). Another method is using audiotape loops. The child in this case is required to write the feared thoughts in detail on paper. Afterwards, the child will then be instructed to read what he has written and it will be recorded in an audiotape. The child will then be required to listen to the recording until the he has become “desensitized” or becomes used to the previously dreaded message in his head or until the message becomes boring as opposed to scary. The parents, on the other hand, need to be informed of the relevance and reason of using bizarre approaches. This kind of technique is applied to kids ages 10 or over, and for younger children, therapists can instead use songs having the feared content so as to expose the children but the tone in this case should be made humorous or meaningless rather than having a serious tone (Siqueland, 2009). If the thoughts are too depressing or overwhelming that the treatment cannot just be done at the moment, the therapist can seek the aid of medication (e.g. SSRI, antipsychotic medications) to eliminate the intrusive thoughts (Siqueland, 2009). Moreover, the role of the parents and family members are vital for the success of the therapy. The children need to know that their parents are brave and give appropriate support. Therefore, the children will have confidence in themselves (Siqueland, 2009).
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