CBT is an effective treatment for OCD due to its ability to trigger lasting neural changes through learning. It involves psychoeducation, challenging irrational assumptions, exposure to feared situations without compulsions, and response prevention. Studies show large effect sizes for CBT compared to medications alone. CBT aims to reduce anxiety and distress from obsessions by stopping thoughts and using distractions, while exposure therapy targets compulsions. Success requires understanding all symptoms, motivated patients, and therapists able to systematically implement the CBT techniques.
Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people's difficulties, and so change the way they feel.
Brief therapy, sometimes also referred to as short term therapy (usually 10 to 20 sessions) , is a generic label for any form of therapy in which time is an explicit element in treatment planning.
Cognitive behaviour therapy is a talk (psychotherapy) therapy wherein the therapist focus on modifying or altering the faulty cognitions in an individual in order to treat the symptoms of mental illness
Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people's difficulties, and so change the way they feel.
Brief therapy, sometimes also referred to as short term therapy (usually 10 to 20 sessions) , is a generic label for any form of therapy in which time is an explicit element in treatment planning.
Cognitive behaviour therapy is a talk (psychotherapy) therapy wherein the therapist focus on modifying or altering the faulty cognitions in an individual in order to treat the symptoms of mental illness
Obsessive–compulsive disorder symptoms and treatment of compulsive behavior...HoneymoonSwami.com
Understanding OCD obsessions and compulsions
Most people with obsessive-compulsive disorder (OCD) fall into one of the following categories:
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Erin McGinty, LPC, Therapist and Program Director at Castlewood Treatment Center presents on the treatment of OCD with Eating Disorder. She explores the use of Exposure and Response Prevention as well as CBT, DBT, and IFS therapy.
Read this article to learn all about the various types of OCD. If you are suffering from OCD, there are treatment options available to help ease your symptoms and get your life back on track. Call now ☎️
https://pathwaysreallife.com/obsessive-compulsive-disorder-ocd-treatment-in-utah/
My thesis about the efficacy and efficiency of OCD treatment.
Brief Strategic Therapy is revealed as the most efficient way of treat OCD. Without drugs obviously.
Meditation as Medication Mastering the Art of Mindfulness
By: Daryush Parvinbenam M. Ed, M.A, LPCCS
R.S.V.P Conference September 29, 2010
- This presentation does not suggest mindfulness practices should immediately replace current medication.
- A holistic model of treatment, as opposed to the current medical model, should be considered.
- Medication issues should be negotiated with the prescribing physician prior to discontinuation or change of medication.
- At least initially, in many cases, the combination of medication and alternative therapies seems to be the best possible option toward recovery for many people.
Behavioral therapy is an umbrella term for types of therapy that treat mental health disorders. This type of therapy seeks to identify and help change potentially self destructive or unhealthy behaviors.
It contains a description of cognitive conceptualization, psychoeducation, exposure excercises (interoceptive and in-vivo) and other techniques for management of the Panic disorder.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
1. 1
CBT FOR OCD
Dr V.Sabitha
Associate Professor
Institute of Mental Health
Chennai
2. 2
WHY CBT FOR OCD?
All thought processes arise from activity in
appropriate neural circuits.
OCD phenomena arise from aberrant thought
processes, likely due to disturbances in the cortico-
thalamo-striatal circuitry.
Neural circuits can be strengthened or weakened.
Drugs modulate neural circuit activity through
receptor effects and later neuroplasticity changes.
CBT triggers learning which is hardwired into the
brain, and may be more enduring in its effects.
3. 3
BIOLOGICAL EFFECTS OF
CBT IN OCD
Decreased metabolic activity in the right caudate
nucleus (reviewed by Linden, Molecular Psychiatry 2006).
Decreased right frontal anterior cingulate cortex
and bilateral thalamic activity (Saxena et al, Molecular
Psychiatry 2009).
Etc.
4. 4
TREATMENT OF OCD
SRI drugs and CBT
Meta-analysis 1:
Effect size for drugs was 0.48 (13 trials)
Effect size for CBT was 1.45 (5 trials)
(Watson and Rees, J Child Psychol Psychiatry 2008)
Meta-analysis 2 (13 trials):
Effect size for group CBT pre vs post: 1.18
Effect size for group CBT vs wait list controls: >1.12
(Jonsson and Hougaard, Acta Psychiatrica Scand 2009)
5. 5
ADVANTAGES OF CBT
Effective as monotherapy.
Large effect size [caveat: biases
could arise from sample selection
and consenting processes].
Improves long-term outcomes
with drugs.
Treating with drugs+CBT may
offer the best outcomes.
6. 6
TREATMENT OF OCD
The proper treatment of
OCD with CBT requires a
complete understanding of
the spectrum of symptoms
that the patient displays.
7. 7
OCD
Prevalence, 2-5% (severe in 0.5%)
The only DSM-IV anxiety disorder in which anxiety
is not the main symptom.
Primary symptoms: obsessions and/or compulsions.
Secondary symptoms include depression.
Underlying OCPD in 50% of patients.
Comorbidities include tic disorder.
OCD may be secondary to other conditions; e.g.
schizophrenia, atypical antipsychotic therapy.
8. 8
NOTE
By definition, mental preoccupations or repetitive
behaviors are not considered under OCD if they
occur in the context of another DSM-IV Axis I
disorder
(e.g. hypochondriasis; eating disorders;
trichotillomania)
9. 9
OBSESSIONS AND
COMPULSIONS
Obsessions are repeated thoughts.
E.g. “My son is going to die.”
E.g. “I will get AIDS.”
Compulsions are repeated actions.
E.g. Handwashing.
Every time a patient sees a picture of a deity, he
feels compelled to say a short, mental prayer to
the deity. Is this an obsession or a compulsion.
[In CBT, the approach to treatment differs between
obsessions and compulsions.]
10. 10
COMPULSIONS
Thoughts which are deliberately repeated to
relieve anxiety are compulsions, not obsessions.
E.g. Compulsively repeating a prayer a certain number
of times to ward off evil after a trigger event.
E.g. Repeating a prayer over and over again just in
case it was not properly said previously (scrupulosity).
Important to differentiate obsession from
compulsion because the treatment approach is
different.
11. PSYCHOPATHOLOGY OF
OCD
Fear acquired through classical conditioning and
maintained by operant conditioning
Eg. Checker associates electrical
appliance(conditioned stimulus) with
death(unconditional stimulus;danger of fire) and
thus feels anxiety (unconditional response and
conditioned response) in the presence of a stove
Checking behaviour:Negative Reinforcer as it
removes anxiety
11
12. OCD COGNITIONS
Inflated sense of Personal Responsibility
Undue Importance to Thoughts
A need to control thoughts
Overestimation of threat
Intolerance of Uncertainity
Perfectionism
12
14. 14
TYPES OF COMPULSIONS
[compulsions relieve anxiety]
Almost always secondary to obsessions
May be behavioral or mental
Yielding:
Counting
Checking
Ordering
Cleaning/washing
Resisting:
Repeating thoughts or actions to prevent or undo a
feared event
(Overlap may be present)
15. 15
ASSESSMENT
(2-4 h)
It is important to comprehensively document all
aspects of the phenomenology present.
List all obsessions.
List all compulsions.
Understand the contexts which generate each.
Arrange in a hierarchy of severity.
Assess insight into the irrationality of each.
Assess motivation to change each.
16. 16
ASSESSMENT
(contd.)
Make a chart with each symptom rated:
Frequency (occasions per day)
Time spent (minutes or hours)
Distress (0-10)
Impairment (0-10, with examples of impairment)
Overall severity
This chart can be used to monitor progress.
Use the Y-BOCS or LOI or other scales.
17. 17
YALE-BROWN OBSESSIVE-
COMPULSIVE SCALE
10 items (5 for obsessions, 5 for compulsions)
Semi-structured interview based on an explanation
to the patient about what obsessions and
compulsions are.
Rated 0-4; range of possible scores, 0-40
For obsessions: Time occupied by obsessive
thoughts, obsession-free interval, interference,
distress, resistance, control.
Ditto for compulsions.
18. 18
LEYTON OBSESSIONAL
INVENTORY
69 items
Identification of OCD s/s
Assessment of resistance
Assessment of interference
Plus: Common OCD s/s listed individually
Minus: Rare s/s are omitted.
19. 19
CORNERSTONES OF CBT
Common to both obsessions and compulsions:
Psychoeducation
Challenging assumptions
[Family support, if indicated]
Obsessions:
Thought-stopping
Distraction
Compulsions:
Exposure
Response prevention
20. 20
CBT FOR OBSESSIONS
Psychoeducation
Challenging assumptions
Family support
Thought stopping
Distraction
21. 21
PSYCHOEDUCATION FOR
OBSESSIONS
Explain about OCD
Destigmatize the illness
Explain the principles of drug
therapy
Explain the principles of CBT
Discuss plan of management
Review patient understanding
Time: 1-2 hours
22. 22
CHALLENGING
ASSUMPTIONS
Obsessions are, by definition, irrational thoughts.
Patients don’t always recognize their irrationality.
Taking each obsession by turn, challenge the
flawed logic that underlies it.
Goal: To reduce anxiety through the realization
that the thought is irrational and can be ignored.
E.g. Obsessive fears: “What if that man [on the bus] is
carrying a bomb?”
E.g. “What if I get AIDS?” [by using public cutlery]
23. 23
CHALLENGING
ASSUMPTIONS
Generalization: The patient must
learn how to reduce anxiety by
arguing against his own beliefs
when the obsessions arise
outside the clinic.
Challenging assumptions should
result in full insight. So, take as
much time as the patient requires
to fully grasp, appreciate, accept,
and articulate the arguments.
24. 24
THOUGHT-STOPPING
Terminates the obsession
Slapping the table or pinching one’s thigh
Shouting stop
Snapping a rubber band on the wrist
Doing these physically or imaginally
25. 25
OTHER DISTRACTOR
TECHNIQUES
Taking up a chore that demands attention
Phoning a friend
Speaking to a family member
Examining details in the environment
Etc. [plan these out]
26. 26
STRATEGY FOR TACKLING
OBSESSIONS
Take one obsession at a time.
Go from education to challenging assumptions to
thought stopping and distraction.
Preferably move to the next obsession only after
the previous obsession has been satisfactorily
overcome.
27. 27
CBT FOR COMPULSIONS
Psychoeducation
Challenging assumptions
Recruit family support
Exposure
Response prevention
28. 28
CHALLENGING ASSUMPTIONS:
CHECKING COMPLSIONS
Did I lock the door?
Strategy
Be aware that this is a problem.
When locking, say “I have done it” [lays memory trace].
When the doubt arises, recall the memory.
Learn to trust the memory [if you cannot trust yourself,
whom will you trust?]
Recall past experience [has there been any occasion that
you checked and repeatedly checked and found that the
door was unlocked?]
29. 29
CHALLENGING ASSUMPTIONS:
WASHING COMPLSIONS
What is dirt?
Why is dirt dirty?
When is dirt dirty?
Can dirt be good (prevents allergy, builds immunity)
Why is water clean?
Note that, after the first wash, washing/soaping
removes layers of skin, not dirt.
30. 30
MORE ABOUT DIRT
Why are bodily secretions
dirty the moment they leave
the body?
Smelling a fart and airborne
particles
Do not tell the patient this!
31. 31
CHALLENGING
ASSUMPTIONS
[Same as with obsessions]
E.g. for checking whether a door was locked
E.g. for removing dirt from the hand
E.g. for repeated rituals lest a deity be offended
E.g. for repeated rituals after stepping on paper
E.g. for rituals that seek to ward off harm.
32. 32
CHALLENGING
ASSUMPTIONS
Challenging assumptions should result in full
insight. So, take as much time as the patient
requires to fully grasp, appreciate, accept, and
articulate the arguments.
This is necessary to ensure motivation in exposure
and response prevention exercises.
33. 33
EXPOSURE AND RESPONSE
PREVENTION
Systematic desensitization
Flooding
Imaginal (as part of the desensitization hierarchy, or if in
vivo exposure is not feasible)
Voluntary response prevention (should not be forced
by family, hospital staff e.g. as in turning off the water supply
in a patient with washing compulsions)
Goal: Anxiety reduction through habituation
Time: At least 30-120 min per exposure session;
anxiety reduction must be substantial.
34. 34
EXPOSURE AND RESPONSE
PREVENTION
E.g. stepping on paper
E.g. touching footwear
E.g. handling currency notes
E.g. checking a locked door
Therapist-assisted exposure (provides
support)
Self-driven exposure (provides
confidence, improves generalization)
35. 35
DEALING WITH
BATHING RITUALS
Identify and tackle underlying obsessions.
Break up the rituals into their component parts
[wetting, soaping, rinsing, wiping].
Define what is the purpose of each, and what is the
normal limit of behavior for each.
Practice behavior within these set limits while
simultaneously challenging the assumptions which
were responsible for the obsessions.
36. 36
DEALING WITH RELIGIOUS
OBSESSIONS AND RITUALS
Understand the cultural context.
Tread carefully, respect beliefs, challenge
assumptions only with informed consent.
Discuss source of beliefs and practices; consider
the ‘tying the dog story’.
Probe inconsistencies between obsessions and
beliefs about the nature of God.
Remind patient that idols and pictures are
representations, not personifications, of God.
37. 37
DEALING WITH
OBSESSIVE SLOWNESS
Suggestions:
Challenge assumptions.
Set timetable with
attention to problem
specifics.
Enlist family supervision.
38. 38
COMMENTS
Patients sometimes develop
substitute rituals after their
primary symptoms are addressed.
E.g. rubbing hands to replace
washing.
Not all patients are suited for
CBT; not all patients will respond;
however, some improvement is
better than no improvement.
39. 39
SESSIONS
3-5 sessions a week for 3-5 weeks.
Each session up to 2 hours.
15 min for review of previous session, homework.
45-90 min for exposure and response prevention.
15 min for setting homework.
Ideally, when a symptom is addressed, there should be
100% compliance with therapy directions [e.g. response
prevention]; otherwise, the therapy work is undermined.
Booster sessions (maintenance therapy).
40. 40
IMPORTANT THERAPIST AND
CLIENT CHARACTERISTS
Client:
Motivation and compliance
Therapist:
Effort to identify the symptoms in their entirety
Ability to successfully challenge assumptions.