This document discusses obsessive compulsive disorder (OCD) and its treatment using cognitive behavioral therapy (CBT). It defines OCD as being characterized by obsessions and/or compulsions. Common obsessions include contamination, symmetry, forbidden thoughts, and harm. Biological and environmental factors can contribute to OCD. The cognitive model of OCD is described, involving triggers, appraisals, bodily sensations, and behavioral inclinations. CBT techniques for treating OCD include psychoeducation, relaxation, exposure and response prevention, thought distraction/stopping, and identifying cognitive errors. Exposure therapy aims to reduce anxiety through habituation. Relapse prevention is also discussed.

1. HiraAhmad
Clinical Psychologist

2.  OCD is characterized by the presence of
obsessions and/or compulsions.
 Obsessions are recurrent and persistent
thoughts, urges or images that are
experienced as intrusive and unwanted.
 Compulsions are the repetitive behaviors or
mental acts that an individual feels driven to
perform in response to an obsession.

3.  Cleaning (contamination obsessions and cleaning
compulsions)
 Symmetry (symmetry obsessions and repeating,
ordering and counting compulsions).
 Forbidden or tabooThoughts (e.g. sexual and
religious thoughts and related compulsions)
 Harm (e.g. fears of harm to oneself and others and
related checking compulsions)

4. Biological Factors:
Research has found a link between low levels of one
neurotransmitter called serotonin.
 In addition, there is evidence that a serotonin imbalance may be
passed on from parents to children. This means the tendency to
develop OCD may be inherited
Environmental Factors:
 There are environmental stressors that can trigger OCD.These
factors include:
1. Abuse
2. Changes in living situation
3. Illness
4. Death of a loved one
5. Work- or school-related changes or problems
6. Relationship concerns

6. • Cognitive appraisal of intrusive thoughts (Salkovskis,
1985; Rachman, 1997)
– Overestimation of danger
– Inflated personal responsibility
– Thought-action fusion
• Thought-suppression (Wegner et al, 1987)
• Cognitive deficits in selective attention
Deficits in inhibiting irrelevant stimuli (particularly internal ones such as
intrusive thoughts) (Clayton et al, 1999)

7. CBT alone
 CBT is a remarkably
effective & durable for
OCD (Dar & Greist,
1992)
 While“booster”sessions
may be necessary,
those who are
successfully treated
with CBT alone tend
to stay well.
Medication alone
• Relapse is more common
following the
discontinuance of
medications
• March (1994) found that
improvement persisted
in 6 of 9 CT responders
following withdrawal
from medication (CBT
helps inhibit relapse).

8.  A type of talking therapy
• Links events with;
– Thoughts
– Feelings
– Behaviors

25. Cognitive Model
Triggering
Event
Bill goes to collection
Appraisa
l
“Ican never do
anythingright…”
Behavior
Avoidance; withdrawal
Bodily Sensations
Low energy, disruption of
sleep, increased fatigue
Behavioral
Inclination
“Idon’t want to deal withit”
“It’s too stressful tothink
about it”

26. Activating
event/evoking
event
Obsessions begin
Excessive anxiety
Neutralizing rituals
Temporary relief

27. 1. Engagement
2. Psychoeducation
3. Case formulation
4. Relaxation Exercise
5. Behavioral Activation
6. Exposure and Response Prevention(ERP)
7. Thought Distraction
8. Thought stoping
9. Habituation
10. Thought postponing
11. Detection of Mood and Thought
12. Identifying Cognitive Errors
13. Alternative Thoughts
14. Coping Statements

28.  Exposure and response prevention (ERP) is an
evidence-based, treatment for people
experiencing OCD and it is recommended by the
National Institute of Health and Care Excellence
(NICE).
 It aims to put you in charge of controlling your
OCD, rather than your OCD controlling you.

29. The purpose of exposure is to reduce the anxiety and
discomfort associated with obsessions through
process of Habituation
Habituation is natural process by which our nervous
system get used to” or “bored by” stimulus through
repeated, prolonged contact

30. 1. Graded- Gradually facing your fear, starting with something
easier and gradually building up to more difficult situations.
2. Repeated- Exposure must be repeated, it is important that
you practice facing your fears many times until you feel
comfortable in that situation.
3. Prolonged- Stay with your fear for long enough for your
anxiety to reduce by at least 50%, which usually takes
between 30 and 60 minutes
4. Prevention-Carrying out the rituals

34.  Imaginal exposure
 In vivo exposure
 Response prevention

35. 1. That thought isn't helpful right now
2. Now is not the time to think about it. I can think about it clearly.
3. This is irrational. I am going to let it go.
4. I won't argue with an irrational thought.
5. This is not an emergency. I can slow down and think clearly about what I
need.
6. This feels threatening and urgent, but it really isn't.
7. I don't have to be perfect to be OK.
8. I don't have to figure out this questions. This best thing is to do is just drop
it.
9. Its ok to make mistakes.
10. I already know from my past experiences that these fears are irrational

36. 11. IT,s ok that I just had that thought/images, and it does mean
anything. I don't have to pay attention to it.
12. I am ready to move on now.
13. I don't deserve to suffer like this. I deserve to feel comfortable.
14. That's not the best problem.
15. I have done best I can.
16. Its good practice to let go of this worry. I wan to practice

37. • Educate client on the nature and course of OCD
• Ensure realistic treatment expectations, including presence
of residual symptoms
• Identify situations that trigger obsessions and compulsions
• Ensure a clear understanding of the CBT model
• Provide written instructions on response to a relapse
preventions
• Instruct client to be vigilant about re-emerging
avoidance, reassurance seeking, or other compulsions
and neutralizing responses.
• Teach coping skills for stress and other life difficulties.
• Fade therapy sessions, providing continued access and
support.