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Psychiatry Res. Feb 28;(3) doi: /leondumoulin.nles​ Epub Dec 8. Efficacy of cognitive-behavioral therapy for.
Table of contents

Original Research ARTICLE

But after a while, your body gets used to the cold, thanks to habituation, and you feel fine. When your therapist helps you with exposures over a period of time, your anxiety shrinks until it is barely noticeable or even fades entirely. The therapist can then help you gain confidence and learn special skills to control the compulsions through a cognitive therapy.

Imaginal Exposure For those who may be resistant to jumping right into real world situations, imaginal exposure IE , sometimes referred to as visualization, can be a helpful way to alleviate enough anxiety to move willingly to ERP. With visualization, the therapist helps create a scenario that elicits the anxiety someone might experience in a routine situation.

As they habituates to the discomfort, with decreased anxiety over time, they are gradually desensitized to the feared situation, making them more willing to move the process to real life, and engage in the next step, ERP.


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Habit Reversal Training This intervention includes awareness training, introduction of a competing response, social support, positive reinforcement, and often relaxation techniques. Awareness training may be practicing the habit or tic in front of a mirror, focusing on the sensations of the body and specific muscles before and while engaging in the behavior, and identifying and recording when the habit or tic occurs.

These techniques increase awareness of how and when the urges develop, making it more likely that an individual will be able to intervene and make a change. That is where the competing response comes in, with the individual and therapist working together to find something similar to the movement or tic that is not noticeable to others. Someone with a vocal tic who learns awareness of the developing urge may practice tensing the muscles around their cheeks and mouth to ride out the urge and prevent the tic.

Or someone with a compulsion to touch things symmetrically may be directed to tense the opposite arm, holding it tightly against their body, preventing them from completing the ritual. This method of treatment takes time, diligent practice, and patience, as well as integrating relaxation skills prior to beginning. Also extremely critical to success is the support and positive reinforcement of family.

Cognitive Therapy When applied to treating OCD, cognitive therapy helps you understand that the brain is sending error messages. The training environment consisted of an empty room with three windows, a glass door, and a cat resting on a table. The participant could hear the calm sound of a breeze and birds singing.

The purpose of this environment was to allow participants to familiarize themselves with the immersion in the CAVE-like system. The training environment was only used once, more specifically at the beginning of the fourth session. The therapeutic environment depicted a public washroom with various degrees of filthiness see Figure 1 and nothing allowing to eliminate germs i. Figure 1. The prescreening phone interview was conducted using a questionnaire overviewing different OCD symptoms, including those related to the contamination subtype.

This semi-structured interview was conducted by two therapists trained in administering the SCID and supervised by a licensed psychologist. The establishment of primary and comorbid diagnosis was based on clarity and causal sequence of the clinical presentation. Daily self-monitoring based on forms using a similar design 36 were provided to participants who had to rate the presence i.

The literature on OCD suggests that percentages should be preferred over hours since, in some cases, intrusive thoughts or compulsive behaviors are numerous but short in duration, whereas in others, obsessions are less frequent but last longer The YBOCS is a item scale administered by therapist in the form of a semi-structured interview to measure the severity of obsessions and compulsions. Each item was rated on a five-point scale ranging from 0 to 4; 0 reflecting no symptoms and 4 reflecting extremely severe symptoms.

In order to include participants with fear of contamination as their main subtype, participants had score higher on this subscale compared with other subtypes.

Dr. Wayne Goodman on How OCD Behavior Therapy Works

Daily functioning was assessed with the Evaluation of Actual Life Functioning [EALF; 44 ] measuring seven different life domains, namely, a occupation or employment, b education, c social life, d hobbies, e entertainment, f holiday, and g everyday activities cleaning, shopping, etc. For each life domain, participant had to indicate on a Likert-type scale ranging from 1 no problem to 9 severe difficulties the extent to which the OCD symptoms had influenced each life domain 1 item per life domain.

An average was then calculated. It uses Likert-type rating scales, ranging from 1 not true at all to 7 completely true with a maximum score of Cognitive—behavioral therapy unfolded according to a standardized treatment protocol using a guided manual for therapists Individual weekly therapy sessions lasted 60 min.

Homework usually included a review of the didactic material viewed in session, the occasional practice of exposure see below , and self-monitoring The first three sessions aimed at case conceptualization and introducing treatment planning. During these sessions, therapist gathered information about obsessive fears and rituals and developed an exposure hierarchy of anxiety-provoking situations. Furthermore, the cognitive—behavioral model of OCD and the rationale for exposure and response prevention were discussed.

Principles of exposure in VR were also briefly discussed. Sessions 4—11 consisted of exposure and response prevention in VR in virtuo exposure. The first exposure sessions were devoted to mild anxiety-provoking situations, which eventually progressed to situations causing greater distress. Contextual information relevant to contamination i.

Response prevention consisted of instructing participants to refrain from any compulsive behavior. Session 12 was devoted to relapse prevention. Self-monitoring was used between sessions not only to assess outcome but also to increase awareness of situations triggering urges to ritualize.

Cognitive behavioral therapy

Two therapists Ph. The therapists had more experience with traditional exposure than in virtuo , but had already carried out therapy using VR. Continuous supervision by the senior author, a licensed psychologist with 18 years of experience with CBT for anxiety disorders and 9 years of experience in the treatment of anxiety disorders with VR, ensured proper monitoring and standardized and uniform application of treatment. Assessing how treatment is delivered is important in clinical trials 53 , 54 and following a clear treatment plan, establishing a good therapeutic alliance, explaining treatment rationale, and setting explicit goals are expected to increase the likelihood of treatment adherence among participants.

Each therapy session was recorded. Recordings were assessed with the help of a checklist adapted from the Competency Checklist for Cognitive Therapist 55 and the Cognitive Therapy Checklist of Therapist Competency 56 , Results showed that treatment protocol was respected.

What is Cognitive Behavioural Therapy (CBT)? | OCD-UK

More specifically, Only two items were rated as fairly respected at times during therapy proposed exposure exercises not allowing avoidance, therapist adequately reviewed exercises completed at home. Daily data collected from recordings of target OCD symptoms i. The moment at which intervention was introduced is indicated with a vertical line. Figure 2. Presence of obsessions on a daily basis for the three participants. The first solid vertical line represents when CBT was introduced. The second and third dashed vertical lines represent when in virtuo exposure was conducted.

Figure 3. Presence of compulsions on a daily basis for the three participants. Figure 4.

Changes in key brain regions following CBT

Intensity of obsessions on a daily basis for the three participants. Figure 5. Intensity of compulsions on a daily basis for the three participants. The first participant is a woman in her mids with a primary diagnosis of OCD with contamination subtype, and a secondary diagnosis of social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder. She also displayed symptoms from the symmetry and order subtypes, but they were deemed of a lesser severity than that of contamination.

Her main obsessions were related to the contamination of food cross-contamination and contamination of her hands and objects in her surroundings. The case conceptualization explored the specific factors contributing to the maintenance of her OCD. They consisted of a difficulty to be aware of direct or subtle avoidance behavior and a tendency to deny her disorder.

The eight VR sessions were focused on her daily difficulties i. Touching the actual floor and walls of the CAVE-like system while immersed in the virtual environment was encouraged in order to increase her sense of presence. Assigned home practice for this participant focused on meal preparation as well as exposure to contaminated objects, while, at the same time, attempting to reduce or avoid rituals. Table 1.

Results for measures of anxiety and daily functioning completed pre- and posttreatments as well as at the fourth and eighth month follow-ups. The second participant was a woman in her mids with a primary diagnosis of OCD with contamination subtype and secondary diagnoses of generalized anxiety disorder as well as social anxiety disorder. She had been receiving treatment with a hypnotherapist for about a year.

Following a discussion with the hypnotherapist, it was clarified that no therapeutic efforts had been made to treat her OCD and that it was not included in their treatment plan. OCDs maintaining factors were also addressed in therapy using cognitive restructuring technique.

They included low self-esteem, depressed mood, social isolation, and a tendency to self-criticize. The third participant was a woman in her late 20s with a primary diagnosis of OCD with contamination subtype. This participant also reported obsessive doubts and compulsions of verification, but they appeared to be secondary to the fear of contamination. She had also been suffering from a depressed mood in recent weeks. It should be noted that the last session lasted min as sessions 11 and 12 were combined due to time constraints.

Her OCD symptoms related to the fear of infecting others, especially through a sexually transmitted infection i. Following VR exposure, cognitive restructuring was conducted based on discussed topics, such as the possibility of contracting a sexually transmitted infection. Despite having successfully completed VR exposure, Participant 3 showed difficulty with respect to homework i. Maintaining factors were explored and included low self-esteem, difficulty in risk-taking behaviors, high personal standards and the presence of an irritable mood in regard to her general dissatisfaction with her life employment and relationship.

Traditional visual inspection of graphs was performed for all three participants see Figures 2 — 5. For Participant 1 and Participant 3, results are more difficult to interpret on the basis of visual inspection, but suggest that the effect takes place progressively during the course of the treatment. Toward the end of therapy, Participant 1 reported a decrease in OCD symptoms YBOCS results in Table 1 are in the range of mild symptoms and the ability to be exposed to anxiety-provoking situations without performing rituals.

A decrease in OCD symptoms was also noted for Participant 2. She reported being able to take risks in regard to contamination and to tolerate the associated discomfort. She also mentioned she wanted to keep practicing this technique and apply exposure to objects associated with residual symptoms of OCD. As for Participant 3, the candidate reported less avoidance, was able to restructure her unrealistic thoughts and to challenge her fears, as well as give herself better self-appraisal and take greater risks at the end of therapy.