When the Problem is Beneath the Surface in OCD: The Cognitive Treatment of a Case of Pure Mental Contamination

2012 ◽  
Vol 40 (4) ◽  
pp. 383-399 ◽  
Author(s):  
Emma Warnock-Parkes ◽  
Paul M. Salkovskis ◽  
Jack Rachman
Keyword(s):  
Cognitive Therapy ◽  
Single Case ◽  
Single Case Study ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Mental Contamination ◽  
Cognitive Behavioural ◽  
History Of

Background: Mental contamination is a phenomenon whereby people experience feelings of contamination from a non-physical contaminant. Rachman (2006) proposes that standard cognitive behavioural treatments (CBT) need to be adapted here and there is a developing empirical grounding supporting the concept, although suggestions on adapting treatment have yet to be tested. Method: A single case study is presented of a man with a 20-year history of severe treatment resistant Obsessive Compulsive Disorder (OCD) characterized by mental contamination following the experience of “betrayal”. He was offered two consecutive treatments: standard CBT and then (following disengagement with this) a cognitive therapy variant adapted for mental contamination. Clinician and patient rated OCD severity was measured at baseline and the start and end of both interventions. Results: Six sessions of high quality CBT were initially attended before refusal to engage with further sessions. There were no changes in OCD severity ratings across these sessions. A second course of cognitive therapy adapted for mental contamination was then offered and all 14 sessions and follow-ups were attended. OCD severity fell from the severe to non-clinical range across these sessions. Conclusions: The need to consider adapting standard treatments for mental contamination is suggested. Limitations and implications are discussed.

Acceptance and Commitment Therapy-Specific Processes in the Psychotherapeutic Treatment of Obsessive Compulsive Disorder: A Single Case Study

2017 ◽  
Vol 16 (4) ◽  
pp. 313-327
Author(s):  
Claire Heather Boynton Wheeler
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Rating Scale ◽  
Single Case ◽  
Well Being ◽  
Single Case Study ◽  
Obsessive Compulsive ◽  
Clinical Change ◽  
Compulsive Disorder ◽  
Acceptance And Commitment

This single case study describes acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) used with a client presenting with symptoms of obsessive compulsive disorder (OCD). Standardized and idiographic outcome measures, including OCD-specific measures (Brief Yale-Brown Obsessive Compulsive Scale; Obsessional Compulsive Inventory), general measures of well-being and risk (CORE Outcome Measure; Outcome Rating Scale), an idiographic measure (Easy Personal Questionnaire), and a Sessional Rating Scale, were used across baseline and treatment phases. Statistical measures of reliable and clinical change were calculated, and client perspective on change was sought through interview. Cause–effect analysis was used to evaluate the extent to which therapeutic change was due to ACT-specific processes. Results showed reliable positive change with a probability of p < .05 across measures, and clinical change in three of five of the measures in which it could be calculated. The client reported improvements in well-being and the extent to which she lives her life according to her values. ACT-specific processes as well as generic therapy processes influenced change. The client’s own strengths and personal contributions to therapy played a major role in her achievement of therapeutic goals. The use of ACT with ERP in treating OCD and collaborative use of outcome measures with careful evaluation are recommended to clinicians.

‘If you have good skin, you are god. If you have bad skin, you are a piece of rubbish’. Mastery of shame and anger in treatment-resistant body dysmorphic disorder: a single case study

2016 ◽  
Vol 9 ◽  
Author(s):  
Oliver Sündermann ◽  
Jonathan Wheatley ◽  
David Veale
Keyword(s):  
Body Dysmorphic Disorder ◽  
Single Case ◽  
Behavioural Therapy ◽  
Post Treatment ◽  
Self Report ◽  
Single Case Study ◽  
Treatment Resistant ◽  
Compassion Focused Therapy ◽  
History Of

AbstractBody dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived flaw in one's appearance, and is often emotionally linked with early adverse experiences. Cognitive behavioural therapy (CBT) is effective but may not resolve shame and anger that can be at the emotional root of BDD. This paper presents a single-case study of a 25-year-old man with a history of treatment-resistant BDD characterized by a preoccupation with facial skin linked to a developmental history of sexual abuse and bullying. He was treated at a national residential specialist unit for 16 weeks during which time he received three individual 1-hour weekly CBT sessions (42 sessions overall), and participated in the residential group programme and therapeutic community. CBT was enhanced using imagery rescripting, compassion-focused therapy and family work to specifically target shame and anger-based past experiences. Severity of BDD was assessed with the BDD-Yale–Brown Obsessive Compulsive Scale (BDD-YBOCS) at pre-, mid-, post-, 3-month and 18-month follow-ups; a weekly self-report measure (Appearance Anxiety Inventory), and a client-drawn self-portrait of his perceived skin flaws at pre- and post-treatment. Treatment outcome was positive. The BDD-YBOCS dropped 94% from the extremely severe range pre-treatment to the sub-clinical range post-treatment. BDD symptoms improved progressively throughout treatment, and when the emotions of anger and shame were resolved (as reported by the client) fell to the non-clinical range. Gains were maintained at 18-month follow-up. We conclude that enhancing CBT for BDD using emotion-focused techniques is to be recommended, particularly when emotional memories continue to affect body shame.

Personalised 360o video exposure therapy for the treatment of obsessive-compulsive disorder: A single case study

2020 ◽  
Vol 1 ◽  
pp. 31-38
Author(s):  
Nabil Benzina ◽  
Margot Morgiève ◽  
Marine Euvrard ◽  
João Flores Alves Dos Santos ◽  
Antoine Pelissolo ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Exposure Therapy ◽  
Single Case ◽  
Single Case Study ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

scholarly journals The impact of the COVID-19 pandemic on obsessive compulsive disorder: a single case study

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S120-S121
Author(s):  
Josephine Sibanda-Mbanga ◽  
Anusha Govender
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Single Case ◽  
Total Duration ◽  
Response To Treatment ◽  
Depression Symptoms ◽  
Single Case Study ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
The Impact

ObjectiveA growing body of research evidence shows that individuals with Obsessive Compulsive Disorder (OCD) have been negatively affected by the COVID-19 pandemic including deterioration of OCD symptoms plus relapse from previously well-controlled OCD. The impact of the COVID-19 pandemic is discussed in a single case study of a patient with OCD consisting of contamination concerns. In addition, the effectiveness of providing Exposure and Response Prevention (ERP) virtually is evaluated with regards to the treatment outcome in COVID-19 related OCD.Case reportThis study describes a 41-year-old, single, employed female with OCD consisting of concerns of contamination and infecting others thereby causing harm. The total duration of the disorder is 32 years with the most recent presentation being of three years duration. Relapse during the pandemic resulted in OCD symptoms being solely concerned with COVID-related contamination. The questionnaires routinely completed at the time of assessment and treatment were the Obsessive Compulsive Inventory (OCI); Yale Brown Obsessive Compulsive Scale (YBOCS); Beck Depression Inventory (BDI). Clinical data were collated and analysed prior to and during the pandemic. Treatment consisted of ERP and was adapted for provision via a virtual platform. ERP involved exposure to a graded hierarchy of COVID-specific anxiety-provoking situations modified to take government guidelines into consideration.DiscussionPrior to the COVID-19 pandemic the patient's response to treatment with cognitive behavioural therapy (CBT) including ERP indicated a 79% improvement in OCD symptoms on self -rated measures. The impact of the pandemic led to a significant 65% deterioration in OCD symptoms, regarding COVID-19 contamination concerns. Intervention with ERP resulted in 73% improvement over a three-month period. Measures of depression symptoms indicated an 80% improvement pre-COVID, with a 78% deterioration at relapse. Following treatment, the patient also showed a 65% improvement in depression symptoms. Improvements have been maintained at one month follow-up.ConclusionThe case study supports literature indicating the exacerbation of OCD symptoms due to the COVID-19 pandemic for patients with contamination fears and washing compulsions. The promising results support the use of ERP as an effective treatment for COVID-related OCD symptoms. It also validates the provision of CBT interventions virtually to ensure accessibility of treatment to OCD sufferers.

scholarly journals Emotional Freedom Techniques for Stroke Rehabilitation: A Single Case Study

2021 ◽  
Vol 06 (04) ◽  
pp. 1-1
Author(s):  
Sue Anne Fuller ◽  
◽  
Peta Stapleton ◽  
Keyword(s):  
Stroke Rehabilitation ◽  
Guided Imagery ◽  
Single Case ◽  
Ct Scans ◽  
Anxiety And Depression ◽  
Single Case Study ◽  
History Of ◽  
Emotional Freedom Techniques ◽  
The Right

A 37-year-old female with a history of complex trauma, anxiety and depression was treated with Emotional Freedom Techniques (EFT) supplemented with guided imagery within the first 24 hours of having a stroke that affected the right side. CT scans indicated a haemorrhage and brain clot. Surgery was delayed as another seizure was expected. Interventions occurred during COVID-19 restrictions. The patient then engaged in 90 minutes of EFT every day over the course of a week while in hospital. After seven days she was discharged, and there were significant reductions in depression, anxiety and pain, and mobility returned. Upon discharge the patient had evident improvement in balance and coordination and successfully completed a driving test within the weeks that followed. Subsequent CT scans reveal very little scaring or evidence of the stroke, blood pressure remained stable, and no medication was warranted. This case study presents the practitioner’s perspective of the sessions provided.

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