Exposure and Response Prevention in the Treatment of Distressing and Repugnant Thoughts and Images

2012 ◽  
Vol 11 (2) ◽  
pp. 140-151 ◽  
Author(s):  
Tamara S. Ferris ◽  
Janette P. Mills ◽  
Tanya L. Hanstock
Keyword(s):  
Psychological Treatment ◽  
Emotional Responses ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
General Decline ◽  
Prevention Methods ◽  
Do So

Repugnant thoughts are often described as intrusive and distressing thoughts that are not acceptable to one’s own, and society’s, morals and values. They can occur in a small number of sufferers with obsessive-compulsive disorder. The following case study describes a young woman who experienced a number of distressing and repugnant thoughts and images. Her presenting most distressing obsessive thought was about committing suicide when she had no desire or intent to do so; however, her most repugnant thoughts centered around thoughts of harming her children. Psychological treatment sessions initially focused on psychoeducation and relaxation to prepare the client for more intense therapy. Exposure and response prevention methods were then used in a graded exposure method to help the client confront her feared obsessions and to help the client to overcome her subsequent strong emotional responses. Following 11 psychological treatment sessions, the client demonstrated significant improvements, including decreased distress from her obsessions, as well as a general decline in stress and anxiety.

Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Case Study of a Veteran With Violent Intrusive Thoughts

2019 ◽  
Vol 33 (1) ◽  
pp. 71-81
Author(s):  
Veronica Siffert ◽  
Colette Riahi ◽  
Melinda A. Stanley ◽  
Terri L. Fletcher
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Negative Emotion ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Supportive Psychotherapy ◽  
Compulsive Disorder ◽  
Patient Health ◽  
Poor Treatment

Exposure and Response Prevention (ERP) is the gold standard treatment for obsessive-compulsive disorder (OCD); however, few studies have evaluated the use of ERP with veterans. This case study describes ERP and medication treatment of a veteran who experienced violent sexual thoughts, countered by compulsions of focusing on the distressing thought to ensure a negative emotion or reversing the thought to a nonviolent thought or image. The veteran had previously received supportive psychotherapy and medication for depression, anxiety, and sleep difficulties, with poor treatment adherence. Upon reengagement in treatment, the therapist provided ERP in 34 sessions over 14 months, with 15 sessions via video telehealth to home. The patient used the OCD Workbook as a resource throughout treatment. The patient developed a hierarchy of target obsessions and rituals with associated subjective units of distress; completed exposures, beginning with lower-level items; and wrote imaginal scripts. He also received zolpidem for insomnia and venlafaxine for anxiety and depression. His scores on the nine-item Patient Health Questionnaire and Yale Brown Obsessive-Compulsive Scale decreased significantly.

scholarly journals The Efficacy of Exposure and Response Prevention for Geriatric Obsessive Compulsive Disorder: A Clinical Case Illustration

2012 ◽  
Vol 2012 ◽  
pp. 1-5
Author(s):  
Mairwen K. Jones ◽  
Bethany M. Wootton ◽  
Lisa D. Vaccaro
Keyword(s):  
Older Adults ◽  
Obsessive Compulsive Disorder ◽  
Clinical Case ◽  
Psychological Treatment ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Clinical Case Study ◽  
History Of

Obsessive compulsive disorder (OCD) is one of the most frequently occurring psychiatric conditions in older adults. While exposure and response prevention (ERP) is considered the most effective psychological treatment for children and adults with OCD, research investigating its effectiveness for older adults is scarce. This clinical case study investigates the effectiveness of ERP in an 80-year-old man with a 65-year history of OCD. The client received 14 individual, 50-minute ERP treatment sessions. Clinician-based Y-BOCS scores reduced by 65% from 20 (moderate) at pretreatment to 7 (subclinical) at 7-month posttreatment followup. OCI-R total scores reduced by 45% from 38 at baseline to 21 at 7-month follow-up. Despite his long history of the disorder, ERP was effective and well tolerated. The application of ERP for older adults with OCD, including age-specific modifications that may be required for this treatment approach, is discussed.

scholarly journals Adapting an Exposure and Response Prevention Manual To Treat Youth Obsessive-Compulsive Disorder and Comorbid Anxiety Disorder: The Case of "Daniel"

2019 ◽  
Vol 15 (1) ◽  
pp. 1
Author(s):  
Alexander M.B. Tice
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Case Study Method ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Positive Treatment ◽  
Evidenced Based ◽  
Manualized Protocol

Exposure and Response Prevention (E/RP) is an evidenced-based, short-term (12-20 sessions) treatment for Obsessive-Compulsive Disorder (OCD). This treatment has been shown to be effective in randomized control trials (RCTs), including pediatric samples (Franklin et al., 2011). Despite the strong evidence supporting the effectiveness of E/RP, the current E/RP literature remains wanting in terms of clinical process research to support novice clinicians in the adaptation of the principles, techniques, and interventions with such a complex and heterogeneous disorder, as well as with youth suffering from comorbid disorders. Thus, the present study aims to provide a detailed account of the course of a 25-session E/RP treatment and its outcomes with a 14-year-old called by the pseudonym "Daniel," to protect his identity. Guided by the Pragmatic Case Study Method (Fishman, 1999, 2005, 2013), as the therapist I examined this case in systematic qualitative detail and also gathered and analyzed data from standardized quantitative assessment measures. The study concludes with an analysis of the process used in meeting Daniel’s positive treatment goals as well as a discussion of the importance of adaptations made to the E/RP manualized protocol to address the entire range of Daniels’s symptoms.

Treating Sexual Orientation Obsessions

2019 ◽  
pp. 163-206
Author(s):  
Jenifer A. Viscusi ◽  
Monnica T. Williams
Keyword(s):  
Sexual Orientation ◽  
Obsessive Compulsive Disorder ◽  
Real Life ◽  
Response Prevention ◽  
Case Conceptualization ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

This chapter presents a case study of the treatment of sexual orientation obsessions in obsessive-compulsive disorder (also called SO-OCD or H-OCD for homosexual OCD). The case study includes information about the client background and case conceptualization of a male with upsetting sexual thoughts who was effectively treated using exposure and response prevention by the authors. Included are measures administered, Real-life examples of his exposure hierarchy, and sample imaginal exposures from the case that serve as realistic examples of what treatment may include. Additionally, this chapter includes additional detailed sample ideas of in vivo and imaginal exposures that can be used as part of treatment for SO-OCD for other clients.

Cognitive Therapy for Obsessive Compulsive Disorder

2000 ◽  
Vol 14 (3) ◽  
pp. 245-259 ◽  
Author(s):  
Sabine Wilhelm
Keyword(s):  
Cognitive Therapy ◽  
Obsessive Compulsive Disorder ◽  
Psychological Treatment ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Treatment Techniques ◽  
Current Psychological ◽  
Therapy Studies

Cognitive therapy for Obsessive-Compulsive Disorder (OCD) may be at least as effective and less stressful as the current psychological treatment of choice, exposure and response prevention (ERP). Cognitive therapy studies will be reviewed and a case example used to illustrate specific cognitive treatment techniques.

Utilizing Exposure and Response Prevention to Address Poor Insight in Obsessive-Compulsive Disorder

2019 ◽  
Vol 33 (3) ◽  
pp. 213-227 ◽  
Author(s):  
Rachel R. Middleton ◽  
Dianne M. Hezel
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Comorbid Depression ◽  
Obsessive Compulsive ◽  
Illness Onset ◽  
Compulsive Disorder ◽  
Compulsive Behaviors ◽  
Insight Into

Studies indicate that approximately 9%–30% of adults diagnosed with obsessive-compulsive disorder have poor insight into their symptoms. That is, they fail to recognize the excessiveness or irrationality of the obsessive thoughts or their compulsive behaviors. Poor insight in OCD is associated with more severe symptoms, earlier age of illness onset, longer illness duration, and higher rates of comorbid depression. Moreover, some studies have also reported that patients with poor insight are less likely than are those with good or fair insight to respond to first-line treatments such as exposure and response prevention (ERP). Despite the clinical relevance of poor insight, very little research has focused on how to enhance therapy with strategies specifically used to target it. In this report, we use a case study to demonstrate how different techniques can be emphasized or integrated with standard ERP to improve treatment outcomes for this subset of patients.

Cognitive Behaviour Therapy for the Management of Obsessive-Compulsive Disorder

2001 ◽  
Vol 18 (1) ◽  
pp. 28-35 ◽  
Author(s):  
Kate Sofronoff
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Best Practice ◽  
Psychological Treatment ◽  
Response Prevention ◽  
Exposure And Response Prevention ◽  
Behaviour Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behaviour ◽  
Treatment Measures

AbstractCurrent research reflects conflict regarding best practice in the treatment of obsessive-compulsive disorder (OCD). The present study reports on the psychological treatment of a 54-year-old woman diagnosed with OCD, and follows the implementation of pharmacological treatment. The study utilises both exposure and response prevention (ERP) and cognitive therapy (CT), although there was no attempt to compare these approaches in an experimental design. Measures of avoiding and neutralising behaviours were taken on three occasions across treatment. Measures were also taken of intrusive thoughts, appraisal of responsibility, and effective challenging, both across treatment and at follow-up. The results indicate that gains were made in addition to those reported following the implementation of medication. The results also suggest that the addition of CT to exposure and response prevention facilitates the extinction of neutralising behaviours.

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