scholarly journals The Case of "Daniel": Flexibly Delivering an Inherently Challenging Treatment in the Face of a Complex Presentation

2019 ◽  
Vol 15 (1) ◽  
pp. 90
Author(s):  
Alexander M.B. Tice
Keyword(s):  
Behavioral Approach ◽  
Major Theme ◽  
Exposure And Response Prevention ◽  
Life Situation ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Factors Associated ◽  
The Face ◽  
Nonspecific Factors

In this article, I respond to commentaries by Martin Franklin (2019) and by Liza Pincus and Andrea Quinn (2019) about my case study of "Daniel" (Tice, 2019), a 14-year-old young man presenting to therapy with Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD). I treated Daniel with a manual-based, 25-session treatment centered around the cognitive-behavioral approach of Exposure and Response Prevention (E/RP). A major theme running through my case study and the two commentaries is the need for flexibility in adapting the manual to be responsive to a variety of factors associated with Daniel’s disorder, such as his personality, interests, life situation, attitude towards his symptoms, and his way of relating to the therapist. In the context of the commentaries, I review a variety of the specific ways in which I learned to be flexible. Some of these included (a) focusing on nonspecific factors in developing a strong therapeutic alliance and rapport; (b) paying particular attention to how I communicated relevant psychoeducational concepts to Daniel, particularly by the use of metaphors, in preparing him for the E/RP procedures and in encouraging his participation; and (c) focusing on the process of making decisions at important clinical choice points.

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.

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.

scholarly journals Treatment of Limerence Using a Cognitive Behavioral Approach: A Case Study

2021 ◽  
Vol 8 ◽  
pp. 237437352110608
Author(s):  
Brandy E Wyant
Keyword(s):  
Subjective Assessment ◽  
Significant Loss ◽  
Behavioral Approach ◽  
Cognitive Behavioral ◽  
Obsessive Compulsive ◽  
Healthy Relationships ◽  
Compulsive Disorder ◽  
Thought Patterns

Limerence is an underresearched condition of unknown prevalence that causes significant loss of productivity and emotional distress to sufferers. Individuals with limerence display an obsessive attachment to a particular person or “limerent object” (LO) that interferes with daily functioning and the formation and maintenance of healthy relationships. The current study proposes a conceptualization of the condition in a 28-year-old individual and describes a treatment approach using cognitive-behavioral techniques, most notably exposure responsive prevention as used in the treatment of obsessive-compulsive disorder. The number and type of compulsive rituals performed by the treated individual were notably decreased at 9-month follow-up after treatment, and a subjective assessment of dysfunctional thought patterns related to the LO also suggested improvement. A novel screening instrument is presented, as validated screening instruments do not yet exist. Implications for diagnosis and treatment are 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.

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.

scholarly journals Likely Exacerbation of Psychological Disorders from Covid-19 Response

2021 ◽  
Vol 12 ◽  
pp. 215013272110167
Author(s):  
Tara Rava Zolnikov ◽  
Tanya Clark ◽  
Tessa Zolnikov
Keyword(s):  
Psychological Disorders ◽  
Emotional Reactions ◽  
Post Traumatic Stress ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Current State ◽  
The Face ◽  
Adults And Children ◽  
Post Traumatic ◽  
Anxiety Depression

Anxiety and fear felt by people around the world regarding the coronavirus pandemic is real and can be overwhelming, resulting in strong emotional reactions in adults and children. With depressive and anxiety disorders already highly prevalent in the general population (300 million worldwide), depression and/or anxiety specifically because of the pandemic response is likely. Moreover, the current state of panic in the face of uncertainty is apt to produce significant amounts of stress. While this situation has the potential to cause psychological disorders in previously unaffected populations, perhaps more impactful is the exacerbation of symptoms of many existing disorders including anxiety, depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and hoarding disorder.

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