carrying out treatment
Polly Waite, Catherine Gallop and Linda J. Atkinson CBT Model
This treatment approach is based on Salkovskis’ (1985) cognitive model of OCD, but modified in order to work with young people and families. This model proposes that in individuals with OCD the normal phenomena of intrusive thoughts are misinterpreted as meaningful and seen as an indication that they might be responsible for harm to themselves or others unless they take preventative action. As a result, the individual attempts to suppress and neutralise the thought through compulsions, avoidance, seeking reassurance or by attempting to get rid of the thought. The aim of these neutralising behaviours is to reduce perceived responsibility. However, they actually make further intrusive thoughts more meaningful and more likely to occur, evoke more discomfort and lead to further neutralising. The key components of therapy are: • carrying out an individualised formulation
• psychoeducation
• establishing goals
• developing an alternative way of making sense of the problem
• testing this out through behavioural experiments
• relapse prevention.
This approach has similarities with traditional ways of working with young people with OCD (e.g. March and Mulle, 1998) in that it involves techniques such as externalising the OCD in order to separate it from the child and family and the use of metaphors and stories. It also involves a large behavioural component in order to get rid of OCD. In both approaches, treatment is predictable and the young person has explicit control over what they carry out inside and outside sessions. However, there are also key differences: 51
52
Waite, Gallop and Atkinson
1
March and Mulle’s (1998) treatment package involves extensive discussion of OCD as a medical illness and compares it to illnesses such as diabetes. Our approach is based on the idea that OCD stems from misunderstanding thoughts and that stressing biological factors can be unhelpful, in that it can lead to children and families feeling that there is something wrong with them and that it may not be treatable.
2
March and Mulle’s treatment involves a cognitive component, in that youngsters learn cognitive tactics for resisting OCD, such as construct-ive self-talk (‘bossing back the OCD’) and positive coping strategies to use during exposure and response prevention (ERP). In contrast, this approach sees faulty cognitions at the heart of the problem and so treatment focuses on psychoeducation about thinking in OCD, works to identify the young person’s beliefs and then tests out whether these beliefs are true.
3
This is done through behavioural experiments that are set up in order to find out how the world really works. This differs from traditional approaches where the cornerstone of treatment is ERP, involving a graded hierarchy that the young person works their way through. Within our approach, there is no hierarchy as young people are encouraged to carry out experiments that relate to their specific beliefs and treatment goals. Rather than having a list of tasks that they have to work through, they are encouraged to take a curious stance to try to understand how the problem is working and experiments are devised in order to learn information. Very often the young person will choose to start with tasks that are less anxiety provoking in order to be able to achieve them and leave the most difficult experiments to later sessions. However, this comes from the child, giving them more flexibility and allowing them to feel more in control of the process.
• OCD arises from misunderstanding thoughts.
• Behavioural experiments are designed to test specific predictions.
Number of sessions
Before treatment begins, it is helpful to give the young person and family an idea of the number of sessions that may be required. This can assist the young person to feel that the problem is treatable and that they will not need therapy
Polly Waite, Catherine Gallop and Linda J. Atkinson CBT Model
This treatment approach is based on Salkovskis’ (1985) cognitive model of OCD, but modified in order to work with young people and families. This model proposes that in individuals with OCD the normal phenomena of intrusive thoughts are misinterpreted as meaningful and seen as an indication that they might be responsible for harm to themselves or others unless they take preventative action. As a result, the individual attempts to suppress and neutralise the thought through compulsions, avoidance, seeking reassurance or by attempting to get rid of the thought. The aim of these neutralising behaviours is to reduce perceived responsibility. However, they actually make further intrusive thoughts more meaningful and more likely to occur, evoke more discomfort and lead to further neutralising. The key components of therapy are: • carrying out an individualised formulation
• psychoeducation
• establishing goals
• developing an alternative way of making sense of the problem
• testing this out through behavioural experiments
• relapse prevention.
This approach has similarities with traditional ways of working with young people with OCD (e.g. March and Mulle, 1998) in that it involves techniques such as externalising the OCD in order to separate it from the child and family and the use of metaphors and stories. It also involves a large behavioural component in order to get rid of OCD. In both approaches, treatment is predictable and the young person has explicit control over what they carry out inside and outside sessions. However, there are also key differences: 51
52
Waite, Gallop and Atkinson
1
March and Mulle’s (1998) treatment package involves extensive discussion of OCD as a medical illness and compares it to illnesses such as diabetes. Our approach is based on the idea that OCD stems from misunderstanding thoughts and that stressing biological factors can be unhelpful, in that it can lead to children and families feeling that there is something wrong with them and that it may not be treatable.
2
March and Mulle’s treatment involves a cognitive component, in that youngsters learn cognitive tactics for resisting OCD, such as construct-ive self-talk (‘bossing back the OCD’) and positive coping strategies to use during exposure and response prevention (ERP). In contrast, this approach sees faulty cognitions at the heart of the problem and so treatment focuses on psychoeducation about thinking in OCD, works to identify the young person’s beliefs and then tests out whether these beliefs are true.
3
This is done through behavioural experiments that are set up in order to find out how the world really works. This differs from traditional approaches where the cornerstone of treatment is ERP, involving a graded hierarchy that the young person works their way through. Within our approach, there is no hierarchy as young people are encouraged to carry out experiments that relate to their specific beliefs and treatment goals. Rather than having a list of tasks that they have to work through, they are encouraged to take a curious stance to try to understand how the problem is working and experiments are devised in order to learn information. Very often the young person will choose to start with tasks that are less anxiety provoking in order to be able to achieve them and leave the most difficult experiments to later sessions. However, this comes from the child, giving them more flexibility and allowing them to feel more in control of the process.
• OCD arises from misunderstanding thoughts.
• Behavioural experiments are designed to test specific predictions.
Number of sessions
Before treatment begins, it is helpful to give the young person and family an idea of the number of sessions that may be required. This can assist the young person to feel that the problem is treatable and that they will not need therapy
Similar Books
