Management of Obsessive and Compulsive Disorder.pptx

Obsessions and Compulsions are result of anxiety. When an individual gets repetitive thoughts are called as obsessive thoughts and the action to those repetitive thoughts is known as compulsive behavior.
This is one of the major psychiatric disorders commonly known as Obsessive and Compulsive Disorder. CBT, Exposure and Response Prevention Therapy, ACT, Brain Lock Methods are some of the psychosocial interventions for OCD.

1. Management of obsessive compulsive disorder CHAIRPERSON: MR. ANANTHARAMU B. G. ASSISSTANT PROFESSOR PSW DEPARTMENT DIMHANS DHARWAD PRESENTER: RANJANI H. G. VAKODA I YEAR MPHIL SCHOLAR PSW DEPARTMENT DIMHANS DHARWAD

2. CONTENT INTRODUCTION CLASSIFICATION ASSESSMENT TOOLS MANAGEMENT OF OCD PHARMACOLOGICAL MANAGEMENT PSYCHO SOCIAL INTERVENTIONS CONCLUSION REFERENCE

3. INTRODUCTION Obsessive-Compulsive Disorder is characterized by the presence of persistent obsessions or compulsions, or most commonly both. Obsessions are repetitive & persistent thoughts, images or impulses/urges that are intrusive, unwanted and are commonly associated with anxiety The individual attempts to ignore or suppress obsessions or to neutralize them by performing compulsions. Compulsions are repetitive behaviors including repetitive mental acts that the individual feel driven to perform in response to an obsession, according to rigid rules or to achieve a sense of ‘completeness’. In order for OCD to be diagnosed, obsessions and compulsions must be time consuming and result in significant distress or significant impairment in personal, family, social, educational or other important areas of functioning.

4. Classification In ICD-11 under the code BlockL1-6B2 there are several classification of Obsessive Compulsive Disorder 6B20 – Obsessive-Compulsive Disorder 6B21 – Body Dysmorphic Disorder 6B22 – Olfactory Reference Disorder 6B23 – Hypochondriasis 6B24 – Hoarding Disorder 6B25 – Body-Focused Repetitive Behaviour Disorders 6B2Y – Other specified Obsessive-Compulsive or related disorders 6B2Z – Obsessive-compulsive or related disorders, unspecified

5. ASSESSMENT TOOLS Yale-Brown Obsessive and Compulsive Scale (Y-BOCS) This is a 10 items questionnaire developed by Wayne K. Goodman and et al. of 4 point Likert scale where it’s final score 0-13 indicates mild symptoms, 14-25 indicates moderate symptoms, 26-34 moderate-severe symptoms and 35-40 severe symptoms Children’s Yale-Brown Obsessive and Compulsive Scale (CY-BOCS) This scale is administered to the children’s of 6 to 17 years of age. Developed by Wayne K. Goodman and et al.  the original CY-BOCS total score ranges from 0 to 40 based on item responses ranging from 0 to 4, with ratings of 4 capturing a wide range of patients in the severe to extremely severe range.

6. Management of OCD Management of OCD can be done through Pharmacological and Non Pharmacological management. In pharmacological management psychiatrists treats with antidepressants, anti psychotics, mood stabilizers along with this prolonged administration of selective serotonin reuptake inhibitor’s(SSRIs) will be most effective.

7. Non Pharmacological Treatment Non pharmacological treatment is also known as psycho social interventions Psychoeducation Cognitive behaviour therapy Exposure and response prevention therapy Acceptance and Commitment Therapy Self-Help Strategies (Brain lock method)

8. Psychoeducation Psychoeducation is a powerful treatment component for various mental health conditions, including obsessive-compulsive disorder (OCD). Through providing essential information about the disorder, its impacts, and ways to manage it, psychoeducation empowers individuals with OCD to take an active role in their recovery journey. Psychoeducation for OCD often covers several key areas. The first area is education about OCD, including its common symptoms, such as recurring obsessions and compulsions, and how these may impact daily life. This step can relieve many individuals, as it normalizes their experiences and helps them understand they are not alone in their struggles. The second component involves educating about the causes and triggers of OCD. This includes a discussion of genetic and environmental factors and how they might interact to contribute to the development and persistence of the disorder.

9. Psychoeducation Thirdly, psychoeducation provides information about treatment options. This typically includes an overview of CBT, particularly exposure and response prevention (ERP), considered the gold standard in OCD treatment. It may also cover medication options, highlighting how these treatments work and their potential side effects. Finally, psychoeducation offers strategies for coping with OCD. These can include stress management techniques, self-care practices, and advice on seeking support from friends, family, or support groups.

10. Psychoeducation Benefits of psychoeducation in OCD treatment Psychoeducation can bring about numerous benefits in the treatment of OCD. First, it can demystify the disorder, helping individuals understand that their experiences are symptomatic of a recognized condition many others face. This understanding can alleviate feelings of isolation and stigma, fostering a more positive outlook and greater motivation toward recovery. Furthermore, psychoeducation can enhance treatment adherence. By understanding the rationale behind treatments like CBT or medication, individuals are likelier to stick with them, even when they become challenging. Psychoeducation also empowers individuals with OCD, encouraging them to participate actively in treatment. Armed with knowledge and resources, they can make informed decisions about their care and work collaboratively with their healthcare providers.

11. Psychoeducation Psychoeducation to family members and caregivers Psychoeducation is not only beneficial for individuals with OCD but also holds significant value for their family members and caregivers. The impact of OCD extends beyond the individual, often affecting those close to them. Thus, equipping family members and caregivers with knowledge about the disorder and ways to provide effective support can play a vital role in treatment outcomes. Family-focused psychoeducation sessions aim to inform about the nature of OCD, its symptoms, and its impacts on the individual and the family. These sessions can help family members recognize and understand the behaviours associated with OCD. By gaining insight into the struggles faced by their loved ones, family members can develop more empathy and patience. In addition, psychoeducation can provide family members with strategies to support their loved ones without enabling compulsions. Learning to respond effectively to OCD behaviours can create a more supportive home environment and prevent inadvertently reinforcing OCD symptoms. Furthermore, caregivers can learn about self-care and ways to manage the stress of supporting a loved one with OCD

12. Cognitive Behaviour Therapy Cognitive Behaviour therapy is considered as a gold standard treatment in the field of psychotherapy. Aron T Beck is known as father of cognitive therapy and cognitive behaviour therapy. It is found to be effective in many disorder such as OCD, GAD, Somatization, depression and some other CBT sessions 1 to 2 sessions per week initially Each session lasts for 45 minutes to 60 minutes Usually CBT done in 16 to 24 sessions

13. Cognitive Behaviour Therapy Steps to follow in CBT Intake session Baseline assessment Goal setting and Psychoeducation Understanding the relation between cognition, feeling, physical sensations, behaviour Five column chart and homework assignment

14. Cognitive Behaviour Therapy Identifying dysfunctional thoughts Challenging those dysfunctional thoughts Behavioral activation Problem solving Relapse prevention

15. Exposure and Response Prevention Therapy Meyer(1966) first described a treatment using ERP, in which e xposure and response prevention a two-step process. ERP starts with exposure to the very things that cause you discomfort. Then, with the help of a trained specialist, you learn how to prevent your ritualized or compulsive response via a process called habituation (becoming more comfortable with the stimuli), as follows: The  exposure  phase of ERP refers to purposely putting you in direct contact with the discomfort-inducing stimuli (germs, public places, elevators, etc.) that typically trigger obsessive thoughts, ritualized compulsive behaviour, fear, or anxiety. The  response prevention  phase of ERP involves getting used to and not engaging in compulsive behaviour when exposed to the stimuli. It also allows you to let go of intrusive thoughts after being triggered by exposure. 

16. Exposure and Response Prevention Therapy H ow it works on OCD It works by breaking the link between your obsessional thoughts, images, urges or impulses and the compulsive things that you do to reduce the distress or anxiety that they cause. During ERP exercises you gradually expose yourself to situations that bring on or cue your obsessions, whilst not carrying out your compulsions. It is done in a graded way that feels manageable for you. ERP can be challenging; but for many people it has helped them to learn to manage their symptoms more effectively so that they do not interfere with their daily life.

17. Exposure and Response Prevention Therapy The Vicious Circle of OCD

18. Exposure and Response Prevention Therapy 5 conditions: Condition 1: Graded - List things in your exposure hierarchy that give you at least 50-60% anxiety from the easier things up to more difficult things. Remember not to grade an exercise by time. When you have been repeating an exercise and it no longer gives you at least 40% anxiety at the start of the exercise, you are then ready to move up to the next item on your exposure hierarchy. Condition 2: Prolonged - Stay in the exposure exercise situation, without using distraction until your anxiety drops by 50% from the start of the exercise. So, for example if you were 80% anxious, you would stay in the situation until your anxiety drops to 40%. You would then repeat the exercise until it no longer gets above 40% at the start of the exercise.

19. Exposure and Response Prevention Therapy Condition 3: Repeated - Expose yourself to each step on the hierarchy at a time. You should repeat each step until the exercise no longer makes you feel anxious, say if it no longer goes above 40% anxiety at the start of the exercise. Then it is time to move up to the next exercise on your hierarchy ladder. On average you should aim to do exposure treatment 4-5 times per week (these may be different exercises depending on your ratings). Condition 4: Without Distraction - Try to remove things from your hierarchy that reduce your anxiety artificially or distract you from how you are feeling during your exposure exercises. Whist these may seem like the give temporary relief from feeling anxious, they are keeping you stuck in that vicious circle. Condition 5: Without Compulsion - Each time you expose yourself to an exercise on your hierarchy, you need to remain in the situation, resisting the urge to carry out a compulsion to reduce your distress (either one that you have done before, or a new one).

20. Acceptance and Commitment Therapy ACT is a type of behavioral therapy that is becoming increasingly popular in the treatment of OCD, and there is a good reason for it. It is developed by Steven C. H ayes in 1982, to integrate features of cognitive therapy and behaviour analysis. It is so easy to get entangled in endless obsessions and compulsions and to lose sight of what really matters to you. With ACT, you don’t have to delay living the life you want to live until your OCD gets better. ACT provides the compass that allows you to start taking steps toward being the person you want to be right away. ACT is nothing but A ccept your thoughts and emotions C hoose a valid direction T ake action

21. Acceptance and Commitment Therapy The 6 core principles are Cognitive diffusion, Acceptance, Contact with the present moment, the observing self, values, and committed action. P rocesses of ACT were delivered in an eight-session format of weekly sessions, over a period of 8 weeks. The duration of each session was 1 hour. Every session began with a recap of the skills learned in the previous session and a review of the homework exercise. The first few minutes were spent on a mindfulness-based breathing exercise with the eyes closed, thereby serving the dual purposes of relaxing the client as well as practicing the skill of mindfulness, which forms an integral part of ACT.

22. Brain Lock Method Effective management strategies and self-help techniques are essential for individuals with OCD to regain control over their lives and to become free from obsessive thoughts. One such method gaining recognition for its efficacy is the four-step approach developed by Jeffrey Schwartz, outlined in his book   “Brain Lock.” Relabel Reattribute Refocus Revalue

23. Brain Lock Method Relabel: The first step in the Brain Lock method involves relabelling the intrusive thoughts and urges associated with OCD. Instead of viewing these thoughts as accurate reflections of reality or as signals to engage in compulsive behaviours, individuals learn to identify them as symptoms of OCD. By relabelling these thoughts as obsessions, individuals can distance themselves from their content and recognize them as products of their condition rather than as valid concerns. This shift in perspective helps to reduce the emotional impact of the thoughts and undermines their power over the individual.

24. Brain Lock Method Reattribute: Once intrusive thoughts and urges have been relabelled as symptoms of OCD, the next step is to reattribute their cause. Individuals with OCD often believe that their obsessions are rooted in legitimate concerns or fears, leading them to engage in compulsive behaviours to alleviate their anxiety. A definitive classic representation of obsessive compulsive disorder. However, through the reattribution step, individuals learn to recognize that these thoughts are the result of a neurobiological condition rather than genuine threats. this is greatly discussed in Brain lock twentieth anniversary edition. By understanding that their brain is misfiring and producing these thoughts involuntarily, individuals can separate themselves from the content of the obsessions and resist the urge to engage in compulsive behaviors .

25. Brain Lock Method Refocus: Refocusing involves redirecting attention away from the obsessive thoughts and compulsive urges toward constructive and meaningful activities. Instead of dwelling on the content of their obsessions or giving in to the urge to perform compulsive behaviours, individuals learn to engage in activities that align with their values and goals. By refocusing their attention on productive tasks or enjoyable hobbies, individuals can break free from the grip of OCD and reclaim control over their thoughts and actions. This step helps to weaken the neural pathways associated with OCD and strengthen healthier patterns of thinking and behaviour.

26. Brain Lock Method Revalue: The final step in the Brain Lock method is revaluing, which involves reassessing the significance and importance of obsessive thoughts and compulsive urges. Instead of assigning exaggerated importance to these thoughts and behaviours, individuals learn to recognize them as fleeting and insignificant. By devaluing the obsessions and compulsions, individuals can reduce their emotional impact and resist the urge to engage in ritualistic behaviours. This step reinforces the understanding that OCD is a treatable condition and empowers individuals to prioritize their well-being and pursue fulfilling lives free from the constraints of OCD.

27. Conclusion OCD is a neuropsychiatric disorder widely recognized for it’s recurrent obsessions and compulsions It is difficult to diagnose and treat OCD with other co morbidities such as mood disorder (moderate-severe depression) or schizophrenia Along with pharmacological treatment psychosocial interventions also very essential to treat individuals with OCD Many research studies suggests that SSRIs and CBT is the best combination treatment for OCD.

28. Reference Christopher Bergland what is exposure and prevention 2022 https://www.verywellhealth.com/exposure-and-response-prevention-5270826 Hussain the struggling warrior what is brain lock? Four steps to manage OCD https://thestrugglingwarrior.com/brain-lock-four-steps/#Relabel ICD-11 Janardhan Reddy YC, Sundar AS, Narayanaswamy JC, Math SB. Clinical practice guidelines for obsessive-compulsive disorder.  Indian J Psychiatry.  2017;59:S74–S90 Joel Philip Acceptance and Commitment Therapy in Obsessive–Compulsive Disorder: A Case Study Indian J Psychol Med.   2022 Jan https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022919/ Marie Chellingsworth University of Exeter Washington exposure and response prevention https://www.elft.nhs.uk/sites/default/files/2022-05/exposure-and-response-prevention.pdf Pozza A, Dèttore D. Drop-out and efficacy of group versus individual cognitive behavioural therapy: What works best for obsessive-compulsive disorder? A systematic review and meta-analysis of direct comparisons.  Psychiatry Res.  2017;258:24–36. Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication.  Mol Psychiatry.  2010;15:53–63. Y. C. Janardhan Reddy et al Clinical Practice Guidelines for Cognitive-Behavioral Therapies in Anxiety Disorders and Obsessive-Compulsive and Related Disorders Indian J Psychiatry .   2020 Jan; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001348/