CBT for OCD: habituation or cognitive shift?

Abstract

Cognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is recommended by NICE as the psychological treatment of choice for obsessive compulsive disorder (OCD). Twenty-five percent of OCD patients refuse ERP, and many psychologists advocate formulation-driven cognitive therapy, including ERP, as opposed to ERP alone. However, a recent meta-analysis suggested there is insufficient evidence to suggest ERP is improved by cognitive methods. This paper proposes to contribute to this debate by providing a detailed description of the treatment of a patient with intrusive cognitions of a sexual nature, who was treated successfully using behavioural experiments designed to test cognitions, rather than ERP. This is, arguably, the way in which most cognitive behavioural therapists would work with someone with OCD. However, this approach is not reflected in the literature at present. The authors report the patient's feedback that therapeutic change was brought about through cognitive shift, as a result of the formulation-driven behavioural experiments. Theoretical and research basis for therapyThis paper begins by reviewing pertinent literature relating to this case. Anna's presenting problem is then described, along with the cognitive behavioural hypotheses developed during treatment. The process and outcomes of treatment are outlined, and the paper then focuses on exploring the patient's views of which aspects of therapy were the most important factors in stimulating change. Literature reviewObsessive compulsive disorder (OCD) is characterized by persistent, intrusive cognitions, and/or compulsive behaviours (DSM-IV-TR; APA, 2000). OCD can be a debilitating, longterm disorder, if left untreated. The efficacy of CBT approaches for OCD has been well established in highly controlled clinical settings (e.g. NICE, 2005;Ponniah et al. 2013) and in

Techniki pracy z zaburzeniem obsesyjno-kompulsyjnym w terapii poznawczo-behawioralnej

“…Dla potwierdzenia zmiany dokonywanej interpretacji w realnych sytuacjach wskazane jest stosowanie eksperymentów behawioralnych. Jest to technika polegająca na podejmowaniu przez pacjenta nowej aktywności i obserwacji jej skutków w sposób ściśle zaplanowany (Morris, Nightingale, 2014;Westbrook, 2007). Eksperyment behawioralny prowadzony jest podobnie jak eksperyment naukowy.…”