Wednesday, 28 September 2011

CBT for OCD (Obsessive Compulsive Disorder)

Obsessive Compulsive Disorder (OCD) is one of the most disabling and at first sight puzzling of the anxiety disorders. Yet it is treatable, and CBT has the most impressive evidence base of all the treatments.

A new self-help book has just come out, Break Free from CBT. I went to a Paul Salkovskis workshop
at the recent BABCP conference at Guildford and was very impressed by his ideas.
The key idea to the CBT treatment for OCD can best be described in terms of Theory A and Theory B.
Theory A is what the client is already thinking. Its contents vary depending on the type of OCD, but basically it will be a varient of
Theory A: My problem is that I might get contaminated/harm someone/leave the house open. Because of this I need to avoid any contact with germs/avoid people/ repeatedly check that the door is locked.

The key insight of CBT for OCD is that theory A is the problem, and the compulsive behaviour that is meant to solve it (checking, avoidance) is also part of the problem. So we have Theory B, namely
Theory B: My problem is that  I worry that I get contaminated/ I worry that I will harm someone/ I worry that I have left the door unlocked. Because of this I need to stop doing the checking/avoiding. 

Of course it may take an OCD sufferer some time to be convinced of theory B, and the whole ethos of CBT isn't so much about convincing, more about examining the evidence. So the client will be asked to do a behavioural experiment to see which fits the data best, theory A or theory B. For example, if someone has thoughts they will harm someone, they will be asked "how often have you harmed someone before?" and "what is more likely, that you are the sort of person who harms someone, or the sort of person who has high moral standards and is worried they will harm someone?".
There is a lot more detail in the book featuring different case examples and a variety of other techniques (including ERP, exposure and response prevention, which is the more behavioural and less cognitive treatment for CBT).

 In summary, OCD is treatable, and I'd thoroughly recommend this book for sufferers and therapists alike.

Read an extract from Break Free from OCD by Challacombe, Oldfield and Salkovskis

Buy Break Free from OCD from Amazon

OCD Resources for therapists
Book Review of Break Free From OCD
Salkovskis 1985 cognitive model of OCD& formulation sheet for OCD
Salkovskis et al  vicious flowerformulation sheet for OCD
Presentation on benefit of guided self-help using CBT for OCD
OCD questionnaires including OCI and RAS
NICE guidelines on OCD

Self - help resources for OCD

OCDUK - lots of resources for those suffering from OCD and their families -especially strong on help for  children with OCD
Institute of Psychiatry  expert advice on OCD - includes  further reading suggestions
OCD Thought Record form - Thought record sheet customised for OCD
ERP logging for OCD - to record exposure and its effects
OCD Rituals Diary
OCD and Beckham - helping to take some of the stigma from OCD from the OCD Closet
6 minute video on CBT and OCD featuring Paul Salkovskis
CBT techniques for OCD -self-help page
Introduction to Overcoming OCD by Lee Brosan - a very short, clear and inexpensive guide - a good place to start.
Overcoming OCD by David Veale and Rob Wilson - another good self-help guide