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This chapter discusses the treatment of a Kyle, a young adult with obsessive-compulsive disorder (OCD), and focuses on the design and implementation of cognitive behavioral therapy with exposure and response prevention to treat Kyle’s sexual obsessions and compulsions. This case report begins by reviewing background literature on sexual obsessive-compulsive symptoms, as well as factors that are relevant to conducting exposures to treat these symptoms. A discussion of relevant background information about Kyle, our case conceptualization, and a session-by-session account of exposures that were conducted to target Kyle’s obsessive-compulsive symptoms (with an emphasis on the treatment of Kyle’s sexual symptoms) is presented. Several barriers that had to be addressed during these exposure sessions are reviewed, such as therapists’ non-avoidance of sexually explicit content due to their own anxiety or disgust sensitivity, and the chapter concludes with clinical recommendations for therapists who conduct exposures to treat sexual obsessive-compulsive symptoms in adults.Keywords
OCD Sexual symptoms CBT EXRP Therapist non-avoidance AdultsReferences
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▾ Book descriptionsAmazon.com Product Description (ISBN 0323323413. Hardcover)
Neurotransmitters in the brain are the current focus of obsessive compulsive disorders to better address the approximately 2.5 million people in the United States diagnosed with OCD. As seems the way of psychiatry practice, a disorder is viewed and treated from one perspective for a period, then a new perspective is in the forefront. Such is the case with obsessive compulsive disorders, originally treated as a behavioral problem with psychotherapy, now considered a brain circuitry disorder that can be treated with psychopharmacotherapeutics. This issue contains topics that focus on neuroscience of the brain and genetics in relation to OCD, providing the psychiatrist a comprehensive review of the current thought, approach, diagnosis, and treatment related to OCD and its related disorders. Topics include: Etiological hypotheses of OCD - molecules to circuits; Models of obsessive compulsive and related disorders; Cognitive neuroscience of OCD; Genetics of obsessive compulsive and related disorders; Tic disorders - spearate or related disorder; Pediatric acute-onset neuropsychiatric syndrome (PANS); Body dysmorphic disorder; Trichotillomania; Hoarding disorder; Pharmacotherapy; Device based interventions; Cognitive behavioral therapy for OCD.
(retrieved from Amazon Sun, 30 Aug 2015 02:08:10 -0400)
▾ Library descriptions
Neurotransmitters in the brain are the current focus of obsessive compulsive disorders to better address the approximately 2.5 million people in the United States diagnosed with OCD. As seems the way of psychiatry practice, a disorder is viewed and treated from one perspective for a period, then a new perspective is in the forefront. Such is the case with obsessive compulsive disorders, originally treated as a behavioral problem with psychotherapy, now considered a brain circuitry disorder that can be treated with psychopharmacotherapeutics. This issue contains topics that focus on neuroscience of the brain and genetics in relation to OCD, providing the psychiatrist a comprehensive review of the current thought, approach, diagnosis, and treatment related to OCD and its related disorders. Topics include: Etiological hypotheses of OCD - molecules to circuits; Models of obsessive compulsive and related disorders; Cognitive neuroscience of OCD; Genetics of obsessive compulsive and related disorders; Tic disorders - spearate or related disorder; Pediatric acute-onset neuropsychiatric syndrome (PANS); Body dysmorphic disorder; Trichotillomania; Hoarding disorder; Pharmacotherapy; Device based interventions; Cognitive behavioral therapy for OCD.Details
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An estimated 2-3% of the population is affected by obsessive-compulsive disorder (OCD). This is a chronic condition that significantly affects daily functioning and quality of life. Many people with OCD would greatly benefit from receiving professional help to learn how to successfully manage this debilitating condition. This book guides clinicians in treating individuals with OCD through the use of exposure and ritual (response) prevention, one of the most effective and the most studied treatments for OCD.
Designed to be used in conjunction with its companion patient workbook titled Treating Your OCD with Exposure and Ritual (Response) Prevention Therapy. this Therapist Guide includes supporting theoretical, historical and research background information, diagnostic descriptions, differential diagnoses, session by session treatment outlines, case examples, sample dialogues, practice assignments, and tailored application to the vast variety of presentations and nuances of the disorder. The manual contains the 'nuts and bolts' of how to provide the treatment and is a comprehensive resource for therapists. It is an invaluable guide for clinicians in overcoming the barriers and difficulties that are part and parcel of every treatment.
"Exposure and ritual (response) prevention (EX/RP) is the best treatment we have for obsessive compulsive disorder. The Therapist Guide and Workbook by Foa, Yadin, and Licher will do two very important things. The first is to make EX/RP much more available to people suffering from OCD. The second is to help ensure that the treatment that is made more available is a treatment that should really work."--Michael R. Liebowitz M.D. Professor of Clinical Psychiatry, Columbia University and Former Director, Anxiety Disorders Clinic, New York State Psychiatric Institute
"In this well-organized and succinct manual, leading experts describe exposure and ritual (response) prevention (EX/RP), a proven first-line treatment for obsessive-compulsive disorder (OCD). They detail how to evaluate clients for EX/RP treatment, provide session-by-session instructions for treatment delivery, and offer invaluable advice on handling problems like patient nonadherence. This outstanding therapist manual, together with its accompanying client workbook, provides state-of-the-art tools for transforming the lives of people with OCD."--H. Blair Simpson, M.D. Ph.D. Professor of Clinical Psychiatry, Columbia University Director of the Anxiety Disorders Clinic and the OCD Research Program at the New York State Psychiatric Institute
"A concise, up-to-date, and extremely useful clinical guide to understanding and treating people struggling with OCD. State-of-the-art essentials for how to provide the most effective intervention for this often difficult to treat condition are covered in a clear and practical manner that is certain to facilitate positive outcomes."--Jonathan S. Abramowitz, Ph.D. ABPP, Professor of Psychology, University of North Carolina at Chapel Hill and Editor-in-Chief, Journal of Obsessive-Compulsive and Related Disorders
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Obsessive-Compulsive Disorder (OCD)
Obsessive-compulsive disorder (OCD) is characterized by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images (obsessions) and/or by repetitive behaviors or mental acts that patients feel driven to do (compulsions) to try to lessen or prevent the anxiety that obsessions cause. Diagnosis is based on history. Treatment consists of psychotherapy (specifically, exposure and response prevention), drug therapy (specifically, SSRIs or clomipramine ), or, especially in severe cases, both.
OCD is slightly more common among women than men and affects about 1 to 2% of the population. Up to 30% of people with OCD also have a past or current tic disorder (see Tic Disorders and Tourette Syndrome in Children and Adolescents ).Symptoms and Signs
Obsessions are unwanted, intrusive thoughts, urges, or images, the presence of which usually cause marked distress or anxiety. The dominant theme of the obsessive thoughts may be harm, risk to self or others, danger, contamination, doubt, loss, or aggression. For example, patients may obsess about becoming contaminated with dirt or germs unless they wash their hands for ≥ 2 h a day. The obsessions are not pleasurable. Thus, patients try to ignore and/or suppress the thoughts, urges, or images. Or they try to neutralize them by performing a compulsion.
Compulsions (often called rituals) are excessive, repetitive, purposeful behaviors that affected people feel they must do to prevent or reduce the anxiety caused by their obsessive thoughts or to neutralize their obsessions. Examples are
Washing (eg, handwashing, showering),
Checking (eg, that the stove is turned off, that doors are locked)
Counting (eg, repeating a behavior a certain number of times)
Ordering (eg, arranging tableware or workspace items in a specific pattern)
Most rituals, such as hand washing or checking locks, are observable, but some mental rituals, such as silent repetitive counting or statements muttered under the breath, are not. Typically, the compulsive rituals must be done in a precise way according to rigid rules. The rituals may or may not be connected realistically to the feared event. When connected realistically (eg, showering to avoid being dirty, checking the stove to prevent fire), the compulsions are clearly excessive—eg, showering for hours each day or always checking the stove 30 times before leaving the house. In all cases, the obsessions and/or compulsions must be time-consuming (> 1 h/day, often much more) or cause patients significant distress or impairment in functioning; at their extreme, obsessions and compulsions may be incapacitating.
The degree of insight varies. Most people with OCD recognize to some degree that the beliefs underlying their obsessions are not realistic (eg, that they really will not get cancer if they touch an ashtray). However, occasionally, insight is completely lacking (ie, patients are convinced that the beliefs underlying their obsessions are true and that their compulsions are reasonable).
Because people with this disorder fear embarrassment or stigmatization, they often conceal their obsessions and rituals. Relationships often deteriorate, and performance in school or at work may decline. Depression is a common secondary feature.Diagnosis
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