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Obsessive Compulsive Disorder

Behavioral Therapy

1. Homework Preparation

2. Homework Session

3. After Homework...

Strategies and Pitfalls

Coping with Obsessions and Compulsions

1. Keep some key ideas in mind when working on developing skills to cope with and master the obsessions and compulsions:
   1. The fear or anxiety that comes along with the obsessions and compulsions can decrease and pass over time.
   2. The feelings that come along with the obsessions and compulsions do not cause personal damage. They are triggered off along with the obsessions or compulsions.
   3. Don't be fooled into giving into the obsessions or compulsions. It may provide temporary reduction of unpleasant feelings. It, however, fails to produce any long-term reduction of the obsessions and compulsions or may even increase them.
   4. Work to maintain control over the focus of thought and action. Prevent obsessions and compulsions from occupying the focus of thought and action.

   Back to HIGHLIGHTS

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   GOAL: STOP ALL OBSESSIONS AND COMPULSIONS
2. Commit to the goal of stopping all obsessions, compulsive behaviors, mental compulsions, and compulsive rituals:
   1. The aim of the work is resistance to all obsessions and compulsions.
   2. Resistance should be applied to the obsessions and compulsive urges as long as possible.

      NOTE:

      Some people see this strategy as requiring them to be perfect.

      Practice, however, develops skills at coping and managing the symptoms.

      Success takes time and effort.

   3. Watch out for other obsessions or compulsions developing as substitutes for the ones treatment is attacking.

   Back to HIGHLIGHTS

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   PLAN TO USE FREE TIME
3. Free time breeds obsessions and compulsions.
   1. Develop activities to keep idle, free time limited.
   2. If obsessions and compulsions intrude during free time, use the time to perform another homework activity.
   3. Watch for a decrease in the feelings of fear or anxiety that come with the obsessions and compulsions as the behavioral work progresses.

   Back to HIGHLIGHTS

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   SUCCESS COMES FROM REPEATED PRACTICE
4. Success at coping with the feelings and behavior comes from repeated practice.
   1. If you cannot resist carrying out a compulsive urge, wait for the feelings to decrease a little before performing the compulsive behavior.
   2. Aim at increasing control over the compulsive urge.

      PROBLEM:

      When a compulsive urge cannot be stopped...

      ACTION:

      INTRODUCE AN INTERMEDIATE STEP...

      EXAMPLE:

      Increase the time that passes before performing a compulsion.

      When success is achieved at resisting for that period of time, increase the time limit.

      Continue increasing the time until control is achieved over the compulsion.

   3. Set up activities that require completion of tasks triggering obsessions or compulsions.
      1. Complete the activities a second time.
      2. Repeat the activities that caused the fear or anxiety AS SOON AS POSSIBLE.

         GOALS:

         Increase resistance to the urges.

         Improve the capacity to cope with the feelings and obsessions.

   Back to HIGHLIGHTS

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   HELP WANTED:
5. Help from others increases the chances of success overcoming the obsessions and compulsions.
   1. Get a family member or a friend to help you face the task that produces obsessions or compulsions.
   2. Helpers need to be informed of the nature of the problems and the method to avoid pitfalls.
   3. Reassurance ("things are really O.K.") should not be provided by helpers.

      EXPLANATION:

      Reassurance can become a ritual in which another person acts to discharge the feelings and urges by making reassuring comments.

      Reassurance can provide relief; whereas, the treatment aims at (1)improving capacity to endure the feelings, obsessions, and urges and (2) eliminating them.

Back to CONTENTS

Behavioral Action Plan

How to Proceed ...

1. Set aside three hours daily to work on the problems.
2. Set a goal of performing NO rituals or compulsions.
3. Work on the most disturbing problems in the first two weeks.

Back to CONTENTS

HOMEWORK PREPARATION

1. Homework tasks need to careful selecion and clear definition.
2. Rank the tasks by their difficulty.
3. Set up a calendar for your work.
   • Write down the goals for each homework session.
   • Set up the calendar for a full week at a time.
4. Know exactly what you plan to do in your session.

   EXAMPLES:

   Avoid handwashing for __ hours.

   Avoid checking (e.g., doors, locks, stoves, lights) for __ hours.

   Avoid checking weather reports (e.g., about tornados, hurricanes, blizzards) for __ hours.

   Touch __ objects.

   Discard hoarded (e.g., newspapers, magazines, mail, boxes) for __ hours.

Back to CONTENTS

HOMEWORK SESSION

1. Carry out homework assignments as planned.
2. Note when contact is made with objects that generate anxiety, fear and compulsive urges.
   1. Stay focused and meet the goals of the homework session.
   2. Don't "secretly" perform rituals during the homework.
3. Resist urges to stop contact with the "triggering" objects.

   RESIST URGES:

   To stop the exposure to the "triggering" object,

   To flee from the "triggering" object,

   To perform a compulsion associated with the "triggering" object.

4. When the homework increase anxiety levels,

   WAIT...

   To experience how the anxiety drops a little.

   To build increased tolerance of the anxiety.

5. Repeat the exposure assignment. Practice increases your comfort level.
6. Get a family member or a friend to help wit the homework tasks.
7. Stay in the situation until the anxiety is down.

Back to CONTENTS

AFTER HOMEWORK...

1. Reward yourself for the work you did.
2. Don't give in to despair if you didn't do as well as you like.
   • Remember you made an effort.
   • Practice WILL lead to success.
3. Make a note of problems.
   • Figure out a way to deal with the problems.

Back to CONTENTS

This therapeutic approach has been adapted from behavioral treatment approach developed by Professor Isaac Marks at the Institute of Psychiatry and Maudsley and Bethlehem Royal Hospitals in London.

The various therapeutic approaches presented have been developed, modified, and refined over the course of twenty-six years of work with patients who have obsessive compulsive disorder and related conditions.