OCD Treatment Approaches

PAPER ONE

Abstract

This paper reviews the two treatment approaches to Obsessive Compulsive Disorder (OCD) described in Chapter thirteen of our Orvashel, et al, (2001) textbook.  Family Systems Therapy and Cognitive Behavioral Therapy Methods are described and contrasted.

This assignment focuses on a case study in chapter thirteen of our Orvashel, et al, (2001) textbook.   In this case study, we learn about a 12-year-old, 6th grader by the name of Jack, who lives with his parents and younger 9-year-old sister.  He has been referred for outpatient services for a worsening of OCD symptoms over the last several months.  While Jack was diagnosed approximately three years ago, his ability to cope with OCD has become increasingly problematic.   In an assigned video this week we hear an OCD sufferer describe the fears associated with it as a mental torture in which you realize the irrationality of your thoughts and actions, but feel compelled toward them nonetheless (Mayo Clinic, 2008).  This insight provides a useful starting point for understanding Jack’s symptoms.   As a result of his OCD, Jack has experienced difficulty in several areas of his life.  His relationship with others has become strained, and ability to participate in home and school-related tasks is suffering.

CBT and Exposure Therapy

In our textbook’s hypothetical case scenario, the therapist utilizes a CBT approach coupled with exposure therapy.   From this perspective, a neurobehavioral case conceptualization describes Jack’s OCD as a byproduct of individual vulnerabilities and environmental factors (Orvashel, et al, 2001).  Jack’s OCD is reinforced by his perceived understanding of the contingent relationship between his obsessive fears and the compulsive reactions he uses to cope.

Naturally, regardless of what method a therapist might use, psycho-education is an essential starting point.  While this family has been dealing with this for quite some time, it is important to make sure that they are interpreting his behaviors and symptoms correctly.  I like the textbook’s description of these behaviors and thoughts in utilizing a computer language with terms such as “bad microchip” and “re-programming” (Orvashel, et al, 2001).  This psychoeducational process should provide Jack with an overview of the therapy process and its purpose to “reprogram” and learn to talk back to his thoughts so they can no longer control him.

Before initiating exposure and response interventions, the therapist will need to create  a hierarchical list of anxiety-provoking situations with Jack.  This hierarchical list could then be utilized to expose Jack to these anxiety producing situations.  The goal in doing so, the goal would be to provide Jack an opportunity to utilize CBT coping methods as an alternative to his compulsive habits.  These CBT coping methods can include, for example, relaxation methods or a cognitively based “talking-back” (Orvashel, et al, 2001, p279) technique.   Including exposure-related at home, with the guidance and participation of his parents, can allow further habituation to occur.  While these technique’s don’t cure OCD, they are successful in decreasing anxieties and overcoming his compulsions.

Family Systems Therapy

An alternate case conceptualization of Jack’s OCD can involve an examination of any areas of familial dysfunction.  This model might useful if family characteristics are observed during treatment that indicates family therapy is warranted.  Orvashel, et al, (2001) state that oftentimes familial dysfunction

References

MayoClinic [Screen Name] (2008, May 13) New treatment for kids with obsessive compulsive disorder-Mayo Clinic. Retrieved from:  http://www.youtube.com/watch?v=OcXn3m3M-U0
Orvaschel, H., Faust, J., & Hersen, M. (Eds.). (2001). Handbook of conceptualization  and treatment of child psychopathology.  Oxford, UL: Elsevier LTD.

PAPER TWO

This assignment focuses on a case study in chapter thirteen of our Orvashel, et al, (2001) textbook.   In this case study, we learn about a 12-year-old, 6th grader by the name of Jack, who lives with his parents and younger 9-year-old sister.  He has been referred for outpatient services for a worsening of OCD symptoms over the last several months.  While Jack was diagnosed approximately three years ago, his ability to cope with OCD has become increasingly problematic.   In an assigned video this week we hear an OCD sufferer describe the fears associated with it as a mental torture in which you realize the irrationality of your thoughts and actions, but feel compelled toward them nonetheless (Mayo Clinic, 2008).  This insight provides a useful starting point for understanding Jack’s symptoms.   As a result of his OCD, Jack has experienced difficulty in several areas of his life.  His relationship with others has become strained, and ability to participate in home and school-related tasks is suffering.

CBT and Exposure Therapy

In our textbook’s hypothetical case scenario, the therapist utilizes a CBT approach coupled with exposure therapy.   From this perspective, a neurobehavioral case conceptualization describes Jack’s OCD as a byproduct of individual vulnerabilities and environmental factors (Orvashel, et al, 2001).  Jack’s OCD is reinforced by his perceived understanding of the contingent relationship between his obsessive fears and the compulsive reactions he uses to cope.

Naturally, regardless of what method a therapist might use, psycho-education is an essential starting point.  While this family has been dealing with this for quite some time, it is important to make sure that they are interpreting his behaviors and symptoms correctly.  I like the textbook’s description of these behaviors and thoughts in utilizing a computer language with terms such as “bad microchip” and “re-programming” (Orvashel, et al, 2001).  This psychoeducational process should provide Jack with an overview of the therapy process and its purpose to “reprogram” and learn to talk back to his thoughts so they can no longer control him.

Before initiating exposure and response interventions, the therapist will need to create  a hierarchical list of anxiety-provoking situations with Jack.  This hierarchical list could then be utilized to expose Jack to these anxiety-producing situations.  The goal in doing so, the goal would be to provide Jack an opportunity to utilize CBT coping methods as an alternative to his compulsive habits.  These CBT coping methods can include, for example, relaxation methods or a cognitively based “talking-back” (Orvashel, et al, 2001, p279) technique.   Including exposure-related at home, with the guidance and participation of his parents, can allow further habituation to occur.  While these technique’s don’t cure OCD, they are successful in decreasing anxieties and overcoming his compulsions.

Family Systems Therapy

An alternate case conceptualization of Jack’s OCD can involve an examination of any areas of familial dysfunction.  This model might be useful if family characteristics are observed during treatment that indicates family therapy is warranted.  Orvashel, et al, (2001) state that oftentimes, familial dysfunction until the therapist notes that Jack fails to progress through treatment successful and suffers an array of setbacks (p283).   For example, if one of Jack’s parents worried excessive and tends to enable him.  This might involve acknowledging and agreeing with his obsessive worries, and helping him avoid feared items while facilitating compulsions.  As an alternative, other symptoms indicative of a family dysfunction can be if jack’s illness somehow draws attention to other family issues, such as marital disharmony.

In such cases, it would be necessary to involve the entire family in treatment.   This might involving teaching Jack and his parents about alternative CBT-oriented coping methods.  This would allow the parents to model healthier methods of coping with anxiety so they can work together on exposure-related homework interventions.   Addressing how Jack’s OCD behaviors fit within the larger family system would also be essential.   How does the family adapt to these behaviors, and what purpose does Jack’s OCD serve in maintaining the interpersonal homeostasis?

Comparing Therapy Methods

When utilizing CBT to treat OCD in childhood, individualized psychopathology is the focus.   The case conceptualization is based on a nature versus nurture, neurobiological perspective.   Jack obsessions and compulsions are the focus of therapy in this instance.  The treatment response is to focus on exposure therapy with homework assignments that build on these efforts.   The family’s inclusion in therapy is limited to any facilitative efforts they might engage in at home to help Jack utilize alternative CBT coping methods.

In contrast the family systems perspective, looks at how Jack OCD fits within the larger family system.  Rather than focusing on individualized psychopathology, the concern is familial dysfunction.  Addressing how families adjust to Jack’s OCD, and greater issues in home environment influence his progress in therapy are the key issues.

Ideally, I would think both these perspectives are best when utilized in tandem.  Regarding CBT, I would be interested in learning it in depth in the future since it is used so frequently throughout the therapy field.  Regarding family systems therapy, I would be very interested in developing solid clinical judgments that can allow me to see the bigger picture.  To be honest, I think both perspectives are very pertinent and it would be a disservice to exclude either one.

References

MayoClinic [Screen Name] (2008, May 13) New treatment for kids with obsessive compulsive disorder-Mayo Clinic. Retrieved from:  http://www.youtube.com/watch?v=OcXn3m3M-U0
Orvaschel, H., Faust, J., & Hersen, M. (Eds.). (2001). Handbook of conceptualization  and treatment of child psychopathology.  Oxford, UL: Elsevier LTD.

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