Exposure therapy and Ritual Prevention therapy – Flashcards

persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause marked anxiety or distress Common ones are repeated thoughts about causing harm to others, contamination, and doubting whether one locked the front door. [Compulsions are defined as overt (behavioral) or covert (mental) actions that are performed in an attempt to reduce the distress brought on by these]

It involves the exposure of the patient to the feared object or context without any danger, in order to overcome their anxiety and/or distress often done in real-life settings (for example, by asking the patient who fears accidentally causing a house fire by leaving the stove on, to leave the house without checking the burners).

It is believed that repeated, prolonged exposure to feared thoughts and situations provides information that disconfirms mistaken associations and evaluations held by the patients and thereby promotes habituation

keeping an individual from participating in a ritual caused by a stimuli. (For example, if a person washes their hands every time they see a fireplace, keep them from doing that) is not effective if they are forced to stop, instead give instructions, encouragement, support, and suggestions about alternatives, to refrain from ritualizing and avoidance

A Cognitive-Behavioral approach that involves exposure to an avoided stimulus and preventing the client from participating in rituals that they typically do in that situation. Ex) a person who is afraid of spiders counts when they see a spider. This method shows them a spider while asking them to not count. - Is effective for treating phobias and OCD.

A type of exposure therapy that involves imagining or seeing a picture of avoided stimuli, as opposed to actually being exposed to it. - Should be used when patients report specific feared consequences of refraining from rituals or when actually exposure is impossible (going to space)

Situations of moderate difficulty are usually confronted first, followed by several intermediate steps, before the most distressing exposures are attempted. (Exposure should proceed at a pace that is acceptable to the patient, and that no exposure will ever be attempted without the patient's approval.) - At the same time, it is preferable to confront the highest item on the treatment hierarchy relatively early in treatment (e.g., within the first week of intensive treatment) to allow sufficient time to repeat these difficult exposures over the later sessions. It can also be gradually done by starting off with imaginal exposure and then exposure exercises.

Individuals with OCD often attempt to avoid anxiety evoking situations. Most passive avoidance strategies are fairly obvious (e.g., not entering public rest rooms). However, the therapist also needs to be attentive to subtle forms of avoidance, such as wearing slip-on shoes to avoid touching laces

fifteen 2-hour treatment sessions conducted daily for 3 weeks (every week day). (none intensive are 1 hour sessions monthly) Each session begins with a 10- to 15-minute discussion of homework assignments and the previous day's ritual monitoring. - The next 90 minutes are divided into 45 minutes each of imaginal and in vivo exposure. - The final 15 minutes are spent discussing the homework assignment for the following

information gathering intensive Exposure therapy and Ritual Prevention therapy a home visit a maintenance and relapse prevention phase.

First it must be determined that OCD is their main psychopathology. - Seek out information about the obsessional content, including external and internal fear cues and beliefs about consequences and information about passive avoidance patterns and types of rituals Then use the information gathered to administer the Subjective Units of Discomfort Scale (SUDS) which asks clients to rate the level of distress that each situation between 0 and 100. Then ask about the onset of the problem Discuss the rationale for treatment and to describe the treatment program in detail. Make sure they know that they may experience some discomfort because they will be asked to refrain from rituals. Give them a self-monitoring form to complete as homework. This will gather information about their rituals that they may not even know.

First seek out information about the obsessional content, including external and internal fear cues (what causes behavior. Ex. What makes you want to wash your hands) beliefs about consequences (what happens if you don't wash your hands) and information about passive avoidance patterns and types of rituals (washing your hands).

asks clients to rate the level of distress that each situation between 0 and 100. Ex) On a scale of 1-100 how upsetting is it for you to go into the laundry room.

Give them a self-monitoring form to complete as homework. This will gather information about their rituals that they may not even know. Maybe they wash their hands after hearing a dog bark, but don't realize it.

the therapist devotes time to the patient's self-monitoring form, which includes examining the descriptions of situations that trigger ritualistic behavior The bulk of the second information-gathering session is allotted to gathering detailed information about the patient's symptoms and, based on what is learned about the symptoms, developing a treatment with the patient. Homework is given that includes exposure exercises for OCD stimuli. More uncomfortable stimuli will be evaluated as time goes on. - We suggest that the patient monitor his or her SUDS level every 10 minutes during the homework exposures.

(Somebody who washes their hands if they see a fireplace) On the first day we should start with things that you rated below a 60 on the Subjective Units of Discomfort Scale. - You will be asked to, for example, be shown a fire poker and not wash your hands while looking at it. On the second day, we'll do the 60- to 70-level [The therapist continued to detail Sessions 3 to 5, increasing the level of difficulty each day.] In the second week, we will repeat the worse situations Before being exposed, you will be taught coping techniques to help avoid rituals, such as deep breathing. During the third week, I will be doing a home visit.

Homework is given that includes exposure exercises for OCD stimuli. More uncomfortable stimuli will be evaluated as time goes on. - The self monitoring homework will also be given - We suggest that the patient monitor his or her SUDS level every 10 minutes during the homework exposures.

The bulk of the time in these sessions is used to conduct additional exposures to obsessive stimuli in and around the patient's home or workplace. For example, the therapist might accompany the patient as they contaminates objects around the house or at the local grocery store.

Every so often, the client comes back to the therapist. These sessions may be used to plan additional exposures, to refine guidelines for normal behavior, and to address issues that arise as the patient adjusts to life without OCD

1. Lower the level of discomfort that the fire place has on the client to a manageable amount (40 SUDs score). - During the last session record the SUDs score for the fireplace and make sure that it is at least to a 40. 2. Avoid unnecessary washing of hands (not including when hands are dirty, before eating, after using bathroom, etc.) - Have the client complete a self-monitoring form that will be gone over at the beginning of every session. Included on the form is the amount of times that they have washed their hands and the reasons for washing hands. (note: beforehand you and the client have defined what unnecessary washing of hands is). - Then you and the client determine what reaching the goal looks like (is it completely abstinent, cutting it in half, etc.) Then look at the self-monitoring form during the last session to see if the goal was reached.