INTENSIVE TREATMENT FOR SEVERE OCD. How Far Do You Go?

Transcription

1 Anxiety Disorders Association of America 30 th Annual Conference 2010 INTENSIVE TREATMENT FOR SEVERE OCD How Far Do You Go? Westwood Institute for Anxiety Disorders, Inc.

2 PRESENTERS: Eda Gorbis, Ph.D., LMFT Founder/Director, Westwood Institute for Anxiety Disorders, Inc. Assistant Clinical Professor, UCLA Department of Psychiatry Westwood Institute for Anxiety Disorders, Inc. 921 Westwood Blvd., Suite 224, Los Angeles, CA Tel: (310) , Ext. #2 Website: Dr. Gorbis joined Dr. Edna B. Foa, an internationally recognized authority who pioneered the protocols for ERP, in 1994 and received extensive training in the field of OCD treatment. In 1996, she began working with Dr. Schwartz at UCLA, where she integrated Dr. Foa s ERP methods. Over the past seven years, she has treated more than 150 in- and out-patients with OCD while working closely with their families. Her method synthesizes the blends successful treatment modalities for OCD and PTSD and has yielded a high rate of success. Dr. Gorbis work has received large amount of attention from the national media. Her intensive method has been the topic on National Geographic, the Discovery Channel, BBC, 20/20, MTV, and numerous local news channels. Jenny C. Yip, Psy.D. Clinical Psychologist Director of Education, Westwood Institute for Anxiety Disorders, Inc. Director, Renewed Freedom Treatment Center for Rapid Anxiety Relief 1849 Sawtelle Blvd., Suite 680, Los Angeles, CA Tel: (310) , Ext. #1 [email protected] Website: Dr. Yip has been extensively trained by nationally recognized clinical and research experts in the field of OCD and Strategic Family Therapy. In 1999, she joined Dr. Charles Mansueto and gained extensive training on OCD and its treatment. During her years working with children/adolescents suffering from OCD and their families, she received mentoring from Cloe Madanes on the use of paradoxical techniques with resistant patients and families. In 2004, she joined forces with Dr. Eda Gorbis to develop a groundbreaking treatment protocol for patients with body image issues, such as BDD and Eating Disorders. In 2005, Dr. Yip developed her own innovative treatment modality integrating Mindfulness Training and Strategic Paradoxical Techniques with CBT in the treatment of children and adolescents suffering from severe OCD, body image issues, emotional eating, and related anxiety disorders within the family system. She has published articles, presented her work at national and international conferences, and consulted on documentaries and major film productions on OCD in children and adolescents Westwood Institute for Anxiety Disorders, Inc. 2

3 Intensive Treatment for Severe OCD OCD is a multifaceted anxiety disorder characterized by symptoms of obsessive thoughts and compulsive behaviors, in which the sufferer attempts to gain what ends up as only temporary relief. Heritable in nature, OCD affects 3% of the population of the US, and was untreatable until Victor Meyer developed the first modern exposure and response prevention (ERP) treatment in Since then, it has been shown that when correctly used, behavior therapy can produce a 76% symptom reduction in patients for 3 months to 6 years following termination of treatment (Foa & Kozak, 1996). This rate increases for those sufferers of severe OCD when participating in an intensive treatment program. However due to the natural inclination to resist exposing oneself to fears, caution must be taken in determining patient readiness and the appropriateness of a more intensive treatment approach. The intensive treatment can be viewed as a last resort program for those individuals with severe OCD, in which traditional weekly treatments have offered limited benefit. An intensive treatment approach typically involves several continuous hours on consecutive days/weeks of repeated and prolonged exposures to external and internal triggers of OCD. Research indicates that prolonged ERP is more effective for habituation to fears than shortduration ERP Westwood Institute for Anxiety Disorders, Inc. 3

4 EDUCATIONAL OBJECTIVES: I. Effective Treatment for OCD What is OCD?? What is ERP Treatment? Intensive Treatment Program for Severe OCD Prolonged ERP vs. short-duration ERP II. Assessment and Evaluation of OC Symptoms: Ascertain relationship between external/internal triggers and feared consequences Diagnostic Instruments Preparation of individualized treatment prescription Continual monitoring of relationship between feared cues and ritualistic/avoidance behaviors Psychoeducation on the effects, cycle, and consequences of OCD III. Treatment Phase: Planning for exposures in a hierarchical system using the SUD measurement Self-monitoring of rituals to feared cues to increase mindful awareness Cognitive restructuring of overvalued ideation and over-appraisals of harm and danger Daily assignments to reinforce learned skills Repeated/Prolonged ERP via in vivo, imagery, writing exercises How far do you go? Feared consequences IV. Relapse Prevention: Maintenance of skills learned to preserve treatment efficacy Relapse preparation to manage setbacks in OCD Goal setting (reevaluation of life style) to enhance healthy functioning 2010 Westwood Institute for Anxiety Disorders, Inc. 4

5 Diagnostic Instruments Y-BOCS Symptom Checklist (Goodman et al. 1989): Generates a Target Symptoms List of specific obsessions and compulsions that distinguishes between current and past symptoms. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; Goodman et al. 1989): A 19- point-scale semi-structured interview that measures the presence and severity of OCD. Hamilton Rating Scale for Depression (Ham-D; Hamilton 1960a): A 28-point scale semi-structured interview that measures the presence and severity of depression. The questions relate to the presence of sadness, hopefulness, helplessness, poor selfimage, motor retardation and agitation, anxiety, gastrointestinal somatic symptoms, sexual symptoms, hypochondriasis, weight fluctuation, and insight. Hamilton Anxiety Rating Scale (HARS; Hamilton 1960b): A 14-point scale semistructured interview that measures the severity of anxiety. It lists common symptoms of anxiety, tension, fear, depression, and physical symptoms, such as dry mouth, tension headaches, etc. Fixity of Beliefs Questionnaire (Foa & Kozak 1995): A 5-item questionnaire that evaluates a subject s insight into their condition. Global Assessment Scale (GAS; Endicott et al. 1976): A scale that provides a general rating on a subject s condition, and measures overall severity of psychiatric disturbance. NIMH Global Obsessive-compulsive Scale (NIMH GOCS; Goodman & Price 1992): A scale that provides a clinical rating on a subject s present obsessive-compulsive behavior. Brown Assessment of Beliefs Scale (BABS; Eisen et al. 1998): A 6-item questionnaire that measures level of insight. Obsessive-Compulsive Inventory (OCI; Foa et al. 1998): A self-report instrument for determining the diagnosis and severity of OCD. Obsessive-Compulsive Rating Scale (OCON; Foa et al. 1998): A 42-item self-report inventory to quantify the intensity and frequency of OCD symptoms. The Fear Survey Schedule (FSS; Wolpe & Lang 1964): A 107-item self-report test that addresses a wide variety of phobic fears. Revised Willoughby Questionnaire (Willoughby 1969): A 25-item self-report instrument that assesses various emotional traits associated with symptoms of social anxiety Westwood Institute for Anxiety Disorders, Inc. 5

6 References Foa, E.B. and Kozak, M.J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, Foa, E.B. and Kozak, M.J. (1985). Treatment of anxiety disorders: Implications for psychopathology. In A.H. Tuma and J.D. Maser (Eds.) Anxiety and The Anxiety Disorders. Hillsdale, N.J.: Lawrence Erlabum. Grayson, J.B., Foa, E.B. and Steketee, G. (1982). Habituation during exposure treatment: Distraction versus attention-focusing. Behavior Research and Therapy, 20, Grayson, J.B., Foa, E.B., and Steketee, G. (1986). Exposure in vivo under distracting and attention focusing conditions: Replication and extinction. Behavior Research and Therapy, 24, Marks, I.M. (1978). Exposure treatments: Clinical applications. In W.S. Agras (Ed.), Behavior modification: Principles and Clinical Applications. Boston: Little, Brown, and Co. Rabavilas, A.D., Boulougouris, J.C. and Stefanis, C. (1976). Duration of flooding sessions in the treatment of obsessive-compulsive patients. Behavior Research and Therapy, 14, Westwood Institute for Anxiety Disorders, Inc. 6