Obsessive-Compulsive Disorder by Abramowitz

Jonathan S. Abramowitz, PhD,

Course Description

Based on decades of scientific research and clinical refinement, cognitive-behavioral therapy using the techniques of exposure and response prevention has helped countless individuals with OCD overcome debilitating symptoms and live fuller, more satisfying lives.

From leading expert Jonathan S. Abramowitz, this volume opens with an overview of the diagnosis and assessment of OCD and delineates a research-based conceptual framework for understanding the development, maintenance, and treatment of obsessions and compulsions. The core of the book is highly practical treatment manual packed with helpful clinical pearls, therapist-patient dialogues, illustrative case vignettes, and sample forms and handouts. Readers are equipped with skills for tailoring exposure and response prevention techniques for patients with different types of OCD symptoms, including washing, checking, ordering, obsessions and mental rituals. The book, which also addresses common obstacles in treating individuals with OCD, represents an essential resource for anyone providing services for individuals with anxiety disorders.

About Authors

Jonathan S. Abramowitz, PhD, is Associate Professor and director of the OCD/Anxiety Disorders Program at the Mayo Clinic. He has written or edited four books and over 75 research articles and book chapters on OCD and other anxiety disorders. For his contributions to the field, Dr. Abromowitz has received awards from the American Psychological Association and the Mayo Clinic

Learning Objectives

  1. State the term that was used previously to identify OCD.
  2. State how the American Psychiatric Association defines OCD.
  3. Define compulsions.
  4. List several common obsessions.
  5. Compare how men and women are affected by OCD.
  6. Describe how OCD symptoms develop.
  7. Define obsessions.
  8. Compare impulsive and compulsive rituals.
  9. Describe the Yale-Brown Obsessive Compulsive Scale.
  10. Describe the Beck Anxiety Inventory.
  11. Discuss the findings of positron emission tomography studies in patients with OCD.
  12. Define intrusive thoughts according to the cognitive-behavioral model.
  13. Define the distal cause of OCD.
  14. List the essential features of the functional aspects emphasized in the cognitive-behavioral model.
  15. List the advantages of medication for OCD.
  16. State the basis for CBT in OCD.
  17. Describe exposure and response prevention.
  18. State how the elderly respond to medications for OCD.
  19. State the response of OCD patients with depression and anxiety to CBT.
  20. List several recommendations that should be conveyed to the patient at the beginning of CBT.
  21. List the fears of experiencing long-term anxiety.
  22. State the points that convey to the patient the symptoms of OCD that can be broken with practice.
  23. State the aim of treatment to eliminate obsessional thoughts.
  24. List the two levels of dysfunctional thinking according to Beck’s Cognitive Model.
  25. Describe safety-seeking behaviors in maintaining OCD.
  26. Define habituation.
  27. State how collaborative empiricism is promoted.
  28. Define the fear hierarchy.
  29. Describe the SUDS scale.
  30. Describe the three types of imaginal exposure.
  31. Define amplifying.
  32. List symptoms of incompleteness.
  33. Discuss why the most feared hierarchy items should be conducted during the middle third of the treatment program.
  34. State when fear reduction is most complete and durable.
  35. List examples of “normal” behavior after treatment.
  36. List 3 indicators of change during exposure-based treatment of fear according to Foa and Kozak.
  37. State the drop out and ineffectiveness statistics of CBT for patients with OCD.
  38. List negative reactions to the CBT model.
  39. Describe conflict resolution when the patient argues.
  40. Describe what to do when a patient becomes extremely anxious or emotional during an exposure.
  41. Discuss the three possibilities when a patient reports little or no distress during exposure.

Course Contents

1 Description

1.1 Terminology
1.2 Definition
1.2.1 Insight
1.3 Epidemiology
1.4 Course and Prognosis
1.5 Differential Diagnoses
1.5.1 Generalized Anxiety Disorder (GAD)
1.5.2 Depression
1.5.3 Tics and Tourette’s Syndrome (TS)
1.5.4 Delusional Disorders (e.g., Schizophrenia)
1.5.5 Impulse Control Disorders
1.5.6 Obsessive Compulsive Personality Disorder (OCPD)
1.5.7 Hypochondriasis
1.5.8 Body Dysmorphic Disorder (BDD)
1.6 Comorbidities
1.7 Diagnostic Procedures and Documentation
1.7.1 Structured Diagnostic Interviews
1.7.2 Semi-Structured Symptom Interviews
1.7.3 Self-Report Inventories
1.7.4 Documenting Changes in Symptom Levels

2 Theories and Models

2.1 Neuropsychiatric Theories
2.1.1 Neurochemical Theories
2.1.2 Neuroanatomical Theories
2.2 Psychological Theories
2.2.1 Learning Theory
2.2.2 Cognitive Deficit Models
2.2.3 Contemporary Cognitive-Behavioral Models

3 Diagnosis and Treatment Indications

3.1 Form Versus Function
3.2 The Diagnostic Assessment
3.3 Identifying the Appropriate Treatment
3.3.1 Empirically Supported Treatments for OCD
3.4 Factors that Influence Treatment Decisions
3.4.1 Age
3.4.2 Gender
3.4.3 Race
3.4.4 Educational Level
3.4.5 Patient Preference
3.4.6 Social Support
3.4.7 Clinical Presentation
3.4.8 OCD Symptom Theme
3.4.9 Insight
3.4.10 Comorbidity
3.4.11 Treatment History
3.5 Presenting the Recommendation for CBT

4 Treatment

4.1 Methods of Treatment
4.1.1 Functional Assessment
4.1.2 Self-Monitoring
4.1.3 Psychoeducation
4.1.4 Using Cognitive Therapy Techniques
4.1.5 Planning for Exposure and Response Prevention
4.1.6 Implementing Exposure and Response Prevention
4.1.7 Ending Treatment
4.2 Mechanism of Action
4.3 Efficacy and Prognosis
4.4 Variations and Combinations of Methods
4.4.1 Variants of CBT Treatment Procedures
4.4.2 Combining Medication and CBT
4.5 Problems in Carrying out the Treatment
4.5.1 Negative Reactions to the CBT Model
4.5.2 Nonadherence
4.5.3 Arguments
4.5.4 Therapist’s Inclination to Challenge the Obsession
4.5.5 When Cognitive Interventions Become Rituals
4.5.6 Unbearable Anxiety Levels During Exposure
4.5.7 Absence of Anxiety During Exposure
4.5.8 Therapist Discomfort with Conducting Exposure Exercises

5 Case Vignettes

6 Further Reading

7 References

8 Appendix: Tools and Resources