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Took A levels this year (AAB) and one AEA Manchester born and bred but moving in 3 weeks! Will study French w/ psychology modules Hoping to become a CBT therapist or policewoman! OCD sufferer for many years No kids, one extremely spoilt cat...\6& And a little bit about Roz Ph.D. studying OCD Worked in anxiety and eating disorders Clinical Psychologist Funded by Wellcome Trust Works in Oxford 2 kids, no pets& ..Z  ( OCD OBSESSION: unwanted intrusive thought, image or urge, which repeatedly enters the person s mind. Aggressive, sexual, blasphemous themes Obsessions in young people are particularly fluid i.e., many different ones over time ZWb~ ]LJo - A personal example of obsessions& & zAge 10 - felt the need to  confess to my mum Age 15 onwards - contamination obsessions Age 17 onwards - fear of harming others, incl. people and animals Other minor obsessions, very fluid ^2Really important to know&  Intrusive thoughts are normal No difference in content between such thoughts in people with OCD Differ in terms of intensity, frequency, distress and ease of dismissal _jJo s thoughts on intensity, frequency and distress...5  Has been very important for me to learn that intrusive thoughts are normal Difference between sufferers and non-sufferers is that they can  let the thoughts go Definitely find that OCD obsessions worsen in intensity, frequency and distress when I m under stress.D Compulsions  aRepetitive behaviours or mental acts that the person feels driven to perform. A compulsion can either be overt and observable by others, such as checking that a door is locked, or a covert mental act that cannot be observed as in repeating a certain phrase in the mind. Again, fluid over time esp. in young people Checking, cleaning, repeating common bb. P `@Jo s long list of compulsions...   Confessing Excessive washing - hands, clothes etc Throwing away  contaminated objects Avoidance of certain activities which I used to enjoy Avoidance of particular places Checking behind me to make sure I haven t harmed anyone  Rituals and Ruminations The term  ritual is synonymous with compulsion but usually refers to behaviours that other people can see. The term  rumination refers to prolonged thinking that is experienced as uncontrollable around and around the same subject. It includes both intrusive thoughts, often in the form of doubts or questions, and repeated attempts to find an answer. In this way it covers both the obsession (the doubts or question) and the accompanying compulsive thinking which attempt to answer the question. "ZF a8Jo on Rituals & Ruminations&  For me, my rituals are the same as the physical compulsions that I do (e.g. washing) Also have ruminations - I re-run situations in my head, trying to be certain that nothing is wrong / has happened$%  How common is it? 2-3% likely to be overestimate High comorbidity with other disorders e.g., depression (Abramowitz, 2004) Similar presentation in children and adults.$   e bJo and her other problems... Anorexia aged 13/14 Clinical Depression for approx. 2 years but only recent diagnosis. OCD & Depression disabled me to the point that I spent several days in hospital during the last year Self-harmed on and off from Jan 2003 - June 2005. Currently been stopped for over 10 weeks! Diagnosis  <Secrecy Misdiagnosis Depression Tourettes Syndrome Dementia&''.!    cJo s Diagnoses Self-diagnosed as having OCD aged 15 but looking back now can see it earlier Diagnosed with OCD by a psychologist at age 16 Diagnosed as suffering from Depression by a psychologist and CPN, aged 18 o:Jo s Secrecy and Misdiagnosis  Mother s refusal to admit my OCD Wasn t until 3rd visit to GP that I managed to tell her I had OCD Depression misdiagnosed as an  adjustment disorder in April 2005 by a consultant psychiatrist. Thankfully, other professionals have always correctly diagnosed Depression   9,"Children & Adolescents: Medication##&" Drugs most commonly used for children and young people with OCD are the same as those used for adults, including the SSRIs, and clomipramine is also used for young people. SSRIs are effective in treating children and young people with OCD. With depression SSRIs can cause significant adverse reactions, including increased suicidal thoughts and self-harm, although they may be safer when combined with psychological treatments. "ZPu !QdJo and her drugs!?! Used to be very reluctant to take medication Finally took Fluoxetine/Prozac (Oct 2004 - April 2005) but it seemed to be having no effect after a while Currently taking Citalopram/Cipramil, which seems to be working well Consultant s insistence about Clomipramine>: e? ;.2Children and Adolescents: Psychological treatments33&2 Cognitive-behaviour therapy (CBT), based on principles of exposure and response prevention (explained in next couple of slides), is treatment of choice. Published protocols exist e.g., March & Mulle, 1998 Useful to involve family Long waiting listsP.  4 e@Jo s Psychological Treatments...  3rd psychologist that I have seen Very important to find someone whom the sufferer trusts and feels able to be open with Sufferer needs to be ready to tackle their OCD Currently receiving CBT (only had 2 sessions so far though!)q!Other support for Young People... " Can be helpful to liase with the school re: OCD Extra support can be given, e.g. someone to talk to at school (school nurse) Special consideration for exams Understanding that stress & pressure often exacerbate OCD Friends can be a great help in the OCD battle  rExtra Support for Jo...  \School nurse - someone to talk to Form tutors Sixth form assembly Other unknowing helpers... ] UEVFBehavioural theory  Normal learning processes maintain the obsession-compulsion cycle Normal learning processes can break the obsession-compulsion cycle WG"What is behaviour therapy for OCD?3 Exposure to feared stimulus Response prevention XH E.g. Washing Exposure to feared stimulus - touching a  dirty tissue Response prevention -  not washing hands YIE.g., CheckingW Exposure to feared stimulus - shutting the window Response prevention - not checking ZJObsessional Thoughts D Exposure to feared stimulus - the thought itself e.g., unwanted sexual/blasphemous/aggressive image Response prevention e.g., not  cancelling out /neutralising ,  [K How does behaviour therapy work?b Person learns that anxiety will decay spontaneously ?? Physiological process of habituation?? \LFace Everything And Recover|LL LLgJo s CBT...  Currently receiving CBT with a clinical psychologist once per week Had 2 sessions so far Wrote down my beliefs about my obsessions and compulsions Exposure and Response Prevention (see next slide)pLJo s Exposure & Response Prevention... ' ~Too anxious to carry out the ERP myself, therefore therapist did so ERP which therapist carried out Asked how likely I thought it was that it could cause illness (the thing I fear hence I do all these compulsions) She is 100% certain that no harm will come to her or anyone else Will be seeing her on Tuesday, at which point if she is not ill I will have to re-think my OCD beliefs!  ]M Limitations of behaviour therapyPeople find it aversive and don t want to do it (?what? Do the thing that I m most afraid of? Risk the lives of my family? Are you nuts?) It doesn t seem to work for a significant number of people, particularly those with obsessions and mental compulsions Doesn t really explain why people with OCD have SO many of the thoughts hJo on Behaviour Therapy... JAt first, terrified that I would be told the OCD fears were real fears and not  just a thought When told what exposure and response prevention the therapist wanted me to do, I replied,  are you sure it s safe? Are you mad?!? Once you realise it s OCD and not you, it loses its power over you3^NCognitive-behaviour theorySame starting point as behaviour therapy - don t want to throw the baby out with the bathwater Everyone has intrusive thoughts It is the meaning placed on these intrusive thoughts that is critical (i.e., appraising the intrusion in terms of being responsible for harm or its prevention; Salkovskis, 1985; Rachman, 1997).&B.2 _U Appraisals The meaning placed on obsessions E.g., Having these thoughts mean that I am going mad This thought means that I am a bad person This thought means I m dangerous I ve lost control of my thoughts - I might lose control of myself Now that I ve had this thought, I m responsible if anything bad happens This thought means that something bad is about to happen These thoughts mean that if anything bad happens, it will be my fault This thought is important. I should pay attention to it This thought means I should check again This thought means I should wash my hands again Z4!  )iZJo s Appraisals as written at start of CBT...- This thought is definitely true I should listen to this thought Since I have had this thought, if anything bad happens because of me not listening to it then it will be my fault No-one else gets these thoughts I must be a bad person for having these thoughts aPCognitive-behavioural treatment  AIM: to obtain personally salient evidence that the obsessions are unimportant and that it is the reaction to the obsessions (compulsions, suppression, avoidance, monitoring for threat, neutralising) that increases their frequency and increases distress in the longer term  L@2CBT Consensus guidelines have suggested between 13-20 weekly sessions (March et al, 1997). Different modes of delivery  Good response rate (>35% on clinician rated YBOCS) but many do not accept the treatment or drop-out due to demands When taking into account those who refuse or dropout of treatment and those who do not benefit immediately or relapse, researchers have estimated that those treated successfully with behaviour therapy is around 55% (Stanley & Turner, 1995). 8PWW j Jo on CBT...  L1 session per week initially, to provide regular support and input for the sufferer Once treatment has finished, perhaps occasional  refresher sessions Sufferer needs to be ready to face their OCD. Aged 16 I couldn t face the CBT and mistakenly hoped that OCD would go away of its own accord J;Combination treatments These results suggest that adults with OCD should be offered the possibility of combined treatment. For children and young people CBT should be offered first, but that combined treatment may also be offered. DPNPPNl$A word about NICE&  |National Institute for Clinical Excellence& . www.nice.org.uk B?.    <.      0.93!&NICE Clinical Practice Recommendations''&& Treatment and care should take into account the individual needs and preferences of people Provision of information, treatment and care should be tailored to the needs of the individual, culturally appropriate, and provided in a form that is accessible Healthcare professionals should inform people with OCD and their family and carers about local self-help and support groups, and encourage them to participate in such groups where appropriate. Because OCD often has an impact on families and carers, healthcare professionals should promote a collaborative approach with the person with OCD and their family or carers Family members and carers should be provided with good information (both verbal and written) about the disorder, its likely causes, its course and treatment. :PLPMpmNICE Jo? Important to have central guidelines for professionals, sufferers and carers Used NICE guidelines to help me decide whether to stay on SSRIs or switch to Clomipramine Unfortunately it seems that perhaps not all professionals are up-to-date with the NICE guidelines>F; cB4:Roz s summary and conclusions"  `OCD similar in young people to adults Treatment different i.e., psychological treatment first Not use specific medication if depressed Theory and reality don t always tie in!! n8Jo s summary and conclusions Sufferer needs to be reassured that their worries are OCD and not them I feel that CBT should definitely be offered, regardless of whether or not medication is prescribed Useful to involve others e.g. school Be patient! Recovery can take a while but is well worth it! 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