(C)BT of OCD.

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OCD Facts. 1990 WHO study - OCD recorded as fifth in infection trouble for ladies matured 15-44Estimated lifetime pervasiveness rates 2-3%, 6-month point commonness - 1.6%Impaired nature of lifeDelay in suitable treatment. Demographics. Period of onset - prior for men (19 yoa) contrasted with ladies (22 yoa)Gender proportion - approx equivalent as adultsCourse - lion's share are rambling with inadequate abatement and a little p
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(C)BT of OCD Adam C. Chodkiewicz MD FRCP(C) Maureen L. Whittal, Ph.D UBC Hospital November, 2006

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OCD Facts 1990 WHO study - OCD recorded as fifth in illness trouble for ladies matured 15-44 Estimated lifetime commonness rates 2-3%, 6-month point pervasiveness - 1.6% Impaired personal satisfaction Delay in proper treatment

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Demographics Age of onset - prior for men (19 yoa) contrasted with ladies (22 yoa) Gender proportion - approx equivalent as grown-ups Course - dominant part are long winded with fragmented abatement and a little rate logically disintegrate

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Comorbidity 1/3 comorbid with dejection 24% with another tension issue 8% with a dietary problem 5% with tourette\'s

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Assessment of OCD YBOCS Obsessive Compulsive Inventory Padua Inventory (PI-WSUR) Obsessional Belief Questionnaire Interpretations of Intrusions Inventory Personal Significance Scale (PSS)

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YBOCS Gold standard treatment result measure Obsessions subscale and impulses subscale. Scores range from 0-40. 0-7=subclinical, 8-15=mild, 16-23=mod, 24-31=severe, and 32-40=extreme

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OCD Subtypes Contamination and questioning most normal fixations took after by substantial, requirement for symmetry, hostility, and sexual interruptions Checking and washing most regular impulses took after by numbering, the need to admit, requesting, and storing

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Forms of Obsessions Thoughts Ideas experienced as unsatisfactory or undesirable (e.g., thought of cutting my kid) Images Mental perceptions that are experienced as upsetting or troubling (e.g., one\'s elderly grandparents engaging in sexual relations) Impulses Unwanted inclinations or thoughts to act in unseemly routes (e.g., to holler obscenities)

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Typical Content of Obsessions Violence Impulse: to assault a defenseless individual Image: adores one\'s being dissected Impulse to go after a cop\'s firearm Sex Impulse: to gaze at people groups\' private parts Thought: what it resembles to be gay person Blasphemy and heresy Image: Jesus with an erection on the cross Thought: God is dead

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What is NOT an Obsession Worries about genuine issues (e.g., work) Depressive ruminations Recurrent appetitive sexual dreams Jealousy Preoccupation with another auto, beau, and so forth. Yearnings to bet, take, drink liquor, and so forth

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Mental Rituals (Neutralization) versus Fixations Often mistook for each other Obsessions are meddling, undesirable musings that summon uneasiness or trouble Mental ceremonies are planned mental acts intended to kill or diminish nervousness or misery

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Compulsions Overt or incognito reactions to interruptions Designed to balance the fixation and to diminish the tension the last creates Sense of having \'no decision\', is tedious, exorbitant and silly Egs incorporate checking, washing, rehashing, tallying, requesting, noiseless asking and so forth

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Learning Theory View of OCD Obsessions offer ascent to nervousness or pain Compulsions lessen obsessional uneasiness The execution of impulses keeps the elimination of obsessional nervousness Compulsions are adversely fortified by the brief decrease of uneasiness they cause

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Behavior Therapy Techniques In vivo (situational) introduction Gradual encounter with circumstances that inspire obsessional contemplations Imaginal presentation Gradual showdown with the undesirable considerations (by means of circle tapes, and so on.) Response counteractive action Refrain from killing, mental customs, consolation looking for, and thought control systems, and so forth.

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Criteria for Fear Reduction During Exposure Therapy Elicit dread Allow habituation to happen Provide remedial data

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Exposure and Response Prevention (ERP) Psychosocial treatment of decision not long after it was created in the 1960s Establish a trepidation chain of command starting with generally simple things and slowly getting more troublesome Graduated presentation to triggers and habituation of apprehension reaction

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The Treatment of Fear Exposure to fear-evoking boosts or circumstances Abstinence from departure/shirking practices Anxiety increments at first, trailed by habituation

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What Happens During Exposure Therapy?

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Setting Up the Treatment Plan Generate rundown of circumstances and contemplations that would summon uneasiness and desires to kill Patient rates subjective units of inconvenience (SUDS) for every circumstance or thought Collaborative exertion in creating presentation chain of importance Start with circumstances of moderate trouble Highest things must be incorporated Situations are reasonably protected, yet will bring out obsessional pain

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Treatment result utilizing ERP Approximately 80% of treatment completers report advantageous impacts Up to 6 years taking after treatment roughly 70% of individuals keep up their additions However, ERP is not a panacea

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Problems with ERP "advantage" is characterized as a 30% decrease in YBOCS High refusal/drop out rate Particularly risky for individuals who experience the ill effects of essential fixations

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Cognitively engaged treatment of OCD Based on information that undesirable meddling considerations are ordinary It\'s not the interruption that causes the tension and the enthusiastic conduct, yet the examination of the interruption Goal is to psychologically challenge evaluation and distinguish less debilitating evaluations

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CBT model for the upkeep of OCD Trigger Leaving the house Intrusive thought On, open, or unplugged? Evaluation My flaw if something terrible happens Distress Anxiety/dread Compulsion Checking

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Overimportance of contemplations Having a musings means it\'s essential Likelihood thought activity combination (having the idea makes the result appear to be more probable) Moral thought activity combination (having the idea and taking part in the demonstration are equivalent)

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Thought Action Fusion (TAF) Likelihood self - on the grounds that I\'ve had the musing it will probably transpire probability others - in light of the fact that I\'ve had the musing, it will probably transpire (e.g., MVA) moral - the musing is as unpardonable as the activity

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Challenging probability TAF Thought tests - e.g., intentionally having an antagonistic pondered something awful transpiring yourself or something progressing rundown of "hunches" and their result

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Challenging good TAF Continuum standardization of ITs List characteristics of a decent and awful individual Identification of a conceivable twofold standard

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The need to control considerations The part of thought concealment and consideration Belief that I should be in control of my musings and feelings at all times Experiences a typical meddlesome thought, yet assesses it as unsafe Further endeavors to control considerations Efforts are made to battle, control, smother, occupy, or kill the idea Not making enough of an effort to control considerations Notices more ITs Increased carefulness or consideration

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Challenging the requirement for thought control Set up an exchanging days test where half of the days are "battle and stay" and the other half are "travel every which way" have patients make forecasts early

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The Catch 22 of thought control The communication between regard for contemplations and the recurrence of musings consideration tests

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Challenging obligation with piecharting Me 10% Wife 5% Toy creators half Son 20% Weather 10% Playmate 5%

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Challenging overestimations of threat

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