Giselle BrookCognitive Behavioural PsychotherapistJoe CurranPrincipal Cognitive Behavioural PsychotherapistTom RickettsCognitive Behavioural Psychotherapist/Consultant Nurse

Obsessions and CompulsionsObsessions: Thoughts urges or images

that are experienced as unwanted, intrusive and out-of-character

Compulsions: Repetitive intentional behaviours or mental acts that are often linked to obsessions and serve to reduce discomfort or anxiety

Exposure & Response Prevention (ERP) for OCDERP is an effective psychological

treatment for OCD (Abramowitz,1997)

However up to 30% of participants do not benefit from ERP, and a further 15-20% withdraw from treatment (Foa et al 1983)

‘Recovery’ as defined using the Y-BOCS occurs for perhaps 50-60% of completers in ERP (Foa, 2005)

Rationale for an ACT-informed Group for OCDLow levels of psychological flexibility is a key

aspect of OCD phenomenologyPeople suffering from OCD often are working

very hard to ‘control’ obsessionsValued aspects of life are often severely

disrupted by OCD, put on hold pending symptom relief

Experiential avoidance is evident ( Trowhig, Hayes, Masuda 2006 )

Client GroupClients with longstanding ‘treatment

resistant’ problems with OCDA majority have received prior CBP, generally

ERP

Structure and Group ProcessIndividual pre-group meetings to discuss

group attendance , assessment and completion of measures

12 x 2 hr groups, new material during each of the first 10 sessions, then negotiated revision

Overall content predetermined, ordering and emphasis varied according to group needs

Strategies to gradually enhance willingness to disclose experiences to each other, make behavioural commitments and feed back

MeasurementPre, mid, end and 3-month f/upYale-Brown Obsessive Compulsive ScaleLife Adjustments Scale (5-item)Acceptance and Action questionnaire

Phase 1: Creative HopelessnessDifferentiating obsessions and compulsionsWhat works?Tug-of-war with a monsterPerson-in-a-holeWhat is digging for you?

Phase 2: Willingness & De-FusionWillingness as an alternative to controlThe two scales of anxiety and willingnessAcceptance of thoughts and feelingsWillingness to have obsessionsWord repetitionDe-fusing self-evaluation

Phase 3: Values & Barriers to Valued LivingValued Living questionnaireDiscrepancy between values and actionsLife compassBarriers to achieving valued livingValues guided behavioural commitmentsPassengers on the bus

Phase 4: PersonalisationSelecting the approaches which suit youPersonal plansContinued application of acceptance and

action strategies through follow-up

Case Study 1: Background48 yr old divorced woman15 year history of obsessions regarding

contamination, hand-washing cleaning and avoidance

Reported disruptions of relationships, home life and loss of job associated with OCD

Case Study 2: InterventionCreative hopelessness associated with

reported surprise at the idea that mental events may not be controllable

Values work associated with client reporting increased focus on time for self and time with children

Acceptance of thoughts and feelings associated with reported increased willingness to have obsessions

In-session willingness exercise associated with reduced avoidance and increased behavioural change between session

Our LearningACT is congruent with ERP approachesDifferent people take different things from

the approaches - formulation mattersThe group is an excellent vehicle for

addressing the ‘unacceptability’ of certain mental events

Experiential approaches are most effectiveAbandoning the control agenda is difficult for

people suffering from OCD (and us)

Next StepsComplete three-month follow-up on the

current groupReport the resultsMaintain the focus on ‘treatment non-

responders’ as we deliver further groupsMaintain the tertiary care focus of the service

in line with NICE guidelines