The Obsessive-Compulsive Disorder Center uses a cognitive-behavioral therapy (CBT) approach, with the main emphasis being a technique called exposure and ritual prevention (ERP). In addition to ERP, cognitive restructuring strategies are also taught.
According to the goals and objectives of their individualized treatment plan, patients may participate in the following components:
Our program uses a highly structured program of exposure and, for obsessive-compulsive disorder (OCD), ritual prevention. Exposure is the graduated, repeated confrontation of feared situations, objects or ideas. Ritual prevention is blocking the typical response before, during, and after exposure so habituation can take place. Based on the principle of habituation, our program seeks to prolong the exposure until the fear reduces on its own accord with the passage of time.
To maximize its effectiveness, this process must be:
- Prolonged enough to lead to within trial habituation (at least 50% reduction in anxiety)
- Repetitive enough to lead to between trial habituation (until it causes minimal to no anxiety)
- Graduated enough to increase compliance
Patients learn how to identify and correct errors in thinking that generate anxiety and depression. This is accomplished through a series of steps including the use of individual therapy, group therapy and specialized exercises to provide the structure necessary.
Community Outings and Therapeutic Passes
With physician approval, patients have opportunities to practice newly acquired strategies in “real life” settings through supervised outings and therapeutic passes with clinical staff or family members. These experiences are useful for patients in reducing anxiety and easing their transition and integration back into their home communities.
Daily Living Skills Training
This realistic aspect of living is a crucial component to overcoming OCD and helps to create a sense of belonging to the residential community. Patients practice independent living skills by having the responsibility of maintaining their bedrooms, washing their personal laundry and linens, and jointly being responsible for care of their living areas. If a patient is unable to do a certain task because of his or her OCD, assistance will be given until he or she is able to accomplish the task.
Each patient may participate in a range of experiential therapy groups during the week. Experiential therapy may include art, music and recreation components that assist in exploring communication, cooperation and problem-solving skills in a variety of settings. These therapies provide opportunities for patients to develop self-awareness, critical decision making skills and increase personal responsibility.
Family Education and Therapy
Families are a vital part of patients’ treatment and successful transition back home. Family members become involved by learning about the illness, its consequences and how to support their loved one during the ongoing recovery process. Families participate in weekly therapy. During these sessions the patient’s illness is considered within the context of the family’s communication patterns, value and belief system, rules, roles and expectations.
Patients participate in group psychotherapy to review assignments daily. A process group is held twice weekly to help patients focus on conflict resolution, effective coping strategies, relapse prevention and discharge planning/continuing care.
Each patient is assigned to a core clinical team consisting of psychiatry, nursing and behavioral specialist staff that develop the treatment goals and exposure hierarchy, then facilitate and monitor the patient’s progress. Patients meet with a member of their team at least twice each week to address treatment issues, refine their exposure hierarchy and discuss the course of treatment.
The psychiatrist will meet with the patient to complete a comprehensive psychiatric evaluation, which includes history, diagnosis and treatment recommendations. Subsequently, the psychiatrist will meet once or twice per week with the patient to monitor medications and review medical status. During these sessions, the psychiatrist also discusses treatment progress, obstacles, and provides guidance and support.