Cognitive behavioral therapy for obsessive compulsive disorder. CBT for OCD (ERP in OCD)

Dr. Suresh Badmat, a professor of psychiatry at NIMHANS Bangalore, introduces the topic of cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD). He clarifies that the presentation is academic and for training purposes only, and advises consulting a psychiatrist for clinical opinions. The video discusses the steps of CBT, its efficacy, and tips for therapists administering treatment. It references the Indian Psychiatric Society's 2017 clinical practice guidelines and highlights the challenges in India due to a limited number of trained clinical psychologists. The video also mentions a study showing the benefits of CBT for SSRI non-responders and discusses the neurological changes associated with CBT.

The script explains the medical and cognitive models of OCD, emphasizing the importance of understanding the neurochemical imbalance in the brain and the overestimation of threat or responsibility by the patient. It outlines different therapy types, including Exposure and Response Prevention (ERP), cognitive therapy, and their combination in CBT. The video aims to simplify CBT steps for therapists and discusses common cognitive errors in OCD, such as thought-action fusion and inflated sense of responsibility, which are crucial to address during therapy.

This paragraph delves into the cognitive errors commonly seen in OCD, such as perfectionism and overestimation of danger, and the emotional responses that accompany them, including anxiety, disgust, and guilt. It also covers behaviors like compulsions, safety behaviors, and avoidance. The importance of recognizing and addressing these elements in CBT is stressed, as they are key to understanding and treating OCD effectively.

CBT is framed as a training program in this section, with the patient required to practice therapeutic techniques at home to reinforce the training received during sessions. The video outlines the structure of CBT sessions, including intake, assessment, psychoeducation, and the importance of consistent practice. It also discusses different therapy formats, such as individual, group, and self-therapy, and emphasizes the time-bound nature of CBT, typically requiring 16 to 30 sessions over several months.

The importance of family involvement in CBT is highlighted, with family members acting as co-therapists, supporting and monitoring the patient's progress at home. The video discusses the negative impact of family accommodation of OCD symptoms and the benefits of family psychoeducation. It stresses the need to educate families about OCD and to involve them in the treatment process to improve outcomes.

Psychoeducation is a critical component of CBT, covering the medical model of OCD, epidemiology, symptoms, comorbidity, and the role of stress. The video script explains the importance of setting realistic expectations for therapy progress, which often involves fluctuations rather than a straight line of improvement. It also discusses the role of family members in supporting the patient's therapy journey and the importance of addressing substance use and other treatment considerations.

Habituation, the process of reducing response to a stimulus through repeated exposure, is explained with examples such as fear of the dark or water. The video emphasizes the importance of understanding and applying the principle of habituation in CBT for OCD, as it helps patients learn to tolerate anxiety and reduce compulsive behaviors over time.

This section introduces the ERP activity scheduling book, a tool for monitoring and documenting the patient's progress in CBT. It outlines a seven-column schedule for recording details of exposure activities, including time, anxiety levels, and compulsions performed. The script stresses the importance of consistent documentation and the role of family members as co-therapists in monitoring the patient's daily progress.

The script discusses strategies for cognitive challenging, which involves questioning and challenging the irrational thoughts and beliefs associated with OCD. It provides examples of how to use Socratic questioning to help patients reassess the likelihood and impact of their feared outcomes, thereby reducing the intensity of their obsessions and compulsions.

Audio exposure is presented as an effective technique for treating sexual obsessions in OCD. The process involves creating a detailed script of the obsessions, recording it, and having the patient listen to it repeatedly to habituate to the anxiety it provokes. The video script outlines the steps for preparing and using audio exposure and the importance of patient consent and modification as needed.

The final paragraph discusses the progression of CBT sessions, including feedback, family involvement, and planning for booster sessions. It also addresses the importance of relapse prevention and the continuation of medication. The video script highlights the barriers to CBT, such as the lack of qualified psychologists, patient refusal, and the challenges of maintaining therapy compliance. It concludes with a reminder of the importance of practice and the role of family members as co-therapists in the success of CBT for OCD.