Intensive EX/RP treatment, rapid relief of obsessive-compulsive disorder in one month

Cognitive model analysis of patients with obsessive-compulsive disorder:

For patients with obsessive-compulsive thinking, Intrusive obsessive thoughts trigger some of his negative automatic thoughts. That is, intrusive obsessive thoughts can trigger some negative, negative, and even catastrophic thoughts in patients. When these unacceptable intrusive thoughts interact with the patient's own belief system and trigger negative automatic thoughts, they can cause anxiety and distress in the patient. An exaggerated sense of responsibility and self-blame are central themes in the belief systems of people with OCD. Patients with obsessive-compulsive disorder generally have the following five dysfunctional beliefs:

1. Whatever behavior comes to mind, this behavior may be performed.

For example: when someone is driving and suddenly thinks that he will hit a pedestrian or a tree on the roadside (this is intrusive obsessive thinking), he will think that such a thing is likely to happen. happened, and then thought of the serious consequences of this incident, resulting in fear, pain and anxiety; so he tried every means to control himself not to have such thoughts, but the result was that he could not control it at all, which further aggravated his of fear, pain and anxiety.

2. If you are unable to stop the thought of harming yourself or others, your crime is equal to the culprit who committed the harm.

For example: A person often has images of family members being killed or dead in his mind (intrusive obsessive thoughts). Although such a thing has not happened, he cannot control his thoughts and will think that he The guilt is equal to that of the culprit who actually committed the harm.

3. Other factors will not weaken your responsibility.

For example: A person is afraid that he will bring germs home and infect his family, so he washes them repeatedly. If he/she or a family member gets sick, it is due to other factors, not because he/she brought the germs home. But he will still think that it is entirely his/her responsibility.

4. If an intrusive thought occurs but is not suppressed, it is equivalent to hoping that such a thing will happen.

For example: A person often thinks about having sex with his family or some acquaintances (intrusive obsessive thinking). He cannot control these thoughts and thinks that he really wants such a thing to happen. , and thus feel that one is a morally corrupt person, and then have the idea of ????self-blame, causing one's own pain and anxiety.

5. People should learn to control their thoughts

For example: someone has a lot of obsessive thinking and compulsive behavior. He thinks it is caused by his own thoughts, and he should be able to Control these thoughts of yours. However, in fact, the reason why it is called compulsion is because it is beyond control. However, patients have intense inner conflicts because they cannot control their thoughts. He could not attribute this phenomenon to obsessive-compulsive disorder.

EX/RP therapy:

EX/RP therapy is currently recognized as the most effective treatment method for obsessive-compulsive disorder in the world. An initial follow-up study on 15 obsessive-compulsive disorder patients found that it was very effective for 10 of the obsessive-compulsive disorder patients and also had a comparable effect on the other five obsessive-compulsive disorder patients. A follow-up investigation after 5 years found that only 2 of the 15 people relapsed. A study of 330 patients who completed EX/RP treatment found that 86% of patients experienced significant symptom relief. A 29-month follow-up survey of 376 obsessive-compulsive disorder patients who completed EX/RP treatment found that 76% of the patients maintained significant efficacy.

Among the 17 patients with obsessive-compulsive disorder who I have treated with EX/RP therapy, 12 had very significant results, 4 had satisfactory results, and 1 had no effect (his underlying disease was severe depression) disease, the treatment plan has been modified to first conduct cognitive therapy for his depression).

Preparation before EX/RP treatment:

1. Since most patients with obsessive-compulsive disorder have a long course of disease, usually more than ten years, it is their first time to actively seek treatment. The average time of onset is 7 years after the first onset of illness.

Due to the long course of the disease, they can no longer remember most of the circumstances when the disease first occurred, and it is also difficult for them to recall the things or thoughts they feared at that time. What can be observed now and what the patient himself can self-aware is only the current content of obsessive thoughts and compulsive behaviors. Moreover, due to the transfer and generalization of compulsions, the current content of compulsions is also very different from the initial onset. This requires Before starting EX/RP treatment, the therapist needs to spend a certain amount of time using professional psychotherapy techniques to explore and explore the patient's external fear cues, internal fear cues, fear consequences, the strength of beliefs, avoidance behaviors and ritual behaviors. Evaluate.

2. Almost all patients with obsessive-compulsive disorder have a history of extensive psychotherapy and drug treatment, and some patients have also received treatments similar to EX/RP. Many people have lost faith in treatment. At this time, it is necessary to conduct a detailed investigation of the impact of previous treatments on the patient, and analyze previous unsuccessful experiences and what aspects were effective. We need to let patients know that the past does not equal the future, and that previous unsuccessful treatments do not mean that future EX/RP will also be ineffective, and help patients build confidence in treatment.

EX/RP treatment principle:

1. Break the wrong connection between the situation and the negative emotional experience

Expose the patient to fearful thoughts repeatedly and for a long time and situation, this will provide the patient with rich information, break the original wrong connection, correct the negative evaluation that the patient has always held, and ultimately promote the patient's habituation to previous threatening stimuli. Help patients experience and believe that what they fear is not as terrible as they imagine, and the consequences are not as serious as they imagine. Eventually normal behavioral response patterns are established.

2. Break the wrong connection between obsessive-compulsive behavior and alleviating the patient's pain

Obsessive thinking causes pain, while obsessive actions can reduce this pain. For example, patients who are forced to wash their hands and check repeatedly, their pain and anxiety are relieved after performing the compulsive behavior. As a result, the patient believes that this compulsive behavior is the only effective way to relieve anxiety and pain. This allows obsessive behaviors to become fixed and developed. The purpose of treatment is to break the erroneous connection between the obsessive-compulsive behavior and the relief of the patient's pain, so that the patient can experience and believe that his or her pain and anxiety can be relieved without committing the obsessive-compulsive behavior.

If all conditions permit, the implementation of intensive EX/RP treatment can significantly alleviate the patient's obsessive-compulsive symptoms within one month, followed by consolidation treatment and relapse prevention treatment in one to two years.

Note: The following three types of obsessive-compulsive disorder patients are not suitable for immediate EX/RP treatment

1. Patients with alcohol dependence or substance abuse, before receiving EX/RP treatment, finally Get relevant treatment first.

2. Patients with obvious delusions and hallucinations are not suitable for EX/RP treatment.

3. Patients with severe depression should first receive treatment for depression before EX/RP treatment. (30% of obsessive-compulsive disorder patients suffer from concurrent depression, which requires therapists to make accurate judgments and assessments before implementing EX/RP treatment)

About drug treatment:

Research At least 60% of patients taking selective serotonin reuptake inhibitors were found to respond. But on average, the therapeutic effects achieved were moderate at best. Moreover, the improvement of obsessive-compulsive symptoms requires maintenance of medication. In a carefully controlled, double-blind study, 90% of patients relapsed a few weeks after stopping the drug clomipramine.