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Treatments for obsessive-compulsive disorder: deciding what method for whom
- Authors:
- ABRAMOWITZ Jonathan S., SCHWARTZ Stefanie A.
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(2), Summer 2003, pp.261-273.
- Publisher:
- Oxford University Press
The aim of the present paper was to address variables that should be considered in deciding the optimal treatment modality for individual patients with obsessive-compulsive disorder (OCD). We begin by briefly discussing strengths and limitations of the various empirically supported treatments for this disorder. Next we discuss general factors, such as demographics and familial support, that may contribute to the treatment decision-making process. Following this, we describe factors related to the presentation of OCD (e.g., insight, comorbidity) that may impact such decisions. It is important to rely on both empirical findings and informed clinical judgment when deciding which treatment(s) to recommend for patients. For this reason, familiarity with the research literature as a backdrop to thoroughly assessing the relevant variables is imperative for clinicians working with OCD patients.
Understanding the suicidal brain
- Authors:
- VAN HEERINGEN C., MARUSIC A.
- Journal article citation:
- British Journal of Psychiatry, 183(10), October 2003, pp.282-284.
- Publisher:
- Cambridge University Press
It has been suggested that the key to preventing suicide is not in the study of the brain, but in the direct study of the human emotions. However, recent advances in neuroscience are providing support for a theory of human emotions that implicates increasingly well-defined brain regions.
Standardised Assessment of Personality – Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder
- Authors:
- MORAN Paul, et al
- Journal article citation:
- British Journal of Psychiatry, 18(9), September 2003, pp.228-232.
- Publisher:
- Cambridge University Press
There is a need for a brief and simple screen for personality disorders that can be used in routine psychiatric assessments. The aim was to test the concurrent validity and test–retest reliability of a brief screen for personality disorder. Sixty psychiatric patients were administered a brief screening interview for personality disorder. On the same day, they were interviewed with an established assessment for DSM–IV personality disorder. Three weeks later, the brief screening interview was repeated in order to examine test–retest reliability. A score of 3 on the screening interview correctly identified the presence of DSM–IV personality disorder in 90% of participants. The sensitivity and specificity were were 0.94 and and 0.85 respectively. The study provides preliminary evidence of the usefulness of the screen in routine clinical settings
Assessment of obsessive-compulsive disorder and spectrum disorders
- Authors:
- STEKETEE Gail, NEZIROGLU Fugen
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(2), Summer 2003, pp.169-185.
- Publisher:
- Oxford University Press
This paper summarizes a variety of assessment tools for use with obsessive-compulsive disorder (OCD) and obsessive-compulsive (OC) spectrum conditions. The description of instruments and methods of assessment is intended to help clinicians identify measures that might be especially useful in determining, first, what problems to address in treatment and, second, whether therapy is having the desired effect. Included are clinician interviews, self-report questionnaires, clinician-rated forms, and behavioral observations and self-monitoring by the patient. These cover patients' presenting symptoms, comorbid conditions, mood, ability to function, family aspects, and cognitive factors including insight, beliefs, and motivation. Clinicians are encouraged to provide immediate feedback about patients' responses to interviews, questionnaires, and behavioural measures so that they understand the purpose of the instrument and its relevance to their treatment.
Cognitive treatment of obsessions
- Author:
- WILHELM Sabine
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(2), Summer 2003, pp.187-199.
- Publisher:
- Oxford University Press
This article briefly describes the nature and prevalence of obsessions without overt compulsions, and it reviews a cognitive model and cognitive domains relevant for OCD. A case example highlights the application of cognitive strategies for obsessions without overt rituals.
Self-injurious skin picking: clinical characteristics, assessment methods, and treatment modalities
- Authors:
- DECKERSBACH Thilo, WILHELM Sabine, KEUTHEN Nancy
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(2), Summer 2003, pp.249-260.
- Publisher:
- Oxford University Press
Self-injurious skin picking is characterized by repetitive, ritualistic, or impulsive skin manipulation that results in tissue damage. It occurs in the absence of an underlying dermatologic condition and causes significant distress or impairment in daily functioning. The present article reviews the clinical characteristics of self-injurious skin picking, methods for assessing this problem, and modalities of treatment. A clinical vignette describes the implementation and outcome of cognitive-behavioral therapy for a patient with self-injurious skin picking and comorbid body dysmorphic disorder.
Family responses and multifamily behavioural treatment for obsessive-compulsive disorder
- Authors:
- VAN NOPPEN Barbara, STEKETEE Gail
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(2), Summer 2003, pp.231-247.
- Publisher:
- Oxford University Press
Family responses to obsessive-compulsive disorder (OCD) that have relevance to behavioural treatments for adults with this disorder include family accommodation, family members' expression of emotion (EE) toward patients, and the effects of including family members in treatment. Family accommodation to OCD symptoms has been linked to greater severity of symptoms and poorer family mental health. Components of EE, including hostility and perceived criticism, have proved predictive of poorer outcome following behavioural treatment, but nonhostile criticism appears to improve outcomes. A model of multifamily behavioural treatment, in which relatives and patients are trained in exposure and blocking of rituals, as well as behavioural contracting to improve communication, is presented and illustrated in case examples.
Cognitive and behavioural methods for obsessive-compulsive disorder
- Authors:
- WHITTAL Maureen L., O'NEILL Melanie L.
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(2), Summer 2003, pp.201-225.
- Publisher:
- Oxford University Press
The psychological treatment of choice for obsessive-compulsive disorder (OCD) has been behavioural in nature, that is, mainly exposure and response prevention (ERP). Recent advances and interest in cognitive therapy, largely spurred by the theoretical paper of Salkovskis in 1985, led to the development of cognitively focused approaches for the treatment of OCD. Although ERP has strong empirical support for its efficacy, cognitive interventions are receiving mounting evidence. Combining cognitive and behavioural techniques to match with a patient's unique symptom presentation may help maximize treatment outcomes and patient satisfaction. The purpose of this article is to introduce the cognitive-behavioural theory, assessment, and treatment strategies for OCD, and to illustrate their use in the case of an individual with compulsive checking behaviours.
Behavioural and pharmacological treatment of Trichotillomania
- Authors:
- STEMBERGER Ruth M. T., STEIN Dan J., MANSUETO Charles S.
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(3), 2003, pp.339-352.
- Publisher:
- Oxford University Press
Hair pulling, known as trichotillomania (TTM), has become increasingly recognized as an often chronic problem for a large number of individuals, most of whom are women. This paper discusses current conceptualizations of TTM with particular focus on the medical and behavioral approaches. The relationship of TTM to other disorders is discussed and issues in pharmacotherapy that are unique to TTM are reviewed. A comprehensive behavioral model (ComB) that explains the environmental, motoric, sensory, cognitive, and affective patterns involved in hair pulling is presented. This model is used to describe how a clinician can develop treatment plans tailored to individual patients, including specific strategies for hair pulling reduction. Potential pitfalls and complications that may occur during treatment are also discussed.
Cognitive-behavioral therapy for children and adolescents with obsessive-compulsive disorder
- Author:
- WAGNER Aureen Pinto
- Journal article citation:
- Brief Treatment and Crisis Intervention, 3(3), 2003, pp.291-306.
- Publisher:
- Oxford University Press
Selected by experts as the treatment of choice for youngsters, cognitive-behavioral therapy (CBT) has emerged as a safe, viable, and effective treatment for obsessive-compulsive disorder (OCD) among children and adolescents. Yet, most children with OCD do not receive CBT, at least in part due to the shortage of clinicians who are well versed in managing the unique challenges that arise in the treatment of children. This paper reviews developmental factors that complicate the diagnosis and treatment of OCD in youngsters; it discusses appropriate adaptations of CBT protocols for children; and it presents the application of CBT for children and adolescents, using a developmentally sensitive protocol that is flexible and feasible in clinical settings: RIDE Up and Down the Worry Hill. Illustrated is the use of this protocol with a 15-year-old girl with forbidden thoughts and praying rituals, and a 6-year-old boy with fears of harm and reassurance-seeking rituals. Future directions for making CBT available and accessible to children with OCD are discussed.