Modify Standard Cognitive Therapy Methods to Treat OCD. (Don't Neutralize Exposures)

Article excerpt

TORONTO -- just a few modifications are needed to make standard cognitive therapy techniques effective tools for treating obsessive-compulsive disorders, Jonathan Grayson, Ph.D., and Harold Kirby said at the annual conference of the Anxiety Disorders Association of America.

Eight cognitive therapy methods--experimental, downward arrow or what if, survey double standard, Socratic questioning, cost-benefit analysis, externalization of voices, and distraction and refocusing--can be modified to treat patients with obsessive-compulsive disorder (OCD), according to Dr. Grayson and Mr. Kirby, who are both with the same group practice in Bala Cynwyd, Pa.

The experimental method emphasizes hypothesis testing, which suggests that certainty is obtainable. For this reason, Dr. Grayson does not recommend using this method to treat patients with OCD.

"In this model, the failure of a disaster to take place is supposed to be reassuring," Dr. Grayson said. The problem is that people with OCD are experts at finding flaws with this approach. "Remember that the purpose of exposure is not to create reassurance or safety but to help patients learn to live with the uncertainty," Dr. Grayson said.

With the downward arrow (what if) method, the standard idea is to identify the automatic thought and, through a series of questions, identify and test feared consequences of exposure to obsessive fears. The problem is that with OCD, this approach sets up a series of neutralizing rituals that patients tend to incorporate into their disorder. Instead, Dr. Grayson and Mr. Kirby use the same process to help patients identify the possible consequences of their fears with which they will have to learn to live. After the feared consequences are identified, they can be recorded onto a tape that the patient listens to as a form of exposure.

The survey method normally compares patients' behaviors to those of others to help them identify how to cope with obsessional triggers. However, the therapist should not allow this information to be used as reassurance that something is safe, Dr. Grayson said. In other words, just because everyone does something one way does not mean that that approach is safe. …