Basic and advanced cognitive-behavioural interventions in managing Obsessive Compulsive Disorder: Targeting mood, behaviours, cognitions and the self (Βασικές και προηγμένες γνωστικο-συμπεριφορικές παρεμβάσεις στη διαχείριση της Ιδεο–ψυχαναγκαστικής Διαταραχής (ΙΨΔ): Στόχευση στη διάθεση, τη συμπεριφορά, τις γνώσεις και τον εαυτό)
NOTE: The workshop will be conducted in English
Scientific background and description of workshop:
Obsessive Compulsive Disorder (OCD) is a complex but common and highly disabling disorder associated with high degrees of comorbidity that presents throughout the lifespan. Effective treatments for OCD include pharmacological and psychological interventions. From a psychological perspective, cognitive-behavioral conceptualisations of OCD have led to effective treatments, including exposure and response prevention (ERP), specific cognitive therapy (CT) techniques, and their combination in cognitive-behaviour therapy (CBT) programs. These can be applied in individual, group, bibliotherapy and internet-based modalities with or without medication. More recently, family-based interventions have also been used to target the family accommodation that maintains maladaptive behaviours in affected individuals. On the other hand, while dominating the etiological landscape, neurocognitive theories have generated limited interventions.
Our research in the 1990s concentrated on developing manualised individual and group treatments for OCD, based on CBT principles. We focused on cognitive strategies to augment established behavioural interventions. Cognitive and behavioural treatments for OCD are recommended by guidelines as first-line treatments (e.g., National Institute of Clinical Excellence). However, outcomes can vary and dropout/relapse rates remain high (McKay et al., 2015). Furthermore, access to CBT for OCD has been limited due to finite numbers of appropriately trained mental health professionals, as well as geographical and financial challenges in accessing trained professionals. In response, our research turned to (a) developing effective online CBT treatment programs with the aim of facilitating access through the internet, and (b) identifying factors predictive of poorer outcomes with the subsequent aim of developing augmented or novel treatment strategies based on new theoretical approaches that extended the cognitive-behavioural model of OCD.
With respect to identifying additional factors amenable to psychological intervention, our research focused on identifying self-based constructs associated with OCD. Based on the seminal theoretical work of Guidano and Liotti (1983), our research found that perceptions about the importance of the moral domain, ambivalence about one’s self-worth, and dissonance between implicit and explicit self-concepts are associated with greater OCD phenomena. On the basis of findings about the relevance of these self-based constructs, we propose the development of self-based interventions in the psychological treatment of OCD.
This workshop presents a conceptual model of OCD where concerns about transgressions in the moral domain and their impact on self concept are prominent, in conjunction with OCD-relevant cognitions and dysfunctional responses to intrusions. The conceptual model incorporates cognitive, self-construal, mood and behavioural factors, and has direct implications for engagement with affected individuals and their treatment. Following on from this model, traditional cognitive-behaviour therapy for OCD can be enhanced by incorporating interventions that target self-concept. Our group posits interventions that target self cognitions and self-related constructs can be integrated into CBT for OCD.
The first half of this full-day workshop focuses on describing OCD phenomena and theoretical understandings of its phenomenology. The workshop goes on to present traditional cognitive and behavioural strategies in the psychological treatment of OCD. Case examples will be used to illustrate key points, and to compare traditional and revised conceptualizations of specific cases.
In the second half of the workshop, a range of self-based concepts are reviewed, focusing on the theoretical work of Guidano and Liotti (1983) who highlighted the centrality of attachment and self ambivalence in understanding the development and maintenance of OCD symptoms. The workshop presents a series of published research findings that support Guidano and Liotti’s theory. The workshop then goes on to “workshop” cases using these augmented self-based understandings to develop management/treatment strategies. Workshop attendees are asked to bring at least one case to the workshop. If time permits, we will also discuss the relevance of self-based conceptualisations of related disorders such as hoarding disorder and buying-shopping disorder.
10.00 am – 1.00 pm: PART A – OCD & Cognitive Behaviour Therapy
- What is OCD and its associated symptoms and phenomena?
- Developing a useful model that explains how OCD develops & is maintained
- Treatment outcome literature
- focus on evidence-based psychological treatment strategies
- investigating predictors
- Assessment of OCD
- Description of specific behavioural & cognitive treatment strategies
- Relapse prevention
2.00 – 5.00 pm: PART B – The self in OCD & treatment implications
- Expanding on the model of how OCD develops & is maintained
- focus on the importance of the self in OCD
- Description of self phenomena in OCD
- Description of various techniques that can be used to target aspects of the self.
- description of rationale & strategy
- description of specific techniques
- discussion of client engagement, therapeutic alliance & attachment
- discussion of therapist values in working with OCD
Cases examples will be discussed throughout,augmented by video presentations.
Key learning objectives
- Understand the cognitive-behavioural framework of OCD
- Understand the range of self constructs that can be used to further understand vulnerabilities to OCD cognitions and symptoms
- Develop case formulations for OCD cases that incorporate self constructs
- Develop engagement and intervention strategies to facilitate treatment of OCD
- Learn to integrate self-based conceptualisations into cognitive-behavioural treatment formulations
- Cognitive-behaviour therapy
- Self-based strategies using attachment and psychodynamic, narrative, Acceptance and Commitment Therapy, and metacognitive conceptualisations