Obsessive Compulsive Disorder (33 page)

dead or in prison).

e.

e likely it will

ge to do

e I think about this

ead the futur

Intrusive thoughts mean I

can r

The mor

thought the mor

happen.

Having an ur

something means I will do it.

.

’t stop harm.

PREDICTIONS

If OCD is right that rituals can stop harm then the pen will not hit my mother

If OCD is a liar then the pen will hit my mother

because rituals don

,

ed

other

ge is

owing a

equir

ges to

e harmless

. The child is

om thr

d your br

der

ges ar

ess it har

esponsibility can be

’t use rituals why would

e harm could be attributed

nd out that ur

’s cries, etc.). Having an ur

ge to pr

fi

event the therapist fr

esponsibility pie graphs.

other

oat, hold their sister near a balcony,

’s hand while having intrusive sexual

e to carry out rituals, then the child

’s thr

e your br

DISCUSSION AND EXPERIMENTS

The child is asked to consider all the steps r

to carry out a complex action (e.g. move your hand, pick up a knife, move the knife towar

ignor

not enough.

The therapist holds a knife to their own neck and

reports a normal ur

encouraged to allow violent and/or sexual ur

stay so they can to

and alone do not lead to harm (e.g. hold a knife to the therapist

touch sister

thoughts or feelings.)

Ask the child to imagine what they would say to a

policeman if a scary man was following them: that is, would they ask the policeman (1) to carry out rituals and then walk away or (2) or to run after the scary man and catch him? Discussion focuses on the idea

that if a policeman wouldn

you?

Ask the child to pr

pen at their mother by carrying out rituals in the

session.

If a child believes that futur

to their failur

needs to specify what this harm would be so that

exaggerated beliefs about r

challenged via r

e.

BELIEF

Rituals can stop harm some

time in the futur

ed because I am

If OCD is right I will become very ill and I will die.

If OCD is a liar I will be very scar

worried about dying, but I will be okay.

If OCD is right I will feel better when I do my rituals.

If OCD is a liar I will feel better when I stop doing my rituals and get on with life.

ound

d) while trying to have a

ound the building, touching

ve minutes doing ritualsfi

e used to challenge excessive

’s arm and then eat a biscuit

nate between carrying out rituals

ce and then touching their face and

ce and also to touch their face and

f and eating a sandwich with their

e seriously harmed because of

fi

fi

etending that they hate OCD by

d will stop their worry about eyeballs

ent; (3) encouraging the child to walk ar

oom including the toilet seat and then

der to see what happens to the size of their worry.

The child is asked to list all the times when they or their friends wer

germs. Pie graphs ar

responsibility beliefs.

Experiments may include: (1) the therapist touching objects in the of

mouth; (2) encouraging the child to touch several

objects in the of

their par

the building pr

touching lots of objects and then making a cup of tea to drink; (4) the therapist touching lots of objects in the bathr

wiping their arms and face; (5) encouraging the child to touch the therapist

without washing; (6) have the child make an anti—

OCD movie by walking ar

lots of germy stuf

germy hands. Encourage the child to design his or

her own experiment without telling the therapist.

Ask the child to alter

and not carrying out rituals for a period of time in or

For example, if a child believes that holding their head forwar

rolling into the back of their head, then this child can be encouraged to spend

(i.e. holding their head forwar

normal conversation. The therapist asks how this

.

better

feel

me

make

Germs will make me very ill

or kill me.

Rituals

’t ask for

e I focus

onger the mor

.

om Mum.

PREDICTIONS

If OCD is right I will feel better if I can ask for lots of reassurance fr

If OCD is a liar I will feel better when I don

reassurance and carry on with life normally.

If OCD is right then looking for danger in my body

will make me feel better

If OCD is a liar then looking danger in my body will make me worse. It is normal to notice strange

things when you look for them and it is normal for

the feelings to become str

on my body.

ve minutesfi

, it sounds loud,

eases their intensity

eassurance or not asking

ve minutes the therapist

d to swallow

e thinking about while doing

fi

nate between seeking

asking for r–

e: doing rituals or not doing rituals. The

ve minutes of letting the worry stay in

om rituals. The child is asked what they

fi

e saliva). Discussion focuses on the idea that

eases the chances of noticing normal

e). Discussion focuses on what gave them

nd out if this makes them feel better or makes

e worries

eassurance.

fi

DISCUSSION AND EXPERIMENTS

feels and what they ar

this ritual. For the next

plays a game with the child (e.g. Simon Says) while refraining fr

enjoyed mor

child can also be encouraged to double their rituals to

them feel worse.

Ask the child to alter

reassurance and carrying on with life normally so that the child can see what happens to the size of their worry. For example, a child could spend

asking their mother lots of questions about harm,

followed by

their mind and just carrying on with normal life (e.g.

playing a game, having a conversation, or drawing a pictur

mor

for r

The child could be asked to focus on their neck for two minutes followed by describing everything that

they noticed (e.g. it is har

lots mor

looking for body symptoms incr

and incr

reactions. The therapist then engages the child in a game for a few minutes and asks the child what

happened to the signs in their body that they noticed

.

ed.

onment helps me feel

epar

BELIEF

Reassurance makes me feel

better

Looking out for signs of

danger in my body or in the

envir

better because then I can be

pr

rst,fi

ne.fi

oom like a crazy person).

ound the r

If OCD is right then I will go mad with worry

(e.g. run ar

If OCD is a liar then I will feel worried at

but after a while I will be

ndfi

ound

e and why.

e. Ask the child how

ound normally. The child is

eport that their bodily

ed when they stopped looking

’ such as looking for harm and

en r

rst walk the child is asked to dofi

emember how many times they have

efer to Chapter 4). Encourage the

.

‘OCD looking

e. Most childr

cles or jump out the window). Educate the child

befor

symptoms disappear

for danger

Another experiment involves taking the child for two walks. During the

lots of

scary things. During the second walk the child is

asked to act as if they hate OCD and to stop looking for danger and to walk ar

asked what walk they enjoyed mor

Ask the child to r

gone mad or lost their mind befor

they will know when they gone mad (e.g. run ar

in cir

about anxiety (r

child to touch something germy so that they can

out they do not go mad with worry.

’t wash my hands after

I will go mad with worry if I

don

touching germy things.

Index

Adolescence, 97, 98

Autism, 41–42

Age, 3, 4, 6, 7, 10, 20, 21, 35, 43, 46, 47, 77,

78, 120–121, 139–140, 148, 150

Behavioural experiments, 16, 24, 26, 27,

Agenda, 23, 54–55, 98, 114

28–29, 30, 31, 32, 42, 51–52, 62, 71–73, 74,

Alternative explanation of OCD (theory A

87–93, 98, 106–111, 112, 115, 119, 130,

and B), 51, 68–71, 87, 105–106, 130–132,

132–133, 134, 135, 147; ‘over the top’ or

137

‘pushing it’ experiments, 76, 92–93, 95, 110

Anxiety, 2, 25, 31, 59, 97, 119, 139;

Behavioural models, 13, 19

assessment, 41–44, 46, 48; in behavioural

Behavioural treatments, 13, 19

experiments, 28–29, 52, 71–72, 74, 89, 110;

Biological factors, 9, 11, 52, 123, 143–145

in ERP, 13, 16, 19; in formulation,

Blueprint, 75–76

125–127; parental beliefs, 31, 36–37;

Brain structure, 11

psychoeducation, 64–67

‘Bully’ metaphor, 79, 83, 94, 95

Anxiety disorders, 6–9, 12–13, 15, 19, 30, 32,

35, 41–42, 44, 53, 143, 146, 148, 149

Causes of OCD, 12, 21, 137, 139–142

Anxiety Disorders Interview Schedule
(ADIS),
Child Depression Inventory
(CDI), 46

44

Child Obsessive Compulsive Impact Scale

Appraisals, 14–17, 33, 38–39, 46, 47,

(COIS), 47

125–127, 132, 139–140, 142

Child Obsessive Compulsive Inventory
(Child Asperger’s syndrome, 7, 41–42

OCI), 46

Assessment, comorbidity, 39–42; cognitive

Child Responsibility Attitude Scale
(CRAS), appraisals and underlying beliefs, 38–39,

47

140; family and developmental history,

Child Responsibility Interpretation

35–37; family involvement, 53; general,

Questionnaire
(CRIQ), 47

33–35, 138, motivation and suitability for

Children’s Obsessional Compulsive Inventory

CBT, 42–43; OCD symptoms, 37–38;

(ChOCI), 46

planning treatment, 53; specific issues in

Children’s Yale-Brown Obsessive Compulsive

OCD, 48–50; tools, 44–48

Scale
(CY-BOCS), 45

Attention deficit hyperactivity disorder

Circular questioning, 134

(ADHD), 8

Clinician-administered measures, 45–46

Attention difficulties, 10

Clomipramine, 16–17

189

190

Index

Cognitions, 8, 16, 24, 52, 57; key cognitions

Difficulties in treatment, 67, 73, 94–95,

in OCD, 14–15; in young people, 15,

114–117, 134–135, 138

20–22, 30, 139–140

Discussion techniques, 26–27, 68, 111–114,

Cognitive behaviour therapy (CBT), 6, 8, 16,

126, 134

18, 19, 29, 30, 54, 78, 79, 101, 123, 134,

137, 138, 147, 148; access to CBT,

Embarrassment, 5, 49

149–150; with autistic spectrum disorders,

Engagement, 8, 20, 22, 34, 72, 73–74, 77–78,

41–42; basic tools, 23–29; as a choice of

125, 144, 148

treatment, 17–18, 145, 149; effectiveness,

Epidemiology, 4, 150

16–17; family-based CBT, 30–31, 148;

Eradicating OCD, 116–117

versus family therapy, 119–120; individual

Executive deficits, 10

versus family CBT, 12–13; number of

Exposure and response prevention (ERP),

sessions, 52–53; suitability, 42–43;

13, 16, 28, 52

structure of sessions, 23; with young

Externalising disorders, 8, 139

people, 22, 77

Externalising OCD, 51, 55, 77, 105–106

Cognitive control, 15, 21, 36

Cognitive deficits, 10–11

Family Accommodation Scale
(FAS), 47

Cognitive model of OCD, 14–15, 20–21,

Family, 2, 4, 5, 8, 18, 22, 51, 70, 142, 144, 147;

51–52, 69, 79, 120; modified version for

assessment, 34–37, 46–47; beliefs, 77, 122;

working with families, 123–126

family-based CBT, 12, 16, 30, 42, 148;

Collaboration, 22–23, 30, 34, 42, 54, 74, 100,

family therapy, 6, 118–120; functioning,

103, 119, 121, 126

12–13, 53, 67, 145–146; involvement in

Comorbidity, 7–8, 33, 53, 143, 148;

OCD, 100, 118, 120, 145–146, 148; life

assessment, 39–42, 46

cycle, 120–121; involvement in treatment,

Compulsions, 2–3, 16, 24, 25, 31, 32, 33, 36,

18, 22–25, 30–31, 53–54, 62, 78, 93, 95,

49, 55–56, 60, 64, 78, 102–104, 108, 110,

98–99, 101–102, 107, 113–114, 121–135

115, 123, 136, 138, 140; assessment of,

Field trips, 90

38–39, 48, 58; cognitive account of, 4, 51;

Formulation, 23, 24, 26, 29–32, 33, 35, 51, 53,

differential diagnosis, 8, 41, 50; effect of

55–60, 76, 79–84, 93, 99, 100–101, 102,

behavioural treatments, 13; gender

107, 118, 122–123, 126–127, 143