COGNITIVO-BEHAVIORAL THERAPY
COGNITIVO-BEHAVIORAL THERAPY
Research has shown that cognitive behavioral therapy (CBT) is a very effective treatment for OCD. CBT is a type of therapy in which a person learns:
how thoughts, feelings and behaviors are related,
push aside worries or unrealistic thoughts,
to replace his thoughts with more rational or realistic ones.
Under the influence of OCD, a person overestimates the importance of intrusive thought. This can make her anxious. The rituals created offer temporary relief from their anxiety, but they do not provide any real guarantee that such thoughts will not resurface. As a result, the ritual is repeated, usually several times, until the person feels "better" or has repeated the same actions a number of times.
CBT helps resolve the anxiety a child with OCD might be feeling, but another treatment, response prevention exposure (RPE), helps push back thoughts and learn relaxation techniques like relaxation. deep breathing and muscle relaxation.
What are CBTs?
It is the idea that maladaptive behavior can be changed by learning a new behavior as well as changing erroneous thoughts and beliefs. It is a therapy which is based on the current and disabling symptoms on a daily basis. Human beings function mainly through patterns learned from childhood. These patterns cause reactions that may, at some point, no longer be adapted to our environment and require changes. These are not always easy to set up and help can be provided in certain situations.
When is CBT?
Studies have shown an improvement in problematic behaviors in various pathologies: tocs, social or specific phobia, generalized anxiety, depression, addiction, autism spectrum disorder, schizophrenia ... However, it is not necessary to have a diagnosed pathology for be able to benefit from CBTs. Indeed, these therapies can be proposed when one encounters a difficulty which is embarrassing in professional, school, personal or family life. For example, if we lack self-confidence, or if we cannot control our emotions, our anxiety, if we wish to modify a situation or a behavior that seems inappropriate to us ...
What is CBT like?
Like any therapy, CBT begins with interviews in order to understand the reason for consultation, the patient's life history and the history of the disorder. Diagnostic hypotheses can be raised in order to orient the therapy and the patient in the most suitable way.
CBTs are said to be scientific because they are standardized and quantifiable. Thus, the therapist will invite the patient to objectively measure his difficulties. For example, as part of a hand wash, the patient may be asked to note the number of times they wash their hands and for how long. Scales and questionnaires can be proposed to help this objectification of problem behaviors.
In order to better understand the mechanisms, habits and behaviors put in place, the therapist and the patient carry out analyzes of each situation. They make it possible to sort out the various problems, set priorities and define therapeutic objectives. The purpose of these analyzes is to build a battle plan for how to set up therapy, what to do and in what order. When the therapist and the patient agree on the therapeutic plan, they enter into a "work contract" which determines the number of sessions and plans the exercises to be performed.
Behavioral and cognitive therapy uses different techniques and tools allowing a tailor-made personalization of the patient's care. The therapist's role is to help the patient find cognitive strategies more suited to the problem situation. This is because there are usually negative automatic thoughts and beliefs that can feed the problem or consolidate it. Different techniques can then be proposed in order to help the patient to create alternative strategies: assertiveness, mindfulness, home tasks, role plays, decentration, cognitive restructuring ... For example, in the context of a phobia, the therapist can bring his patient to expose himself, gradually, to the object of his fear, while controlling his anxiety and his anguish through relaxation or breathing.
Finally, a qualitative and quantitative evaluation of the results is carried out in order to objectify the patient's progress. Therapy is stopped when the target behavior or situation is no longer considered problematic by the patient.
Who is the CBT therapist?
He is a therapist who holds a university degree obtained after 5 years of study and giving him the title of psychologist. Specialization in CBT is achieved through recognized training leading to two or three years of qualification.
Source: https: //issy-psy.com/presentation/tcc/
EXPOSURE RESPONSE PREVENTION (ERP)
EXPOSURE WITH RESPONSE PREVENTION (RPE)
As the name suggests, the RPE consists of two main parts: exposure and prevention of response.
Exposure means that the child has to face the feared situation (for example by touching an object which he thinks is contaminated).
Preventing the response involves preventing the child from acting compulsively immediately (for example by preventing him from washing his hands immediately).
Although parents can help prevent the child from following his ritual, (for example by turning off the main water supply, so no water in the house), the child should eventually be able to stop. his behavior by itself.
The RPE is designed to allow the child to tolerate anxiety without following the ritual. At first, not going through the ritual is the most difficult part for the child, but over time the anxiety naturally reduces and the connection between fear and the ritual weakens.
If your child needs RPE, it often takes many sessions before the ritual is ended. Even so, this treatment is still the most effective way to treat OCD.
Course of a CBT:
Source: https://tcc.apprendre-la-psychologie.fr/les-differentes-etapes-d-une-tcc.html
Contact
First of all, there is the making of contact with the patient, like any work centered on the helping relationship. This usually goes through the secretariat, the patient can very well come already with elements to see a diagnosis. The patient may have been referred by colleagues.
We will study the person's subjective complaint.
The person suffers from agoraphobia, he would like to be able to leave his home again without anxiety. The person suffers from verification OCD, they would like to reduce wasted social time and be able to return to full-time activity.
Goals and motivations for change
Then, we will study the goals and motivation for change for the person through the interview. We will see what stage the person is at, the level of awareness of his psychological disorder and if he wishes to make a change.
We all tend to underestimate the difficulty of change. We can therefore suffer from a disorder and be very difficult to change. Often, caregivers have different goals than their patients. In this case we will find ourselves in a dead end and find ourselves in a situation of failure and we will end up blaming the patient. These difficulties could have been avoided if we had more accurately assessed the patient's capacity to commit to change. For this type of evaluation we will use the techniques of motivational interview.
Functional analysis
Through this interview, we will then do a functional analysis in order to derive a clinical and behavioral diagnosis. It is the conceptual framework that will allow us to know what is happening for this particular patient.
2 patients suffering from the same disorder will not necessarily have the same needs in terms of strategy for change.
In the story of this patient what made this disorder develop and maintain?
Functional analysis is the established French term. In Anglo-Saxon works we will speak of “case conceptualization”. This work of formulating hypotheses is also linked to clinical diagnosis (“what's the name of your disorder?”), Which refers to the ICD-10 and DSM-5 to categorize what is happening. This allows for the benefit of research and evidence relating to the disorder. But be careful not to fall into the ready-to-think.
You really have to adapt to the patient specifically, you can't "copy and paste".
CBT is the application of the scientific approach in psychology to the psycho-therapeutic approach. We are going to pose hypotheses and take the corresponding approach to see if it works. It's a very experimental process.
Restitution to the patient
We are also in a collaborative approach, we will share our hypotheses and our approach with the patient in the form of an explanatory summary. We want the patient to understand, so the communication aspect with the patient is very important.
When we have made this diagnosis, we will have to give it back to the patient, give him information, explain to him what he is suffering from.
We want the patient to learn about his disorder and the strategies to get better. There is therefore an aspect of psycho-education for him to become autonomous. The goal is that the patient can do without a therapist.
The means for this is the transfer of knowledge, but above all of skills.
Assumptions and prioritization
Exposing our hypotheses to the patient allows him to see where we are in terms of understanding things, he will be able to confirm / refute / complete ... Often the patient does not have only one problem. He may have a major disorder, a social anxiety that stems from his disorder and a motivational problem to change. Obviously, you need the patient to make the required changes.
We then set up hypotheses and establish priorities with a hierarchy. We are going to list everything that the patient should be taught to cope with his disorders and change.
Effectiveness evaluation
Therapeutic strategies appropriate to the pathology are then evaluated in order to be able to give the patient adequate treatment.
Using adapted psychometric scales, we are going to compare the baseline level before and after treatment (or to assess the objectives) in order to be able to assess the effectiveness of the therapeutic strategies put in place.
We can also assess subjectively: assess the expectations before the treatment and then assess whether this patient has achieved these goals or not following the treatment.
This evaluation also makes it possible to verify whether or not actual experience confirms our hypotheses.
Prevention of relapse
The last step, once the patient is really doing better and therefore wants to stop the therapy, is relapse prevention, so to check from time to time if he has not relapsed with more sessions. spaced. We want lasting change.
TO REMEMBER
CBT should be performed by a specialist experienced in the treatment of OCD.
CBT and RPE should always be tried before prescribing medication.
Medicines are usually used at the same time as CBT in more severe cases of OCD.