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Talking therapy

Zak Powers BSc (hons) MIACP, MPPS is Principal Clinician at Bergin Psychotherapy Services in Dublin 2. He works with clients who have Obsessive Compulsive Disorder and has found that Cognitive Behavioural Therapy can be extremely beneficial

It is not uncommon to hear people say things like “I’m a little OCD” or “that’s so OCD”. It would seem that obsessive compulsive disorder (OCD) has crept into our daily vocabulary, even though the vast majority of people do not understand this condition. The reality of OCD is that it robs the sufferer of time, energy and self-confidence and left untreated, symptoms can rise to a point where they take over the life of the person. The World Health Organisation ranks OCD within the top 20 leading causes of medical disability.

To have OCD is to have persistent ideas, thoughts, impulses, or images that feel intrusive and inappropriate and that cause the sufferer huge distress. The individual with obsessions usually attempts to ignore such thoughts with compulsions. These compulsions are repetitive behaviours such as hand washing, ordering, checking or mental acts, such as praying, counting or repeating words silently.

In most cases the person feels driven to perform the compulsions to reduce the distress they are feeling or to prevent some dreaded event or situation. Although the sufferer knows there is no real threat, he or she cannot override the fear that they are at risk.

John* was a compulsive washer. He had a chronic fear of being contaminated by a dog which caused him to compulsively wash. His specific irrational fear was contacting rabies or another serious infection. He actively washed himself repeatedly when he thought he was contaminated.

This would happen every time he saw a dog, was near a person who he felt had been in contact with a dog or if he brushed against anyone or anything he thought might have been in contact with a dog. At times his fear felt so unbearable that he started throwing out any clothes that he felt may have been in contact with man’s best friend.

John came to see me and I suggested ERP therapy (Exposure and Response Prevention, a CBT technique) where we designed a list of anxiety scenarios which were scaled and rated from 0 to 100. This scaled challenge allowed John to gradually expose himself to the irrational anxious situations.

One of the exposures involved him having to touch the ‘contaminated’ items thoroughly and then rubbing his hands all over his arms and body and resist washing or changing his clothes for a period of three hours after each session.

John had three sessions a day and he also experienced continued exposure by continuously carrying with him a piece of cloth which had been in contact with a dog. He even slept with the cloth under his pillow.

Johns initial high level of anxiety to the treatment decreased fairly rapidly. He began to move more freely again and returned to using public transport and mixing socially. He maintained his gains well and some months later when he felt the return of the obsession and compulsion, he treated himself using ERP to help get himself back to a place where he could work around his condition and proceed with life.

Tell me about it - CBT and ERP

Cognitive Behavioural Therapy (CBT) is a talking therapy that has been successful in the treatment of OCD. It can help you manage your problems by changing the way you think and behave and is used to treat anxiety and panic disorders such as depression, phobia, OCDand other mental health problems. It is based on the belief that your thoughts, feelings and actions are interconnected and that negative thoughts and feelings con trap you in a distressing loop of thinking. CBT helps to break this pattern by taking the overwhelming feelings and breaking it down into smaller parts and showing you how to break these patterns.

For OCD sufferers the CBT technique used is called Exposure and Response Prevention (ERP). This involves gentle and gradual exposure of the sufferer to their particular obsession. When this exposure takes place, the therapist teaches the sufferer ways to control their anxiety and reach a point of feeling in charge of their own safety.

Check out www.zakpowers.com, tel: 01 6705016.
Zak Powers, Bergin Psychotherapy Services, Dublin 2

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