1. Getting the most out of CBT Karina Lovell

2. Aims  What do we know about OCD?  What is CBT?  Getting the most out of CBT  Different delivery methods

3. What do we know about OCD?

4. Obsessive Compulsive Disorder  OCD is under recognized and causes significant impact on peoples lives.  Usually starts in early adolescence  Lifetime prevalence (1.9-3.0%)  There is evidence that without adequate treatment the disorder tends to have a chronic fluctuating course

5. Obsessions Obsessions are repetitive, recurring thoughts, ideas, images or impulses that are experienced as intrusive and are usually distressing or anxiety provoking. Such thoughts are often centered on dirt and contamination, accidental harm, illness, aggression, sex, orderliness and perfection.

6. Compulsions Compulsions: (rituals) are repetitive and intentional acts and serve to reduce anxiety the thoughts provoke. The person recognizes that their behavior is excessive or unreasonable.

7. Things to know  The content of the thoughts that people with OCD have are no different to those that people without OCD have.  What is different is the frequency and intensity of the thoughts

8. How OCD is maintained Trigger Obsessional thought Anxiety Ritual Relief (temporary)

9. What is CBT?

10. What is CBT  CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. It is most commonly used to treat anxiety and depression

11. CBT  Over estimation of risk/ likelihood  Unable to tolerate uncertainty

12. CBT  Cognitive behaviour therapy  Exposure and response prevention  Cognitive therapy  Behavioural experiments

13. Does CBT work? There is a good evidence that CBT works with OCD with about 50-60% of people- it is not the panacea of all ills It is the treatment of choice and recommended by NICE – as well as anti depressants

14. Getting the most out of CBT?

15.  Key messages Your therapist’s role in CBT Your family/friends role in CBT Your role in CBT

16. What should you know about your therapist?  Are they qualified to deliver CBT?  What does qualified mean?  Are they experienced in treating OCD?  What CBT interventions will they use and why?

17. What should you expect from your therapist Work with you in partnership (ie therapist knowledge of therapy and OCD and your lived experience) and at the end of the Ist/2 nd session have a shared understanding of the difficulties that you are having Feedback what you have said to check understanding Ask about family and friends involvement Provide you with information about OCD and therapy (how often, for how long, etc) Answer your questions (sometimes we don’t know all the answers) but you should always be told that we will find out if we can – or is there is not an answer provide you with accurate information Monitor and ask you how you feel that treatment is progressing and if not progressing having an open discussion with you about next steps Agree what you will do between sessions

18. Your family and friends role in CBT  You therapist should ask you whether you want family/friends involvement in your treatment (this may be information, talking to them, and or involving them in your treatment)

19. Your role in CBT Work in partnership with your therapist (therapy is not a one way process) Clarify what you want from your therapy – and what you want to be able to do at the end of therapy (goals) Is this the right therapy for you – are you prepared to take what you perceive as ‘risks’ Knowing the therapy - Understand what the key messages are (if you are unsure ask your therapist to explain it again) A cliché but “therapy is hard work” With your therapist agree what work will be done between session (it is the work between sessions that make the difference) Feedback to your therapist things that you are happy with and issues that you are unhappy with

20. Different Delivery methods  Face to face  Telephone  cCBT  Groups

21. Please do ask me any questions

22. Thank you for listening Karina.Lovell@manchester.ac.uk