Response prevention – OCD

Patients with OCD need rituals (hand washing, cup counting). The exposure therapy you do with your patient afterwards will get them to stop doing their rituals. You can't ask a patient to stop doing them, it's too abrupt and will traumatize the patient. You have to do things slowly and gradually so that they can decrease them as they go along. To do this, you will have to touch several parameters of these rituals. This means that you need to be aware of your patients' practices. For example: How long do they last? What triggers them? What do you use?

The first thing to do with your patient is to list the situations in which they occur. Structure it in a way that answers the questions: When? How? With whom? How long? You can also give him a sheet of paper with about 50 empty boxes so that he can count them. Beforehand, you should list all the situations and rituals, whether they are behavioral (checking the locks, cleaning) or thought-related (counting). Once all the key situations and rituals are outlined, you can begin to modify them with the patient. On the basis of the parameters mentioned, you will progressively modify each of the parameters which will lead to a cessation of this ritual after several months, or even after a year.

The first parameter to change is the frequency of the ritual. If the patient washes their hands 50 times a day, you can reduce that to 45 times. To change it, patients have to be committed and have to be able to do it. The goal is that they can actually change that frequency in that ritual. Ask, "If we go from 60 times a day to 45 times a day, can you do it?" Once the commitment is made, you can give her another chart with the ground rules. (I must change my rituals, I must follow my therapies, I must apply my therapies). The other parameter on which we can play is the duration of the ritual, if your patient washes his hands for 5 min, you can propose to him to wash them only 4 min 30.

Another factor to consider is the delay in initiating the ritual. For example, tell your patients that when they are anxious and wash their hands, it is possible for them not to wash their hands right away, but to wait 30 seconds. In the meantime, suggest that they do some meditation, some relaxation methods, repeat slogans, mental imagery seen in previous therapies.

It is also possible to play on the removal of certain elements associated with rituals. For example: the use of a specific brand of soap to wash the hands. Suggest that they change the brand of soap. In the example seen throughout this article, the patient who is going to wash his hands 50 times a day will no longer wash 50 times but 40 times and not 5 min but 4 min 30, so he will be delayed by 30 seconds and will not wash with the same soap. All these modifications, associated with the ritual, will be noted on the patient's chart so that he/she will remember them.

The parameters will be modified progressively by playing on the frequency and duration until the ritual is completely extinguished. If unfortunately the patient has not been able to follow the modifications of all these parameters, propose only one or two.

Let's talk in this last part about impulse phobia. This is a false friend, it's not a phobia but an impulse OCD. These are patients who will say: instead of falling down, I'm going to throw myself, or I'm going to strangle my husband, I'm going to kick the grandmother's poodle. Everyone has this kind of thought, most people just don't pay attention. In impulse phobia, patients will stay focused on these thoughts. By trying to stay in control and trying not to think about it, they will reinforce these thoughts and they will keep coming back. Having crazy thoughts is a normal phenomenon, it is the process of brain function. It is normal to have violent, blasphemous, transgressive thoughts. In the impulse toc, there is no acting out because the patient is afraid of acting out.

Discover the Jacobson's progressive muscle relaxation method, and the AWARE method.