Obsessive Compulsive Disorder Read Online Free PDF Page A

young person is unable to complete tasks without asking the parents for reassurance that the tasks have indeed been completed correctly or they may get parents to carry out compulsions for them, such as turning out the bedroom light before going to sleep. Recent studies have suggested that there are particular issues which differentiate families of children with OCD from those that have children with other types of problem. Barrett et al. (2002) found that parents of children with OCD were less confident in their children’s abilities and independence skills than parents of children with other anxiety disorders and were less likely to use positive problem-solving techniques. Derisley et al. (2005) found that parents of children with OCD
    tended to cope with problems by avoiding them.
    However, research on the best way of helping families overcome these difficulties is still at an early stage. There are not yet any studies comparing individual CBT with CBT involving families in young people with OCD.
    However, Barrett et al. (2004) obtained greater effect sizes using family CBT
    than the effect sizes in the paediatric OCD treatment study (POTS) trial (March et al. , 2004). Where comparative studies have been carried out in anxiety disorders more generally, the picture is unclear; for example, Introduction to obsessive compulsive disorder 13
    Cobham et al. (1998) only found limited benefits in involving parents in the intervention.
    Research on family involvement is still at an early stage and so far studies on anxiety disorders more generally have found limited benefits in involving parents in therapy.
    Behavioural models of OCD
    Behavioural theories of OCD stem from Mowrer’s (1960) two-factor theory of the development of anxiety, which involves both classical and operant conditioning. Obsessions are previously neutral stimuli which have become associated with anxiety. The individual then develops avoidance and escape responses, such as washing or checking, that terminate exposure to the feared stimulus. The behaviours are negatively reinforced, which makes them more likely to occur and termination of exposure prevents the anxiety from extinguishing (Rachman, 1971).
    Behavioural treatments of OCD
    Behavioural accounts led to the development of exposure and response prevention (ERP) as a psychological treatment for OCD (Meyer, 1966; Rachman et al. , 1971). This involves encouraging the individual to expose themselves to the thoughts, situations or activities that induce anxiety for a prolonged period of time, without carrying out the compulsion or other responses that normally terminate the exposure. As a result, they learn to tolerate the anxiety or discomfort, over time the anxiety decreases and through repetition it eventually habituates. In addition, they may discover that the feared consequence does not occur.
    Early studies in adults demonstrated that ERP was a successful treatment (Meyer et al. , 1974; Rachman and Hodgson, 1980); around 60 to 70 per cent of individuals with compulsions who completed treatment made significant improvements (Abramowitz, 1996). However, behavioural treatments have been difficult to apply to young people who ruminate or do not have compulsions and treatment refusal and drop-outs have been common.
    There has been one randomised controlled trial of ERP in young people (Bolton and Perrin, 2008), which found that ERP reduced OCD symptoms substantially as compared with a waiting list condition.
    Psychological interventions for OCD began in the 1960s with the development of ERP and this led to reasonable success with adults and later with young people.
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    Cognitive theories of OCD
    Most cognitive accounts of OCD have developed from Rachman and de Silva’s (1978) finding that almost 90 per cent of a non-clinical sample reported intrusive thoughts that were no different to the obsessional thoughts experienced in OCD. This finding has been subsequently replicated and more