Obsessive Compulsive Disorder Read Online Free PDF Page B

commonly in other disorders.
    Cognitions in young people with OCD
    There is evidence to suggest that young people in general also experience intrusive thoughts that are no different to those experienced in OCD and that if the thoughts cause distress and/or are more actively managed, they tend to persist for longer (Allsopp and Williams, 1996). Studies comparing young people with OCD to non-anxious controls or young people with other anxiety disorders have sought to investigate whether the same belief domains shown in adults with OCD are present in younger populations.
    Libby et al. (2004) found that young people with OCD had significantly more responsibility appraisals and beliefs around thought–action fusion than anxious controls. Barrett and Healy (2003) also found inflated responsibility and increased thought–action fusion and higher ratings of harm severity in young people with OCD but that the differences were not significant. This may reflect differences in measures used, or it may be that as this was with a younger sample cognitions may not be fully developed.
    Nevertheless, they did find the group of young people with OCD were significantly different when it came to cognitive control. This provides some preliminary evidence that young people with OCD demonstrate similar cognitions identified in adults with OCD.
    Cognitive accounts of OCD suggest that intrusive thoughts are experienced by most of the population and that the key difference between people with and without OCD is the way in which the intrusive thoughts are interpreted in terms of their occurrence and content.
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    Williams and Waite
    Cognitive behaviour therapy for OCD
    Cognitive behaviour therapy (CBT) for OCD developed as an attempt to increase adherence to ERP, by helping the individual to modify dysfunctional thoughts and beliefs (Salkovskis and Warwick, 1985). However, as theoretical and empirical studies on cognitions in OCD developed, CBT
    has evolved as a treatment in its own right. It is based on modifying key beliefs and appraisals so that the individual learns that intrusive thoughts are not of special significance and do not indicate increased responsibility or probability of harm. CBT aims to help the individual to construct and test a new and less threatening model of their experience through developing an understanding of how the problem may be working and then testing this out through behavioural experiments to learn that the problem is about thinking and worry, rather than actual danger or harm. Whereas in ERP the individual is encouraged to stop carrying out compulsions, in CBT the individual is encouraged to carry out experiments to identify and challenge their misinterpretations. As a result, they learn that they no longer need to carry out compulsions.
    It is clear that CBT is effective in significantly reducing symptoms of OCD and that these gains are maintained post-treatment (Clark, 2004).
    There is evidence that it is effective with symptoms that have been more difficult to treat with ERP, such as obsessional ruminations and hoarding (Freeston et al. , 1997; Hartl and Frost, 1999). More recently, controlled trials with adults have compared CBT to ERP and found CBT to be superior to ERP in reducing symptom severity and shifting obsessional beliefs (Rector et al. , 2006; Salkovskis et al. , in press).
    CBT with young people and families
    A number of studies of CBT with young people have been carried out. One of the earliest controlled studies demonstrated that CBT was as effective as clomipramine for the control of the symptoms of OCD (de Haan et al. , 1998). Subsequent studies have compared CBT with waiting list controls (Bolton and Perrin, 2008), with sertraline (Asbahr et al. , 2005; March et al. , 2004) and have delivered CBT in family (Barrett et al. , 2004) or group formats (Asbahr et al. , 2005). All of the CBT programmes have produced similar improvements in measures of OCD. Nevertheless, there are differences between the