Group ACT for OCD Giselle Brook Cognitive Behavioural

Group ACT for OCD Giselle Brook Cognitive Behavioural Psychotherapist Joe Curran Principal Cognitive Behavioural Psychotherapist Tom Ricketts Cognitive Behavioural

Obsessions and Compulsions Obsessions: Thoughts urges or images that are experienced as unwanted, intrusive and out-ofcharacter Compulsions: Repetitive intentional behaviours or mental acts that are often linked to obsessions and serve to reduce discomfort or anxiety

Exposure & Response Prevention (ERP) for OCD ERP is an effective psychological treatment for OCD (Abramowitz, 1997) However up to 30% of participants do not benefit from ERP, and a further 15 -20% withdraw from treatment (Foa et al 1983) ‘Recovery’ as defined using the Y-BOCS occurs for perhaps 50 -60% of completers in ERP (Foa, 2005)

Rationale for an ACT-informed Group for OCD Low levels of psychological flexibility is a key aspect of OCD phenomenology People suffering from OCD often are working very hard to ‘control’ obsessions Valued aspects of life are often severely disrupted by OCD, put on hold pending symptom relief Experiential avoidance is evident ( Trowhig, Hayes, Masuda 2006 )

Client Group Clients with longstanding ‘treatment resistant’ problems with OCD A majority have received prior CBP, generally ERP

Structure and Group Process Individual pre-group meetings to discuss group attendance , assessment and completion of measures 12 x 2 hr groups, new material during each of the first 10 sessions, then negotiated revision Overall content predetermined, ordering and emphasis varied according to group needs Strategies to gradually enhance willingness to disclose experiences to each other, make behavioural commitments and feed back

Measurement Pre, mid, end and 3 -month f/up Yale-Brown Obsessive Compulsive Scale Life Adjustments Scale (5 -item) Acceptance and Action questionnaire

Phase 1: Creative Hopelessness Differentiating obsessions and compulsions What works? Tug-of-war with a monster Person-in-a-hole What is digging for you?

Phase 2: Willingness & De-Fusion Willingness as an alternative to control The two scales of anxiety and willingness Acceptance of thoughts and feelings Willingness to have obsessions Word repetition De-fusing self-evaluation

Phase 3: Values & Barriers to Valued Living questionnaire Discrepancy between values and actions Life compass Barriers to achieving valued living Values guided behavioural commitments Passengers on the bus

Phase 4: Personalisation Selecting the approaches which suit you Personal plans Continued application of acceptance and action strategies through follow-up

Case Study 1: Background 48 yr old divorced woman 15 year history of obsessions regarding contamination, hand-washing cleaning and avoidance Reported disruptions of relationships, home life and loss of job associated with OCD

Case Study 2: Intervention Creative hopelessness associated with reported surprise at the idea that mental events may not be controllable Values work associated with client reporting increased focus on time for self and time with children Acceptance of thoughts and feelings associated with reported increased willingness to have obsessions In-session willingness exercise associated with reduced avoidance and increased behavioural change between session

Our Learning ACT is congruent with ERP approaches Different people take different things from the approaches - formulation matters The group is an excellent vehicle for addressing the ‘unacceptability’ of certain mental events Experiential approaches are most effective Abandoning the control agenda is difficult for people suffering from OCD (and us)

Next Steps Complete three-month follow-up on the current group Report the results Maintain the focus on ‘treatment non-responders’ as we deliver further groups Maintain the tertiary care focus of the service in line with NICE guidelines