Group ACT for OCD

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Group ACT for OCD

• Giselle Brook
• Cognitive Behavioural Psychotherapist
• Joe Curran
• Principal Cognitive Behavioural Psychotherapist
• Tom Ricketts
• Cognitive Behavioural Psychotherapist/Consultant
  Nurse

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Obsessions and Compulsions

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

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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)

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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 )

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Client Group

• Clients with longstanding treatment resistant
  problems with OCD
• A majority have received prior CBP, generally ERP

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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

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Measurement

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

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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?

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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

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Phase 3 Values Barriers to Valued Living

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

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Phase 4 Personalisation

• Selecting the approaches which suit you
• Personal plans
• Continued application of acceptance and action
  strategies through follow-up

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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

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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

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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)

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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