A Clinician's Guide to Treating OCD by Jan Van Niekerk

Author:Jan Van Niekerk
Language: eng
Format: epub
Publisher: New Harbinger Publications
Published: 2018-07-23T22:09:30+00:00

Next I will consider cognitive restructuring in specific categories of appraisal. This work can be supplemented by the client’s use of the Intrusive Thoughts Worksheet (appendix 1, also available at http//:www.newharbinger.com/38952), with columns for situation/intrusion-­trigger, intrusive thought, OCD interpretation, emotion, OCD coping strategies, and helpful interpretation and response. However, the worksheet should only be an initial therapy prop to assist the client in formulating the situation and should eventually be withdrawn in favor of an approach that resembles non-­OCD thinking and action: nonexcessive, flexible, and adaptive—­predicated on the demands of reality and sound judgment.

Overestimation of Threat

Inflated estimates of the probability and magnitude of danger are common in OCD, particularly in contamination or checking subtypes. The strategies discussed below may prove to be useful, although obsessional symptoms may prevail if additional appraisals of inflated responsibility or intolerance of uncertainty are unattended to (“Even though I appreciate the risk is one in a billion, I still can’t stand the thought of potentially being to blame for someone getting hurt!”).

Cognitive strategies. Consider the following lines of questioning and data-­gathering strategies:

How would a reasonable, responsible, trusted friend or relative (ask for the person’s name to make the question more personal) estimate the likelihood of the negative event? (The client could also conduct a survey, asking specific, detailed questions of trusted others, and collate the information.) Which factors would explain the discrepancy between that person’s estimate and the client’s estimate?

The client may benefit from consulting experts, such as an infectious disease physician to discuss the probability of contracting HIV from using a public toilet, or an occupational health physician to discuss concerns about asbestos exposure. It may be advisable to have a conversation with the expert to brief him or her about OCD prior to the meeting with the client.This strategy is likely to be particularly helpful when the client is ignorant of relevant information and considers the expert to be credible; however, this intervention can easily be sabotaged by obsessional doubting (“I didn’t provide all the details, which might have changed his opinion”). Therefore, it would be wise to prompt the client to preconsider what level of detail is reasonable and how the new information can help her modify her appraisals and behaviors to overcome OCD (inflated responsibility and intolerance of uncertainty are also relevant to consider here; see below).

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