Cognitivebehavioural therapy

Cognitive-behavioural therapy is regarded as the psychological treatment of choice for children and adolescents with OCD. In contrast to medication, where relapse is common when treatment is withdrawn, cognitive-behavioural therapy has been shown to be a more durable treatment, although booster sessions may be required from time to time. Treatment generally involves a three-stage approach, consisting of information gathering, therapist-assisted graded exposure and response prevention, and homework assignments. Interventions for children with predominantly internalizing symptoms also include relaxation training and cognitive training. Family needs to be involved in treatment, at varying extent according to individual situations. Cognitive-behavioural therapy is usually implemented initially with 13 to 20 weekly individual or family sessions and homework assignments. Partial or non-responders may require more frequent visits, and out-of-office therapist-assisted training. A few open studies have shown beneficial effects of cognitive-behavioural therapy, alone or in addition to pharmacotherapy, in series of 14 to 15 children and adolescents with OCD;(66,6Z and 68> post-treatment, symptoms were relieved entirely or reduced to a mildly incapacitating level in 50 to 86 per cent of cases.

In tic disorders, the relative suppressibility of symptoms may have implications for cognitive-behavioural therapy, and a variety of cognitive and behavioural approaches have been used. A battery of habit-reversal training techniques encompassing awareness training, self-monitoring, relaxation training, competing response training (where a movement is performed that is opposite to a particular tic), and contingency management have been reported to reduce tic symptoms markedly in one study.(69> Most other reports are case reports. Many families say that some methods, temporarily useful, may lose their effectiveness over time.

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