Psychological approaches

The effect of a psychodynamic approach in OCD is limited, whereas modern interventions like cognitive and behavioural therapy show promising results. (55> Behavioural therapy is as effective as pharmacotherapy in OCD,(5 56) and some data indicate that the beneficial effects of behavioural therapy are longer lasting. About two-thirds of patients with moderately severe rituals can be expected to improve substantially, but not completely. A combination of behavioural therapy and pharmacotherapy may constitute the optimal treatment for OCD. Recently, two neuroimaging studies found that patients with OCD who are successfully treated with behavioural therapy show changes in cerebral metabolism similar to those produced by successful treatment with SRIs. (3 58ยป

Behavioural therapy can be conducted in inpatient and outpatient settings. The principal behavioural approaches in OCD are exposure for obsessions and response prevention for rituals (see Chapte.L.6,3;.2 1...). Desensitization, thought stopping, flooding, implosion therapy, and aversion conditioning have also been used in patients with OCD. In behavioural therapy the patient must collaborate and perform assignments. In a study of 18 patients with OCD, those receiving exposure and response prevention therapy showed significant improvement, whereas patients on a general anxiety management intervention (control) showed no improvement from baseline.(59) Direct comparisons of behavioural therapy and pharmacotherapy are few and are limited by methodological issues. Cox et al.(60) reported equal efficacy in a meta-analysis.

In thought stopping, the patient (or initially the therapist) shouts 'stop' or applies an aversive stimulus to counteract the obsessional preoccupation. The patient may also imagine a stop sign with a police officer nearby or another image that evokes inhibition at the same time that he or she recognizes the presence of the obsession. Another technique is to 'postpone' the thought until a specified time (e.g. an hour later) and not to think about it until then.

Despite the fact that biological interventions are more efficacious in patients with OCD, psychodynamic factors might be of considerable benefit in understanding what precipitates exacerbations of the disorder and in treating various forms of resistances to treatment, such as non-compliance to medications or to homework assignments. It is important to remember that the symptoms may have important psychological meanings that make patients reluctant to give them up. A psychodynamic assessment of the patient's resistance to treatment may result in improved compliance.

In the absence of controlled studies of insight-oriented psychotherapy for OCD, the anecdotal reports reporting lasting change do not allow generalizations to be made regarding efficacy. Also, the efficacy of medications in producing quick improvement has rendered slow and long-term psychotherapy out of favour.

Supportive psychotherapy has a place in managing patients with OCD, and may help patients improve their functioning and adjustment. The management plan should also include attention to the family members through the provision of emotional support, reassurance, explanation, and advice on how to manage and respond to the patient. Family therapy may reduce marital discord and build a treatment alliance, as well as helping in the resistance to compulsions. Group therapy is useful as a support system for some patients.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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