OCD Obsession Family Help

Self-Help Exposure sessions for Obsessive Compulsive Disorder begin with less disturbing items in the hierarchy and progress toward the most disturbing items. Patients can engage in these procedures when in session with a therapist and when at home.

During exposure sessions, patients are required to expose themselves to the feared item. For example, a person with a contamination obsession would be asked to touch the side of a wastebasket or, if further along in the hierarchy, to reach inside it.

The patients must then refrain from any rituals (e.g. hand washing) that could reduce the discomfort they are experiencing. This discomfort is assessed every few minutes by means of the discomfort scale described above. The urge to ritualize should also be assessed on a 100 point scale.

In general, people should be urged to focus their attention on the distress they are feeling rather than using distraction techniques. The self-help for ocd exposure session should continue until the distress level has decreased by at least 25% on the distress scale. Imaginal exposure sessions can be helpful also. Imaginal exposure is discussed in more detail below.

Exposure practice at home can help. While it may be helpful for the therapist to demonstrate or model exposure initially, people with Obsessive Compulsive Disorder must also conduct exposure self-help exercises themselves as homework assignments for this procedure to be effective, and for gains to be maintained. Monitoring exposure and response prevention exercises at home in writing is important.

Unwillingness to do this is associated with poor outcomes. Home sessions are necessary if the treatment is to succeed and, whenever possible, this should involve family members and friends. Baer (1993) has pointed out that family members often provide the patient with a `reassurance ritual', whereby they enable the Obsessive Compulsive Disorder sufferer to maintain their symptoms by reassuring the patient that, for example, the doors are locked, the dishes are really clean, etc.

It is important that family members become co-therapists and help with the exposure and response prevention sessions at home. They should inform the patient that they will not be reassuring anymore `because this only makes your OCD worse'. However, this should only be done with the patient's permission and this is not always possible.

While there is no right or wrong duration for exposure sessions, greater improvements are made with longer sessions. Patients should progress up the hierarchy as quickly as is possible and they must be willing to endure the distress that this will create.  It should not take more than four weeks to reach the most distressing item in the hierarchy. Finally, not all of a patient's obsessions and compulsions should be worked on at the same time, for fear of overwhelming him/her. They should be attacked one or two at a time.