This presentation was originally reviewed on October 5, 2023, and broadcast live online on October 6, 2023, from 12:00 PM – 1:30 PM ET. Go to the Register tab above to learn how to participate for continuing education credit, watch the broadcast, and download the slides.

The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.

Exposure and response prevention (ERP) is considered to be the gold standard of treatment for obsessive compulsive disorder (OCD). However, despite both the fact that the following groups, American Psychological Association, the American Psychiatric Association, the International OCD Foundation, and almost all OCD experts, have agreed with this since the 1990's, it remains hard for sufferers to find proper treatment.  To further complicate this, if they can find a provider who claims to use ERP, it is often poorly done.

One of the main sources of this problem is the failure of therapists to understand the actual goals of treatment; goals that go beyond simply lowering anxiety and reducing/eliminating rituals.  As a result, clients cannot agree to the goals (goals that are necessary prerequisites for the successful implementation of ERP) that have never been presented to them.

This presentation will focus on the underlying treatment goals of ERP and how to properly prepare clients for treatment.  Furthermore, the many different manifestations of OCD (e.g., contamination, checking, harm ocd, pedophile OCD, scrupulosity, etc), require different 'arguments' to help the client decide to take, what seems to them, the risk of committing to ERP.  Sample dialogs, tailored to different OCD presentations, will be included in the presentation.

LEARNING OBJECTIVES

After this lecture, registrants will be able to:

1. Recognize intolerance of uncertainty as a core OCD issue and will be able to effectively discuss and help clients to accept the goal of learning to live with uncertainty before implementing ERP.
2. Modify and tailor treatment preparation discussions to the client's particular manifestation of OCD.
3. Understand the nature of acceptance as choosing to live the second best life and why this would make sense.

SESSION II: Sleep, Dreams and Rumination in OCD

In humans, approximately 30% of a 24-hour period is spent sleeping or trying to sleep. It is incredibly hard to NOT sleep. Over the past 25 years of working with individuals with mental health disorders, I cannot think of a single person who reported that they couldn’t sleep at all. And yet it also seems incredibly hard to sleep “well”. The vast majority of people I have worked with clinically have reported wanting more sleep, or sleeping too much, or having trouble falling asleep, or having chronic nightmares and nighttime panic or waking up exhausted. When it works well, sleep is supposed to be restorative - which means we wake up rested and ready for the challenges of a new day. Under the umbrella of sleep terminology, there are a variety of terms - sleep architecture, sleep continuity, sleep onset latency, rapid eye movement latency and narrative and emotional experiences while dreaming.  In this talk we are going to learn about these terms and apply them to individuals struggling with OCD. A quick pubmed search for journal articles on OCD and sleep show that from 1979-2010 there were 60 published papers on the topic. That’s about 2 papers per year. Since 2011 to now, there have been 163 published articles - that’s about 13 papers per year. Quite a nice increase in interest in this topic. But type in sleep and depression and from 2011-to now you will see more than 24,000 published papers. This is my long-winded way of saying, we really do need more research. But here are some things we know. Poor sleep seems to be a problem in people with OCD - but the nature of the poor sleep varies across studies. Perhaps one of the more consistent findings is something called a delayed sleep phase. People with OCD sleep later in the night. Although there are a variety of other findings such as reduced total sleep, shortened REM latency, more frequent waking through the night and trouble falling and staying asleep. These findings are less consistent across studies and when these sleep problems have been detected in studies, they may be due to co-morbid depression. In the context of dreams, the content of dreams has not been studied much in OCD, but there has been at least one study to find that people with OCD have dreams related to their obsessions and compulsions. There is an established set of treatments for poor sleep derived from treating insomnia and other sleep problems that we can apply to helping individuals who are sleeping poorly and have OCD. We will go over these treatments including sleep restriction training, stimulus control procedures and nighttime mood management strategies. 

LEARNING OBJECTIVES

After this lecture, registrants will be able to:

1. Describe sleep and what poor sleep actually means.
2. Define the most common sleep problem associated with OCD.
3. Identify some basic behavioral strategies to help individuals with OCD sleep better.