OCD and Related Disorders : Assessment

• Counselors must conduct a comprehensive evaluation of clients that considers the bio-psycho-social-cultural-spiritual model before choosing treatment frameworks.
• Formal and informal assessments help counselors identify which disorder is present and its reasons.

Assessments

• Counselors should evaluate general assumptions about why the client is seeking counseling now, their expectations, their awareness of their condition, and its impact on their lives.
• The answers to these questions can guide the appropriate assessment tool selection.
• Clinical interviews are crucial for OCD and Related Disorders, keeping in mind that obsessions and compulsions manifest differently due to various factors.
• Counselors should ask specific questions about symptom presence rather than their nature.
• The initial step is to ask clients about intrusive thoughts they can't stop and behaviors that interfere with their life, gauging symptom severity.
• Counselors should create a comfortable and safe space, as clients may fear judgment or retribution for divulging intrusive thoughts.
• The Structured Clinical Interview for DSM-5 is a 90-minute screening for all disorders; the OCD module can be used for OCD diagnosis.
• The Mini-International Neuropsychiatric Interview is another screening tool.
• The Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Second Edition) (Y-BOCS-II) assesses symptom severity, not for diagnosis.
• It can be used to measure treatment improvement.
• Other formal standardized instruments measuring symptom severity include:
  • Obsessive-Compulsive Inventory (Revised) (OCI-R)
  • Maudsley Obsessive-Compulsive Inventory (MOCI)
  • Leyton Obsessional Inventory – Child Version (LOI-CV)
• Assessment tools should be used vigilantly; a person's symptoms or scores do not fully encompass their experiences.
• Symptoms leading to a diagnosis are not the only ways a person might need support and help.
• A person's medical and family history contribute to how counselors conceptualize their clients.
• Family evaluations are recommended, because those with OCD or Related Disorders often face challenges within family dynamics.
• Families can provide information on symptoms and may contribute to tension due to a lack of understanding, which can perpetuate compulsions.
• Counselors can include the family as part of treatment.

Theories of Conceptualization

• Considerations for people who display symptoms of obsessions, compulsions, and preoccupations include:
  • Culture
  • Religion
  • Socioeconomic status
  • Family and medical history
  • Experiences of abuse or trauma
• Counselors should consider these factors when treating a client with OCD or a Related Disorder; treatment depends on how the counselor views the problem's origin.

Learning and Conditioning

• Learning theory and classical conditioning describe how people with OCD experience and process information.
• Early researchers state that anxiety and fears are triggered by experience, leading to avoidance and negative reinforcement of the behavior.
• Avoiding shaking hands with others reinforces the idea that it causes illness, leading to hand washing and anxiety reduction.
• Research indicates operant conditioning continues to grow, indicating that OCD and Related Disorders result from avoidant behavior becoming prioritized over functional aspects of life.

Cognitive (and Behavioral) Theory

• Cognitive theory builds upon Learning Theory, describing the distorted beliefs that those with OCD or a Related Disorder have experienced.
• OCD researchers claim that obsessions and preoccupations have meanings for the person’s specific life contexts.
• Cognitive theorists would argue that a person's dysfunctional and intrusive thoughts result from their inability to properly process what is occurring for them and around them.
• Counselors would work with this person on controlling their thoughts, identifying the distorted beliefs that accompany their behavior.

Attachment Theory

• Attachment theory argues that a person's basic need for trust and comfort from caregivers or companions is key to emotional regulation and self-concept development.
• People develop one of three attachment styles based on caregivers' reactions and provisions during times of stress:
  • Anxious
  • Avoidant
  • Secure attachment
• Research combined anxious and avoidant attachment into a fourth style: disorganized attachment.
• A meta-analysis identified a strong association between attachment style and OCD symptomology, understanding developmental factors that underlay symptoms is vital for treatment.

Treatment

• Studies identify Cognitive Behavioral Therapy (CBT) as the most effective treatment for OCD and Related Disorders across different demographics.
• Variations of CBT continue to grow in the literature, highlighting exposure and response prevention (ERP) as a suitable modification of CBT.
• ERP uses CBT assumptions to challenge thought patterns to change destructive behaviors, and ERP helps clients confront the intrusive and distorted thoughts.
• A client who fears shaking hands with other people and touching anything in public would gradually be exposed to engaging in such behavior
• ERP is a gold standard for OCD and Related Disorders, but counselors are not trained in ERP, and it is also time-consuming and expensive.
• Mindfulness-Based Cognitive Therapy (MBCT) helps clients regain control when distorted thoughts/images occur.
• Clients observe what is happening in their minds and bodies by taking note of bodily sensations, feelings, and thought patterns and engage in non-judgmental, self-soothing exercises.
• Counselors utilize techniques from several cognitive approaches when working with their clients with OCD.
• Group counseling is more cost-effective than ERP; when paired with CBT worksheets, evidence suggests group counseling can be just as effective as individual counseling.
• Acceptance and Commitment Therapy (ACT) is another alternative to ERP, where clients shift their focus from controlling their symptoms to the positive aspects of their lives.
• ACT builds psychological flexibility, helps clients separate from intrusive thoughts or images, and encourages acceptance and diffusion skills for value-based participation in life.