NAME: Amna Amer ( 88 )

Iqra Jabeen ( 64 )

Maham ( 75 )

Samra khan ( 28 )

SECTION: B

SUBMITTED TO : Ms Samia Khalid

Session 2023-2025

MS Clinical Psychology
 Tool Kit for OCD (Obsessive Compulsive Disorder)

Definition:

OCD is characterized by the presence of obsessions and/or compulsions. Obsessions are

recurrent And persistent thoughts, urges or images that are experienced as intrusive and
unwanted, whereas compulsions are repetitive behaviors or mental acts that an individual
feels driven to perform in an obsession.

Diagnostic Criteria:

According to the DSM-5-TR ((Diagnostic and Statistical Manual of Mental Disorders, 5th
Edition), the diagnostic criteria for OCD are: A Presence of obsessions, Compulsions, or
both.

Obsessions are defined as:

1. Recurrent or persistent thoughts, urges or images that are experienced at some time
during the disturbance as intrusive and unwanted and that in most individuals cause marked
anxiety or distress.

2. The individuals attempts to ignore or suppress such thoughts, urges or images, or to

neutralize them with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined as:

1- Repetitive behaviors (like hand washing, ordering, checking) or mental acts (like praying,
counting, repeating words silently) that the individual feels driven to perform in response to
an obsession or according to rules that must be applied rigidly.

2- The behaviors or mental acts are aimed at preventing or reducing anxiety or distress or
preventing some dreaded event or situation; however, these behaviors or mental acts are
not connected in a realistic way with what they are designed to neutralize or prevent, or are
clearly excessive.

A- The obsessions or compulsions are time consuming (take more than one hour per day) or
cause clinically distress or impairment in social, occupational or other important areas of life.

B- The Obsessive - Compulsive symptoms are not attributable to the physiological effects of
a substance or another medical condition.

C- The disturbance is not better explained by the symptoms of another mental disorder.

The DSM-5-TR code for OCD is F42.2

Prevalence:

The 12-month prevalence of OCD in the US is 1.2%, with a similar prevalence

internationally. Women are affected at a slightly higher rate than men in adulthood, although
men are more commonly affected in childhood.
Prognostic and risk factors:

Greater internalizing symptoms, higher negative emotionality, and behavioral inhibition in

childhood are possible temperamental risk factors. Different environmental factors may
increase the risk for OCD. Familial transmission is due in part to genetic factors.

Comorbidity:

OCD is often comorbid with other mental health conditions, such as:

Other anxiety disorders, such as Panic Disorder or Social Anxiety Disorder, Generalized
anxiety disorder, specific phobia Depressive disorders or bipolar disorder Substance use
disorders.

Body Dysmorphic Disorder:

It is a mental health condition where a person spends a lot of time worrying about
flaws in their appearance.

According to the DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th
Edition), the diagnostic criteria for Body Dysmorphic Disorder are:

Preoccupation with one or more perceived defects or flaws in physical appearance that are
not observable or appear slight to others at some point during the course of the disorder, the
individual has performed repetitive behaviors (mirror checking excessive grooming, skin
picking, reassurance seeking) or mental acts (comparing his or her appearance with that of
others) in response to the appearance concerns.

The preoccupation causes clinically significant distress or impairment in social, occupational,

or other important areas of functioning. The appearance occupation is not better explained
by concerns with body fat or weight in an individual whose symptoms meet diagnostic
criteria for an eating disorder.

The DSM-5-TR code for Body Dysmorphic Disorder is F45.22

Prevalence:

Prevalence in a nationwide study among U.S, adults was 2.4%. Outside the US, it is
indicated 1.7%-2.9%. It is 11%-13% among dermatology patients, 13-15% among general
cosmetic surgery patients, 20% in rhino plasty surgery patients.

Prognosis and risk factors:

BDD has been associated with high rates of childhood abuse, neglect, trauma and teasing.
Heritability of BDD is 37%-49% among adolescents and young adult twins. The prevalence
of BDD is elevated in first-degree relatives of individuals with OCD.

Comorbidity:

Body Dysmorphic Disorder comorbid with:

 Major depressive disorder

 Social anxiety disorder
  Obsessive-Compulsive disorder
 Substance related disorders

Hoarding disorder:

Hoarding disorder is an ongoing difficulty throwing away or parting with possessions

because you believe that you need to save them. Persistent difficulty discarding or parting
with possessions regardless of their actual value. This difficult is due to perceived need to
save the items and to distress associated with discarding them. The difficulty discarding
possessions results in the accumulation of possessions that congest and clutter active living
areas and substantially compromises their intended use.

Hoarding causes clinically significant distress or impairment in social occupational or other

important areas of functioning.

The hoarding is not attributable to another medical condition.

The hoarding is not better explained by another mental disorder.

The DSM 5 TR code for hoarding disorder is F42.3

Prevalence:

Nationally representative prevalence studies of this disorder are not available. In one
population based study in Netherlands, hoarding symptoms appeared to be almost three
times more prevalent in older adults compared with younger adults.

Prognosis and risk factors:

Hoarding behavior is familial; more than 50% of individuals who hoard report having a
relative who also hoards.

Comorbidity:

Hoarding disorder comorbids with:

 50% of individuals with hoarding disorder have mood or anxiety disorders

 30%-50% have major depressive disorder
 20% Individuals have symptoms that meets criteria of OCD

Trichotillomania (hair pulling disorder):

Trichotillomania, also known as trich, is when someone cannot resist the urge to pull out
their hair. They may pull out the hair on their head or in other places, such as their eyebrows
or eyelashes. Trich is more common in teenagers and young adults

Diagnostic Criteria:

Recurrent pulling out of one’s hair, resulting in hair loss

Repeated attempts to decrease or stop hair pulling

The hair pulling causes clinically significant distress or impairment in social, occupational or
other important areas of functioning
The hair pulling or hair loss is not attributable to another medical condition

The hair pulling is not better explained by the symptoms of another mental disorder

The DSM 5 TR code for trichotillomania is F63. 3

Prevalence:

The general population data suggests that the 12 months prevalence estimates for
trichotillomania in adults and adolescents may be in the range of 1% to 2%.Women are more
affected than men in clinical samples at a ratio estimated at 10:1 or greater.

Prognosis and risk factors:

The disorder is most common in individuals with OCD and their first degree
relatives than in general population.

Comorbidity:

Trichotillomania comorbids with

 Major depressive disorder

 Excoriation (skin picking disorder)

Repetitive body focused symptoms other than hair pulling or skin picking occurs in
individuals with trichotillomania

Excoriation (skin-picking) disorder:

A mental health condition where you compulsively pick at your skin. If untreated, skin-picking
behaviors may come and go for weeks, months, or years at a time. It is common for
individuals with this disorder to spend significant amounts of time, sometimes even several
hours a day, on their picking behavior.

Diagnostic Criteria:

Recurrent skin picking results in skin lesions.

Repeated attempts to decrease or stop skin picking

The skin picking causes clinically significant distress or impairment in social occupational or
other important areas of functioning.

The skin picking is not attributable to the physiological effects of a substance or another
medical condition.

The skin picking is not better explained by symptoms of another mental disorder

The DSM 5 TR code for excoriation disorder is F42.4

Prevalence:

An online survey among 10,000 adults, ages 18-69 years, found that 2.1% having current
excoriation and 3.1% reported lifetime excoriation disorder.
Prognosis and risk factors:

This disorder is most common in individuals with OCD and their first degree family members
than in general population.

Comorbidity:

It comorbid with:

 Obsessive-Compulsive disorder
 Trichotillomania
 Major depressive disorder assessment

In-formal Assessment
 Clinical Interview
 Behavior Observation
 Mental Status Examination
 DSM-V TR Checklist

Formal Assessment
 Symptom checklist
 Beck Anxiety Inventory (BAI)
 Yale Brown Obsessive Compulsive Scale
 Short term goals

Establishing rapport with the patient. It helps to establish good interpersonal relationships.
Psycho education can be provided regarding the client’s diagnosis and treatment to the
patient. Psycho education regarding the nature of obsessions and compulsions.

A deep breathing technique can be done to become her calm and relax.

Sleep hygiene can be taught to the patient to manage her disturbed sleep.

A daily activity schedule can be used to make her daily routine activities a structured way
and guide her to engage in healthy activities.

Distraction techniques can be used that helped the patient to overcome the symptoms of
anxiety such as counting backward, counting objects, and deep breathing.

Progressive muscle relaxation technique can be taught to the patient for relaxation and to
reduce body pain.

Exposure Response Prevention techniques can be used to assist the patient by exposing
them to anxiety-provoking situations in a graded manner with negotiations.

Thought stopping technique can be taught to the patient to understand about how to stop
her intrusive thoughts.

A coping statement can be taught to the patient to overcome their obsessive thoughts and
compulsions and anxiety. Some positive lines and statements should be given to the patient
to read and repeat over and over when feeling anxious.

Relapse Prevention should be done to educate the client to identify the triggers and high-risk
situations in order to prepare for future relapse.
Long Term Goals

Continuation of short-term goals, by encouraging the patient to continue the techniques

she/he learned during therapy. Regular follow up to be done to check the progress after the
therapy

Management plan

Rapport building:

Rapport building is defined as developing a relationship between psychologist and client. It is

the invisible wave along which information can flow from client to psychologist. If there is a
problem with rapport the information received may be distorted or not received at all (Yves,
2006).

Psycho education:

Psycho education combines the elements of cognitive-behavior therapy, group therapy, and
education. The basic aim is to provide the patient and families knowledge about various
facets of the illness and its treatment so that they can work together with mental health
professionals for a better overall outcome.

Deep breathing:

Deep breathing is an easy way to relax and let the client’s worries go. In which a therapist
can do pretty much anywhere and it only takes a few minutes. The steps are as follows:

 Find a comfortable, quiet place to sit.

 Choose a spot where you know you wouldn't be disturbed. If sitting ask the patient to
keep her back straight and her feet flat on the floor. Ask the patient to close her eyes.
Ask the patient to inhale the air with the nose for the remainder of 3 seconds and
then slowly exhale the air through the mouth (Pranayama, 2014).

Sleep hygiene:

Sleep hygiene practices affect the quality of sleep greatly. Many activities are considered
proper sleep hygiene that promotes good sleep such as avoiding caffeine and many more
(Yazdi, 2016).

 Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
 Remove electronic devices, such as TVs, computers, and smart phones, from the
bedroom.
 Avoid large meals, caffeine, and alcohol before bedtime.
 Set a consistent sleep schedule. Go to bed at the same time and wake up at the
same time.
 Get regular exercise.
 Avoid alcohol.
 Keep naps short.
 Use your bedroom for sleep only.
Activity Scheduling:

Activity scheduling is a CBT technique that helps people to engage in behavior they
ordinarily would avoid due to anxiety or depression. The first step in Activity Scheduling is
simply to monitor the activity over the course of a week by recording it on a chart. It allows
the therapist to take a baseline reading of current activity levels and it gives an opportunity to
set realistic goals to improve mood (Moyers & Houck, 2011).

So in this technique, we identified her rewarding low-frequency behavior and found time
throughout the week to schedule that behavior to increase its frequency. In this technique
client’s full-day activities are arranged in a schedule. The purpose of activity scheduling is to
make the client busy, and she asked to follow that schedule.

Distraction technique:

The distraction technique is a short-term technique that can help in reducing anxiety
effectively. Its basis is that our mind focuses on one thing at a time, by implying distraction
techniques; we simply move the attention away from our worry or fear and pay attention to
something else (Birnie, 2014).

The therapist can assist the patient in learning distraction techniques such as deep
breathing, backward counting, and counting things such as how many blue objects are in
your environment.

Progressive Muscle Relaxation (PMR)

14 progressive Muscle Relaxation exercise was used to make the Patient realize that she
has to control her muscles the body by making them tense and relax during the pain and
stress in the muscles. Progressive muscle relaxation can be helpful for a range of reasons,
including:

 Anxiety
 High blood pressure
 Lower back pain
 Migraine
 Muscle tension
 Neck pain
 Stress

Progressive muscle relaxation can be combined with deep breathing for additional stress
relief. Following instructions were given to client:

Start at your feet and work your way up to your face, trying to only tense those muscles
intended.
Loosen clothing, take off your shoes, and get comfortable.
Take a few minutes to breathe in and out in slow, deep breaths.
When you’re ready, shift your attention to your right foot. Take a moment to focus on the way
it feels.
Slowly tense the muscles in your right foot, squeezing as tightly as you can. Hold for a count
of 10.
Relax your foot. Focus on the tension flowing away and how your foot feels as it becomes
limp and loose.
Stay in this relaxed state for a moment, deeply and slowly.
Shift your attention to your left foot. Follow the same sequence of muscle tension and
release.
Move slowly up through your body, contracting and relaxing the different muscle groups.
It may take some practice at first, but try not to tense muscles other than those intended.

Exposure and response prevention (ERP).

Exposure and response prevention (ERP) is a first-line treatment for OCD. ERP is a form of
cognitive-behavioral therapy (CBT) that involves providing psycho education to the patient,
helping the patient confront fears or discomfort related to their obsessional thoughts
(exposure), and having the patient resist performing compulsions (response prevention)
(Law, 2019).

The goal of ERP is to challenge how the Patient responded to distress and eventually learns
that feared stimuli are safe. Exposure and response prevention intended to have the patient
sit with the upsetting thoughts and images without avoiding or engaging in a compulsion.

Thought Stopping Technique

Thought stopping is common in cognitive-behavioral therapy. In this technique, when the

obsessive or racing thoughts begin, the client says, clearly and distinctly, "Stop!" There is
actually a type of therapy known as “thought stopping” by which the therapist will call out
“Stop!” as a therapeutic technique whenever the client with OCD reports having an
obsessive thought.

Copying Statement

Coping statements are introduced that are truthful positive statements used to replace the
negative and untrue thoughts that take over when you feel anxious, stressed, angry, and/or
when facing other overwhelming situations. The patient can use these statements in a range
of situations such as aid to memory, challenge inappropriate cognition, and facilitate goal-
directed behavior and a positive action (Bourne, 2000).

These thoughts are not good for me. They are not healthy or helpful thoughts, and I have
decided to move in a better direction and learn to think differently.

 Perhaps some of these coping statements will help the client.

 This feeling isn’t comfortable or pleasant, but I can accept it.
 I can be anxious and still deal with this situation.
 I can handle these symptoms or sensations.
 This isn’t an emergence. It is okay to think slowly about what I need to do.
 I am going to go with this and wait for me to learn, to cope with obsession.

Relapse prevention

Relapse prevention therapy provides an alternative view of maintaining a stage of habit

change as an opportunity for new learning to occur (Parks, Anderson & Marlatt, 2004).
Relapse prevention helps patients to maintain their symptoms due to they do not suffer from
the same Problems in the future. In OCD, chances of relapse prevention are common so
that is why the Patient should be suggested some relapse prevention strategies like setting
goals for a healthy lifestyle and coping strategies.
 Therapies or
Short Term Goals Long Term Goals Therapies Or Techniques
techniques

ACT focuses on Acceptance Cognitive This approach helps individuals

accepting uncomfortable and Behavioral identify and challenge their
thoughts and feelings Commitment Therapy (CBT): distorted thoughts and beliefs
rather than trying to Therapy related to obsessions and
control or eliminate them. (ACT): compulsions. It often includes
It emphasizes exposure and response
mindfulness, values prevention (ERP), where
clarification, and patients gradually confront
committed action to help feared situations or stimuli while
individuals live more refraining from engaging in
fulfilling lives despite their compulsive behaviors.
OCD symptoms.

The distraction Distraction Exposure and ERP is a specific technique

technique is a short-term technique. Response within CBT that involves
technique that can help Prevention (ERP): gradually exposing individuals
in reducing anxiety to feared situations or stimuli
effectively. Its basis is while preventing them from
that our mind focuses on engaging in compulsive
one thing at a time, by behaviors. Over time, repeated
implying distraction exposure without engaging in
techniques; we simply compulsions helps reduce
move the attention away anxiety and diminish the impact
from our worry or fear of obsessions.
and pay attention to
something else

OCD can impact not only Family Medication: Selective serotonin reuptake
the individual but also Therapy: inhibitors (SSRIs) and
their family members. serotonin-norepinephrine
Family therapy can help reuptake inhibitors (SNRIs) are
improve communication, commonly prescribed
reduce family medications for OCD. These
accommodation of OCD medications can help alleviate
symptoms, and provide symptoms by affecting
support for both the neurotransmitter levels in the
individual with OCD and brain.
their loved ones
Thought stopping is Thought Psychodynamic This approach explores the
common in cognitive- Stopping Therapy: unconscious conflicts and
behavioral therapy. In Technique underlying psychological issues
this technique, when the contributing to OCD symptoms.
obsessive or racing By gaining insight into these
thoughts begin, the client factors, individuals may better
says, clearly and understand and manage their
distinctly, "Stop!" There is symptoms.
actually a type of therapy
known as “thought
stopping” by which the
therapist will call out
“Stop!” as a therapeutic
technique whenever the
client with OCD reports
having an obsessive
thought.

Post Assessment

Post assessment was done on the Subjective Rating of Symptoms, Beck Anxiety Inventory
(BAI), and Y-BCOS