OCD Group Project

Introduction and Rationale

The proposed group for this writing would be made up of people who present with Obsessive-Compulsive Disorder (OCD). When there are repeated and persistent ideas that become an impediment to everyday life, and they fall outside the norms of the average person those behaviors become obsessions. These behaviors become repetitive and intentional, and they more often than not follow specific patterns. Most people with this issue claim that the behaviors involved help them avoid discomfort and/or relieve anxiety. At this point the behavior becomes a source of interference with normal daily functioning. The use of Cognitive-Behavioral Group Therapy seems to be a very practical way to help alleviate the discomfort of OCD.

The research done by Johns Hopkins with regard to OCD is very extensive and detailed in nature. They have produced volumes of material on the topic of OCD. From their research we find such information as OCD possibly having some genetic linkage, "the prevalence of OCD was significantly greater in relatives of OCD cases than in relatives of controls (12% vs 3%)" (Nestadt M.D. M.P.H., 2009). They, through extensive study, have also found a, "significant linkage of compulsive hoarding" (Nestadt M.D. M.P.H., 2009).

Why would these studies, that are looking at neurological causes, be important to a person desiring to design a group therapy program? There are some good reasons why group therapy would be desirable, and some good reasons to believe that OCD is a viable candidate for treatment in group settings.

All one has to do is turn on the television and tune into the A&E channel to understand why this problem has possibly been overlooked on several levels. Many people laugh, or are repulsed when they see a person, most of the time over the age of 40, who has so much stuff in their house that they cannot even navigate from one room to another. They have "collected" or "can't do without" so many things that the average person would have parted with long ago. The television show is called Hoarders, and it must have a huge following as noted by the leading television ratings website, "2.4 million total viewers, 1.3 million adults 25-54 and 1.1 million adults 18-49... The new episode marked dramatic growth of 60% among total viewers, 52% with adults 25-54 and 43% among adults 18-49" (Gorman, 2012). Generally, people are interested in programs like this for several reasons. One of which would be to feel better about their own behavior, and to know they are not alone. Therefore, it would stand to reason that having a place for people who identify with this type of behavior to come, talk with others, and receive some help with their problem as being a very viable area in which to begin a group work.

Having dealt with my own struggle with obsessive behaviors, and how those behaviors have wreaked havoc in my own life, I absolutely understand the need for a group such as the one proposed in this paper. The hoarding example is only one of many behaviors that this type of therapy could help improve.

Is this a truly a viable idea? Having found several writings concerning CBGT as it pertains to OCD, one study stood out as quite convincing. I realize it was conducted in Brazil, but it was considered important enough to be placed with the U.S. National Library of Medicine/National Institutes of Health archive. The study verifies that this type of group therapy, when used to treat OCD showed, "a significant improvement in the quality of life...the rate of improved patients was 69.6% in the treated group and 4.2% in the control group" (Karger A.G., 2003).

Session Outlines

The sessions should be held in an environment that is very non-threatening, comfortable, accessible, and easy to find. Those should also be the very basic criteria for most group works that fall into the category of being voluntary in nature. With this particular treatment a very basic room setup is desired. The room needs to be simple, free from clutter, somewhat plain, but also warm and inviting enough to reduce the anxiety that often accompanies attending a group meeting. After an interview process, to determine if someone qualifies for the group, where a disclosure statement and informed consent form are read, discussed, and signed, the group members that are selected will be invited to attend the meetings. The remaining candidates will be referred to an appropriate program or counseling center for further follow-up.
Session One

Session one should be a time of getting to know the group and how the group works along with a brief discussion on the nature, and definition, of OCD.

The session begins with the leader discussing the reasons for the group, and an abbreviated description of OCD. This would be followed by handing out a list of rules and expectations for those in the group. The rules would be basic. They would have information on punctuality, attendance, confidentiality, and interpersonal conduct guidelines. They would also include a few words about what constitutes behavioral issues that would be cause for removal from the group. Things such as combative attitudes toward other members, not yielding to the leadership of the group, breeching confidentiality, and missing two or more consecutive meetings.

The meeting would then progress to asking members to introduce themselves and explain why they are seeking help with OCD. Upon the completion of this round, the leader will discuss the importance of doing the tasks (homework) assigned at each meeting. For the first session they would simply be asked to recognize the importance of tolerating exposure to obsessions without falling into the compulsions related to them, and actually trying to modify their behavior to avoid the behavior.

Before sending them out to work on their behavior, there would be a short time of reflection by the members about their obsessions and the triggers they believe lead to the behavior. Included in the discussion would be topics such as the time factor and impact on daily functioning.
Session Two

This session would primarily focus on how to understand how the obsessions and compulsions relate to the way they experience life.

The session begins with a clarification of how obsessions work in relation to how they elevate anxiety levels and distress. Then how those obsessions are countered by compulsions that are meant to reduce the anxiety. The point would be to help members to recognize their own obsessions and compulsions and how they operate within their individual lives. This discussion would be enhanced by teaching them to differentiate between actual cognitive rituals like correcting faulty speech patterns (saying something over and over until it is correct), how they think about certain things in certain ways, and even praying daily versus true obsessions such as checking to see if they locked the car door repeatedly immediately after exiting a car or keeping every newspaper delivered to their house for the last 20 years.

The homework for this session would include having them make a list of actions that they engage in each day, and then differentiate as to whether they are cognitive functions or obsessions. They would be asked to note the activity, behaviors involved, the obsession involved (if applicable), what do they believe triggered the action, and rank them by how much discomfort is associated with each action.
Session Three

Session three will begin the instruction on how to for strategies to overcome the anxiety involved with the compulsions. They will need to understand how repeatedly addressing each issue head-on throughout the day will be the best way to achieve habituation when the anxiety arises. They need to also understand that trying to avoid the issue or trying to find other ways to avoid the behavior will only hinder their progress.

The goal of the session will be to help them actively engage their obsessions without avoiding them during the time between the third and forth sessions.
Session Four

Once they have had the opportunity to work through the obsessions on their own, the leader will introduce some classic coping strategies that they can employ over the next span between sessions.

The primary strategy would be for the member to begin to logically think through the obsession and formulate an image in their mind of what the worst possible outcome would be if they did not engage in the compulsion. At this point they would be instructed on how they can replace the distorted thoughts with a more helpful self-talk.

They would be asked to go round the room and offer examples of how they might apply positive self-talk to an item on their specific list. Preferably the item that causes the most anxiety. The leader will offer feedback as member discusses their issue.
Session Five

Session five would begin by asking the members to report on any positive and/or negative results they have experienced over the span between sessions four and five.

The leader might need to offer differentiation between obsessive rituals and normal behaviors to be sure the group is properly focused. The leader would then instruct the group in how to form a personalized plan for each of their lives based on the prior week's homework results. Included in the instruction would be the leader asking the members to expose themselves daily to the highest rated obsession on their list for as long as it might take for them to reduce their anxiety level. They would be instructed to limit this daily practice to a specific amount of time so as not to impede daily functioning.

Ask the members to keep up with how they respond to this exercise during the week, and bring the results back to the next session.
Session Six

While using rounds to allow the group members to report their progress, the leader will help them identify other issues that might exist with their OCD such as phobias and depression.

Review the plans each member has to improve their situation, and encourage their good ideas while redirecting them on the ideas that will not necessarily produce positive results.

After a fairly long period of rounds, encourage the group to seek help for any ancillary issues that have been identified during the session.

Marketing and Screening

The target group for this proposal would be adults ages 18 and up. They would need to be presenting the classic symptoms of OCD, and be willing to verbally acknowledge that the compulsions are irrational, and they have attempted to overcome the behavior on their own without much success.

The primary way to advertise would probably need to be via the internet. The development of a webpage would be very important due to the fact so many people search the web for answers to life's most asked, and often most difficult questions. Also due to people trying to remain private when searching for help for issues they might consider embarassing, the internet would be a great place for them to start. There is also the possibility of partnering with a local counseling group, and asking them for referrals and to possibly allowing flyers to be placed in their office. There is an example of the flyer/ad found in Appendix-A.

Theory

Cognitive Behavioral Therapy techniques would be the primary methods that would be used with the group. Primarily because of the variety of ways that the leader can approach the different issues from different members. This type of methodology is active involving the thoughts and the actions. It involves acting on a plan, and not just discussing issues. Corey backs up my assertion of the theory through stating, "An advantage behavioral therapists have is the wide variety of specific behavioral techniques at their disposal" (Corey, 2009). He continues to write that, "I value the cognitive behavioral focus on how our thinking affects the way we feel and behave" (Corey, 2009). That makes this type of method very conducive to the way I prefer to work with just about any group. My experience has shown CBT to be effective. Effective mainly because of the various ways it can be adapted to meet the needs to the individuals within the group.

"Non nobis solum nati sumus" -We are not born for ourselves alone

References

Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy (8th Edition ed.). Belmont, CA, USA: Thompson/Brooks/Cole.

Gorman, B. (2012, January 3). A&E's Hoarders and Intervention Return With Double Digit Ratings Growth In New Season. Retrieved February 18, 2012, from TV by the Numbers: http://tvbythenumbers.zap2it.com/2012/01/03/aes-hoarders-and-intervention-return-with-double-digit-ratings-growth-in-new-seasons/115209/

Karger A.G., B. (2003). Cognitive Behavioral group therapy in obsessive-compulsive disorder: a radomized clinical trial. Retrieved February 18, 2012, from US National Library of Medicine, National Institutes of Health: http://www.ncbi.nlm.gov/pubmed/12792126

Nestadt M.D. M.P.H., G. (2009, August 1). Psychiatry and Behavioral Sciences - Research Findings, Obsessive-Compulsive Disorder Program. Retrieved February 18, 2012, from Johns Hopkins Medicine: http://www.hopkinsmedicine.org/psychiatry/specialty_areas/obsessive_compulsive_disorder/research/findings.html