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Tables of Contents for Mastery of Obsessive Compulsive Disorder Therapist Guide
Chapter/Section Title
Page #
Page Count
Section 1: Description and Assessment of OCD
Symptoms of OCD
3
4
Introduction
3
1
Definition of OCD
4
1
Prevalence
5
1
Course
5
1
Associated Disorders
6
1
Theories of OCD
7
6
Learning Theories
7
1
Cognitive Theories
8
2
Neurochemical Theories
10
1
Neuroanatomical Factors
11
2
Assessment of OCD
13
8
Diagnostic Interview
13
2
Differential Diagnosis
15
6
Obsessions Versus Ruminations
15
1
OCD and Other Anxiety Disorders
15
1
Hypochondriasis
16
1
Body Dysmorphic Disorder
16
1
Tourette's Disorder and Tic Disorder
16
1
Delusional Disorder
17
4
Section 2: Available Treatments of OCD
Psychosocial Therapy for OCD
21
8
Cognitive-Behavioral Treatment
21
5
Exposure Versus Response Prevention
22
1
Imaginal Versus Actual Exposure
22
1
Gradual Versus Immediate Exposure
23
1
Duration of Exposure
23
1
Frequency of Exposure
23
1
Therapist-Guided Exposure Versus Self-Exposure
24
1
Ritual Prevention
24
1
Requests for Assurance
25
1
Cognitive Therapy
26
3
Pharmacotherapy for OCD
29
4
Serotonergic Medications
29
1
Combined Treatment by Exposure and Medication
30
3
Choice of Treatment
33
10
Discussion of Treatment Options With the Client
34
4
Additional Considerations
38
5
Treatment History
38
1
Combined Treatments
38
5
Section 3: Cognitive-Behavioral Treatment by Exposure and Ritual Prevention
Treatment Planning: Understanding and Persuading
43
16
Understanding the Client
44
9
Identifying Obsessions
44
1
Identifying Avoidance Patterns
44
1
Identifying Rituals
45
1
The Nature of Obsessions
45
4
Avoidance and Rituals
49
2
General Functioning
51
1
History
51
1
Development of the Client's Symptoms
51
1
Previous Treatment
52
1
General History
53
1
Depression
53
1
Persuading the Client
53
6
Definition of OCD
53
1
Explanation of Treatment
54
5
Treatment Planning: In Vivo Exposure
59
16
Creating a List of Exposure Situations
59
7
Guidelines for Selecting Exposure Situations
60
1
Lines of Inquiry
60
4
Sample Lists of Exposure Items
64
2
Sample Exposure Plans
66
9
Washer
66
3
Checker
69
1
Hoarder
70
5
Treatment Planning: Imaginal Exposure
75
6
Medium of Exposure
76
1
Problems With Imaginal Exposure
77
1
Guidelines for Imaginal Exposure
78
1
Model Introduction to Imaginal Exposure
78
1
Sample Narrative Script for Imaginal Exposure
79
2
Treatment Planning: Ritual Prevention
81
6
Introducing the Concept and Persuading the Client
81
2
Sample Guidelines for Refraining From Rituals
83
1
Decontamination Rituals
83
1
Checking Rituals
84
1
Self-Monitoring of Rituals
84
3
Guidelines for Self-Monitoring
85
1
Reviewing the Self-Monitoring
86
1
Treatment Planning: Social Support
87
6
Patterns of Collaboration
87
2
Interpersonal Conflicts
89
4
Reviewing the Plan: Explicating the Contract
93
4
Beginning Exposure: Revision and Consent
97
10
Goals of the Exposure Sessions
97
1
Revealing Mistaken Beliefs
97
1
Building Confidence in the Therapist and in the Program
98
1
The Importance of Consistency
98
1
Refining the Program
99
1
A Typical Exposure Session
100
5
Imaginal Exposure
100
2
In Vivo Exposure
102
1
Instructions for Washers
102
1
Exposure for Checkers
103
2
Homework Instructions
105
2
Middle Exposure: From Bete Noir to Paper Tiger
107
8
Introducing the Most Difficult Exposures
108
1
Tactics for Helping the Clients
108
4
Scheduling
108
1
Encouragement
109
1
Courage
109
1
Risk Taking
109
1
The Paper Tiger Metaphor
110
1
Therapist Attitude
111
1
Alternatives to the Planned Exposure
112
2
Discontinuing Therapy
112
1
Intermediate Exercises
113
1
Crises Unrelated to Exposure
114
1
End Exposure: Theme and Variations
115
4
Repetitions and Generalizations
115
1
Teaching Normal Patterns of Behavior
116
1
Rules for ''Normal'' Behavior
117
2
Relapse Prevention: Self-Exposure
119
4
The Process of Relapse
119
1
Rules for Self-Exposure
120
1
Stress-Management Techniques
120
1
Meeting With Significant Others
121
1
New Activities and Interests
121
1
Scheduling Follow-Up Contacts
122
1
Resistance and Other Difficulties
123
10
Concealment of Symptoms
123
5
Discussing Problems With Client and Support Person
124
3
First Instance of Concealment
127
1
Second Instance of Concealment
127
1
Symptom (Ritual) Substitution
128
1
Unforbidden Avoidance
129
1
Incomplete Abstinence From Rituals
129
1
Handling Arguments
130
1
Emphasizing the Client's Control Over Treatment
131
1
Intermediate Tasks
131
1
Emotional Obstacles
132
1
Adjustment for Clients With Mental Retardation
133
6
Diagnosis of OCD
133
2
Behavioral Sterotypes Versus Rituals
134
1
Interviewing the Client
134
1
Other Sources of Information
134
1
Treatment of OCD
135
4
Adjustments of Exposure Treatment
135
1
Pessimism
136
1
Impaired Discrimination and Distractibility
136
1
Slower Learning
137
1
Maintenance of Gains
137
2
Adjustment for Children
139
8
Comorbidity in Pediatric OCD
139
1
Adjustment of Exposure Treatment
140
1
Teaching Children and Families About OCD
141
1
Explanation of OCD as a Psychobiological Disease
141
1
Explanation of OCD as a Set of Strong Habits
142
1
Evaluating Parent's Observations
142
1
Pace of Exposure for Children
142
1
A Model Treatment Program
143
2
Assessment and Treatment Planning
144
1
Ritual Prevention
144
1
Reframing OCD as the Child's Enemy
144
1
Family Involvement With Treatment
145
2
Conclusion
147
2
References
149
16
Appendix A
165