Response Prevention – OCD
Response prevention is a method of cognitive behavioral therapy used for Obsessive Compulsive Disorder. This module is done after the five psychotherapy sessions which precede exposure to virtual reality and is only intended for people suffering from OCD.
The main thing to remember
- Response prevention is a method of CBT intended for Obsessive-Compulsive Disorders, applied before exposure to virtual reality.
- It first consists of precisely listing the patient's rituals (frequency, duration, triggers, context).
- The rituals are then modified progressively, never suddenly stopped, by playing on their frequency, their duration, their triggering and the associated elements.
- The objective is a total extinction of the ritual, obtained over several months or even a year.
- The article also addresses impulse phobia, in reality an impulse OCD without taking action.
1. THE BEGINNING OF THE RITUALS
Patients with OCD need ritual (hand washing, cup counting). The exposure therapy that you will carry out afterwards with your patient will ensure that they no longer do their rituals. You cannot ask a patient to stop them, it is too brutal and will traumatize the patient. You have to do things slowly and gradually so that they can reduce them gradually. To do this, you will have to touch several parameters of these rituals. This first requires you to be aware of your patients' practices. For example: How long do they last? What triggers them? What do you use?
The first thing to do with your patient is to list the situations in which they occur. It is necessary to structure it in such a way as to answer the questions: When? How ? With whom ? How long ? You can also give him a sheet with around fifty empty boxes so that he can count them. It is necessary to list all the situations and the modalities of the ritual beforehand, whether behavioral (checking the locks, cleaning), or linked to thought (counting). Once all the situations and the main rituals have been stated, you can begin to modify them with the patient. Based on the parameters mentioned, you will gradually modify each of the parameters which will lead to a cessation of this ritual after several months, or even after a year.
2. THE FREQUENCY OF THE RITUAL
The first parameter to modify is the frequency of the ritual. If the patient washes their hands 50 times a day, you will be able to reduce it to 45 times. To change them, patients must commit and must be able to do so. The goal is that they can really modify this frequency in this ritual. Ask him the question: “Can you do it if we go from 60 times a day to 45 times a day?” Once the commitment is made, you can give him another table with the basic rules. (I have to change my rituals, I have to follow my therapies, I have to apply my therapies). The other parameter that we can play with is the duration of the ritual. If your patient washes his hands for 5 minutes, you can suggest that he wash them for only 4:30 minutes.
3. TRIGGERING THE RITUAL
Another factor to take into account is the delay in triggering the ritual. For example, tell your patients that when they are anxious and wash their hands, is it possible for them not to wash their hands right away, but to wait 30 seconds. While waiting, suggest doing meditation, relaxation methods, repeating slogans, mental imagery seen in previous therapies.
4. REMOVAL OF ELEMENTS
We can also play on the removal of certain elements associated with rituals. For example: using a specific brand of soap to wash your hands. Suggest changing the brand of this soap. In the example seen throughout this article, the patient who is going to wash his hands 50 times a day will no longer wash 50 but 40 times and no longer 5 mins, but 4 mins 30, he will thus be delayed by 30 seconds and will not wash with the same soap. All these modifications, associated with the ritual, will be noted on the patient's chart so that they remember them.
The parameters will be modified gradually by varying the frequency and duration until the ritual is completely extinguished. If unfortunately the patient was unable to follow the changes in all these parameters, only offer him one or two.
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5. IMPULSE PHOBIA
In this last part, let’s talk about impulse phobia. It's a false friend, it's not a phobia but an impulse OCD. These are patients who will say: instead of falling, I will throw myself, or I will strangle my husband, I will kick the grandmother's poodle. Everyone has this type of thinking, most people don't pay attention. In impulse phobia, patients will remain focused on this type of thought. By trying to stay in control and trying not to think about it anymore, they will reinforce these thoughts which will come back again and again. Having crazy thoughts is a normal phenomenon, it is the process of how the brain functions. It is normal to have violent, blasphemous, transgressive thoughts. In impulse OCD, there is no acting out because, precisely, the patient fears carrying out the act.
Discover the method of Jacobson progressive muscle relaxation, and the method AWARE.
FAQs on OCD Response Prevention and VRET
Which patients can benefit from a VRET?
Patients with obsessive-compulsive disorders, with behavioral (washing, checking) or mental (counting) rituals, may benefit from virtual reality exposure therapy. The practitioner gradually reduces the frequency, duration and initiation of the ritual before exposure.
What pathologies can be treated in virtual reality?
Virtual reality treats anxiety disorders (phobias, post-traumatic stress, obsessive-compulsive disorders), addictions, mood disorders and allows cognitive remediation. The practitioner adapts the virtual environment to the pathology and patient profile.
How long has this existed?
C2Care has been testing its virtual reality software in hospitals since 2016. This clinical experience has made it possible to expand the catalog of environments and integrate artificial intelligence, notably the AI assistant Camille, into patient support.
Who can use virtual reality for treatment?
Practitioners such as psychologists, psychiatrists and occupational therapists use virtual reality to support their patients. It is also integrated into healthcare establishments: CHU, hospitals, clinics, EHPADs and follow-up care structures.
Can I feel nauseous while using the headset?
A feeling of cybersickness can occur in around 10% of people using a virtual reality headset. The practitioner then adapts the duration and intensity of the graduated exposure to limit this discomfort.
How is virtual reality used?
The practitioner installs the patient with a headset broadcasting the chosen virtual environment, adapted to his rituals or his pathology. The Camille AI assistant accompanies the patient without judgment during the graduated exposure.
Author
C2Care
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