The emphasis is on individuals having a good psychological understanding of how your solutions have become their problem and the implications for overcoming their problems. Once patients are engaged, they are expected to conduct exposure or behavioural experiments daily and complete their homework diaries and weekly ratings of outcome. In addition, all staff may model exposure or participate in behavioural experiments to help test out a patient’s beliefs.
In-patients with OCD or BDD receive:
- Individual sessions of CBT with their key therapist twice weekly
- A nurse or student who supports you in exposure tasks
- Group CBT sessions which are specific to OCD or BDD.
- A wide range of other groups for related problems such as depression or low self-esteem
- Regular monitoring of your progress
Medication is also reviewed. A SSRI or clomipramine or augmentation of a SRI may be offered. CBT may have a better outcome when combined with an SRI than CBT alone in those with moderate to severe impairment but patient’s make the decision whether to combine treatments.
An initial assessment gives us an opportunity for a treatment plan to be jointly agreed with a patient prior to admission. If this not possible, then an initial assessment may be conducted as a home visit or over the telephone/ Zoom. A formal assessment of response to treatment is completed on the ward within the first 2 weeks. This assessment is focused on the patient’s ability to engage in treatment. Partners and relatives are encouraged to meet with the therapy team. The team will want to assess their involvement and they will be advised on how best to support a patient’s treatment.
We aim for patients to be able to travel (if necessary, with a relative or friend) so they may return home on therapeutic leave as soon as possible at weekends to practice exposure in their own environment. Follow up arrangements including remote consultations and day-patient or out-patient care can also be arranged.
You can find out more about the OCD unit at the Nightingale here.