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:
- Three individual sessions of CBT with their key therapist
- A specialist nurse therapist or OT who supports you
- Group CBT sessions which are specific to OCD or BDD.
- A wide range of other groups for related problems such as depression, low self-esteem or social anxiety.
- Regular monitoring of progress which is used to audit outcome.
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. NHS patients must have an identified local care coordinator who can discuss follow up arrangements and attend a Care Programme Approach (CPA) meeting with a family member. There should be follow up by a local cognitive behaviour therapist who would preferably act as the care co-coordinator. Alternative follow up arrangements including telephone consultations and day-patient or out-patient care can also be arranged.