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The use of the cognitive-behavioural therapy methods in the treatment of children and adolescents with obsessive-compulsive disorder. Leading therapy in the real life circumstances

Justyna Sulej, Artur Kołakowski

Affiliacja i adres do korespondencji
PSYCHIATR. PSYCHOL. KLIN. 2011, 11 (2), p. 92-99
Streszczenie

Epidemiological research shows that most probably 0.5% of children and adolescents suffer from obsessive-compulsive disorder (OCD) and, among adults, about half of the patients claim that they have been experiencing the OCD symptoms since their childhood. In case of OCD treatment, the cognitive-behavioural therapy is considered a well-documented and effective method of choice. One of the basic behavioural interventions for OCD is exposure plus response prevention (E/PR). Applying solely this therapy method often turns out to be insufficient and unsuccessful in children’s and adolescents’ OCD treatment. Clinical data show that, on the one hand, engaging in compulsive behaviour is extremely difficult and stressful for children or adolescents, though, on the other hand, the OCD symptoms constitute a part of their social, school and family environment. They become an important element of family functioning and some of them may be associated with the exposure or supporting of the OCD symptoms. In the article we are presenting how the OCD symptoms, which are a part of the family environment, may influence the clinical picture of the disorder and force the modification of standard behavioural therapy methods used in the OCD treatment. In the cases described herein such a way of leading therapy turned out to be ineffective and made psychotherapists transfer the sessions into the patient’s domestic environment. The sessions at the patients’ home enabled us to notice and modify those actions (of both parents and children) which reinforced the symptoms. Such actions included e.g.: helping out with the tasks that could trigger the symptoms; helping the patient avoid situations which are likely to induce the symptoms; parents’ attitude towards the disorder that supports the symptoms. Helping out with the activities that may trigger the symptoms – often practised by parents – actually provided the patient with additional benefit from suffering from the disorder. In vivo sessions often helped identify the causes of persisting symptoms (e.g. difficult family situation of the patient, disorder as an escape). In the article below we describe in detail a number of cases where the behavioural method has been applied in the real life circumstances and has turned out to be successful as a result of collected observations and implemented modifications.

Słowa kluczowe
cognitive-behavioural therapy, children, adolescents, in vivo therapy, parents, exposure plus response prevention