Alejandro Ibbarra Socorro - Intensive Therapy to OCD For the 2016 Annual OCD Conference

1. 23RD ANNUAL OCD
CONFERENCE. CHICAGO
INTENSIVE THERAPY TO OCD
Alejandro Ibarra Socorro. M. S.
PSINCO TOC ESPAÑA

2. ALEJANDRO IBARRA SOCORRO M.S
PSINCO TOC ESPAÑA
INTENSIVE THERAPY TO OCD

3. CONCEPT AND DEFINITION:
- The intensive treatment for OCD was created and
introduced in Spain in the year 2.010.
- Has is based on the cognitive-behavioral therapeutic
model.
- Program of 3 days of intensive treatment.
- The program is carried out and led by a psychologist
with a cognitive-behavioral approach and with experience
in the treatment and management of the concerned with
OCD.
INTENSIVE THERAPY TO OCD

4. THE PROGRAM INTENSIVE
TREATMENT FOR OCD IS IDEAL IN:
1- Patients whose residence is outside of Seville, Spain.
2- Patients who live outside Spain. (any where around of
the world).
3- Patients who for geographical reasons do not find a
psychologist specialized in cognitive-behavioral therapy and
with recognized experience in the treatment and
management of the OCD.

5. PROFILE OF THE PATIENT WITH OCD
TO BENEFIT FROM INTENSIVE
THERAPY:
- Patient with severe OCD where conventional therapy, (1time
per week), may prove to be insufficient.
- Patient with OCD refractory or that responds with poor results
to conventional therapy (1 time per week).
- Patient with type of OCD (contamination, checking, hoarding,
order), where the rituals or compulsions are hosted in your
environment or habitat. (home, restaurant near to his home,
etc.).
- Patient who wants to achieve results faster, firm and secure.

6. ADVANTAGES AND BENEFITS OF
INTENSIVE THERAPY:
- Proven in the OCD and refractory resistant where conventional therapy is
insufficient or no expected results.
- Therapy carried out in the environment of the affected, on the site where they
occur the obsessions and/or compulsions with or without ritual engine. (not in the
query).
- Cases where the OCD is hosted at home or in the environment of the affected
and to reach the query is masked.
- Training "in situ" for the family of the affected (Co-therapist) for the management
of the patient with specific guidelines for its recovery.
- The patient learns to control, manage and overcome their obsessions and
compulsions effectively together with the help of the therapist and co-therapist
“live”.

7. TECHNIQUES USED IN THE PROGRAM
OF INTENSIVE THERAPY FOR OCD:
• Exposure with response prevention:
Imagination. Live.
• Exposure to thought.

8. • Cognitive therapy.
• Management of thought.
• Mindfulness.
• Diaphragmatic breathing.

9. ASPECTS TO TAKE INTO ACCOUNT BEFORE
PERFORMING INTENSIVE THERAPY:
• Relationship of "confidence" therapist-patient.
• Assessing motivation of the patient.
• Discard major depression.
• Know history OCD on the patient: attempts to previous
treatments, therapeutic approaches used, current
medication, evolution of the OCD, previous achievements in
its treatment.
• Handle real expectations of improvement

10. • Assess family environment near of coexistence (spouse,
parents, siblings, etc.).
• Assess areas of dysfunctional: (familial, social, emotional,
sexual, emotional, labor).
• Assess comorbidity with other disorders: Agoraphobia, TAG,
depression
• Score in scale and-for BOCS degree of severity of the OCD.
• Psychoeducation. (treatment).
ASPECTS TO TAKE INTO ACCOUNT BEFORE
PERFORMING INTENSIVE THERAPY:

11. DAY 1 OF THE PROGRAM OF INTENSIVE THERAPY:
STEP BY STEP:
- Timetable: 10.00 am to 20:00, according to symptoms of tiredness
and fatigue of the affected.
- A study is made of observational field that consists of the affected
expose and describe along with the familiar all those behaviors OCD,
rituals and/or mental engines that exist in your environment.
- Analysis of the conduct "problem" with the goal of winning
functionality in the affected areas.
- Working Psychoeducation driving real expectations of
improvement and eviction of the TOC in your environment.

12. -Construction of hierarchy of situations and/or stimuli triggers.
-The 1th exhibition in vivo together with the family (Co-Terapeuta).
-The exhibition should last until the discomfort or the desire of ritualize disappear
or are minimal.
-Record as has been felt after the 1th exposure. Strengthen the work and the effort
made to
-Work with metaphors. Psychoeducation. Case studies of affected recovered.
-Imagined exposure.
-To carry out the exposure imagined along with the family co-therapist.
-Assess symptoms of fatigue and/or physical fatigue-mental.
-Practice Mindfulness.
DAY 1 OF THE PROGRAM OF INTENSIVE THERAPY:
STEP BY STEP:

13. DAY 2 OF THE PROGRAM OF INTENSIVE
THERAPY FOR THE OCD:
- Taking into account the behavioral cognitive techniques which have
been shown to be effective in a high number of cases with OCD started
making an overall assessment of the day 1 of the program of intensive
therapy:
- That he learned the previous day,
- Difficulties that were found.
- Work in the management of psychoeducation anxiety at the time of
making exhibitions imagined and/or live.
- Strengthen the conduct afforded and learned.
- Prepare the exhibitions and the working session of the day.

14. 1TH EXPOSURE (LIVE) IN THE STREET (AS THE
CASE MAY BE):
Example OCD contamination:
- We started to work on sites "banned" by the TOC: Bars, restaurants,
cafes.
- We chose an item means of discomfort (5 on a scale of 0 to 10), we
moved to the site therapist, affected and co-therapist.
- We make an observational study of the site.
- We expose the affected (exposure in vivo) to the stimulus by teaching it
to manage your anxiety and staying in the exhibition until the urge of
ritualize are minimal or disappear.

15. 2TH EXPOSURE (LIVE)
- You choose an item or situation that generate discomfort 7 on a scale of (0 to 10)
- We work exposure in vivo, according stimulus making prevention of response. At
the same time trains co-therapist so that you can perform later this work.
- It works by decreasing the compulsions (example in OCD of contamination)
-Lunch:
-It was carried out with the affected (regardless of the type of OCD), is the ideal time
to perform exposure in vivo, together with his co-therapist.
-The next activity will be collate: Mindfulness /management of thought/exposure to
thought/leisure activities ( activities carried out at home or outside of it.
-The idea is not to think but to learn to manage it.

16. DAY 3 OF THE PROGRAM OF
INTENSIVE THERAPY FOR THE OCD:
- Is valued and measured motivation with respect to the EPR.
- Working exposure in vivo (you choose item that generate
discomfort 8 on a scale of 0 to 10).
- Exposure is made in imagination with prevention of response.
(You choose high stimulus of discomfort. (9-10 in scale from 0
to 10).
- Feedback of lessons learned and
introduced until the moment in the
life of the person concerned.

17. REAL EXPECTATIONS OF INTENSIVE
THERAPY:
- The affected will learn together with his co-therapist (psychologist or
family) to deal through the EPR among other techniques to their
obsessions and compulsions.
- Teaches you how to manage your anxiety in vivo just at the moment
when they occur the obsessions and compulsions.
- Will begin to introduce the changes and improvements at the learned
regular daily routine of adaptive and healthy way from the day 1 of the
intensive therapy.
- Intensive therapy is a type of specific therapy where at the end of the
same the concerned should continue with EPR and treatment of weekly
follow-up until the total control or remission of symptoms.

18. CLOSURE OF THE INTENSIVE THERAPY OF 3 DAYS.
RECOMMENDATIONS FOR THE PATIENT AND HIS FAMILY:
It becomes an assessment by the affected and co-therapist what
learned until that moment:
A) Work exposure with live response prevention daily,
(hierarchy of situations from lesser to greater discomfort)
always guided by the therapist and supervised by the co-
therapist.
B) Enter the program leisure activity or sport: Walk, career soft,
soft cardiovascular exercise, bicycle, visit to tourist sites,
recreation etc.

19. C) Practice 5-10 minutes of Mindfulness and
diaphragmatic breathing all days if possible.
(D) Practice management of thought a day yes
and one day no. (10 minutes).
E) To cope with a crisis or lapses as part of a
therapeutic process of reprogramming without the
OCD, is not backward steps, is part of learning.
CLOSURE OF THE INTENSIVE THERAPY OF 3 DAYS.

20. F) Recommended Reading: psychological
treatment of obsessive compulsive disorder.
Juan Sevillá and Carmen Pastor.
(G) Did not stop working in the recovery of
the affected can be achieved a high quality of
life, retrieving all the areas of functionality
and recovering the life that the OCD has
stolen.
CLOSURE OF THE INTENSIVE THERAPY OF 3 DAYS.

21. CONCLUSIONS:
- Have been carried out 30 intensive therapies within and outside of Spain
with positive results and hopeful.
- All patients have completed the intensive therapy, only 3 have not
continued with the outpatient treatment.
• In a sample of 24 patients with severe OCD = 24-31 in the scale
and Y-BOCS after completing the intensive therapies and continue
a follow up of 6 months the scores on the scale and Y-BOCS
(severe = 24-31) fell to (Medium = 8-15).
• The patients recovered areas of functionality: labor, family, social,
emotional, emotional and sexual abuse.
- We worked with them once a month for 3 months maintenance
strategies and prevention of relapses.

22. TESTIMONIES OF PATIENTS WHO HAVE MADE
INTENSIVE THERAPY:
TESTIMONY 1:
"Intensive therapy for me is an essential part within the totality of the
therapy.
The result has been of great help. The previous days to the intensive
therapy, although I would like to be optimistic did not think they were
going to get so many challenges. Many rituals and situations which
seemed impossible to overcome have been exceeded in these 3 days.
From this therapy and with our enormous effort we will win
autonomy and we can live more freely without so many
physical and mental shackles."

23. THE TESTIMONY 2:
"Intensive therapy I has been of great utility, I carried out
daily tasks that years ago did not. With intensive therapy I
exposed to situations neglected as a result of the OCD.
The intensive therapy is tough but worth it, requires great
effort, is required to continue the way of overcoming the
OCD.
TESTIMONIES OF PATIENTS WHO HAVE MADE
INTENSIVE THERAPY:

24. TESTIMONY 3:
"The 3 days of intensive therapy have proved entirely
satisfactory. Productive, profitable.
Now story with resources and above all the way to face my
obsessions and compulsions in the site where they occur.
I know that I have a way to go in addition to the already travelled,
however I know that what I am getting. I have recovered the
motivation and the desire to live”
TESTIMONIES OF PATIENTS WHO HAVE MADE
INTENSIVE THERAPY:

26. THANK YOU FOR YOUR ATTENTION