Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

Obsessive compulsive disorder (OCD) is characterised by a person’s obsessive, distressing, intrusive thoughts and their related compulsions. It affects an estimated 1 per cent of teenagers and has been detected in children as young as three years old.

In this concise, accessible book experienced contributors provide detailed guidance on carrying out assessments and treatment for children and young people with OCD

from a cognitive behavioural perspective. This approach has been developed from extensive research and clinical work with young people with OCD and associated problems.

The book includes:

•

an overview of OCD

•

an introduction to CBT and its relevance to OCD in young people

•

assessment and treatment methods

•

case studies and clinical vignettes

•

worksheets for use with the client.

This straightforward text provides essential direction for practitioners and trainees in a range of professions including psychiatry, psychotherapy, counselling, nursing, education and social work.

Online resources:

The appendices of this book provide worksheets that can be downloaded free of charge to purchasers of the print version. Please visit the website www.routledgementalhealth.

com/cbt-with-children to find out more about this facility.

Polly Waite
is a Clinical Psychologist and Senior Research Fellow at the University of Reading.

Tim Williams
is a Consultant Clinical Psychologist and Fellow in the Department of Psychology at the University of Reading.

CBT with Children, Adolescents and Families

Series editor: Paul Stallard

“The
CBT with Children, Adolescents and Families
series, edited by Professor
Paul Stallard and written by a team of international experts, meets the growing need for evidence-based treatment manuals to address prevalent psychological problems in young people. These authoritative, yet practical books will
be of interest to all professionals who work in the field of child and adolescent
mental health.” –
Alan Carr, Professor of Clinical Psychology, University
College Dublin, Ireland

Cognitive behaviour therapy (CBT) is now the predominant treatment approach in both the NHS and private practice and is increasingly used by a range of mental health professionals.

The
CBT with Children, Adolescents and Families
series provides com-prehensive, practical guidance for using CBT when dealing with a variety of common child and adolescent problems, as well as related family issues. The demand for therapy and counselling for children and adolescents is rapidly expanding, and early intervention in family and school settings is increasingly seen as effective and essential. In this series leading authorities in their respective fields provide detailed advice on methods of achieving this.

Each book in this series focuses on one particular problem and guides the professional from initial assessment through to techniques, common problems and future issues. Written especially for the clinician, each title includes summaries of key points, clinical examples and worksheets to use with children and young people.

Titles in this series:

Anxiety
by Paul Stallard

Obsessive Compulsive Disorder
edited by Polly Waite and Tim Williams
Depression
by Chrissie Verduyn, Julia Rogers and Alison Wood
Eating Disorders
by Simon G. Gowers and Lynne Green
Post Traumatic Stress Disorder
by Patrick Smith, Sean Perrin and William Yule Obsessive Compulsive

Disorder

Cognitive Behaviour Therapy

with Children and Young People

Edited by

Polly Waite and Tim Williams

First Published 2009

by Routledge

27 Church Road, Hove, East Sussex BN3 2FA

Simultaneously published in the USA and Canada

by Routledge

270 Madison Avenue, New York, NY 10016

Routledge is an imprint of the Taylor & Francis Group, an informa business
This edition published in the Taylor & Francis e-Library, 2008.

“To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”

Copyright © 2009 Selection and editorial matter, Polly Waite and Tim Williams; individual chapters, the contributors

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

This publication has been produced with paper manufactured to strict environmental standards and with pulp derived from sustainable forests.

British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Obsessive compulsive disorder : cognitive behaviour therapy with children and young people / edited by Polly Waite and Tim Williams.

p. ; cm.

Includes bibliographical references and index.

1. Obsessive-compulsive disorder in children.

adolescence.

3. Cognitive therapy for children.

4. Cognitive therapy for teenagers.

I. Waite, Polly, 1972–

II. Williams, Tim, 1955–.

[DNLM: 1. Obsessive-Compulsive Disorder–therapy. 2. Adolescent. 3. Child.

4. Cognitive Therapy—methods. WM 176 O14268 2009]

RJ506.O25O268 2009

618.92′85227–dc22

20080226702

ISBN 0-203-88465-5 Master e-book ISBN

ISBN: 978–0–415–40388–7 (hbk)

ISBN: 978–0–415–40389–4 (pbk)

Contents

List of figures

vii

Notes on contributors

ix

1

TIM WILLIAMS AND POLLY WAITE

2

The use of CBT with children and adolescents

19

CATHY CRESWELL AND POLLY WAITE

3

Cognitive behavioural assessment of OCD in children
and adolescents

33

CATHERINE GALLOP

4

Planning and carrying out treatment

51

POLLY WAITE, CATHERINE GALLOP AND LINDA J. ATKINSON

5

CBT with younger children

77

LINDA J. ATKINSON

6

CBT with adolescents

97

POLLY WAITE

7

Working with families

118

BLAKE STOBIE

8

Issues and future directions in childhood OCD

136

PAUL M. SALKOVSKIS, POLLY WAITE AND TIM WILLIAMS

v

vi

Contents

References

151

Appendix A:
Child Obsessive Compulsive Inventory
(Child OCI)
163

Appendix B:
Child Responsibility Attitude Scale
(CRAS)
168

Appendix C:
Children’s Responsibility Interpretation Questionnaire
(CRIQ)

173

Appendix D: Diaries

178

Appendix E: Experiments

181

Index

189

Figures

Thoughts, feelings and behaviour game

25

26

27

40

Jack’s formulation

58

Katie’s graph showing what OCD predicts will happen to her anxiety if she does not do a compulsion

64

Katie’s graph showing what normally happens to anxiety 65

Katie’s graph showing what could happen to anxiety over time if you do not do a compulsion

66

What happens to anxiety if you do compulsions

66

Shared understanding of Dan’s OCD

81

Thoughts are not enough to cause harm

86

88

Jacob’s formulation

101

Ellie’s goals

105

Ellie’s predictions about what will happen if she does not neutralise after having an obsessional thought

106

Tom’s thinking experiments

109

Ellie’s experiment

111

Ellie’s responsibility pie chart

113

Jacob’s continuum

114

A modification of the Salkovskis model of OCD for

use with family members

124

Dawn’s formulation

129

Simon’s theory A and theory B

131

Dawn’s behavioural experiment

133

vii

Contributors

Linda J. Atkinson

Clinical Psychologist, Anxiety Disorders Residential Unit, Bethlem Royal Hospital, Alexandra House, Monks Orchard Road, Beckenham BR3 3BX, UK.

Dr Cathy Creswell

Clinical Research Fellow, Winnicott Research Unit,

Department of Psychology, University of Reading, Whiteknights, PO Box 238, Reading RG6 6AL, UK.

Dr Catherine Gallop

Clinical Psychologist and Senior Teaching Fellow,

University of Exeter, School of Psychology, Washington Singer, Perry Road, Exeter EX4 4QG, UK.

Professor Paul M. Salkovskis

Professor of Clinical Psychology and Applied

Science, Department of Psychology, Institute of Psychiatry, de Crespigny Park, Denmark Hill, London SE5 8AF and Clinical Director, Centre for Anxiety Disorders and Trauma, Maudsley Hospital, 99 Denmark Hill, London SE5 8AF, UK.

Blake Stobie

Consultant Clinical Psychologist, Centre for Anxiety Disorders and Trauma, 99 Denmark Hill, London SE5 8AZ, UK.

Dr Polly Waite

Clinical Psychologist and Senior Research Fellow, Department of Psychology, University of Reading, Whiteknights Road, Reading RG6 6AL, UK.

Dr Tim Williams

Consultant Clinical Psychologist, Berkshire Healthcare NHS Trust and Fellow, Department of Psychology, University of Reading, Whiteknights Road, Reading RG6 6AL, UK.

ix

Acknowledgements

We would like to thank all the contributors for their wholehearted support and hard work. We would also like to thank our other clinical colleagues, Dr Mark Allsopp, Prof Derek Bolton and Dr Sean Perrin and the Health Foundation, which brought us together to develop this work.

On a personal note, we would like to thank our families for their encouragement and support.

Finally, a special thank you to the young people and their families who have shared their experiences with us. It has been a privilege to work together and this book is dedicated to them.

xi

1

Tim Williams and Polly Waite

‘OCD can be very stressful, not only affecting yourself but those around you. OCD meant that I felt I had to do habits in order to protect my family and myself. My OCD began when I was bullied at school, when my confidence was at its lowest, but the thing with OCD is that it itself is like a bully, eating away at your confidence.’

‘When I had OCD I was miserable, depressed, worried, upset, felt out of place, alone and unloved. Some other feelings I had were that I was unpopular with people in and out of school. I felt I was stressed because of the thoughts in my head and routines I had done and that I struggled to do anything about it. I was very tired and very angry with myself and OCD.’

‘Having OCD was restrictive and stressful. Because of the worries of having responsibility I was anxious and worried a lot of the time about bad things happening. I wouldn’t really want to go out and at school I’d get conscious of “what if people notice?” I’d have to hide it but it was always there; there wasn’t a break from it.’

These young people are telling us how it feels to be forced to do things again and again, and the worry that if these things are not done, something dread-ful will happen. This is a common experience with obsessive compulsive disorder (OCD).