By Lauren Esworthy, MA, LPC // Admissions Director & Behavior Therapist


Treatment Approach

Our treatment approach is based on empirically supported research, utilizing evidence-based treatment protocols and is effective in treating severe obsessive compulsive disorder, obsessive-compulsive spectrum disorders, anxiety disorders (such as social anxiety, panic disorder, and generalized anxiety disorder), and other coexisting conditions. To achieve maximum benefit for patients, the program adheres to the following five principles:

  1. We use state-of-the-art evidence-based cognitive-behavioral and psychopharmacological treatment modalities
  2. We encourage normalization by patient participation in decision-making about treatment and by providing treatment in a caring environment
  3. We design and provide services in a way that supports, educates, and empowers the patient
  4. We attend to the individual’s physical, emotional, social, and economical problems
  5. Our long-term goal is to establish healthy functioning individuals and families

Assessment

A diagnostic assessment is completed within two weeks of admission by the clinical team. The team utilizes observations, specific interventions, patient and family history, parent and patient reports, psychological testing, and past treatment records in formulating the diagnostic assessment. Given the complex presentation of severe OCD and anxiety disorders, a careful and thorough diagnostic assessment is crucial for future treatment to be effective. Assessment findings are shared by team members during a multidisciplinary team meeting. These findings build the foundation of treatment and are shared with the patient and, when appropriate, with loved ones involved in the patient’s care.


Core Treatment Program

The Houston OCD Program’s clinical team designs an individualized treatment plan with each patient to target the issues impacting the patient’s life. Treatment planning focuses on symptom reduction and prevention with the patient’s active involvement in the treatment design. Discharge planning begins upon admission to assure community reintegration and tenure, as well as planning for future treatment to address the long-term needs of the patient.

An extensive battery of measures in the field, with well-documented reliability and validity, is used throughout the course of treatment to inform decisions about treatment levels and discharge as well as for program evaluation. Patients are provided with weekly progress monitoring feedback.


The Treatment Team

A treatment team is assembled for each patient, including a cognitive-behavioral therapist, a Psychiatrist (when needed), a family therapist, and residential counselors. Involvement of other specialists (e.g., dieticians, chemical dependency counselors, specialty consultations, etc.) varies in time and intensity based on the patient’s clinical status and intensity of care.

The cognitive-behavioral therapist, who designs the individual treatment plan with the patient, provides initial assessments and evaluations. They will also conduct individual behavior therapy sessions three times per week with the patient.

The psychiatrist meets regularly with residents, and with intensive outpatients when indicated. Many patients who seek out this level of treatment have failed multiple medication trials. Hence, previous medication trials are reviewed and assessed for adequacy, and when appropriate, alternative regimens are instituted.

The family therapist will meet with each patient and their family (if desired) once per week, or as needed. Sessions can take place in the office or via tele-therapy. 

The direct delivery of care, 24-hours a day, seven days a week is provided by a team of one to three residential counselors. The staff is trained to help patients enhance response prevention by blocking their rituals (or pertinent anxiety reducing behaviors) and assisting in “ritual free” activities of daily living, as well as to implement behavior therapy techniques through the provision of support and coaching to utilize effective coping skills, reduce isolation, and encourage social interaction.


Behavior Treatment Plans

Individualized treatment plans, or Behavior Treatment Plans, are mutually developed and agreed upon between the patient and their cognitive-behavioral therapist. These plans are re-evaluated on a weekly basis. The Behavior Treatment Plan outlines core problems, specific obsessions, compulsions, avoidances, goals and specific interventions. The Treatment Plan includes information about how to assist the patient through their daily living activities with minimal rituals and, most importantly, how to implement staff- assisted and self-directed exposure and response prevention sessions. The Behavior Treatment Plan represents a collaborative endeavor, as patients are active in designing and implementing the plan.


Delivery of CBT, Milieu and Group Therapy

The program’s setting fosters an atmosphere for change, while maintaining the milieu and a safe environment where patients and staff work collaboratively toward treatment goals. The staff is attentive to the unique challenges that OCD and anxiety symptoms have on patients and their families. 

What you can expect during your treatment:

  • The cognitive-behavioral therapist conducts individual behavior therapy sessions
  • Residential Counselors assist the patients in following patients’ Treatment Plan, especially aiding in implementing challenging exposure and response prevention sessions
  • Daily group therapy utilizing a variety of primary and supplemental treatment approaches are incorporated into the treatment day
  • Patients and staff participate in a group forum community meeting to foster an atmosphere for change and support, and to provide opportunity to influence program procedures

The cornerstone of the treatment program are the daily exposure and response prevention (E-RP) sessions and daily self-directed E-RP sessions. E-RP sessions are initially completed with staff assistance, while gradually increasing the patient’s independence on completing the exposures during E-RP sessions.

All additional therapeutic groups are designed to complement the evidence-based E-RP sessions, to build upon the patient’s skill sets and resilience, as well as to foster support from peers.


Family Education and Support

Throughout treatment, staff members provide psycho-education about OCD/anxiety and the impact it has on family relationships. They also coach family members on how to work with loved ones, without providing accommodations and work to minimize any enabling behaviors in an effort to boost their loved one’s recovery from symptoms. It is especially important, in the work with patients who live at home, to include the family in the treatment. Family sessions occur once weekly, or as needed, either at our office or via tele-therapy.


Discharge Planning

Discharge and aftercare planning are an ongoing process, which begins at the onset of treatment. This is completed in both group and individual contexts. As patients near completion of treatment, therapeutic passes from the program to the home are often scheduled to promote the application of CBT skills, and to facilitate ways to challenge the OCD and anxiety triggers in their home environment. Every effort is made to find an experienced cognitive-behavioral therapist in one’s community at the time of discharge in an effort to ensure future success.


References

Björgvinsson T., Wetterneck, C., Powell, D., Chasson, G., Hart, J., Heffelfinger, S., Azzouz, R., Entricht, T., Davidson, J., & Stanley, M. (2008). Treatment outcome for adolescent obsessive-compulsive disorder in a specialized hospital setting. Journal of Psychiatric Practice, 14, 137-145.

Björgvinsson T., Hart, J., & Heffelfinger, S. (2007). Obsessive-Compulsive Disorder: An Update on assessment and Treatment. Journal of Psychiatric Practice, 13, 362-372.

Davidson, J., & Björgvinsson, T. (2003). Current and future treatments of obsessive-compulsive-disorder. Expert Opinion on Investigational Drugs, 12(6), 993-1001.

Osgood-Hynes, D., Riemann, B., & Björgvinsson, T. (2003). Short term residential treatment for obsessive-compulsive disorder. Crisis Intervention and Brief Treatment, 3, 413-435.