Treatment Program

The Gold Standard in Treatment, CBT with Exposure and Response Prevention

Intensive Outpatient Treatment Program

At Behavioral Sciences of Alabama, we design and carry out intensive OCD treatment programs to help you to reduce intensely uncomfortable emotions in your life as quickly as possible. Cognitive behavior therapy, including Exposure and Response Prevention, provides tools for beating back your OCD and other anxiety disorders.

We developed our Intensive Outpatient Treatment Program to address all OCD spectrum disorders and anxiety disorders. As an institutional member of the International Obsessive-Compulsive Disorder Foundation (IOCDF), Behavioral Sciences provides intensive outpatient OCD treatment by therapists trained through the IOCDF Behavior Therapy Training Institute (BTTI) or by our senior professional staff. Using cognitive behavior therapy, the gold-standard treatment for obsessive-compulsive disorder, compassionate licensed therapists work with individuals to confront obsessions and compulsions.

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develop skills to reduce the anxiety

Through counseling and exposure and response prevention, patients participate in therapy in various settings outside the office to develop skills to reduce the anxiety that accompanies the intrusion of obsessions and compulsions in daily life. Real-world treatment includes home, public spaces, hospitals, restaurants, libraries depending upon the nature of obsessions and compulsions and the plan developed by the patient, the family, and the cognitive behavior therapytherapeutic team.

Key components of the program include exposure and response prevention (ERP). Valid intervention includes cognitive behavior therapy utilizing cognitive restructuring, group therapy (including psychoeducational components), family support groups, and medication consultation as needed. To provide patients with effective treatment, we prefer to work with those available within a 100-mile radius of our offices. Telehealth allows us to extend our reach depending upon the nature of OCD symptoms and the available resources.

Steps to OCD Treatment

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The first step is to call us in Huntsville at (256) 883-3231 and ask for a telephone screening for our Intensive Outpatient Program. If the patient is considered eligible for counseling they may schedule an appointment for further evaluation and treatment planning. We work with children, adolescents, and adults.

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The second step is to meet with one of our professional anxiety counseling staff members for an in-depth evaluation. This process will also identify therapy goals and expectations. We will obtain a history that includes identifying the triggers for anxiety, previous therapy accomplishments, medication usage, and family history. There will be checklists and tests to complete, which will help identify symptoms and help us develop a collaborative treatment plan.

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Next, we will outline an initial treatment plan. The cognitive behavior therapy plan will often include a combination of in-office, outside treatment using exposure and response prevention plus homework on your own. You may work with different therapists on different days, depending upon the objectives of OCD treatment. Each participating therapist will be a part of your treatment team and will have helped in the development of your plan.

Exposure and Response Prevention (ERP)

One of CBT's primary goals is to teach the patient the skills needed to confront fear-evoking stimuli without engaging in fear-neutralizing rituals. Through exposure and response prevention (ERP), the patient will begin to experience a natural reduction in anxiety and, more importantly, will eventually be able to go about his/her day-to-day activities without the need for elaborate rituals or avoidance repertoires.

Exposure (E) in exposure and response prevention teaches patients to approach their anxiety or fear-producing stimuli. Response prevention (RP) entails preventing mental or physical rituals meant to reduce fear or anxiety. We emphasize ERP and using cognitive behavior therapy techniques to help patients learn from repeated experience that the feared consequences don't occur and their anxiety reduces over time.

Upon completing the clinical interviews, history, and assessments, and after the patient's treatment goals have been defined, the OCD counseling treatment team collaborates with the patient to target obsessions, compulsions, and avoidance behaviors. Cognitive behavior therapy Interventions are planned with consideration given to the patient's observed capacity to tolerate discomfort with exposure and response prevention , generally focusing on triggers that evoke moderate anxiety levels. Then, beginning with moderate anxiety, the patient gradually works up the hierarchy leading to the more difficult triggers. OCD treatment begins with psychoeducation to prepare the patient for the approach and methods for habituating to triggers and tolerating anxiety. Medication consultations may be a part of this process.

Each patient usually has a 90- to 120-minute or more individual session each workday with a staff therapist. Staff members may participate with the patient in ERP in the community two hours or more daily until they begin to carry out exposure with friends, family, or independently.

Co-Occurring Mental Disorders

When treating OCD patients, we take into account coexisting depression and other conditions they may have. We have worked with autism spectrum, bipolar disorder, depression (including teenage depression), and other disorders on a case-by-case basis. Our approach with other disorders is consistent with cognitive-behavioral principles. We do not work with individuals who are recently suicidal, actively engaged in substance abuse, or those with intellectual functioning below a measured IQ of 80.

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Family, Friends, and Other Participation

Part of our process involves the participation of family members and significant others in psychoeducation and our family support. Family members and others can often help with homework, especially in ERP with children or spouses. Children always have a behavior modification component that includes reinforcement and contingency management.

Friends may accompany patients to facilitate social and other exposure. Teachers may help students resist reassurance and provide contingency management in the classroom. We consult with teachers, principals, and counselors in the schools when needed.

Relapse Prevention

Intensive treatment can last from three to eight weeks. We work with patients
to develop a relapse prevention plan. This plan can consist of group support,
self-directed ERP, medication management, and therapist consultation as planned.

Types of Exposure

  • In Vivo exposure: doing something in the context of a patient’s life that triggers discomfort, such as talking to a stranger, crossing a bridge, touching a public toilet, wearing dirty clothes.
  • Imaginal exposure: using the imagination to trigger discomfort associated with a patient’s fears or worst-case scenario. Examples of imaginal exposure include watching YouTube, writing a narrative of a worst-case scenario, pictures of feared objects, writing feared sentences or words, reading about a feared disease.
  • Interoceptive exposure: doing something to trigger a feeling related to health anxiety, such as creating dizziness by shaking the head side to side, spinning, or holding the breath. Hyperventilate using deep, rapid breaths every 2 seconds for 60 seconds; rebreathe expired air from bag; breath through a small cocktail straw with a pinched nose as long as possible; take quick breaths for 60 seconds, minimum of two trials. Increase heart rate by running in place, high knees running, push-ups.