“It Is Dangerous to Ignore This Thought” – A Case Study in Obsessive Compulsive Disorder

Abstract

This case study describes a 14-session course CBT for moderate-to-severe obsessive-compulsive disorder (OCD). The patient, Sundeep, was a pharmacist in his early 30s who was married with two children. He presented with frequent obsessional concerns about contamination and concomitant checking, washing, reassurance-seeking, and avoidance enacted to neutralize the harm represented in his obsessions and reduce his distress. Treatment addressed appraisal of the obsession and the need to do the compulsions, and Sundeep’s core beliefs and assumptions/rules for living using cognitive (Socratic dialogue, thought records, continuum method) and behavioural strategies (behavioural experiments, exposure with response prevention). Treatment was guided by a collaboratively developed case formulation. At the end of treatment Sundeep’s symptoms were mild, he had reclaimed his professional and family life, and he was confident he could continue to progress independently. Keys to treatment success included: working from a shared case formulation that identified causal mechanisms; presenting a clear illustration of how therapy would overcome them; addressing appraisal of the obsessions rather than their content; targeting Sundeep’s unwillingness to trust his own judgement and his deference to the OCD “voice”; not engaging the OCD voice in session; addressing core beliefs and assumptions.