INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD_ Intervention Notebook For Adolescents with OCD Priscilla Hernandez REC: 458: Clinical Techniques in Therapeutic Recreation Melissa H. D'Eloia, PH.D., CTRS California State University, Long Beach a &INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. Intervention Notebook for Adolescents with OCD 1. RIDE: Ride Up and Down “The Worry Hill” Purpose Statement: The purpose of this intervention is for adolescents with OCD to use the Cognitive-Behavioral approaches that will teach them to stop, think, take control, and respond assertively to OCD than to purist with obsessions and compulsions. Behavior Goals and Objectives: Goal: Leaming how to stop OCD will be accomplished by understanding and contrasting their OCD to the concept of RIDE: Ride up and Down “The Worry Hill” which is the metaphor of riding their bicycle up and down a hill by expressing, distancing, and taking control of OCD thoughts, exposure, and self-reinforcement. Objectives: RIDE (Rename, Insist, Defy, and Enjoy) a) Adolescent will rename their obsessive thoughts by recognizing their OCD thoughts as they. are unrealistic. b) Adolescent will insist they have active control over being passive. ©) Adolescent will defy themselves and believe they can ride up “The worry Hill” 4) Adolescents will enjoy their accomplishment and review their success. Activity Logisties (Length, Materials, Facility) Length: The average treatment depends on the severity of OCD. Average treatment may range from 10 to 20 treatments incorporating the metaphor of Ride with their obsessions and compulsions. Materials: Children’s books Facility: Indoor or Outdoor Description of Activity: Using children’s books that has the main focus of “Ride: Ride Up and Down the Worry Hill.” Adolescent will be able to read and look at the pictures of the metaphor and incorporate them into their own life. Adaptation Techniques: Incorporating their OCD with the metaphor Ride up and Down “The Worry Hill” ive outcome is rewarding to let them know they can conquer their disorder.INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. Activity processing questions i, Do you feel like you made it over the hill at the end? How does it feel to be in control of your OCD symptoms? Do you think you can use this metaphor in the future? RIDE: UP AND DOWN THE WORRY HILL STICK IT OUT UNTIL THE FEELING PASSES Example of Children’s book: A Children’s Beck aboot Obseniv-Compokive Diver and it Treatment Dy Are Pinte Waar, PD. tras by Pal A. tonINTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD 4 2. Exposure and Response Prevention Purpose Statement: The purpose of this intervention for this particular case is to expose child’s feared obsessions (germs) and teach them to refrain fronrtheir compulsions (washing hands) for a certain period of time. Behavior Goals and Objectives: Goals: Exposing their obsession over time will decrease their anxiety, eventually becoming, barely noticeable or even fades entirely. Objectives: a) The therapist will expose themselves to germs in front of child by not washing their hands and eating. b) Modeling allows the child to see that the therapist is willing to assume the same risks that are asked of the child. ©) With gradual exposure overtime will lead to a decrease in the frequency of compulsions and the intensity of obsessions. Activity Logistics: (Length, Materials, Facility) Length: The amount of time for the child to gain control over the persistent fears and overcome them has no prediction of time. The effects are gradual. Materials: Food. Facility: Indoors or Outdoors Description of the activi ‘The therapist will expose themselves to germs in front of child by not washing their hands and eating. Adaptation Techniques: * Vicarious Experience will demonstrate the task with showing a visualization of success. © Habituation will be the outcome, Activity processing questions How do you feel seeing the therapist not having to immediately wash their hands? ii, If the therapist can do it then do you think you can to?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. 5 3. Cognitive Therapy A purpose statement: The purpose of this intervention is to apply behavior techniques throughout the cognitive-emotion process by emphasizing adolescent's thoughts that dictate their emotions and work on helping the child examine their cognitive interpretations. Behavior Goals and Objectives: Goal: The adolescent will leam a new way of thinking so they can understand their fears aren’t real and lear to manage the urge and control their compulsive act. Objectives: a) Adolescents will be aware and recognize their brain is playing a trick on them. b) Adolescent will challenge their negative thought that involves a sense of harm and learn an alternative by self-positive motivation with Self-Talk. Activity logistics: (length, materials needed, facility) Length: 30 minutes. 20 sessions. 2x a week. Materials: Pencil Facility: Indoor or Outdoor Description of the activity When adolescent starts to fear to touch the pencil due to the thought they will become ill and cause his family members to also be Ill they will then recognize their fear of emotion. Once they recognize their emotion they will use self-talk as a replacement. They will trick themselves into thinking of having a positive outcome. Adaptation techniques ‘* Replace negative thoughts for positive ones by tricking the mind © Positive reinforcement ‘* Enhance self-confidence and willingness Activity processing questions How does restating positive self-talk feel instead of the fear of germs? ii, How will you make use of learning positive reinforcement? Does this give you insight on how to take control of your OCD?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. 6 4. Beck’s Cognitive Therapy (Negative Schemas ) using Flashcards A purpose statement: The purpose of this intervention is to allow adolescents negative concepts relating to rejection, abandonment, or unrelenting standards influence their focus as they are important negative thoughts to produce opposite effects, Behavior Goals and Objectives: Goals: Adolescents cognitive needs are met by enhancing positive schemas when negative schemas are triggered. Objectives: a) Adolescent will recognize their automatic negative thoughts. b) Adolescent will be taught to examine their beliefs ©) Stop seeking evidence that they are being rejected, abandoned or have low standards 4) Positive schemes will not be ignored Activity logistics: (length, materials needed, facility) Length: Adolescent will proceed through the CBT process at their own pace. Materials: Flashcards with Positive sayings Facility: Indoor or Outdoor Description of the activity Adolescent will receive flashcards that have messages and positive sentiments that will gradually internalize the adolescent. When adolescent recognizes their negative thoughts they will look at their flashcards to change the negative schemas that are triggered. Adaptation techniques * Addressing negative schemas present when they occur and reflect more on positive schemas. ‘* Execute the opposite of negative schemas. Activity processing questions: i. How does it feel to know you can replace bad thoughts with positive thoughts? ii, Do the flashcards bring a sense of control for your negative schemas? iii, Can you incorporate the flashcards for other negative schemas you are having?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. 7 5. CBT Behavioral Reward Treatment A purpose statement: The purpose of this intervention is to enhance treatment compliance with increasing motivation such as rewards to resist OCD symptoms. Behavior Goals and Objectives: Goals: Rewards provide adolescents with immediate incentive to participate and maintain . Adolescent is rewarded for effort, rather than success, since effort reflects desired Objectives: a) Rewards will help adolescent identify their OCD as a problem b) Rewards will increase self-esteem ©) Rewards will help resist their OCD symptoms Activity logisties: (length, materials needed, facility) Length: 30 minutes. Gradually reducing when symptoms reduce. Materials: Certificates Facility: Indoor or Outdoor Description of the activity Adolescent will be told at the beginning of task they will receive an award for completing task. They will identify their problem of OCD and hold off on continuing with compulsions. Resisting OCD is hard work and is rewarded like a chore. They will then get a positive verbal praise or a certificate that the child has successfully “Beat up” OCD. Adaptation techniques * Positive reinforcement Activity proc questions How does it feel when you receive an award? How does rewards help your OCD? iii, Do you feel that rewards help you control your OCD?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD 8 6. Metacognitive Therapy A purpose statement: The purpose of this intervention is to teach adolescents how to ignore their disturbing thoughts by learning to emotionally detach from their obsessions and to observe their obsession without any judgment. Behavior Goals and Objectives: Goals: Focus on the judgment and the management of these thoughts. They become normalized by accepting them. Objectives: a) Changing the adolescents metacognitive beliefs about their Obsessions b) Changing beliefs about the rituals and stop signals Activity logisties: (length, materials needed, facility) Length: 10-12 weekly Sessions of 50 min each Materials: Notebook to take keep track of Patients progress Facility: Indoor or Outdoor Description of the activity Adolescent’s symptoms of obsession and compulsions have started. Obsession of death or dying then the act of their compulsion of repeatedly telling herself she wants to live. The metacognitive judgment would be (Thinking about dying means, they want to die). The metacognitive therapy for the adolescent is to do a thought experiment. A thought experiment would be trying to win the lottery by mental power and this would be a replacement. Adaptation techniques Actively selecting, evaluating, and monitoring schemas Activity processing questions i. Accepting the judgment instead of focusing on your obsessions seem to help you with compulsions? ii, _ How do you feel after focusing on your judgment and thinking of switching it to something positive?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. 9 7. CBT: Group therapy A purpose statement: The purpose of this intervention is for adolescent to engage in supportive environment with individuals who also experience similar struggles and experiences. Behavior Goals and Objectives: Goals: Engaging adolescents with other individuals will provide information to educate them on their Obsessive Compulsive Disorder along with forms of treatment and other difficulties to watch out for. Objectives: a) Providing support and encouragement that will decrease feeling of isolation ) Develop personal growth with social skills ©) Adolescent will become aware of their behavior and alter behavior to more healthy behavior. Activity logisties: (length, materials needed, facility) Length: Can vary between weeks to months. Each group activity should be an hour long. Materials: Chairs to form a circle Facility: Indoor or Outdoor Description of the activity Ina group, another group member will be able to share a similar problem which they managed and they can share how they coped. Sharing coping behaviors will reflect on adolescent. Adaptation techniques Cognitive restructuring Relaxation Mindfulness and respect of other individuals Problem solving Humor in Therapy Activity processing questions i. Was there anyone you can relate to? ii, Did you learn ways to manage your symptoms?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD 10 8. Exposure and Response Prevention (ERP) or “Exposure therapy” ‘A purpose statement: The purpose of this intervention is to give adolescent parental attention directed towards pleasant exposure therapy and away from potentially negative exposure therapy. Behavior Goals and Objectives: Goals: Manage OCD by having parent demonstrate positive reinforcement by removing all rituals they are involved in their child’s OCD and will gradually reduce these rituals. Objectives: a) Parent will demonstrate positive reinforcement by not being a part of their child’s OCD. ) Parent will expose child’s fear thus creates a positive response by not taking part of their child’s OCD. Activity logisties: (length, materials needed, facility) Length: Every time parent needs to be part of their child’s adolescent they will take part until Habituation occurs. Materials: Washing clothes detergent or house cleaning supplies. Facility: Indoor Description of the activity Adolescent OCD is when they their parent to clean the house or do the laundry in a certain way (such as using bleach everywhere, or cleaning clothes separately), When adolescent is experiencing their symptoms the parent will suddenly stop encouraging the rituals and refrain from giving in which can be very overwhelming for adolescent. The parent will stop encouraging with negative responses such as using bleach everywhere or cleaning clothes separately. Adaptation techniques © Stopping Parent-Assisted Rituals © Habituation Activity processing questions 1. Working together with your parent helped your fear of OCD? 2. Do you feel like you can con conquer problems with the help and encouragement of your parent? 3. How do you feel that you're not alone with your fear?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD 1 9. Imaginal Exposure A purpose statement: The purpose of this intervention is to decrease adolescent's anxious and fearful reactions using imaginal exposure. Behavior Goals and Objectives: Goals: Have adolescent use their imagination their worst fears without doing any rituals by having them develop a script of their worst fears so they can visualize every day until they are no longer scared of their obsessions and can visualize themselves facing their fear without any rituals. Objectives: a) Imagination of fear instead of vivo. b) Visualization will be narrated by adolescent so they have control. ©) Imagery will activate their anxiety and their compulsions become true through imagination. 4) Adolescent will see their script every day and come to realize it will not happen in vivo. Activity logistics: (length, materials needed, facility) Length: Three to Five minutes long Materials: Pencil and flasheards/paper Facility: Indoor or Outdoor Description of the activi Adolescent will develop a script (or series of scripts) for their record and see the script every day until they are no longer scared of the content of their obsessions and can visualize themselves facing their fear without any rituals. Adaptation techniques * Repetitive imaginal exposure ‘© Self-Control © Habituation Activity processing questions 1. After seeing your fear over and over where you able to overcome your fear? 2. How does it feel to be in control of your fear? 3. Can you use the flashcards for other types of fear?INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. 2 intervention is for adolescent to face their fears without using rituals or compulsions by first rating their fears (obsessions) on a fear ladder from most feared to less fear which will allow adolescent to start from the least feared and conquer each fear as they move up to the most feared obsession. Behavior Goals and Objectives: Goals: Adolescents goals are accomplished by Exposure, climbing up the fear ladder by facing their fears one gradual step at a time without any compulsions. The adolescents will learn their worst fears are unlikely to come true and they gain confidence to be in charge of their life. Objectives: a) Ladder will contain adolescent’s whole range of situations. b) Ladder will be modified for adolescent so they can start with some anxiety rating from less, moderate, and to most severe anxiety. c) Starting with small anxiety will allow adolescent to take gradual steps. Activity logistics: (length, materials needed, facility) Length Materials: Fear Ladder Worksheet Facility: Indoor or Outdoor Description of the activi Adolescent will have their Fear Ladder created on a worksheet. Each step will be accomplished gradually until the last step. Adaptation techniques Gradual steps to success Extinetion of negative reinforcement Exposure and Response Prevention Modifications of the Ladder (more steps added) Activity processing questions What was your goal?” Where you to accomplish your goal using the “Fear Ladder” How do you feel after completing each step of the ladder? Does the Ladder help you feel in control of your fear? ew itINTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. B Climbing My Fear Ladder What is my Goal? Go into Public Places Without worrying of Germs Fear Rating Use hands to open and close stall door 10/10 Touch counter and taps in mall bathroom 9/10 Touch doorknob to mall bathroom 8/10 Use hands to push open doors to mall entrance 7/10 Touch food counter at mall 6/10 Sit on bench at mall and touch bench with hands 5/10 Touch railing at mall 4/10 Touch items in a store 3/10 Sit ona bench at mall 2/10INTERVENTION NOTEBOOK: ADOLESCENTS WITH OCD. 4 REFERENCES Aureen Pinto Wagner, PhD . “Cognitive-Behavioral Therapy for Children and Adolescents with Obsessive-Compulsive Disorder” http://www anxietybe.conv/parenting/home- nt-strategies-ocd Bruce Hyman, PhD. “This Month’s Expert: Exposure and Response Prevention Therapy for OCD” HTTP:/PRO.PSYCHCENTRAL.COM/THIS-MONTHS-EXPERT- EXPOSURE-AND-RESPONSE-PREVENTION-THERAPY-FOR-OCD-BY-BRUCE- HYMAN-PHD/004675, HTML# Dr. Lisa Napolitano hitp://www.cbtdbtassociates.com/ocd-group/#. VUVYRIUtDIU Edward S. Friedman, Michael E. Thase, Jesse H. Wright. “Cognitive and Behavioral Therapies” Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA John S. March (MD.), Karen Mulle. “OCD in Children and Adolescents: A Cognitive- behavioral Treatment Manual” Laura Johnson. Schema Therapy: Basics and Beyond. Oct 30 http://cognitivebehavi -enter.com/category/schema-the 2014. Developed by Devsaran. http://isstonline.com/flash-cards “Therapy for Teens: What Is Cognitive Behavior Therapy (CBT)?” http://beyondocd.org/just-for-teens/therapy-for-teens Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu,Ph.D. “Exposure and Response Prevention (ERP) Therapy for Obsessive-Compulsive and Related Disorders” Updated: Jan 2nd 2014 http://www.mentalhelp.neU/poc/view_doc.php?type=doc8&id=52493 &en~6 “Helping Your Child Face Fears” http://www.anxietybe.cor ing/helping-your-child-face-fearsREC 458/358 Clinical Techniques in Recreation Therapy Intervention Resource Notebook Grading Rubric Requirements for the Interventions: (100 points) ] 1. Includes at least 10 interventions that span over a variety of modalities (¢.g., 10pts | Physical Activity, Leisure education, Creative Activity, Game-like Activity, lo Challenge Activity, etc...) 2. Thoroughness and Accuracy of Activity Descriptions | Opts * Clear and accurate purpose statement | 55 ‘© Clear and accurate behavior goals and objectives ‘© Description of activity logistics © Clear description of the activity '* Describes appropriate and useful adaptation techniques Clear and thoughtful activity processing questions 3. Creativity of Interventions Sots. 4. Organization of Notebook eee 5. Overall Quality of the Interventions (Are interventions appropriate for the Tx 10pts population and specified Tx Goals and Objectives?) 10 ‘* 6. Grammar and References (Free from grammatical and spelling mistakes, | Spts 5 uses references when ert Comments: Rcjuilus We appropliak and spanned arms « vanet atti re GUNA E ta. roe Pores ene B TOTAL | _/100pts