Michael A. Tompkins, Ph.D.
Co-Director of the San Francisco Bay Area Center for Cognitive Therapy
Obsessive-compulsive disorder (OCD) is a chronic condition and therefore even following an effective treatment, your client always and will forever face the possibility of relapse. Assisting the client to manage the risk of relapse is an essential part of treatment for the condition. As you taper sessions with the client, use the times between sessions to assist the client to practice the relapse prevention plan you and the client developed. An effective relapse prevention plan includes several features, such as practicing and reinforcing self-directed exposures.
Self-directed exposures. Develop a practice schedule that includes the top third of the client’s exposure with response prevention (ERP) hierarchy. Ask the client to practice one or more of the exposures (without engaging in compulsions and other neutralization strategies) listed in the practice schedule according to the schedule you and the client create. It is best that the client agrees to practice at a particular time and day to counter his tendency to practice exposures when less anxious. I usually include at least six exposures – numbered 1 to 6 — to the practice plan and instruct the client to toss a die to determine the exposure to perform. For example, if he tosses a 5, he performs exposure number 5 on his practice plan. This reinforces randomness and counters the client’s tendency to favor one exposure over another. Ask the client to record the results of the self-directed exposure on a form that includes the exposure tasks (numbered 1 to 6), the date and time the client agrees to perform the exposure, the date and time that he actually performed the exposure, and his maximum anxiety level. Review this form at each session during the therapy taper period.