CBT/ERP

[GraceUnderPressure]

I have been meaning to ask - can CBT/ERP help with Tourette's type of OCD? My ds18 does not have obvious anxieties. The OCD aspect of his condition is that if he passes a certain place or object or hears a certain sound or whatever, a tic (or actually, usually a series) is triggered.

 

He has been very gradually worsening over the years since the age of 4, but has never really gotten better. I describe it as instead of waxing & waning, he waxes & maintains. This past year for some reason the pace of his decline has really picked up. He started another exacerbation a couple of days ago and we are at the point where they seem to be coming out of nowhere. My limited understanding from what I have read about it was that as long as the tics are worsening, ERP can't help? I guess if they can't tell what's triggering their tics that would make sense.

 

He goes to great lengths to avoid his triggers, but from what he tells me about them, I suspect anyone would. When he does not do a tic, he says that it creates a sensation in his brain that is almost painful. And it always causes him to be worse tic-wise as much as days afterward, depending how strong & how much the tics were that he bypassed.

 

So am I right in thinking that this probably would not be of help to him right now?

 

(We have an appt with our dr in Dallas this Thursday & I am going to ask for plasmapheresis at this point - ds is so close to incapacitated now that the "turning back the pages" aspect of trying IVIG frightens me - don't expect it to do any good as this dr only does IVIG, but I am going to beg for some kind of referral or something anyway. Maybe I'll just plant myself in the office & cry till they call the cops to haul me away )

[Megs_Mom]

Wow, what a great question & great observations. I am so completely not qualified to answer this, that it's sad! I think my best recommendation would be to find someone that is an expert in ERP - not just someone that does it, but someone that has been doing it for 10 years, with hundreds of kids. Having him evaluated there would be most helpful, as tic vs compulsion can sometimes be very confusing. And certainly if it is true tics, a professional should be able to tell you if the therapy would help or be neutral or make it worse.

 

My daughter did not have tics, so while I listen with great interest here on the forum, I don't have first hand experience. Early on, we thought my daugher had tics - the best example is spitting. At the worst she spat thousands of times a day - and we did have to use Habit Reversal Therapy, it became so ingrained. But her spitting did have a thought behind it, although it was astonishingly fleeting, and ERP was also a key role in the process. It was, in the end, much more of a compulsion & a habit, rather than a tic.

 

It sounds like your son's has a pretty high level of anxiety behind the tics. That would lead me to think that ERP could be helpful - as an example, if my daughter did not do a specific compulsion, she would then have such anxiety for days afterwards, that she might add in another 20 compulsions to try to "make it up".

 

There are some great places that could help around the country - what area are you in? Rogers, Duke, Univ of Tampa, etc. Univ of Tampa has a skype program that you might want to try if you don't have a really good program locally. You could go down there once for the evaluation, and then do it at home if they recommend that you move forward.

 

I think crying non-stop in the doctors office might be a great strategy! I always get mad and then I can't cry. I only cry if you are nice to me, which is very frustrating. Always been an issue for me when stopped by a cop for speeding as well. All my girlfriends weep & get out of the ticket. I am dry eyed until someone says "oh, I am so sorry". Completely useless crying pattern! Good luck on both fronts!

[airial95]

Meg's Mom - what information do you have on the U of Tampa program? That's local for us, right now we're doing ERP through the behavior group in Dr. Murphy's office - which is also "local" - but an hour's drive vs. 20 min.

 

Thanks

[Megs_Mom]

Meg's Mom - what information do you have on the U of Tampa program? That's local for us, right now we're doing ERP through the behavior group in Dr. Murphy's office - which is also "local" - but an hour's drive vs. 20 min.

 

Thanks

It may be the same program - through Dr. Storch's office? I see it is actually SF, not Tampa (sorry, I get all those FL schools mixed up ). Here is the info to contact them to see if you qualify for the skype program (which I believe is free ) http://www.ocfoundation.org/participants.aspx#videophone. I think your son may be a little young for it.

 

Here is the text: Based on our promising findings, the University of South Florida OCD program is conducting a research study to examine what factors predict treatment outcome to cognitive-behavioral therapy that is delivered via videophone. We are recruiting a group of children and adolescents with Obsessive-Compulsive Disorder (OCD). Our past research has found that as many as 80% of kids who received this type of CBT received some benefit. However, we want to know for whom this treatment is most appropriate because videophone-administered CBT may be a way to make treatment more convenient and affordable (less travel costs) and less time-consuming.

 

Your child must be between the ages of 7-17 and have problematic OCD symptoms to be able to participate in this study. You will have to travel to our facility for the initial evaluation (we cannot cover these costs); however, study treatment and evaluations will be provided at no charge. If he/she is eligible to participate in this study, he/she will either receive 14 90-minute sessions of videophone-CBT (twice a week for the first 4 sessions) and 3 psychiatric evaluations of varying lengths.

 

If you are interested or have questions, please call Dr. Eric Storch at (727) 767-8230 or email him at estorch@health.usf.edu.

 

I know 3 parents that had very good experiences through this program.

[airial95]

Yep - those are the folks we see!! But my son is too young for the study...but I should ask about using skype as an option for some of our visits!! Driving to St. Pete once a week can get very trying on us!!!