TY - JOUR TI - Overcoming confounding sleep avoidance behavior in cognitive behavioral treatment for obsessive compulsive disorder DO - https://doi.org/doi:10.7282/T3HM56W0 PY - 2014 AB - Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP) is widely accepted as the gold standard treatment for Obsessive Compulsive Disorder (OCD). Many efficacious treatment manuals have been developed over the years, resulting in clinicians being able to select protocols that best match their patient’s developmental stage, and thus helping to facilitate positive outcomes. However, challenges do present themselves when applying CBT treatment protocols with anxious patients. This requires the creation of an individualized case formulation and an associated treatment plan, which is specific to each particular patient. In this context the purpose of this case study is to analyze a particular deleterious confound to the therapy process: an OCD patient falling asleep during in-session ERP tasks. The case study chronicles the process of coming to understand the impact of the patient’s sleep behavior on his treatment, and the unfolding of both ineffective and effective interventions aimed at overcoming this obstacle. Importantly, a functional analysis of the sleep behavior determined that this behavior was, in fact, employed in avoidance of the feared stimuli presented during exposure tasks. Once this was established, the patient and I as the therapist worked collaboratively to develop novel interventions to eliminate the sleep avoidance behavior, in order for the established benefits of CBT with ERP to take hold. This proved to be a fluid process requiring frequent adjustments to each intervention, as they no longer proved effective over time. As the treatment process unfolded, the intervention of walking outside during exposure tasks was employed and proved to trump all other interventions in its effectiveness in eliminating the patient’s sleep avoidance behavior. This resulted in a complete eradication of the patient’s sleeping during therapy sessions and the development of rapid treatment gains from that point forward in the treatment process. KW - Clinical Psychology KW - Cognitive-behavioral therapy KW - Obsessive-compulsive disorder--Treatment KW - Exposure therapy LA - eng ER -