How to Create an Evidence-Based Treatment Plan for OCD (With an Example)

Obsessive-compulsive disorder is a mental health condition characterized by persistent obsessions, compulsions, or a blend of both. Obsessions manifest as intrusive, repetitive thoughts, while compulsions involve repetitive behaviors aimed at alleviating anxiety. These symptoms can consume significant time, cause distress, and lead to embarrassment, severely affecting an individual’s daily functioning and overall well-being. Keep reading to learn how to create an evidence-based treatment plan for OCD, with an example.

OCD encompasses various obsessions, characterized by intrusive thoughts, urges, or mental images that provoke anxiety. Common examples include:

  • Fear of germs and contamination
  • Fear of losing, misplacing, or forgetting items
  • Fear of losing control over one’s behavior
  • Intrusive aggressive thoughts towards oneself
  • Unwanted thoughts related to religion, harm, or sex
  • Persistent need for symmetry or orderliness in objects

Common compulsions observed in clinical settings may include:

  • Repeated or excessive hand washing and cleaning
  • Arranging items meticulously in a specific order
  • Compulsive checking behaviors, such as ensuring the stove is off or doors are locked
  • Counting compulsively
  • Engaging in repetitive praying or silently repeating words

It’s crucial to understand that experiencing both obsessions and compulsions doesn’t necessarily mean someone has OCD. Key indicators of OCD include:

  • Inability to control obsessions and compulsions, even when aware they’re excessive
  • Devoting at least an hour daily to these thoughts or behaviors
  • Feeling temporary relief after engaging in compulsions or obsessions
  • Experiencing significant disruptions in daily life due to compulsions or obsessions, such as impaired work performance, social isolation, or relationship conflicts

Aligning with many other mental health illnesses, the exact cause of OCD is unknown. We do know that some factors that can increase a person’s risk of developing OCD include their generics, brain structure and functioning, temperament, and a history of childhood trauma. OCD affects approximately 2-3% of Americans

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Setting OCD Treatmente Plan Goals and Objectives With Clients

Treatment for OCD can significantly enhance clients’ functioning in various aspects of life, including work, school, relationships, and leisure activities. Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is widely employed. ERP helps clients manage intrusive thoughts by gradually exposing them to anxiety-provoking situations, teaching coping skills, and reducing compulsive behaviors.

Additionally, medications such as serotonin reuptake inhibitors (SSRIs) are commonly prescribed, although their effects may take several weeks to manifest. SSRIs are often combined with CBT or ERP for optimal results.

For individuals who haven’t responded to other treatments, repetitive transcranial magnetic stimulation (rTMS) provides a non-invasive alternative, targeting specific brain regions associated with OCD. Deep brain stimulation, while invasive and reserved for severe cases, is still under investigation for its effectiveness in treating OCD.

Various assessment instruments aid in evaluating the presence and intensity of a client’s OCD, such as:

  • The Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
  • Obsessive-Compulsive Inventory-Revised (OCI-R)
  • Florida Obsessive-Compulsive Inventory (FOCI)
  • Obsessive-Compulsive Spectrum Inventory (OCSI)
  • Obsessive-Compulsive Drinking Scale (OCDS)
  • Child Yale-Brown Obsessive Compulsive Scale (CY-BOCS)

What to Include in a Treatment Plan for OCD + Sample

For the duration of this article, we will be referencing a hypothetical case example for a client, John, and create an OCD treatment plan reflective of his clinical needs. Treatment plans should be tailored to each individual, making note of their symptoms, level of impairment, and other mental health concerns. Our case study will follow a TherapyByPro treatment plan outline with our OCD treatment plan sample.

Johns Case:

John S. is a 35-year-old man who sought treatment after being encouraged by his wife to get help. John reported that his symptoms started in his early twenties but have worsened over the past few years. He spends several hours each day performing his compulsive rituals, which significantly interferes with his daily functioning and productivity at work. His wife has expressed concern over the amount of time he spends on these behaviors, and it has started to strain their relationship. John indicated that he experiences both obsessions and compulsions. His obsessions include intrusive thoughts about germs and contamination, which he fears will harm his family. Though he has tried to suppress or ignore these thoughts, they are quite distressing and persistent. John estimates that he washes his hands 30 times each day, and encourages his family to wash their hands throughout the day as well. John explained that he does experience temporary relief when he washes his hands, however, his obsessions tend to reoccur throughout the day. John noted that his symptoms have begun to affect his concentration and work performance because he keeps getting up to wash his hands.

John denied receiving treatment in the past for this, or other mental health concerns. He reported being in good physical health, exercising regularly, and denied taking any medications.

Agencies Involved and Plans for Care Coordination

Though John initially reported that he was in good health and was not taking medications, based on his presentation a component of his treatment plan will be to refer him to a psychiatrist for an assessment, and to explore possible medications that could enhance his treatment. If John is agreeable, you can sign the needed consent and include the referred healthcare provider in this section of your treatment plan for OCD.

Example for John:

Other Agency: Psychiatrist, Doctor Smith

Plan to coordinate: Initiate a referral for John to see Dr. Smith for an evaluation of OCD symptoms, and to explore possible medications that could enhance his treatment experience.

Clinical Diagnoses

Based on the provided information, John meets the criteria for obsessive-compulsive disorder. His symptoms that support this diagnosis are his experience with obsessions and compulsions, and that he has had similar obsessions and compulsions since he was younger. The overarching theme of his obsessions and compulsions is germs and contamination, which could lead to illnesses.

Example for John:

Diagnosis: Obsessive-compulsive disorder, F 42

Supporting Assessments:

  • Yale-Brown Obsessive Compulsive Scale : Total score 32
  • Obsessive-Compulsive Inventory-Revised (OCI-R): Total score 40

Current Medications and Responses

At this time John is not taking medications, however, should this change, it should be reflected in his treatment plan.

Example for John:

No medications at this time

Presenting Problem and Related Symptoms

This section of your OCD treatment plan can be used to highlight your client’s symptoms, impairment, and other factors contributing to the development of their treatment plan. You can use this as the location for your clinical summary that provides clarification into your case conceptualization and where your work will be focusing. You can be detailed and specific in this section to support your treatment plan.

Example for John:

John Smith, a 35-year-old software engineer, presents with severe symptoms of obsessive-compulsive disorder (OCD), specifically characterized by intense contamination obsessions and compulsive hand washing behaviors. His intrusive thoughts about germs and contamination lead to significant anxiety, compelling him to wash his hands up to 30 times a day. Despite efforts to suppress these thoughts, they persist, causing considerable distress. His Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 32 and Obsessive-Compulsive Inventory-Revised (OCI-R) score of 40 indicate severe OCD symptoms, particularly related to washing.

These symptoms profoundly impact John’s life, affecting his productivity at work due to frequent interruptions for handwashing and creating social isolation as he avoids public places and social interactions. His compulsions also strain his marriage, disrupting daily routines and causing emotional stress. To address these impairments, a comprehensive treatment plan involving cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP), alongside possible medication, is recommended. This approach aims to reduce his symptoms, improve daily functioning, and enhance his overall quality of life.

Goals and Objectives

Your goals and objectives should be specific to John, along with being reasonable and realistic based on his current presentation. If you find that your client is having a hard time working through their objectives, it may be necessary to adjust them so they are more attainable. As you develop your goals, keep in mind where your client falls within the stages of change, and how important the goals you selected would be to them.

Example for John:

Goal 1: Reduce the Frequency of Compulsive Hand-Washing

  • Objective 1: Identify and document-specific triggers for handwashing.
  • Objective 2: Gradually decrease the frequency of handwashing.
  • Objective 3: Practice exposure to contamination triggers without engaging in compulsive handwashing.

Goal 2: Increase Social Engagement and Reduce Avoidance Behaviors

  • Objective 1: Identify and challenge negative thoughts related to social situations.
  • Objective 2: Gradually reintroduce social activities in a controlled manner.
  • Objective 3: Enhance social support and communication skills.

Goal 3: Improve Overall Daily Functioning and Productivity

  • Objective 1: Develop a structured daily routine to minimize time spent on compulsions.
  • Objective 2: Enhance coping strategies for managing work-related stress and anxiety.
  • Objective 3: Increase participation in pleasurable and meaningful activities.

Specific Interventions to Be Used

The interventions that you use should align with the goals and objectives that you have outlined in your treatment plan. Your interventions will be the most impactful if they are evidence-based for OCD treatment. If you find that your client needs more support to achieve a goal or objective, you can amend your treatment plan to reflect the necessary changes.

Example for John:

Intervention/Action: Keep a daily log of triggers that you experience that lead to an urge to wash your hands. Bring this list into your therapy session to review

Responsible Person: John and Counselor A

Intervention/Action: Set specific time intervals of when to wash hands, slowly increasing the time between washed. Utilize relaxation techniques, such as deep breathing, to manage anxiety and discomfort that arises in between washes

Responsible Person: John

Intervention/Action: Use cognitive restructuring techniques to identify irrational thoughts about contamination in social settings.

Responsible Person: John with assistance from Counselor A

Intervention/Action: Create a graded exposure plan starting with less anxiety-inducing social activities.

Responsible Person: John, with the support and guidance of Counselor A

Intervention/Action: Set specific, achievable goals for social interaction each week.

Responsible Person: John

Family Involvement

If John is agreeable, it sounds as though including his wife in his treatment can be beneficial. Depending on their needs, you could facilitate educational sessions about OCD and effective treatment options, and discuss what could be done or modified in their home environment to better support John. Couples counseling could be another option, depending on the strain in their marriage.

Example for John:

Family sessions with his wife focus on providing psycho-education about OCD, causes, and treatment. 

Additional Services and Interventions

Because this treatment plan is using CBT, there are a number of additional services and interventions that align with his treatment plan and objectives that you could use. Some clinicians find that using worksheets can help facilitate and guide interventions. Examples of relevant worksheets that could be used to treat OCD are the TherapyByPro OCD worksheets. John may also benefit from a support group for those living with OCD, and working with a psychiatrist. 

Example for John:

Additional Services:

  • Attend OCD support group
  • Referral to local Psychiatrist for assessment and to explore possible psychotropic medication options

Estimation for Completion

There are a number of factors that can affect the duration of your treatment. This can include the type of OCD you’re experiencing, the severity of your symptoms, and the length of time that you have been struggling. Individuals who begin taking SSRI medications may not notice a change in symptoms for a few months, which too can lengthen the duration of treatment. Treatment for OCD can last up to one year.

Examples for John:

Duration of 12 months with the use of weekly individual sessions. Family sessions can be included if he and his wife are agreeable

Aftercare Plans

Aftercare plans should reflect what is recommended if John were to terminate treatment today. There are a number of reasons that treatment can end early, so it is best to be prepared in case this happens. Your aftercare plans can be modified as you move throughout the treatment process, to continue providing accurate recommendations. 

Example for John:

Aftercare Plans: Continue engaging in counseling and therapy services, follow up with primary care physician for medication management services if medications are being used

Final Thoughts On Creating a Treatment Plan for OCD

Crafting a successful OCD treatment plan requires a tailored strategy that acknowledges your client’s unique symptoms and hurdles. Utilizing evidence-based therapies such as cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP) aids clients in diminishing compulsive behaviors and navigating obsessions. This comprehensive approach fosters improved daily functioning, enhanced quality of life, and sustained guidance throughout the treatment process.

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and help your clients be their best selves.

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Resources:

Anthony Bart
Author: Anthony Bart

Anthony Bart is a huge mental health advocate. He has primarily positioned his marketing expertise to work with mental health professionals so that they can help as many patients as possible.

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