OCD Protocol with Delayed Cognitive Installation

OCD Protocol with Delayed Cognitive Installation

Note: In this OCD Protocol, targets are desensitized in the following sequence, starting with the current triggers (OCD compulsions and obsessions); followed by the future template (imagining successful future action); and then by past related disturbing memories (if any). Following desensitization of all targets, the positive cognition is developed and installed.

Phase One: Client History.

As with standard EMDR, a full client history is taken, thus providing the therapist with insight into the client’s issues. OCD events are then identified, with the client specifying which were the earliest, worst, and last events.

Phase Two: Preparation.

1. The client is prepared as in the standard EMDR protocol with a calm place, and with the addition of an imaginary nurturing figure, strength figure, or a protection figure if needed.

1. The stop signal is taught; both client and therapist should understand this inclusion as a necessity.

3. A dry run of the therapy is conducted, using a minor issue with little subjective distress. The Subjective Units of Disturbance (SUD; Shapiro, 1995) scale is introduced at this point to measure the subjective disturbance, where 0 is no disturbance or neutral and 10 is the highest disturbance that they could imagine.

Phase Three: Video playback procedure to identify triggers.

The following procedure is used separately for each current trigger (OCD event) and future template.The sequencing of targets is decided by therapist and client, and can be any of the following: first experience of the event, the worst experience, or the most recent experience.

1. The therapist says, “Play the mental videotape of the circumstances of this OCD event. When you begin to experience anxiety similar to the anxiety that you experienced during the actual event, let me know.

2. A modified version of the standard EMDR protocol for phase 3 is then applied, with the client asked to identify the image, emotion, and bodily sensation. A rating on the SUD scale may also be taken as a reference. The negative and positive self-referencing cognitions are not explored.

Phase Four: Reprocessing Sequence.

1.EMDR processing is used to desensitize the disturbing part of the video playback, and continues until the therapist and the client feel this particular anxiety has been processed fully.

2. The next disturbing part of the playback video is identified by saying, “Close your eyes, and mentally run the movie of the OCD event from where you stopped, until you notice anxiety.”

1. The next identified sequence is then processed, until the therapist and the client feel this particular event has been processed fully.

4.This procedure is repeated until the playback video can be run three times without any emotional or somatic distress.

Repeat Phases 3 and 4 Separately for All OCD Events.

Each current trigger is assessed and fully desensitized according the above steps.

Repeat Phases 3 and 4 for the Future Template.

The future template is assessed and fully desensitized according the above steps.

Conduct Phases 3 and 4 of the Standard EMDR Procedures for Past Events.

Past disturbing memories are assessed and desensitized as per standard EMDR procedures.

Phase 5: Cognitive Installation.

Cognitive installation is not conducted until all targets have been desensitized. Then, a positive self-referencing cognition is developed and installed as per standard EMDR procedures.

Phase 6: Body Scan.

Body scan is conducted as per standard EMDR protocol after completion of phase 5.

Phase 7: Session Closure.

Each session is closed as per standard EMDR procedures.

Phase 8: Re-evaluation

At the start of each session, re-evaluation of previous work is conducted as per standard EMDR procedures.