Can you describe your Intensive Treatment Program for OCD at the Cognitive Behavior Therapy Center for OCD and Anxiety?

"Our Intensive Treatment Program is designed for people with OCD who need hands-on assistance from experts to do the therapeutic work. The program operates from 9 AM to 1 PM, Mondays through Fridays, with the total number of days determined by the needs of the particular client. However most clients spend four to six weeks with us and leave the program able to participate in school, work, volunteering, family and social activities without the limitations imposed by OCD. No more than four clients are enrolled at any one time."

"The Intensive Treatment Program takes place in a comfortable, office suite with beautiful views of the San Rafael Mission. Our location offers a variety of opportunities for exposure and response prevention exercises that are not available in hospitals or clinics. People can practice everyday activities that have been blocked by OCD. For example, those with contamination worries can learn to manage them by practicing activities that they have feared such as showering, vacuuming, dusting and so forth. These and similar exercises can also help those who are overly responsible or perfectionistic learn to accept mistakes and set reasonable performance standards for themselves. Our setting also makes it easier for the clients to transfer skills learned in the program to their homes. We think you will find the ambience to be beautiful and peaceful."

What treatment modalities do you employ in your intensive treatment program? Do you use both Exposure and Response Prevention therapy and psychopharmacology and any other treatment techniques?

"Yes, we employ exposure and response prevention therapy used either separately or in combination with medications. Our treatment plans are tailored to the particular needs of the individual; so this could mean a combination of techniques including: exposure and response prevention homework assignments; individual psychotherapy; OCD education to correct maladaptive beliefs; and training in problem solving, social skills, assertiveness, relaxation, and stress management."

What is the philosophy behind your Intensive Treatment Program?

"OCD is a disorder of fear -- fear that is inappropriate and excessive. When the fear is eliminated, so are the obsessions and compulsions. We believe that the best way to eliminate fear is for people to learn how to face it. So using proven methods, we teach clients how to face, embrace, and erase the fear. This is done with patience, compassion, and friendly persuasion. When they feel the fear fading, they become inspired to defeat it and take charge of their lives."

How effective is your Intensive Treatment Program?

"We use the Yale Brown Obsessive-Compulsive Scale (Y-BOCS) to measure the effectiveness of our treatment program by comparing the severity of 46 OCD patients' symptoms before treatment and at the end of treatment, which generally took four weeks. The average score before treatment was 27, which indicates their symptoms were severe. After treatment, their average score was 15, which indicates their symptoms were mild. This change means that, on the average, the severity of the symptoms was reduced by 47% -- progress enough to allow them to function normally while continuing weekly outpatient treatment."

"Patients in your program play an integral part in each other’s treatment. Can you explain how that works?"

"An important way in which we learn new behaviors is by imitating the behavior of others, particularly when it is successful. This occurs in our program when people who have progressed in treatment help those who are just starting by modeling the correct practice of the therapeutic techniques. As a result, these beginners progress more rapidly and soon become models themselves for new clients."

"In addition, clients can form supportive relationships that continue after they leave the program."

What type of person with OCD should consider enrolling in your Intensive Treatment Program?

"The program is for people who need supervised guidance over the course of their OCD treatment. Perhaps they have tried outpatient therapy with no success, or they may live in communities where no effective therapy is available. We also accept people with OCD who have other conditions as well. For example, we have successfully treated OCD in combination with Asperger’s Syndrome, Social Phobia, Eating Disorders, Body Dysmorphic Disorder, and Depression. We also welcome people with obsessions only."

Do you treat children and adolescents in your program or just adults?

"Yes, we do treat children and adolescents in our Intensive Treatment Program. We see this as an opportunity to prevent years of suffering as the onset of obsessions and compulsions in childhood and early adolescence are frequently unrecognized and untreated."

Do you have a set duration for your Intensive Treatment Program or does the length vary with the individual case?

"There is no set duration for our Intensive Treatment Program. The length varies with each individual case. However, most people spend four to six weeks with us. Some stay for shorter periods."

How do you determine how long a person with OCD will stay in the Program?

"This determination is made in collaboration with the person. Treatment progress is periodically assessed with the Yale-Brown Obsessive Compulsive Scale, the Brief Symptom Inventory, and the Target Complaint Scale. This along with observations of staff and, when appropriate, the clients' significant others helps us decide when the person can leave the program and complete recovery with outpatient treatment."

What’s included in a typical day in your program?

"A typical day begins with a group meeting to discuss the clients previous day’s homework and set objectives for the present day. After this, clients work individually with staff for approximately three hours doing supervised exposure and response prevention therapy. During this period, individual and family consultation is also provided for individual issues. The day ends with another group meeting for sharing achievements and homework assignments with each member divulging only that which they do not wish to keep private."

What happens on the first day of your Program?

"The first day is spent familiarizing the client with the program, and getting to know the staff. We also begin our initial assessment by having the client complete questionnaires that survey their OCD and provide information on their personal history and overall psychological health. We review the general operation of the program and inform them of their rights and privileges as clients as well as our responsibilities to them. We formulate a general picture of their OCD symptoms and collaboratively outline treatment goals. With this information, we define our first treatment objectives."

Your program is a day program; do you have facilities for anyone who does not live within commuting distance?

"We do not have facilities for those who do not live within commuting distance. However, affordable lodging is available nearby. We have a list of inns and hotels that we can provide to anyone who wishes it."

What is your patient-to-staff ratio?

"Depending on the number of clients in the program at any one time, the patient-to-staff ratio varies from a one-to-one patient staff ratio to a three-to-four patient staff ratio. We limit the total number of patients to four so we can provide this low patient to staff ratio."

Some consider OCD to be a chronic illness, what kind of relapse prevention program is there at the Center?

"Prior to completing the program, clients are provided with specific recommendations for preventing relapse. In addition, ongoing outpatient appointments are scheduled for those living within commuting distance of our office. Telephone follow-up consultations are scheduled for others who do not live locally, or they are referred to qualified mental health professionals in their communities. If these therapists have no or limited experience with cognitive behavior therapy for OCD, we are willing to provide telephone consultation to them."

Do you involve family members and significant others in your treatment program?

"Family members and significant others are involved in the treatment program to an extent that does not violate the client' s confidentiality. With the client's consent, we find it helpful to teach family members and others how to help with homework assignments. We also find it quite important to work with clients and their helpers to eliminate any practices that maintain OCD symptoms such as enabling the client to avoid exposures exercises or assisting them with rituals. And we provide counseling to resolve interpersonal problems that impede recovery."

What kind of follow-up treatment do you provide for your patients?

"We provide follow-up treatment on an outpatient basis for clients who can come to our office, and make referrals to other professionals for those who live in other locales. We also provide treatment summaries and telephone follow-up to referring professionals and agencies, and treatment consultation when requested."

The Center has two distinct treatment programs. Can you describe and differentiate them? How does a prospective patient determine which of these programs is most suitable?

"We offer individual treatment for mild to severe OCD that requires one or more 45-50 minute sessions per week; and intensive day treatment for moderate to extreme OCD for those who have not responded or have no local access to outpatient therapy."

Do you admit people on an emergency basis to your Intensive Treatment Program?

"We can admit people to our Intensive Treatment Program on an emergency basis provided they have medical clearance from a physician verifying that they do not need 24-hour medically supervised care."

How do you determine who should be in an inpatient program and who should be in the Intensive Treatment Program?

"Inpatient hospitalization should be considered for clients who need 24-hour supervision for exposure and response prevention therapy to be successful, or who need medical supervision for co-occurring complex psychiatric, substance abuse, and/or physical problems. Our Intensive Treatment Program is for clients without these complications, who are willing and able to participate fully in our Intensive Treatment Program."

Does your program involve any in-home visits if an individual has OCD rituals that are concentrated on his/her home?

"We offer in-home visits within driving distance of our center for eliminating rituals that are localized to the home when this is the only way to treat the disorder."

Can individuals with co-morbid conditions or substance abuse problems be admitted to any of your OCD programs?

"As mentioned above, we frequently treat individuals with co-morbid psychological conditions, such as Social Phobia, Asperger’s Syndrome, Eating Disorders, Habit Disorders (Trichotillomania), and Personality Disorders. We require substance abuse problems to be treated before clients enter our program."

Are your programs covered by private insurance? Medicare? Medicaid?

"Most of our clients are covered by private insurance. Coverage is determined on a case-by-case basis. Medicaid does not cover our services and we do not accept Medicare."

Do you treat the Spectrum Disorders in your program?

"We treat Hypochondriasis and Body Dysmorphic Disorder."

Are there any research trials at the Center?

"No pharmacological research trials are being conducted at the Center. However, we conduct ongoing outcome research on the effectiveness of our treatment programs."

To enroll in a program or for more information, how do we contact you?

"Visit the contact page on our website for all our contact details"