Obsessive compulsive disorder: overview of the condition and its nursing management

Obsessive compulsive disorder (OCD) is a complex condition characterised by intrusive and distressing thoughts (obsessions) and repetitive behaviours or mental acts (compulsions). The symptoms of OCD cause significant distress and anxiety and can have a debilitating effect on a person's daily functioning. This article gives an overview of OCD, including its prevalence, aetiology, symptoms and treatment strategies, with the aim of enhancing nurses' understanding of the condition and its adverse effects on a person's life. The author also discusses some of the ways in which nurses in any setting can support a person with OCD.

Participant experiences of guided self-help Acceptance and Commitment Therapy for improving quality of life in muscle disease: a nested qualitative study within the ACTMus randomized controlled trial

Introduction

In adults, muscle disease (MD) is typically a chronic long-term condition that can lead to a reduced quality of life (QoL). Previous research suggests that a psychological intervention, in particular Acceptance and Commitment Therapy (ACT), may help improve QoL for individuals living with chronic conditions such as MD.

Methods

This nested qualitative study was incorporated within a randomized controlled trial which evaluated a guided self-help ACT intervention for people living with MD to explore their experiences of the intervention. Semi-structured interviews (n = 20) were conducted with those who had received ACT. Data were analyzed via thematic analysis.

Results

There were four overarching themes. (1) Views on whether therapy sessions would help with a medical condition: participants' expectations regarding ACT varied. Some participants were skeptical about mindfulness. (2) I was able to look at things in a different way: participants described increased meaningful activity, greater awareness of thoughts and emotions and acceptance or adaptation to mobility problems. Some described improvement in the quality of relationships and a sense of feeling free. (3) Treating the body and the mind together: following the intervention participants noted that a holistic approach to healthcare is beneficial. (4) Intervention delivery: The remote delivery was generally seen as helpful for practical reasons and allowed participants to speak openly. Participants voiced a need for follow-up sessions.

Discussion

Overall, the intervention was experienced as acceptable. Suggested improvements included de-emphasizing the role of mindfulness and adding follow-up sessions.

Socio-demographic differences in access to psychological treatment services: evidence from a national cohort study

BACKGROUND

Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has offered adults in England evidence-based psychological treatments for common mental disorders (CMDs) such as depression and anxiety disorders. However, inequalities in access have not been explored at the national level.

METHODS

Using a unique individual patient dataset that linked 2011 Census information of English residents to national IAPT data collected between April 2017 and March 2018, we estimated the rate of access by a wide range of socio-demographic characteristics that are not routinely available. A large household survey was used to estimate the prevalence of probable CMDs by these socio-demographic characteristics. We estimated the probability of access to IAPT amongst people with CMDs by comparing the rates of access from IAPT data and the estimates of prevalence of CMDs from the household survey. Both unadjusted and adjusted (for important patient characteristics) access rates were estimated in logistic regression models.

RESULTS

As a proportion of those with a probable CMD, access to IAPT varied markedly by socio-demographic characteristics. Older adults, males, people born outside of the UK, people with religious beliefs, people from Asian ethnic backgrounds, people reporting a disability and those without any academic or professional qualifications were underrepresented in IAPT services nationally, in adjusted models.

CONCLUSIONS

The identification of patients who may be underrepresented in IAPT provides an opportunity for services to target outreach and engagement with these groups. Further understanding of barriers to access should help increase equity in access.

Understanding the presentation and treatment of anxiety disorders

Anxiety disorders are the most prevalent mental health issues worldwide and can have significant detrimental effects on people's quality of life and daily functioning. Nurses in a range of healthcare settings are likely to encounter people with various anxiety disorders, so it is essential that they have adequate knowledge and understanding of these conditions. This article explores the development of anxiety, before outlining the aetiologies and symptoms of common anxiety disorders. The author also provides an overview of some of the treatments available for anxiety disorders and explains the nurse's role in supporting those affected by these conditions.

Split-Second Unlearning: Developing a Theory of Psychophysiological Dis-ease

Psychophysiological “stress” underpins many conditions including anxiety, depression, phobias, chronic fatigue syndrome and non-specific musculoskeletal pain such as fibromyalgia. In this article we develop an understanding of chronic psychophysiological stress from a psychological educational perspective, by drawing on supporting evidence that significant emotional events in early life (traumatic and benign) can influence health and well-being later in life. We suggest that traumatic events instigate psychophysiological “stress” responses and the formation of emotional memory images (EMIs) within very short time frames, i.e., “split-second learning.” Once formed these emotional memories are triggered in daily living “re-playing” psychophysiological stress responses, resulting in chronic psychophysiological “dis-ease.” We describe a novel therapeutic approach to scan clients for mannerisms signifying a subconscious “freeze-like” stress response that involves the client as a curious observer within their own experience, feeding back the non-verbal cues as they arrive in the moment. By breaking down the observable fragments of their split-second Pavlovian response to the trigger, clients can detach their EMI from the psychophysiology stress response, i.e., “split-second unlearning.” Our split-second unlearning model recognizes the EMI as a barrier to moving forward and needs to be unlearned before the client can become naturally adaptive again. We argue that this approach places the client at the center of the work without the need of getting bogged down in a life-long narrative.

Role of non-specialist nurses in supporting people who misuse drugs

In their practice, nurses are likely to encounter people who misuse drugs, but they may find it daunting to support these patients. While specialist drug treatment services have an important role in providing substitution treatment and talking therapies, referral is not always appropriate for some patients. Non-specialist nurses are well placed to use techniques such as brief interventions and motivational interviewing to engage patients in discussions about their drug misuse and prompt them to consider how they could reduce it. This article defines drug misuse, describes the contributing factors that can lead to it and its associated health issues. It also discusses how non-specialist nurses can manage and provide optimal support for patients who misuse drugs.

Psychological interventions in obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is a common mental health problem associated with poor quality of life, impaired functioning and increased risk of suicide. Improvement is unlikely and symptoms will remain chronic unless adequate treatment is provided. National Institute for Health and Care Excellence (2006a) guidelines on the management of OCD, recommend the use of psychological treatments that are based on cognitive behavioural therapy (CBT). Brief treatment forms of CBT are recommended initially and more intensive forms are offered when health gain is not apparent. While the presentation of OCD can be complex, nurses can assist in the recognition and treatment of OCD through additional training or current skills.