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AA1? 33@8W ʚ;as8ʚ;g4NdNd@G 0ppp@ <4!d!d@k 0tP8<4dddd@k 0tP8 <4dddd@l 0tj0___PPT10 pp*___PPT9 z? %" TFact and Fiction in the understanding and treatment of Obsessive-compulsive problemsUU(T Paul Salkovskis  2b2Lets get the obvious fictions out of the way first33( 3 QFictions: People with OCD are: Mad Dangerous Weird/bizarre Weak Cowardly Neurotic3R R JFiction:  4Research is answering all of our questions about OCD 5 IK~Clinical Science:  Empirically Grounded Clinical Interventions  @    GFact  eUnderstanding how OCD works is helpful to sufferers, carers and families Oh, and professionals too.  f HFact:   Understanding is in short supply ! +I wish that ( )P  !would be violently killed tonight""P " **More understanding& ..  Q3a*Y@Which emotion when? Emotions are specific to particular meanings A(-( A Depression: Personal loss Anxiety: Threat or danger to you Anger: Someone broke your personal rules (unfairness) Guilt: You broke your own rules  +Z;Why do some people experience particularly intense anxiety?<< < 7$What are obsessions and compulsions? % CObsession: A recurrent thought, image, impulse or doubt which creates awareness of the potential for danger which the person can cause or prevent Compulsion: An action or reaction that is intended to both to prevent the danger of which the obsession has created awareness and to diminish responsibility for its ocurrence. DC &7    D#Cognitive theory of OCD simply put:$$$ $ Unacceptable intrusive thoughts, images, impulses and doubt are a frequent normal occurrence The obsessional patient believes that they might be responsible for harm if they don t act to prevent it They respond by TRYING TOO HARD (to get rid of the thought, to prevent harm, to be sure& ..and so on). As time goes by, THE SOLUTION BECOMES THE PROBLEM. aZa a MR.]/^9/Fact: CBT is a structured approach to treatment00( 0 sEngagement in assessment: helping the patient to feel understood through real understanding Formulation: reaching a shared understanding Discussion of alternative explanations Engagement in treatment: helping the patient to choose to change Helping the patient to actively test the alternative account and explore its implications Generalising changes Relapse prevention tZt t  NFiction:  ?OCD can not be completely eliminated OCD is a genetic disorder ?@ @ !OFiction  ?Getting rid of OCD is just a matter of confronting your fears ?@ @ "PFacts:  Getting rid of OCD requires you to confront your fears Cognitive behaviour therapy is the only psychological treatment which has been found to be effective in the treatment of OCD.  ,[Fact  Reassurance makes OCD worse  -\Fact  PIt is good to get support from people around you when you are resisting your OCD Q 0`+Fact: there is not enough CBT being offered,,( , nOnly 16% of a sample from our clinic had  adequate CBT 88 8 $SFact  :It is really hard to get CBT for OCD in the health service ; %TFiction  There are insufficient health service resources to provide effective psychological treatment for anything other than a small fraction of people suffering from OCD  #Facts:   There is no such thing as a  Hopeless case Some clinicians cover their failure to help by telling their patients to  Learn to live with it , that they are a hopeless case etc; i.e. they blame the victim   ,Am I a hopeless case?   Age? Duration of problem? Severity of problem? My therapist/key worker says I am& ST T 4cSome more fictions:  OCD is caused by not enough serotonin OCD is caused by a malfunctioning part of the brain Psychosurgery helps OCD Deep Brain Stimulation is a reversible procedure   (W5Fiction: Brain scans show that OCD is a brain disease 6 1_Fact:  #The brain is the organ of the mind  $ &UFiction  It is best for sufferers and public perception to describe OCD as a  brain disease  T 'VFact  Describing anxiety as being cased by a  brain disease increases pessimism about the likely response to treatment. s )XFact  ;It usually takes seven years from onset to diagnosis in OCD < 5dFact  ?OCDUK is a wonderful way of empowering both yourself and others @ 7eFact:  DThat s the end of the presentation##P # /p @A#B6C"  0` fff33̙3f` ̙f33f3f` ___` f3ff` fff>?" dd@,?_d@  d " @ `"  n?" dd@   @@``PP   @ ` ` p>>L0 <4(  r  <A?"r  <Af?"c   `BzCDEFd@?N$83$D93 v[F. .=*R5X;cBvJSf{v^U(E1-;M \eg^["X1XOXgP|G@>>88L,_EE8$ ! 0[a ]K 3,DNW`o %73ANG]Pj^ymxzc}Uw@j'j jgPLLgL\^Mm@tDXjvw'F^ypfdEG(8,%tiSF<j&  ~c#E&*9?DP}5aGAYkyvX?Ct^^xL@7iqQc?Y"S3# 'C-U0s2>DGNNmp@"c   `BzCDEFd@?N$83$D93 v[F. .=*R5X;cBvJSf{v^U(E1-;M \eg^["X1XOXgP|G@>>88L,_EE8$ ! 0[a ]K 3,DNW`o %73ANG]Pj^ymxzc}Uw@j'j jgPLLgL\^Mm@tDXjvw'F^ypfdEG(8,%tiSF<j&  ~c#E&*9?DP}5aGAYkyvX?Ct^^xL@7iqQc?Y"S3# 'C-U0s2>DGNNmp@"    `BzCDEFd@?N$83$D93 v[F. .=*R5X;cBvJSf{v^U(E1-;M \eg^["X1XOXgP|G@>>88L,_EE8$ ! 0[a ]K 3,DNW`o %73ANG]Pj^ymxzc}Uw@j'j jgPLLgL\^Mm@tDXjvw'F^ypfdEG(8,%tiSF<j&  ~c#E&*9?DP}5aGAYkyvX?Ct^^xL@7iqQc?Y"S3# 'C-U0s2>DGNNmp@" P {  Td@"^{  B3?" uB    `3f31?"yyB    `3f31?"aaB    `3f31?"CCB    `3f31?"!!H   c BCwDE F3@f1?v@"~{   f(gֳgֳd ?"`  a-Klicken Sie, um das Titelformat zu bearbeiten. .r   `l+gֳgֳd ?"h  pKlicken Sie, um die Formate des Vorlagentextes zu bearbeiten Zweite Ebene Dritte Ebene Vierte Ebene Fnfte Ebene=     q  Zgֳgֳ ?"   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'Care needed: science proceeds in stages( (, ( hh88T P Ngֳgֳ?P,$D  0 BIn the first stage, we know nothing but believe we know everythingC C  C F P ZL1? ,$D 0 @In the second stage, we know nothing and believe we know nothingA 2A  A F P Z1? ,$D 0 *There are no further stages (Max Hamilton).+ 2$$  + b P <d޽h ?"` ___{s___PPT10S+ZD' = @B DJ' = @BA?%,( < +O%,( < +D{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*P%(D' =+4 8?\CB#ppt_xBCB#ppt_xB*Y3>B ppt_x<*PD' =+4 8?dCB1+#ppt_h/2BCB#ppt_yB*Y3>B ppt_y<*PD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*P%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*PD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*PD{' =%(D#' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*P%(D' =+4 8?dCB0-#ppt_w/2BCB#ppt_xB*Y3>B ppt_x<*PD' =+4 8?\CB#ppt_yBCB#ppt_yB*Y3>B ppt_y<*P++0+P0 ++0+P0 ++0+P0 +6S  0 % : 2 PX(  X X  gֳgֳ 8c8c?PH    X C xpgֳgֳ ?~B  - X T䮹gֳgֳ? O M ,$ 0 uClinical practice    hh88, X T踹gֳgֳ? I -,$ 0 tOutcome research   hh88" X T˹gֳgֳ? {P,$ 0 jTheory   hh88E X T0͹gֳgֳ? m,$  0 )Experimental studies and related research* * * hh88@2 X C ENGHZJQp? `T`T`T`T`T`T`T`T`T`T J ,$D 02  X C E$GH I`TQp? `T.T`T.T`T`T`T.T`T`T! ,$D 0@2  X C BTENGY I@Qp? TT`TTT`T@`TT`T@`T!Za ,$D 0F2  X S ENGZHI`TJQp? `T`T`T`T`T`T`T`T`T`T ,$D 02  X C E$GHY I`TQp? `T T`T T`T`T`T T`T`T k,$D 0@2  X C ENGHZJQp? `T`T`T`T`T`T`T`T`T`T0 :Z,$D  0F2 X S ?ENGHgQp? `T`THT`T`THT`T`THT`T` ,$D 0@2 X C ?ENGHgQp? `T`THT`T`THT`T`THT`TP ,$D  0@2 X C ENGHgQp? `T`THT`T`THT`T`THT`T`  ,$D  0"2 X S -E$GH I`TQp? `TQT`TQT`T`T`TQT`T`Tq{[,$D  0F2 X S S@ENGHZJQp? `T`T`T`T`T`T`T`T`T`T z @,$D 0: X Tݹgֳgֳ?@ 9 Z ,$ 0 Evidence based patient choice   hh88"2 X S E$GH I`TQp? `T.T`T.T`T`T`T.T`T`T z ` ,$D 0"2 X S hWE$GH I`TQp? `T.T`T.T`T`T`T.T`T`T J ,$D 0L2 X c ~UfENGZHI`TJQp? `T`T`T`T`T`T`T`T`T`T z ,$D 0 X  f,1?<B,$ 0 : NICE Guidelines  L2 X c sENGZHI`TJQp? `T`T`T`T`T`T`T`T`T`T2 2w,$D 0L2 X c ENGZHI`TJQp? `T`T`T`T`T`T`T`T`T`T :,$D 0X2 X  $׌BClwENGX8HŠdI`TJ #Qp? lwtilwti`T #ti`T #4cF ,$D 0b X <d޽h ?"`X X X X X XXX X X X X XXXXX ff3f22___PPT10h2.+|D0' = @B D0' = @BA?%,( < +O%,( < +DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D ' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* X%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* X%(D ' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* X%(D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D ' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%( D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* X%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* X%(D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D ' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(D4' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<*X%(+P+0+X0 ++0+X0 ++0+X0 ++0+X0 ++0+X0 ++0+X0 +  0L0 H$(  Hr H S w`   r H S wh  H H 0޽h ? fff33̙3f___PPT10i.$+D=' = @B +  0L0  L$(  Lr L S |`   r L S Th  H L 0޽h ? fff33̙3f___PPT10i.pr~+D=' = @B + 0L0 (    S  rAB<$  0    S 0 P <$ 0     f1?5 n(Fact: OCD is not as weird as it appears))6 ) T  <d޽h ? fff33̙3fF>___PPT10.+򝹡D' = @B DA' = @BA?%,( < +O%,( < +D' =%(D' =%(D@' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =-o6Bwipe(up)*<3<*D' =%(D(' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*"%(D' D=-s6Bwipe(down)*<3<*"%(D' =eB]0,0; 0.14,0.36; 0.43,0.73; 0.71,0.91; 1.0,1.0+4 8?fCB#ppt_x-0.25BCB#ppt_xB*Y3>B ppt_x<*"%(D' =mBe0.0,0.0; 0.25,0.07; 0.50,0.2; 0.75,0.467; 1.0,1.0+4 8?lCB?B'#ppt_y-sin(pi*$)/3CB?B*Y3>B ppt_y<*"%(D' =B0, 0; 0.125,0.2665; 0.25,0.4; 0.375,0.465; 0.5,0.5; 0.625,0.535; 0.75,0.6; 0.875,0.7335; 1,1+4 8?lCBB'#ppt_y-sin(pi*$)/9CB?B*Y3>B ppt_y<*"%(D' L=B0, 0; 0.125,0.2665; 0.25,0.4; 0.375,0.465; 0.5,0.5; 0.625,0.535; 0.75,0.6; 0.875,0.7335; 1,1+4 8?nCBB)#ppt_y-sin(pi*$)/27CB?B*Y3>B ppt_y<*"%(,D' =B0, 0; 0.125,0.2665; 0.25,0.4; 0.375,0.465; 0.5,0.5; 0.625,0.535; 0.75,0.6; 0.875,0.7335; 1,1+4 8?nCBB)#ppt_y-sin(pi*$)/81CB?B*Y3>B ppt_y<*"%(xD' =0l9 BBBpB*<3<*"%(D' =0l9 BBBB*<3<*"%())?D' =0l9 BBBB*<3<*"%( D' =0l9 BBBB*<3<*"%(:))?D' =0l9 BBBB*<3<*"%(jD' =0l9 BBBB*<3<*"%())?D' =0l9 BBBB*<3<*"%(D' =0l9 BBBB*<3<*"%(*))?+p+0+0 ++0+0 +  0L0 (  r  S D`      `1?>v?x J Honey(  H  0޽h ? fff33̙3fy___PPT10Y+D=' = @B +B 0L0 %    tb (  t^ t 6?p t Tɓgֳgֳ?G ,$D 0 d negative interpretations     t T0ϓgֳgֳ?@@,$D 0 b Events and situations      t T0ӓgֳgֳ?@!,$D 0 h Reactions to perceived threat! !  !  t Nדgֳgֳ?0 8Simplified Cognitive model of the persistence of anxiety9 9  9 2 t  ۓBE$GHI`TQ)? `T)`T)`T`T`T)`T`T2,$D 0 > 2 t  ܁ߓBTENGy I-Q)? ͫTT`TͫTT`T-`TT`T-`Tp pB,$D 0 > B  t 0D)p @,$D 0B  t 0D) p,$D 0b t <d޽h ?"`/ tt ff3f___PPT10+) ?D ' = @B D ' = @BA?%,( < +O%,( < +D%' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* t%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(D%' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* t%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(DA' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*t%(++0+t0 ++0+t0 ++0+t0 ++0+t0 +"C 0L0 %   (  ^  6?p  THgֳgֳ?G  d negative interpretations      TTgֳgֳ?P @ b Events and situations      Tgֳgֳ?@ ,$D 0 \Automatic reactions      Ngֳgֳ? w-Cognitive model of the persistence of anxiety. .  . 2   BE$GHI`TQ)? `T)`T)`T`T`T)`T`TP ,$D 0 > 2   ܁BTCENGy HI%I-Q)? ͫTBͫTB-`TB-`Tv H ,$D 0 > XB   0D) p2  @  BE$GHI`TQ)? `T)`T)`T`T`T)`T`Tp ,$D 0 > 2  @  ܁tBTC ENGy H!$I-Q)? ͫTSD ͫTSD -`TSD -`T q T| ,$D 0 > B  @ ND)?"p  p,$D' 0B   ND)?"p p p,$D' 0  TXgֳgֳ?@` ,$D 0 \Strategic reactions    b  <d޽h ?"`O@   ff3f___PPT10`+D' = @B D' = @BA?%,( < +O%,( < +DE' =%(%(D' =%(D' =4@BBBB%('D' =1:Bvisible*o3>+B#style.visibility<* %(D' =%()D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D%' =%(D' =%(D' =4@BBBB%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D2' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D2' =%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<* %(+P+0+0 ++0+0 ++0+0 ++0+ 0 ++0+ 0 ++0+0 +4   0 % P (  ^  6?)Z0   Pgֳgֳ 8c8c?`     C xPgֳgֳ ?h<$ 0  H  0޽h ? ff3f  ___PPT10 .+x/DB ' = @B D' = @BA?%,( < +O%,( < +D4' =%(%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*;%(D' =%( D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*;q%(D' =%(D' =A@BBBB0B%(D' =1:Bvisible*o3>+B#style.visibility<*q%(+8+0+0 +  0 % ` g(  \  Tgֳgֳ?7b  >perceived perceived likelihood  awfulness ___________________________ perceived perceived coping rescue @   T   # hh88)  Tgֳgֳ? 5Anxiety is proportional to the perception of threat: "6 4, 6 hh88   $gֳgֳ 8c8c?`     Ttgֳgֳ?  IX      T\gֳgֳ?I F P  I+ 0  H  0޽h ? ff3fy___PPT10Y+D=' = @B +  0 6(  ~  s *`   x  c $4 `  H  0޽h ? ˽'i6ffffy___PPT10Y+D=' = @B +  0L0 <0(  <x < c $h`   x < c $@h  H < 0޽h ? fff33̙3fy___PPT10Y+D=' = @B + A 0 %   p `A (  ` ` Tgֳgֳ? dAppraisal and anxiety: OCD (   ` Tgֳgֳ?P  t, I might kill my baby     pB ` H)? #` ` Tgֳgֳ?@F    Having this thought means that I am wicked and could be a child killer L L L pB `@ H)? >L pB ` H)? S R  ` Tgֳgֳ? P `Anxiety and discomfort      ` Tgֳgֳ? A SGives baby to others, Tries not to have the thought, Neutralises, seeks reassuranceT T T 2  ` c rBRENG H}IQ? qVR9qVR9`TR9`T +  ` 0ppv T Thinking something as as bad as doing it + +&   b ` <d޽h ?"` ` ff3fy___PPT10Y+D=' = @B + 0 % |(  |^ | 6? | Tgֳgֳ? r ,$D 0 >p responsibility interpretations probability X awfulness ------------------------------- coping + rescue : 6 2  E q A | Tgֳgֳ?0,$D 0 5 Intrusions (thoughts, Images, impulses, doubts)$6 1 6  | T gֳgֳ?342 V Mood changes    2 | s wBVENGXHPIWTJQ)? `TV[T{`TV[T{WTV[T{WTD2 | s !;;BPCSENG|HNRJQ)? `T`TPK S`T`TPK SPK SF L2 | c #BQENGy HcI-Q)? ͫTQu?ͫTQu?-`TQu?-`TUP ,$D 0  | Tgֳgֳ?0 @+ GNeutralizing, avoidance, reassurance and other safety seeking behaviourH H H 2  | s -KCNENGHc3I`TJNQ)? @Nj6@Nj6`TNNj6`TN X 2  | c 4B+PENGy HVtI-Q)? ͫT+P9ͫT+P9-`T+P9-`T X2  |  sRBTCTENGSfQH_ITJTQ)? `nLL`nLLTTLLTT P ,$D 02  | s  6B{XENGB~H_\IJQ)? |X`T{XFT|X`T{XFT{XFT|J o 2 | s WBlJENGYHuIJJQ)? `TlJ`TP(`TlJ`TP(JlJ`TP(JL` Z | T`gֳgֳ?Zy gCounter-productive strategies   L2 | c -B0vENG^HPI!Q)? r2v0v^Sr2v0v^S!`T0v^S!`T,$D  0L2 | c B\lC!ENG}|H$IQ)? \l{c[!\l{c[!`T{c[!`TpE ,$D  0L2 | c #MQB~C+ENGKH8CI*Q)? !~} ,K+!~} ,K+*`T} ,K+*`Tx,$D  02 | S zCY<ENGqVJY<Q)? `T:`TY<`T:`TY<Y<:`TY<Y<@N<2 | S CY<ENGqVJY<Q)? `T:`TY<`T:`TY<Y<:`TY<Y< b | <d޽h ?"` |||| | || | | | | | | ff3fy___PPT10Y+D=' = @B + 0L0  (  ^  6?@"  Tgֳgֳ?P  J I am responsible for killing others $& %  &   T$%gֳgֳ?] OAnxious      N)gֳgֳ? q P Attention to Other people s actions) ) )   N,gֳgֳ?V m  x0Checking self For visible signs of contamination1 1 1 2  S &ENGHZJQ)? `T`T`T`T`T`T`T`T`T`T   2  c ENGZHI`TJQ)? `T`T`T`T`T`T`T`T`T`T2   S CE$GHy I`TQ)? `T3T`T3T`T`T`T3T`T`T   T1gֳgֳ?    ZArguing with self    2   S %BTENGy I-Q)? ͫTT`TͫTT`T-`TT`T-`T    Td6gֳgֳ?L@ \Seeking reassurance   2   c `ENGZHI`TJQ)? `T`T`T`T`T`T`T`T`T`TkU 5{  T;gֳgֳ? P  qRumination about Consequences$    2  s C]ENGsH.XI`TJQ)? n.fz/]n.fz/]`Tz/]`T -   TD@gֳgֳ?Y   OWashing   2  S %BTENGy I-Q)? ͫTT`TͫTT`T-`TT`T-`T6 ` B F   NDgֳgֳ?P   ^Demoralised, depressed   2  S  VBTENGy I-Q)? ͫTT`TͫTT`T-`TT`T-`T  $  TIgֳgֳ?jT L Intrusion:  I am contaminated $' &  ' |B  TDN?<0 0 b  <d޽h ?"`    ̙33y___PPT10Y+D=' = @B +! 0L0 #  q(  ^  6?@"  TlPgֳgֳ?P  J I am responsible for killing others $& %  &   TVgֳgֳ?] OAnxious      NtZgֳgֳ? q P Attention to Other people s actions) ) )   Nx]gֳgֳ?V m  x0Checking self For visible signs of contamination1 1 1 2  S &ENGHZJQ)? `T`T`T`T`T`T`T`T`T`T   2  c ENGZHI`TJQ)? `T`T`T`T`T`T`T`T`T`T2   S CE$GHy I`TQ)? `T3T`T3T`T`T`T3T`T`T   Tbgֳgֳ?    ZArguing with self    2   S %BTENGy I-Q