Intensive outpatient treatment programs in Michigan for obsessive-compulsive disorder and anxiety disorders
Cognitive Behavior Therapy (CBT) with emphasis on exposure response prevention (ERP) and habit reversal training (HRT)
Questions and Answers About the Program Description
1. When did you open your program?
The program was opened in July of 2009 in Tampa, Florida. He has currently relocated to the Detroit area and his practice is now located in Bloomfield Hills, Michigan with close proximity to Birmingham, West Bloomfield Hills, Rochester Hills, Auburn Hills, Beverly Hills, Farmington Hills, Pontiac, Clarkston, and Troy. Given the lack of access to evidenced-based intensive programs, Dr. Pence recognized a need for this type of program in Michigan and surrounding states. Dr. Steven Pence has long been concerned about the lack of access that many OCD patients have to evidenced-based care and his objective is that this program will contribute to meeting the needs of this underserved population.
2. Please describe the staff that work at your program in terms of their backgrounds, credentials and experience?
Dr. Pence is a fully licensed psychologist specializing in the treatment of adult and childhood OCD and other anxiety disorders. Dr. Pence completed his post-doctoral fellowship at the University Of Florida OCD Program in the Department of Psychiatry with his focus on clinical CBT and research. Dr. Pence then continued as a faculty member of the OCD Program at the Department of Pediatrics of the University of South Florida (USF) Rothman Center for Neuropsychiatry and was trained by the internationally known OCD expert (Dr. Eric Storch). Dr. Pence supervised postdoctoral fellows, psychiatry residents, & graduate students.
In addition to this experience, Dr. Pence has experience working in an Inpatient Unit, Detox Unit, and in the Emergency Department. Dr. Pence was trained in Cognitive Behavior Therapy, Exposure and Response Prevention, & Habit Reversal Training. Dr. Pence earned his Ph.D in Counseling Psychology from Michigan State University. His practicum, 2 advanced, and APA-Accredited internship all emphasized evidenced-based cognitive-behavioral interventions with a particular focus on OCD and anxiety disorders.
Dr. Pence is currently in private practice in the Detroit, (Bloomfield HIlls) Michigan area where he specializes in Obsessive-Compulsive Disorder and Obsessive-Compulsive related disorders. He has extensive experience in working with both children and adults with OCD and he has had considerable success in working with patients with severe and refractory OCD. He also has significant experience in working with body dysmorphic disorder, excoriation (skin-picking) disorder, and trichotillomania. Dr. Pence provides comprehensive assessment & treatment planning, individual weekly cognitive-behavior therapy with exposure and response prevention, and an intensive 3-week outpatient program. The outpatient program is for those that may lack access to trained CBT providers or are experiencing significant functional impairment as a result of the OCD or other anxiety disorder. In addition, he offers follow up care and family support services.
Dr. Pence published a number of research articles in peer reviewed journals on OCD and related topics. He has worked very closely with Dr. Eric Storch, a nationally recognized expert in this field. Dr. Pence’s primary research focus is on examining variables that may impact treatment response, including psychiatric comorbidity, patient insight, the working alliance, and perfectionism. In addition to this interest, Dr. Pence is also concerned about the limited access that patients and their families have to evidence-based treatments for OCD. Consequently, he is interested in exploring the role that alternative delivery models (e.g., intensive cognitive-behavior therapy) can play in facilitating patient access to empirically supported treatments.
3. Is this program devoted entirely to treating individuals with OCD or will other OCD spectrum disorders or anxiety disorders also be addressed?
Although the program is geared towards the treatment of OCD and related disorders, it is open to serve all children and adults with anxiety disorders. These include Trichotillomania, Body Dysmorphic Disorder, Panic Disorder, Agoraphobia, Social Phobia, Trichotillomania, Excoriation (Skin-Picking) Disorder, & Selective Mutism.
4. Please describe the core treatment components of your program
Available scientific evidence supports cognitive-behavior therapy with exposure and response prevention as the first line treatment for both children and adults. The intensive outpatient program, therefore, is geared towards providing daily individual cognitive-behavior therapy. Dr. Pence, however, strongly believes in an integrated and evidenced-based treatment approach tailored to the unique needs of each patient. He has relationships with psychiatrists who understand the roles of both pharmacotherapy and CBT in treating people with OCD that he can refer to when clinically appropriate. In addition to techniques of cognitive-behavior therapy & Exposure and Response Prevention, Dr. Pence uses In Vivo Exposure, Imaginal Exposure, & Habit Reversal Training. Education, setting ERP & cognitive goals, severity monitoring of progress, and developing lifelong skills to manage these disorders is important in the treatment process.
5. Please describe the treatment planning process at your program.
An extensive psychological research-supported assessment is conducted prior to treatment. This assessment includes a 2-hour clinical interview with Dr. Pence, structured diagnostic interview, and relevant measures. The purposes of this extensive assessment are to develop an initial rapport with patients, to determine accurate diagnoses, and to provide patients with an evidenced-based treatment plan. As part of the initial evaluation, patients are assessed for all psychological conditions, psychological comorbidity, as well as information about their medical, developmental, biological, social, family history and educational background. The impact of the stressors or traumas on the developmental and/or maintenance of anxiety or other symptoms need to be thoroughly assessed. Dr. Pence assesses all patients based on DSM-5 criteria and utilizes appropriate assessment tools as needed. Lastly, the comprehensive psychological assessment is helpful in tracking patient progress. When possible, information is gathered from multiple informants, including the patient, his/her spouse, parents, and other significant relations. Based on a comprehensive assessment, an individualized treatment plan is developed for each patient entering the program.
6. If someone has a comorbid condition, can he or she participate in your program? Will there be treatment for the comorbid condition? If so, can you give an example?
Patients with comorbid conditions are accepted for treatment. In fact, available scientific evidence suggests that, when it comes to OCD, comorbidity is the rule rather than the exception. Dr. Pence believes strongly in treating the whole person and specifically addresses comorbid conditions in treatment. For example, some conditions like severe depression may need to be addressed prior to treatment (e.g., medication management), whereas other conditions can be treated concurrently in treatment (e.g., habit reversal training for skin-picking).
7. Are parents, family members, friends, teachers, etc. included in the treatment? If yes, please describe how.
Dr. Pence has been profoundly influenced by the research conducted by Dr. Eric Storch at the University of South Florida, which emphasizes heavy family involvement throughout the treatment process. Consequently, in the treatment of children, parents and other family members are given extensive psychoeducation about the theory, nature, and treatment of OCD. This education begins during the first session and continues throughout treatment. Similarly, in the treatment of adults, spouses and other family members are given extensive education about OCD and its treatment.
8. How often do patients in the program meet with the doctor individually? How long are these individual sessions?
The unique aspect of this intensive program is that patients in the intensive outpatient program meet daily with Dr. Pence only. All of these sessions are with the licensed psychologist and patients do not work with interns, fellowship trainees, or other supervised individuals in the field. In contrast, no trainees or mid-level providers are utilized, and all patients do all of their treatment exclusively with Dr. Pence. In addition, the focus of treatment is on the patient and they will not be asked to participate in research. The sessions are extended intensive outpatient 90-minute therapy sessions.
9. Is there a set time period for a patient’s treatment in the program? What is the overall time commitment to the program (for example, attend daily for three weeks)? How much flexibility is there in extending someone’s stay if needed?
Patients entering the intensive outpatient program are generally scheduled for 3-weeks. On occasion patients progress more rapidly and complete the program early. In contrast, other patients need additional time and depends on severity of symptoms and comorbidity. The program is flexible to accommodate both scenario and treatment decisions are based on individual patient needs.
10. Is there a homework or “self directed” component to the treatment?
Homework figures prominently in this treatment approach. In addition to the regularly scheduled sessions, patients are given daily homework assignments that can generally be completed in 60 to 90-minutes. Practicing the skills learned in therapy between sessions is thought to be critical to generalizing the learning that occurs during intensive treatment.
11. Please describe the relapse prevention strategies you use in your program.
All patients who undergo intensive treatment are encouraged to obtain follow-up care. Much thoughtful planning goes into aftercare planning, with the hopes of preventing relapse. With that said, a central goal of treatment is to teach patients to manage their symptoms and give them lifelong tools. This is done through providing patients and their families with extensive psychoeducation about OCD and through having the patients practice the skills learned in therapy between sessions. Patients who leave the intensive program are taught to anticipate and identify future challenges and to recognize signs of relapse. In short, patients leave the intensive program with a set of tools that will help them to manage their OCD and to recognize when they need outside assistance. Part of treatment also focuses on lifelong management skills and tools including healthy coping vs. unhealthy coping and developing healthy family and social support systems.
12. What kind of follow-up do you do for those who complete your program? Will the members or your treatment team be in contact with or willing to consult with the individual’s regular treatment provider(s)?
From a treatment standpoint, it is not enough to simply get patients better, but to devise a plan to keep them better. Consequently, all patients who undergo intensive treatment are encouraged to follow-up with weekly CBT following completion of the program. Patients who live in the area can continue with treatment on a more intermittent basis (e.g., weekly). Patients coming from greater distances are encouraged to follow-up with a CBT practitioner in their area. Patients who complete the program are assisted in locating a qualified OCD expert in their area. Patients who do not have access to evidenced-based care are followed through phone contact or can return for “booster sessions” as needed. Videophone conferencing with Dr. Pence is an option for qualified candidates.
13. Does your program only work with individuals who are local or are there arrangements for those who come from farther away (for example, lodging arrangements)?
The program is designed to meet the needs of patients from all across the United States and internationally. Some of Dr. Pence’s patients have come from Mexico, Canada, Honduras, Venezuela and Barbados, etc. Patients coming from long distances are provided with help in securing housing.
While many patients stay in nearby extended stay facilities, other patients opt to rent homes on one of the areas many beautiful lakes. The Detroit Airport is close by and there are many restaurants, shopping centers, and attractions in the Detroit area.
Evidenced-Based Treatment Modalities:
Cognitive Behavior Therapy (CBT)
Exposure Response Prevention (ERP)
Habit Reversal Training (HRT)
Body Dysmorphic Disorder
Excoriation (Skin-Picking) Disorder