OBSESSIVE-COMPULSIVE DISORDER (OCD) 217 B. The client was assessed in regard to the nature of any internal cues (e. g., thoughts, images, impulses) that precipitate the client's obsessions and compulsions. C. The clie nt was provided with feedback about his/her identification of cues. 21. Construct a Hierarchy of Fear Cues (21) A. The client was directed to construct a hierarchy of feared internal and external cues. B. The client was assisted in developing a hierarchy of internal and external fear cues. 22. Select Likely Successful Imaginal Exposure (22) A. The client was assisted in identifying initial imaginal exposures with a bias toward those that have a likelihood of being successful experiences for the client. B. Cognitive restructuring techniques were used within and after the imaginal exposure of the OCD cues. C. Imaginal exposure and cognitive restructuring techniques were used as described in Mastery of Obsessive-Compulsive Disorder (Kozak and Foa). D. Imaginal exposure and cognitive restructuring techniques were used as described in Treatment of Obsessive-Compulsive Disorder (Mc Gran and Sanderson). E. The client was provided with feedback about his/her use of imaginal exposures. 23. Assign Cue Exposure Pr actice (23) A. The client was assigned a homework exercise in which he/she repeats the exposure to the internal and/or external OCD cues. B. The client was instructed to use restructured cognitions between sessions and to record his/her responses. C. The client was assigned to use “Reducing the Strength of Compulsive Behaviors” from the Adult Psychotherapy Homework Planner, 2nd ed. (Jongsma). D. The client's use of the cue exposure homework was reviewed and his/her success was reinforced. E. Corrective feedback was provided to the client for his/her struggles in using restructured cognitions during exposure to OCD cues. F. The client was assisted in using restructured cognitions as described in Mastery of Obsessive-Compulsive Disorder (Kozak and Foa). 24. Differentiate between Lapse and Relapse (24) A. A discussion was held with the client regarding the distinction between a lapse and a relapse. B. A lapse was associated with an initial and reversible return of symptoms, fear, or urges to avoid. C. A relapse was associated with the decision to return to fearful and avoidant patterns. D. The client was provided with support and encouragement as he/she displayed an understanding of the difference between a lapse and a relapse. 25. Discuss Management of Lapse Risk Situations (25) A. The client was assisted in identifying future situations or circumstances in which lapses could occur. B. The session focused on rehearsing the management of future situations or circumstances in which lapses could occur. 