| Course | NU671 PMHNP Psychopathological Disorders and Psychotherapy |
|---|---|
| Unit | Unit 8 |
| Paper type | Early session outline |
| Length | About 1,010 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NU671 Unit 8
Forty Handwashes a Day: An Early Session Outline for Exposure and Response Prevention With a 35-Year-Old School Librarian With Contamination Fears
[Student Name]
Purdue University Global
NU671: PMHNP Psychopathological Disorders and Psychotherapy
Unit 8 Early Session Outline
[Instructor Name]
[Date]
The patient is composite; details and scores are bracketed.
The Patient
Ms. [G.] is a [35]-year-old elementary school librarian. For [six] years she has feared that she will pick up germs from the books children handle and pass illness to her elderly mother. She washes her hands about [40] times a day, uses gloves to shelve returned books, showers for up to two hours after work and asks her husband to change clothes in the garage. Her hands are cracked and bleeding. Her Yale-Brown Obsessive Compulsive Scale score is [29], in the severe range. She has taken sertraline for [two] years with partial benefit.
Why Exposure Waits Until Session Three
Exposure and response prevention is the best-supported psychological treatment for obsessive-compulsive disorder. In a meta-analysis of [37] randomized trials, cognitive behavioral therapy for the disorder, most of it built around exposure, had very large effects compared with waiting list and placebo conditions and was significantly better than antidepressant medication (Öst et al., 2015). The case for starting exposure quickly is therefore strong.
Two sessions of preparation come first, for three reasons. First, the patient must understand and agree to what she is being asked to do. Exposure asks her to touch what she fears and not wash, which will raise her anxiety sharply; without a clear rationale she may refuse or drop out. Second, the therapist needs a detailed map of her fears and rituals to build a hierarchy; starting at the wrong level risks either a trivial first task or an overwhelming one. Third, response prevention requires agreed rules, and she needs time to practice monitoring her rituals before she tries to stop them. Two sessions of preparation are not a delay of treatment; they are the part of treatment that makes the third session possible.
The preparation is kept to two sessions because longer delays allow avoidance to continue and may signal to the patient that the therapist, too, sees exposure as dangerous.
Session One: Assessment and Understanding the Cycle
Goals: complete the assessment, draw the obsessive-compulsive cycle with her, and give the treatment rationale.
1. Review the Yale-Brown Obsessive Compulsive Scale, completed before the session, and ask about each item. The scale was designed to rate severity of obsessions and compulsions regardless of their content, which makes it useful for tracking change across the treatment (Goodman et al., 1989).
2. Draw the cycle on paper: a trigger (touching a returned book), an obsession ("I could bring home a virus that kills my mother"), anxiety, the compulsion (washing), relief and the long-term cost (the fear stays, and she never learns what would happen without washing).
3. Explain the rationale: rituals bring short-term relief but keep the fear alive, and exposure with response prevention allows her to learn that she can tolerate the anxiety and that the feared outcome is unlikely.
4. Discuss her mother's health honestly: the aim is not zero risk but a level of hygiene most people accept.
5. Homework: record every wash, shower and avoidance for one week, with the trigger and the anxiety rating from 0 to 100.
Session Two: Building the Hierarchy and the Rules
Goals: build the exposure hierarchy, agree on response prevention rules, and plan the first exposure.
1. Review the monitoring record. She washed [41] times on the busiest day and [26] on a weekend day, and two-thirds of washes followed contact with books or with her husband's work clothes.
2. Build the hierarchy together, with anxiety ratings:
a. Touching a book she has already cleaned, [25]. b. Touching a returned library book with bare hands, [45]. c. Touching a returned book and then her face, [60]. d. Handling a book returned by a child who had a cold, [75]. e. Hugging her husband while he wears work clothes, then preparing food, [85]. f. Visiting her mother after a full school day without showering first, [95].
3. Agree on response prevention rules: handwashing limited to before meals, after using the toilet and after visible dirt, [30] seconds each; one [ten]-minute shower a day. Her husband will not help with checking or reassurance, and they will practice a phrase he can use instead: "I know this is hard. I'm not going to answer that."
4. Plan the first exposure, item b, for session three.
5. Homework: continue monitoring and begin reducing showers to [30] minutes.
Session Three: The First Exposure
Goals: complete the first exposure in session, begin response prevention, and set daily practice.
1. Review homework and her anxiety about today's task.
2. Exposure: she handles a returned library book with bare hands for [45] minutes, touching the cover and pages, then her arms and clothes. The therapist models the task first and stays with her.
3. Rather than asking only whether her anxiety has fallen, the therapist asks what she expected to happen and what actually happened. Current exposure models suggest that the violation of expectations, not merely the decline of anxiety, drives new learning (Craske et al., 2014).
4. Response prevention: she does not wash until lunch, [two] hours later.
5. Homework: repeat the book exposure daily at work without gloves, and record the anxiety at start and end, what she predicted and what happened.
What Would Change the Plan
If her anxiety at session three is too high to stay with the task, the step will be broken down, not abandoned. If she washes after the session, the plan will be discussed openly, not treated as failure. And if her obsessions include thoughts of harming her mother on purpose, a different presentation, the formulation will be revisited before exposure continues. Sertraline will continue unchanged; in a randomized trial, intensive exposure and ritual prevention was superior to clomipramine alone and was not improved by adding the drug, though all active treatments beat placebo (Foa et al., 2005).
References
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. https://doi.org/10.1016/j.brat.2014.04.006
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., Huppert, J. D., Kjernisted, K., Rowan, V., Schmidt, A. B., Simpson, H. B., & Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162(1), 151-161. https://doi.org/10.1176/appi.ajp.162.1.151
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989). The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Archives of General Psychiatry, 46(11), 1006-1011. https://doi.org/10.1001/archpsyc.1989.01810110048007
Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive-compulsive disorder: A systematic review and meta-analysis of studies published 1993-2014. Clinical Psychology Review, 40, 156-169. https://doi.org/10.1016/j.cpr.2015.06.003
Reading the NU 671 Unit 8 instructions
In Unit 8 you plan the first sessions of an evidence-based psychotherapy for a composite patient. Prompts usually ask for the goals of each session, the specific activities and homework, the rationale given to the patient, and the reasoning behind the pacing. Plans of three to five pages are common, with citations for the therapy's evidence and for any measures used. Graders look for a plan that a supervisor could follow session by session, with enough detail to show the therapist's reasoning. Explaining the order of activities, especially the timing of the first exposure, is often worth as many points as the activities themselves. Contingencies for common problems strengthen the outline.
Inside the NU671 Unit 8 example
The patient is described with her rituals and a Y-BOCS score of 29. A timing section cites the Öst meta-analysis for the case to start quickly, gives three reasons for two sessions of preparation, and a highlighted sentence reframes that preparation as treatment. Session one covers the measure, the cycle drawn from her own example, the rationale and a week of monitoring. Session two reviews the monitoring numbers, builds the six-step hierarchy with ratings and sets the washing and shower rules, including a phrase for her husband. Session three runs the first exposure and asks what she predicted and what happened. A contingencies section closes with the Foa trial on medication.
NU671 Unit 8 rubric: what earns full points
An early session outline in this course is usually scored on fidelity to the treatment model, clarity of session goals, rationale and pacing, use of measurement and flexibility. Fidelity earns full points when each session reflects the established components of the therapy. Goals should be specific enough that a supervisor could tell whether they were met. The pacing row rewards a justified timeline for starting exposure. Measurement points go to a baseline instrument and a monitoring record that later sessions can build on. Flexibility is judged on contingencies, such as what happens if anxiety is too high or a ritual is performed after the session.
Common NU671 Unit 8 mistakes, and how to avoid them
A common error is starting exposure without first building a hierarchy with the patient, which can overwhelm her and lead to dropout. The opposite error, several sessions of preparation, lets avoidance continue and signals that exposure is dangerous. Students often forget response prevention rules, which are half of the treatment. Some outlines leave family members out, even when a spouse is providing reassurance. Others judge the exposure only by whether anxiety fell, missing the expectancy question. And an outline without contingencies suggests the plan will break the first time the patient struggles, which is when she most needs a clear next step. Finally, check that each homework task can be done in the patient's real day, since tasks she cannot fit into a school week will quietly lapse.
Get an NU671 Unit 8 example written to your instructions
Tell us the therapy and presentation your NU671 Unit 8 prompt specifies, along with how many sessions it wants outlined, and attach the rubric. The first outline comes free within 24-48h, each session given distinct aims, every activity tied to the cycle it interrupts, and the order defended rather than assumed. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU671 Unit 8 questions, answered
Why not start exposure in the first session?
Some protocols move quickly, and a prompt may ask for that. But exposure is demanding, and people who do not understand or accept its rationale often refuse or drop out. Building a shared model of the problem and a hierarchy first improves the odds that exposure happens at all. The outline should justify whichever pace it chooses.
Does session one need a standardized measure?
A baseline makes every later claim of progress checkable, and the Y-BOCS is the usual choice for obsessive-compulsive symptoms, with its severity score repeated at set points. Some prompts also want the ritual log treated as data. Stating when the scale is readministered, and what drop would count as meaningful, lets a grader see how the outline would judge its own success.
Is habituation still the goal of exposure?
The emphasis has shifted. Earlier accounts focused on distress falling within and across sessions. Inhibitory learning models, associated with Craske and colleagues, stress learning that feared outcomes do not occur, even when distress stays high. Many outlines now describe debriefs in those terms, and citing the shift shows awareness of how the treatment's rationale has developed.
Where can I find a free NU671 Unit 8 sample paper?
The complete NU671 Unit 8 early session outline can be read on this page, with the timing argument, all three sessions and the contingencies, plus four references. An outline for a different therapy or patient can be drafted to your prompt.
What is on the hierarchy in NU671 Unit 8?
Six steps rated from 25 to 95: touching a cleaned book, touching a returned book, touching a returned book then her face, handling a book from a child with a cold, hugging her husband in work clothes then cooking, and visiting her mother after school without showering.