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Treatment
Mental Help Net Staff

Obsessive-compulsive disorder is commonly treated through a combination approach of modern psychotropic medications and cognitive-behavioral psychotherapy. Learn the details of these treatments and other treatment options here.

Introduction

Persons diagnosed with OCD find themselves repeating certain behaviors or thoughts again and again and again and again. They know the repetition is unnecessary, but they are unable to stop themselves. Common forms of obsessive behavior include checking of locks (to be sure they are locked), and stoves and lights (to be sure they are off). Also fairly common are intrusive and unwanted recurrent thoughts of hurting oneself or one's children.

Afflicted individuals usually experience severe anxiety if unable to act out their compulsive thoughts. Many psychotherapy approaches to treating OCD capitalize on this observation by helping the OCD patient learn that no cause for anxiety will actually occur should they fail to act out their compulsions.

Many patients do not volunteer their symptoms, and instead complain only of anxiety or depression. One possible reason why this may be so is that persons with OCD may be motivated to hide their symptoms due to the often negative reactions that family members have to their obsessions and compulsions. Many times relatives become angry and upset when they are forced to deal with what are commonly time-consuming and unrealistic repetitive behaviors.

Psychotherapy

For many years, OCD was seen as a purely psychological disorder, related to a desire to control one's environment or to undo some perceived wrong action. Insight oriented psychotherapy has been singularly unsuccessful in treating this group of disorders, however. Behavior therapies have had much more success, especially those with specific small steps geared to the exact obsessions or compulsions involved in the individual case.

Behavior therapy has a lot to offer individuals with this disorder. Two common and popular techniques are systematic desensitization and in vivo exposure with response prevention (flooding). Systematic desensitization involves the client imagining ever-increasing anxiety-provoking stimuli and then using relaxation techniques to relax herself/himself if the patient begins to feel anxious. In vivo exposure with response prevention involves the client being directly exposed to the anxiety producing stimulus and using relaxation techniques to relax herself/himself if the person begins to feel anxious or uncomfortable. Over time the feelings of relaxation rather than anxiety become associated with the stimulus.

It is important to note here, though, that such a technique should not be attempted until the client has successfully learned relaxation skills and can demonstrate their use to the therapist. Exposing a patient to either of these techniques without increased coping skills can result in relapse and possible harm to the client. Relaxation techniques may include imagery, breathing skills, and muscle relaxation. It is important for the client to find a relaxation technique that works best for them, before attempting something like systematic desensitization or flooding. Flooding allows the patient to face the most anxiety-provoking situation, while using the relaxation skills learned.

Additional behavioral and cognitive-behavioral techniques, which may have some effectiveness for people who suffer from this disorder, include saturation and thought stopping. Through saturation, the client is directed to do nothing but think of one obsessive thought that they have complained about. After a period of time of concentrating on just this one thought (e.g., 10-15 minutes at a time) over a number of days (3-5 days), the obsession can lose some of its strength. Through thought stopping, the individual learns how to halt obsessive thoughts through identifying the obsessive thoughts, and then averting it by doing an opposite, incompatible response. A common incompatible response to an obsessive thought is simply yelling the word "Stop!" loudly. The client can be encouraged to practice this in therapy (with the clinician's help and modeling, if necessary), and then encouraged to transfer this behavior to the privacy of their home. They can also often use other incompatible stimuli, such as tweaking a rubber band that is around their wrist whenever they have a thought. This latter technique has the benefit of being more appropriate to perform in public.

Medications

In the last 25 years, medications have been found to be fairly successful in the treatment of OCD. First was the tricyclic antidepressant clomipramine (Anafranil). This has been followed by several of the newer SSRI class anti-depressants that act selectively on the re-uptake of the neurotransmitter, serotonin, particularly Fluvoxamine Maleate (Luvox). Generally the dose of these medicines useful for treating depression is not sufficient to control OCD symptoms; Patients often require 2-4 times a typical anti-depressive dosage.

In the last few years, neuro-imaging studies have begun to disclose the underlying pathophysiology of OCD. The area of the brain that functions abnormally is directly next to those areas that relate to tick disorders such as Tourette's Syndrome and to Attention Deficit Disorder, suggesting overlap between these disorders. Many people with ADD also have tics, as do many people with OCD.

Summary

Behavioral therapy with medications seems to offer the best long-term improvement for the treatment of OCD. Virtually no treatment is curative for OCD. Most treatment can be expected to reduce symptoms by 50-80% or more, however. The illness is cyclic, and worsens when the individual is under stress.

References:
James F. Hooper, M.D. and Mental Help Net Staff

 

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