Treatment Approaches for Obsessive Compulsive Disorder by Dr. Fabiana Franco
Obsessive Compulsive Disorder is a serious mental disorder that is more prevalent than once thought. About 2 to 3 percent of the population will struggle with OCD at some point in their lifetime (Pittenger, Kelmendi, Bloch, Krystal, & Coric, 2005).
Treatment Approaches for OCD
To date,a combination of Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (EX/RP) are the most effective forms of psychotherapy for OCD.
Some researchers understand OCD as an inability to tolerate anxiety. For example, many people experience the compulsion for excessive hand washing as a symptom of OCD. After touching a doorknob, you may feel the urge to wash your hands; just in case the doorknob is dirty. Thoughts of germs on the doorknob lead to anxiety about disease. Rather than confront the fear and sit with the anxiety, you wash your hands, maybe while washing your hands anxiety increases and you need to wash your hands a few times in a row before you can carry on with your day.
An effective way to reduce OCD symptoms is to practice facing your fears and learn to tolerate anxiety. Under the guidance and support of a therapist, it is possible to change your responses to anxiety provoking situations and over time, experience a reduction in OCD symptoms.
What is a Therapy Session Like?
Exposure and Response Prevention (EX/RP) involves exposing yourself to situations or thoughts that trigger anxiety and resisting the urge to reduce the anxiety through engaging in compulsions.
Exposure is done gradually, starting with less stressful situations and as you are ready, moving on to more difficult anxiety provoking situations.
Getting the Most Benefit from Therapy
Your therapist will give you Exposure and Response Prevention (EX/RP) guidelines to follow between therapy sessions. Following the guidelines will tend to increase the benefit that you get from therapy.
The degree to which patients adhere to EX/RP procedures outside of sessions has been found to predict therapy outcomes, including who achieves post-treatment wellness. (Wheaton, Galfalvy, Steinman, Wall, Foa, & Simpson, 2016)
Does Exposure and Response Prevention Work?
Exposure and Response Prevention has been shown to be effective in the treatment of OCD (Wheaton, Galfalvy, Steinman, Wall, Foa, & Simpson, 2016).
As clients continue to practice facing their fears with the help and support of a therapist, most see a reduction in OCD symptoms and begin to enjoy a better quality of life.
Patients with OCD often experience depression. There is some evidence that EX/RP for OCD is associated with reduced depressive symptoms. (Blakey, Abramowitz, et. al., 2018).
Is Medication Necessary to Treat OCD?
In some cases, medication may be called for in combination with psychotherapy. For patients who have not yet tried psychotherapy, “starting with psychotherapy is a rational first step for some patients to minimise unnecessary costs and side effects of medication.” (Wheaton, DeSantis, et. al., 2016).
While OCD is not a disorder that can be ‘cured’ it is possible to significantly reduce your symptoms. Exposure and Response Prevention Therapy may be challenging but the benefits are worth it. Many people have experienced a significant reduction of OCD symptoms with CBT and ERP.
Pittenger, C., Kelmendi, B., Bloch, M., Krystal, J. H., & Coric, V. (2005). Clinical Treatment of Obsessive Compulsive Disorder. Psychiatry (Edgemont) 2005. Nov; 2(11), 34-43.
Wheaton, M.G., Galfalvy, H., Steinman, S. A., Wall, M.M., Foa, E.B., & Simpson, H.B. (2016). Patient adherence and treatment outcome with exposure and response prevention for OCD: Which components of adherence matter and who becomes well? Behaviour Research and Therapy, 85, 6-12.
Blakey, S. M., Abramowitz, J. S., Leonard, R. C., & Riemann, B. C. (2018). Does Exposure and Response Prevention Behaviorally Activate Patients with Obsessive–Compulsive Disorder? A Preliminary Test. Behavior Therapy.
Wheaton, M. G., DeSantis, S. M., & Simpson, H. B. (2016). Network meta-analyses and treatment recommendations for obsessive-compulsive disorder. The Lancet Psychiatry, 3(10), 920.