Effective Treatments for OCD

International OCD Foundation – How is OCD Treated?
“Most psychiatrists and therapists believe that combining a type of Cognitive Behavior Therapy (CBT), specifically Exposure and Response Prevention (ERP), and medication is the most effective approach.”  (IOCDF.org)

CBT and ERP

Cognitive Behavior Therapy (CBT) is a type of psychological treatment used by mental health professionals. Exposure and Response Prevention (ERP) is the “behavioural” part of CBT that is key in the treatment of OCD.

Exposure in ERP refers to exposing yourself to the thoughts, images, objects and situations that make you anxious and/or trigger your obsessions.

Response Prevention part of ERP refers to making a choice not to do a compulsive behavior/ritual once the anxiety or obsessions have been “triggered.”

Ideally, this is done under the guidance of a professional.  Ultimately though, someone learns how to do their own ERP exercises to manage symptoms.

You may have tried to confront your obsessions and anxiety on your own only to experience an increase in anxiety. The difference with ERP is that a commitment is made in advance to not engage in compulsive behavior as the chosen obsession is confronted and anxiety results.

When you don’t engage in compulsive behaviors, over time you will feel a drop in your anxiety level. The natural drop in anxiety that happens when you stay “exposed” and “prevent” the compulsive “response” is called habituation.

Talk Therapy vs. ERP for Treatment of OCD

“Traditional talk therapy (or psychotherapy) tries to improve a psychological condition by helping the patient gain “insight” into their problems. Talk therapy can be a very valuable treatment for some disorders, but it has not been shown to be effective at treating the active symptoms of OCD.

While talk therapy may be of benefit at some point in an OCD patient’s recovery, it is important to try ERP or medication first, as these are the types of treatment that have been shown through extensive research to be the most effective for treating OCD.”   (IOCDF.org)

Medication

Medications for OCD – International OCD Foundation
Medication for Pediatric OCD – International OCD Foundation

Research has shown the most effective medication for OCD are Serotonin Reuptake Inhibitors (SRI). Traditionally used as an antidepressant they also help OCD symptoms.  Depression often co-occurs with OCD.  SRI’s can treat both OCD and depression.

The following antidepressants have been found to work well for OCD in research studies:

Type of Medication	Generic Name	Brand Name
Tricyclic Antidepressants	Clomipramine	Anafranil
SSRI Antidepressants	Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline	Celexa Cipralex Prozac Luvox Paxil Zoloft

* High doses are often needed for the treatment of OCD.

According to studies, there is no significant difference in effectiveness for OCD from one SRI to another. However, for any given patient, one drug may be very effective compared to another. The only way to tell which drug will be the most helpful with the least side effects is to try each drug for up to 3 months.

It is important to persist until you find the most effective medication for you!  Don’t give up after one or two drug trials (it is not uncommon to need to try more than one).  It is very individual how medication impacts for each person.

Combined Treatments

Generally, medications and CBT work about equally well in the short term, although some people may respond better to one approach or the other.

In the long term, CBT or combined approaches are more beneficial than medication treatment alone.  Once treatment has stopped, individuals who have been treated with a full course of CBT are less likely to experience a rapid return of symptoms than are individuals who have been treated with medication alone.

In addition, should symptoms increase in another OCD theme area (e.g., doubts about harming someone, concerns about contracting a disease), the techniques learned in CBT can be applied to the new area of difficulty.

Rating symptoms

Measuring Obsessive-Compulsive Symptoms: Common Tools and Techniques – article
Yale-Brown Obsessive-Compulsive Scale -Y-BOCS – rating tool 
Children’s Yale-Brown Obsessive-Compulsive Scale – CY-BOCS – rating tool for children

 

More about CBT for OCD:

CBT is based upon the following understanding of OCD:

Obsessions, with their power to elicit such distress, lead the individual to engage in behaviors
(e.g., compulsions, avoidance), which may provide temporary relief.

These compulsive behaviors are problematic for several reasons:

1) They cause the person to become very sensitized to their obsessions.
The “quick fix” of the compulsion takes away the opportunity to “ride out” the anxiety and logically evaluate both the reasonableness of the thought as well as one’s true ability to bear the anxiety.   This strengthens the power of the obsession to cause distress.

2) Because they provide partial temporary relief, compulsions are self-perpetuating: even partial anxiety reduction on one or two occasions will prompt the person to respond quickly with a similar behavior the next time anxiety arises.

3) Compulsive behaviors themselves quickly begin to cause problems in day-to-day life
(e.g., taking priority over other more important activities).

CBT has two general aims:

a) controlling compulsive rituals and avoidance
b) reducing the anxiety associated with obsessions, and through this, reducing their intensity and frequency.

Behavior Therapy –
The building blocks of behavior therapy for OCD are exposure and response prevention (ERP) and cognitive therapy.

• ERP involves:

a) confronting a distressing situation or experience repeatedly, until it no longer triggers distress, while
b) resisting the drive to engage in problematic anxiety-reducing behaviors. In the case of OCD, it is the obsessions that prompt the distress.

So, in ERP for OCD, exposure is to obsessions, accomplished through deliberately seeking out situations that have the power to provoke them.

For example, an individual with contamination obsessions about germs could be encouraged to practice touching items that have been in public places, with no compulsive washing or avoidance — something that would quickly prompt their obsessive thoughts — until this no longer causes notable anxiety.  A new situation could then be added and practiced until it also loses its power to cause anxiety, and so on.

Over time, exposure first weakens the distress caused by obsessions, then the frequency and intensity of the obsessions themselves.

ERP works best when it occurs frequently (e.g., at least four or five times per week), and lasts long enough for the anxiety to decrease (up to two hours).

•  Cognitive Therapy – Involves learning to identify one’s anxious beliefs about the meaning of obsessions and to replace them with more realistic thoughts.

For example, if an individual is concerned that having an obsession about harming someone may make it more likely that that will actually happen, the individual might be taught to examine the evidence for the specific belief  (e.g., I’ve had that thought hundreds of times and it has never happened) or for the more general belief that all thoughts that pop into one’s mind are always meaningful.

Did you know …?

• About 90% of people have occasional intrusive thoughts and repetitive behaviors that are very similar to those that occur in OCD.   The main difference is that people with OCD experience obsessions and engage in compulsions much more frequently than the average person, and are much more distressed by their symptoms.

 

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More About CBT for OCD –  St. Joseph’s Anxiety Treatment and Research Centre